Changes are happening to the funding of mental health services in Kent and Medway. Funding will be moving from “block contract” arrangements to Payment by Results (PbR), with effect from April 2012.

The new arrangements will see funding aligned with 21 “clusters” or care groups. Each cluster describes a group of individuals according to their needs and difficulties. These groupings have been developed nationally.

In Kent and Medway, mental health commissioners are taking the opportunity presented by Payments By Results (PbR) to redesign community mental health pathways. The aim is to introduce much greater clarity about what to expect for service-users, carers, GPs and staff.

Mental health commissioners are developing an aspirational pathway for each cluster, which sets out well-defined responses to people’s individual care needs, with clarity over treatment and support options, including those paid for using personal budgets. They are currently looking at ways to increase the support available in primary care to help when people are discharged from secondary care services.

As these pathways develop, feedback will be sought from from GPs, service-users, carers, and a range of NHS and social care staff. The aim is for all pathways to be agreed by the end of March 2012.

Case study example: transition between primary and secondary care clusters:

• Saroj is a 26 year old man whose family originates from Nepal. 7 years ago in his final year at school, Saroj had a psychotic episode where he believed that people were trying to kill him and was unable to leave his room.

• He was assessed and subsequently received treatment and support from the Early Intervention in Psychosis service (cluster 10). With this support from the multi-disciplinary team he was able to continue his studies and finish his schooling.

• Shortly thereafter, his condition worsened and he was admitted to hospital (cluster 14) in crisis, under Section 2 of the Mental Health Act. During this admission he was diagnosed with schizophrenia. Saroj had three admissions in the next two years. He became increasingly socially isolated at home and had few interests.

• He was transferred to the recovery service to provide longer term care in the community (cluster 13).

• His mum had a carer’s assessment and through this was supported to attend a Nepalese Women’s support group every month, with care being provided for Saroj at home whilst she was out.

• As a key part of his care, Saroj was helped to apply for a personal budget. These pay for a support worker to help him attend a photography course and a supported work placement in a local gallery twice a week. This is important in meeting his social and work needs. He was proud when his work, along with others, was displayed in an exhibition at the gallery.

• He has been helped to move out of home into the more independent supported accomodation provided by the Horizon’s scheme. He is pleased to have his own tenancy which he manages, with support.

• His medical condition is now stable but he has ongoing needs to help him manage everyday living. The medium term plan is for Saroj’s care to be transfered to primary care (cluster 12), as part of his recovery journey.

• The mental health practitioner in his GP practice will ensure that he continues to receive his medication regularly and will liaise closely with secondary care services if there are any concerns about his mental health.

• He will continue to be supported to maintain his tenancy and through his direct payments to support his social needs.

To read more on the Department of Health’s website about payment by results click here.

Or if you want to read about Payment By Results will affect Mental Health click here.

To see what the definitions of clusters are click here.

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