14.10.15
Block contracts delaying discharges in mental health trusts
Mental health trusts that use lump sum ‘block contracts’ have nearly a third more days of delayed discharge per month than trusts providing services without a block contract, research by the Independent Mental Health Service Alliance (IMHSA) has found.
In 2014-15, more than half of mental health trusts used block contracts, in which providers are paid a lump sum fee to offer services for a certain population during a fixed period of time. Contracts are usually in place for a year but can be rolled over to subsequent years.
Looking at data from the Health and Social Care Information Centre and analysing parliamentary questions, the IMSHA research found that trusts with 100% block contracts last year had, on average, a third more days of delayed discharges than trusts without these contracts.
And trusts with even some element of a block contract experienced almost 20% more days of delayed discharge per month.
Similarly, trusts providing services without block contracts in 2014-15 had an average of 4% less emergency readmissions within 30 days than those with the contract.
Chair of the alliance, Joy Chamberlain, called on NHS England to phase out unaccountable block contracts in mental healthcare.
She said: “The continued use of unaccountable, ill-defined, block contracts for mental health commissioning is detrimental to appropriate access to mental health services for a large number of patients and is wasting money is a number of cases.
“Poor monitoring and accountability mean that these providers are often not incentivised to drive quality or innovation and providers that want to offer high quality services are unable to do so – even if they can better meet the needs of local patients.”
Chamberlain acknowledged that some of block contracts can provide efficient access to services and stability for providers, but said the alliance’s findings actually revealed the detrimental impact these contracts can have on patients.
“We hope that NHS England will look at this and move forward on their longstanding commitment to phase out unaccountable block contracts as soon as possible,” she added.
In 2014, the Nuffield Trust published a report looking into the NHS payment system that found block contracts were still the predominant payment mechanism for secondary care services within mental health and community services. Block contracts were used to reimburse around 90% of community services, and two-thirds of mental health care.
The report said: “While a large part of acute and emergency care is paid for through activity-based methods, mental health and community health services are primarily reimbursed through block contracts.
“Without a link to quality and activity, this will not delivery incentives to improve quality or efficiency. Block contracts can be managed in such a way as to incentivise quality and efficiency. However, the development of incentives and effective pricing of services require robust, accurate and up-to-date information about costs of treating individuals, in order to create effective and efficient incentives.
“The quality of cost information for mental health and community services is poor, and reported costs vary widely between providers. This will need to be urgently addressed to support attempts to expand activity-based payments in these sectors.”