Principles underlying payment by results can be used to commission personalised learning disability services


Payment by Results (PbR) was introduced into the NHS with the aim of improving efficiency and increasing  value for money. The approach uses a national tariff of agreed fixed prices reflecting average prices for procedures.

In this article, the authors argue that given that outcome focused approaches to payment by results will be incrementally introduced into mental health services from 2012, it should be possible to roll this out to learning disability services as well, even though they are currently excluded,.

The authors argue that this approach could be the key commissioning and designing personalised pathways of care for people with learning disabilities..

The authors have produced Health needs are scoped and care pathways are defined as primarily consisting of Needs, Interventions and Outcomes. The mandated cluster groups to be used for PbR in adult mental health and older people’s services are extended to cover the non overlapping needs of people with intellectual disability to provide an integrated framework of health needs usually met by specialist services.

A framework of interventions is suggested and components of “assessment” and “therapeutic” activities are outlined. An outcome framework is described and they present a  case example to illustrate how these components can be used to develop a care pathway to provide personalised, needs led services.

Payment by Results in intellectual disability services – a vehicle for personalising healthcare, Roy A & Bhaumik S, in Advances in Mental Health and Intellectual Disabilities, 6 2, 89 – 98

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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