2. Shift resources to promote better healthcare outcomes
by Department of Health on 12 July 2010 | 5 commentsShift focus and resources towards better health outcomes, including national health outcome measures, patient reported outcomes and patient experience measures
Actions: Scrap targets | Reform Payment by Results | Improve support to hospices | Introduce a value-based pricing system | Introduce new dentistry contract
2.1 Scrap process targets and introduce national health outcome measures to prioritise the health results that really matter, and promote best practice through greater transparency
i. Remove process targets with no clinical justification – (Start Jun 2010)
ii. Instruct NICE to begin publication of quality standards – (Start Jul 2010)
iii. Develop incentives to improve access to primary care in disadvantaged areas – (Start Apr 2011)
iv. Fully implement new outcomes framework – (Start Apr 2012)
2.2 Reform Payment by Results to provide incentives for health care services to deliver high quality care
i. Publish revised Operating Framework and pay for performance plan – (Start Jun 2010)
ii. Start to implement reformed Payment by Results in hospitals – (Start Apr 2011)
iii. Extend Payment by Results to community services, mental health and end-of-life care – (Start Apr 2012)
2.3 Improve support to hospices
i. Review funding model for hospices – (Start Jul 2010 – end Summer 2011)
ii. Funding model on preferred option(s) developed – (Start Summer 2011 – end Oct 2011)
iii. Decision on final option – (Start Dec 2011)
2.4 Introduce a value-based pricing system to align treatments with outcomes
i. Publish proposals in White Paper to reform NICE and place it on a firmer statutory footing – (Start Jul 2010)
ii. Create a Cancer Drugs Fund to enable patients to access an increased range of cancer drugs to operate until full transition to new pricing process – (Start Apr 2011)
iii. Begin work to develop new pricing process with drug companies – (Start Apr 2011)
iv. New pricing process operational – (Start Jan 2014)
2.5 Introduce new dentistry contract, with particular focus on oral health of children
i. Publish proposals for pilots to inform development of contract – (Start Dec 2010)
On 22 July 2010 Lilly said:
I cannot envisage how extending PbR to end of life and community services can possibly improve the quality of care provided to patients and their families at this most challenging and emotive time.
The only ‘Incentive’ needed ‘for healthcare services to deliver high quality care’ is the funding for actual provision of true 24 hour care and support in patients own homes, where this is their preferred place of death.
End of life care is all about Teamwork, and where dying patients and their families/carers have access to round the clock effective and knowledgeable support, a ‘good death’ can be achieved.
This is the only ‘Result’ that really matters.
On 27 July 2010 Paul said:
Re 2.2 Reform Payment by Results to provide incentives for health care services to deliver high quality care
iii. Extend Payment by Results to community services, mental health and end-of-life care – (Start Apr 2012)
I’d like to know how this will work? In community mental health the “result” may be that there is a longstanding problem which ebbs and flows with periods of care and no “discharge” from a service. What outcome measures are going to be utilised by the DH/locally to ascertain what the result is?
In addition where the Mental Health Trust is not currently contracted to provide a service (for example in behavioural services in CAMHS) will acknowledgement be made that this is the case and that “wider CAMHS” is the necessary treatment package via parenting/behavioural services in schools? I can imagine that our service could get quite caught in commissioning arguments. Happy to do the work as long as we get the money and of course the staffing (considerable) required. Not so keen on “everything” being seen as a mental health problem/illness however.
On 03 August 2010 YS said:
Re:2.1 the proposal to remove process targets that have no clinical justification – yet in the revised operating framework the following vital sign: Patient experience of access to primary care (and supporting measures) has been removed with immediate effect. Is this not in direct conflict of what is proposed in 2.1. iii about developing incentives for improving access to primary care. The above vital sign was helping to improve access to primary care – this should not be incentivised i.e. lining the pockets of GPs further. This should be a basic right of all patients that they have appropriate access. Unfortunately this can’t be measured and poor performing GP practices cannot be held to task thanks to the scrapping of a target that was directly linked to patient experience!! – as a clinician and a service user completely justified
On 23 August 2010 DC said:
PBR already produces perverse incentives for providers. It is least valid and most subject to areas of care where there is weaker technological certainty about outcomes. These include end of life care, community services and mental health. There is greater risk of error and poor care by simply introducing PBR into these areas.
On 07 September 2010 stuart clegg said:
The Government should make private hospitals disclose the NHS activity they undertake and the payments they receive for this activity from the public purse. Currently they do not have to do so, so no-one knows how much public money is going into these institutions.
The Government should also have some mechanism for comparing the cost per patient episode for Tier 2 and other services in Primary and community Care, This will show where the real inefficiencies lie. For example, some Darzi Centres have tiny List sizes compared to most local GP Practices and so receive massively more funding per patient.