Value Based Healthcare in mental health settings
Following our presentation at the Healthcare Financial Management Association (HFMA) conference in March, Freya Dixon-van Dijk, previously Project Manager, Clinical Academic Group Development, King’s Health Partners, explores how a Value Based Healthcare approach can help address the rising demand for mental health services.
The need for mental health care services
In 2020 the NHS exceeded targets set out in the NHS Five Year Forward View for Mental Health to treat an additional 70,000 children and young people with a diagnosable mental health condition by March 2020/21. To build on this achievement, the NHS Mental Health Implementation Plan for 2023/24 has outlined a commitment to support investment in mental health which includes a £2.3bn local investment fund to develop more tailored local services.
The rising demand for mental health services, furthered by the increase in depression and anxiety caused by the COVID-19 pandemic, is accompanied by the challenge of being unable to deliver care in a traditional face-to-face setting. It is therefore vital we establish how and where funding can be invested in mental health services to maximise its impact and ensure the best possible care for patients, and a Value Based Healthcare approach is vital to this.
Can Value Based Healthcare help with rising demand?
Value Based Healthcare is a strategy that aims to make best use of available resources to improve the health outcomes that matter most to patients. The financial challenges faced by the NHS and the additional strain caused by the COVID-19 pandemic make this more important than ever.
Dr Rumina Taylor, Value Based Healthcare Mind & Body Lead at King’s Health Partners, has carried out extensive research on embedding this approach specifically in mental health. In March 2021, this work was presented at the Healthcare Financial Management Association (HFMA) annual conference. Her presentation explored the need and opportunity for change within health systems to embed value in mental health.
The complex systems within the NHS and the many different ways people may choose to seek care, whether through a GP or local support group, can make it difficult to fully understand the costs and benefits of each patient’s unique experience throughout their treatment.
While our ability to measure value has developed in certain areas, including physical health settings such as hip replacement, achieving this understanding within mental health care comes with additional challenges. Many people live with multiple concurrent or simultaneous mental health conditions, which means treatment and results can be long-lasting and outcomes are not consistently recorded.
Outcome measures for mental health?
Rumina Taylor’s work built a methodology for collecting and analysing patient data and understanding cost of service delivery. This creates a new opportunity for the development of outcome measures for mental health conditions across the NHS. Her research presented at the HFMA annual conference highlights that while action is needed at individual trust level, systematically measuring patient-reported outcomes is crucial across health services. King’s Health Partners is currently working closely with South London and Maudsley NHS Foundation Trust to implement her recommendations.
Mental health currencies?
Supporting these recommendations, Ellie Melbourne, project manager, Mental Health Infrastructure Team and Sam Stringer, senior payment policy manager, NHS England & NHS Improvement shared their work on developing ‘Mental Health Currencies’, which will be piloted in England next year. These ‘currencies’ will enable us to consistently group and compare the costs and benefits of mental health interventions nationally. This will allow us to target inequalities in outcomes and better align mental and physical health services to provide holistic care for patients.
A personal health budget?
An example of how a Value Based Healthcare approach can impact patients was presented at the HFMA annual conference by Jax Kennedy, Campaigner for Disability Rights & Equality, Co-Facilitator of Realising Change, and volunteer speaker at Canine Partners. Jax highlighted the human impact that being able to quantify the value of services can have, sharing their example of using a physical personal health budget.
A personal health budget is an amount of money allocated to support health and wellbeing needs, agreed between you and your local NHS team and funded by the Department of Health. The budget is a way of personalising care for each individual, based around what matters to them and their needs. For Jax, this gave the opportunity to regain independence following a traumatic attack which caused the development of complex health conditions. Jax now uses this budget to fund their service dog, Kingston, who is now a registered personal carer and has prevented multiple hospital visits due to incidents such as falls.
This personal health budget is made possible by understanding and costing the services previously used on a regular basis, and freeing up funding to spend directly on the most suitable, preventative, and independence-promoting health solutions. The addition of a personal mental health budget, in this case and many others, will go even further to personalise care for patients and provide patients with more control of the care they receive.
Examples like this highlight the benefits of understanding the outcomes that matter most to patients, and the impact it could have when effectively applied in a mental health setting.