A report recommends moving from payment-per-bed-day to payment by outcomes
“It reduces length of stay and ultimately makes use of scarce resources. One inpatient bed can actually be the equivalent of 100 young people being looked after in the community. So these are precious resources we are talking about, hence the quality of inpatient units is really important.” Dr Ananta Dave, consultant CAMHS psychiatrist at Lincolnshire Partnership Foundation Trust
A new funding model for inpatient mental health beds for children and young people has been proposed by NHS England officials, according to HSJ.
The model has been put forward in a report on child and adolescent mental health services (CAMHS) by a national programme called Getting it Right First Time (GIRFT), which is designed to improve the treatment and care of patients through in-depth reviews of services. The programme recommends moving from a payment-per-bed-day model to one in which payment is made according to particular outcomes. This would apply to both NHS and independent provision.
The report has 21 recommendations for improving CAMHS. These have not been made public, but have been seen by HSJ.
Under-provision of inpatient CAMHS services has already been the subject of public concern. Young people are sometimes sent to beds far away from home, and care has been criticised for being of poor quality.
Ananta Dave, consultant CAMHS psychiatrist at Lincolnshire Partnership Foundation Trust, told HSJ that the outcomes-based model proposed by the report would improve the patient experience and lead to better results: “It reduces length of stay and ultimately makes use of scarce resources. One inpatient bed can actually be the equivalent of 100 young people being looked after in the community. So these are precious resources we are talking about, hence the quality of inpatient units is really important.”
She added: “It should not just be a tick-box exercise that a bed exists. Instead, it is about the quality of that service. If you simply go by the number of bed days, you’re unlikely to meet your target or meet your ambition of reducing the spend on inpatient services.”
Paying attention to the right staffing and skill mix, as well as what qualified as a good outcome, would lead to a return on investment, Dave said: “Are there the right occupational therapy activities, the right psychological skills, and are there people to intervene in the right way when there’s a young patient with an eating disorder, for instance?”
Although the introduction of an outcomes-based model might cause cost pressures initially, she said, ultimately the length of stay and readmissions would be reduced, leading to a return on investment.
The report recommends that the model is developed within the next 18 to 24 months. Providers should be asked to develop an outcomes-based specification linking to resourcing of the unit.
The report also recommends that commissioners and providers develop a clear strategy for reducing the number of young people remaining on inpatient units for more than 60 days. A further recommendation is for providers to consider implementing new models of community care for young people on crisis pathways. Dave told HSJ that provision of community support for young people in crisis was key to ensuring patients “aren’t discharged into a vacuum”.
CAMHS has been hit hard in recent years by the double impact of a surge in demand and a drop in the number of inpatient places; the result of private providers cutting bed numbers during the Covid pandemic. While there is still an urgent need for increased capacity, it’s a positive approach to see some fresh thinking applied to this issue. Payment by outcomes has been shown to work well elsewhere, and we agree with Dr. Ananta Dave of Lincolnshire Partnership Foundation Trust that the proposed model could lead both to improved care for patients and less pressure on bed spaces. However, there is more we could do to help people not reach crisis point in the first place, by providing appropriate support at a much earlier stage.