Case Studies

Assessing the impact of new finance arrangements within mental health

Added 01/12/2011


Sustain were commissioned to carry out an important validation project to measure the potential impact which the introduction of the payment by results (PbR) mental health tariff could have on primary care trusts and emerging commissioning consortia. The project came following concerns that the introduction of PbR for mental health could have significant financial implications for commissioners.
Sustain was called in to carry out a detailed examination of the work taking place at the mental health trust to ensure it could be validated. Included in the scope was an analysis of clustering activities and local costings of pathways.

Key challenges
It quickly became apparent that engagement among key stakeholders during the development of the tariff had been limited, while barriers existed between the different partners involved in the project. The potential impact of PbR left many of the organisations involved with concerns. For some partners, this was exacerbated by a sense of isolation.

Main actions

Although tensions between partners delayed the start of the project, Sustain quickly developed relationships with senior managers at the trust to overcome barriers and win support.
We brought together a small team with a wide range of complementary skills to rapidly appraise the financial, performance and operational issues facing the trust which would impact on the development of PbR. This work saw us engage widely with all levels of professional staff working for the provider organisation and commissioner, as well as other stakeholders.
In addition, we:

  • developed a detailed understanding of critical interdependencies and identifying issues for consideration or resolution
  • used our detailed understanding of financial modelling to appraise the methods being used to develop the PbR tariffs; and
  • used our project planning skills to review the PbR development project plan
Outcomes and achievements
As a result of the project, levels of engagement from all stakeholders noticeably improved. Sustain introduced and drove a sub-group to oversee the process of price-setting and its progression into contract management, while our work across organisational boundaries led to a greater system-wide understanding of the issues connected with PbR.
As well as a detailed stage one report detailing our findings and perceptions of PbR across the health economy, we produced a variety of other resources to support the work, including:
  • initial validation of the work on prices, along with pricing trackers to measure progress and confidence as the prices were developed
  • monthly reports on activity, issues and actions
  • options for improving the pace of delivery and monitoring clustering progress.
  • a discussion paper detailing further work which could be carried out to ensure robust delivery for clustering, along with a specific approach for the trust
  • a final report highlighting good practice already in place and areas to be reviewed, along with recommendations for both organisations 
As well as carrying out detailed engagement, Sustain also developed an overarching plan to successfully drive the project.



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