Care clusters and mental health Payment by Results

MacDonald & Elphick ¹ have lucidly described the proposed introduction of Payment by Results into mental health. They mention, however, that ‘concerns include the validity and reliability of the MHCT’ (mental health clustering tool), and there is also the major issue of how cost can be firmly linked to the quality of services delivered.

The Department of Health approach to reliability has been to rely on local initiatives and to commission the development of an algorithm based on the MHCT to ensure that clusters are reliably allocated. Exactly why the Department of Health believes that this is possible by either route is not clear. Local initiatives are the route to mayhem and none of the attempts at devising algorithms so far have been successful. The instrument on which the MHCT is based, Health of the Nation Outcome Scales (HoNOS), was not devised for this purpose. Additional items have been added but this was for clinical reasons. The HoNOS was...