E THE RESULTS
E THE RESULTS
JH: Originally the intention was that the pilots would
be running from October 2011 but it was quickly
recognised that this timescale could not be kept,
particularly in the case of areas like us who were
retendering all of their services. The co-design
process has had some ups and downs, one being
the agreement of all parties on the final outcomes,
but we got there in the end. On the whole, the
process for the pilot areas has been good because
we’ve had the chance to learn from each other.
DG: The real advantage is that you get to link and
work with the other pilot areas, so you’re coming at
things from a similar mentality and you can work
through the processes like that. That’s an
opportunity you don’t get every day – you might
liaise with neighbouring boroughs, but to go and
spend some time looking at different ways of doing
things and different models gives you ideas outside
of the PbR aspect. But it is a pilot at the end of the
day. Some work, some don’t.
But PbR is controversial, with concerns that
it will lead to the cherry picking of clients
with lower levels of need.
JM: The system needs to be designed to take out
cherry picking. It’s not impossible to do, it just takes
some thought. Also, when people talk of cherry
picking it’s assuming that everything is perfect now –
I’m sure some service users may say differently.
JH: Having an independent LASAR who retains
responsibility for the treatment outcomes process
reduces the risk of cherry picking. The client
profiling that we do means that the prime provider
should receive adequate resources in respect of
even the most complex people. A percentage of
each person’s tariff is also paid up front when
someone is taken onto the caseload, in order to
ensure that the prime provider has an incentive to
work with them. Also, if you have a mature
relationship with your provider and they are
committed to the recovery agenda, why would they
turn people away?
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‘When people talk of cherry picking it’s
assuming that everything is perfect now
– I’m sure some service users may say
differently. ‘
Jo Melling
DG: We’re doing it on a cohort basis, which is
different to a lot of the other areas. Because we’ve
profiled it in that way, services can’t ignore the high
complexity cases because there are targets
associated with that. I’m not saying it won’t happen
– with any system there’s always going to be an
element of it, even with non-PbR systems, but that’s
how we’ve managed to reduce some of the risks.
What’s been the level of input from service
users and families?
JM: Every step of the way, service users were
involved in the original concept and every element of
the process thereafter including in all the
commissioning – we have service user
representation in every level including the DAAT
board. It was our service users who were one of the
drivers for change.
JH: One of the people on the project board was in
recovery and was involved in the tender process
from start to finish – she was particularly good at
asking questions about involving people in service
development. We have a strong family and friends
group in Bracknell Forest who were kept up to date
on developments.
DG: We’re working with the existing providers so for
some of the elements we already had a single point
of contact that was working well. So while there’s an
awareness this is happening, service users
shouldn’t see too much difference in terms of how it
actually translates.
At the DDN conference, some service users
expressed fears that PbR could mean them
being ‘kept on the books’ of services and
held back. What would you say to them?
JH: Quite the opposite. The whole reason for
focusing on recovery is to move people on. We see
payment by results as an opportunity to work with
people and help them to achieve their full potential.
‘Give yourself plenty of planning time – a
lot of people might just rush into it and
end up incentivising activity rather than
outcomes.’
David Gray
Payment by results |
Pilots