Daily Insight: Show us outcomes, not costs

National NHS officials have called for a major shift in the provision of mental health services for children and young people, proposing a move away from a cost per bed day model for inpatients.

In a report shared with HSJ, experts at the Getting It Right First Time programme recommend a payment-by-results style system that funds particular outcomes or “therapeutic models”.

Inpatient CAMHS services have come under fire in recent years amid reports of poor care, out of area placements, and under-provision.

It appears the proposal in the GIRFT recommendations would apply to both NHS and independent sector providers, although some NHS organisations are already less likely to receive funding on a “per bed day” basis.

Consultant CAMHS psychiatrist Dr Ananta Dave said having agreed therapy and outcome measures would reduce length of stay and make use of scarce resources. 

But she stressed there must be a focus on quality: “It should not just be a tick-box exercise that a bed exists. Instead, it is about the quality of that service.”

Experts told HSJ that providers may be unlikely to meet targets of reducing spend on services if simply going by numbers of bed days, as per the current model.

The known unknowns

An HSJ deep dive into new workforce disability equality standard data has revealed more than half of staff at eight trusts have their disability status recorded as “unknown” in 2021.

This means individuals have either indicated they would “prefer not to say” or have not answered the disability monitoring question in the electronic staff record.

It brings into question why staff are less likely to declare their status on the ESR than in the annual NHS staff survey, where declaration rates are significantly higher.

NHS England has encouraged leaders to find this out and set organisation-wide targets on increasing declaration rates to at least 4 per cent.

For context, only 3.7 per cent of staff were declared disabled nationally but this was unknown or not recorded for more than a fifth of the entire workforce.

HSJ’s analysis found nearly two-thirds of staff at two trusts had an “unknown” disability status.

Dudley and Walsall Mental Health Partnership Trust was first, at 63.8 per cent, followed by East Midlands Ambulance Service Trust at 61.6 per cent.

Black Country Partnership Foundation Trust came in third, at 59.3 per cent, but the organisation has since merged with Dudley and Walsall to form Black Country Healthcare FT.