Transformation of payment by results in mental health: ensuring a recovery focused and socially inclusive system

摘要

The article aims to discuss the process of assessment within the developing model of care clusters for mental health being implemented in England as a potential basis for a payment by results (PbR) system. Assessment, leading to allocation to care cluster, determines the care package individuals receive from services. Hence, assessment needs to be thorough and holistic and, it is argued, grounded in the philosophy upon which all care processes should be based. Design/methodology/approach - The process of assessment is critically reviewed in the context of allocation to care clusters. An innovative approach of recovery focused conversations (RFCs) is outlined, along with its theoretical grounding in Buber's philosophy of "dialogue", to help ensure assessment processes in PbR are fit for purpose. Findings - Care clusters present opportunities to deliver high quality care, actively engaging people in their care and supporting their recovery. These are not a given, though. Further means are required to operationalise all the desirable ingredients of what care is delivered and how it is done. RFCs are outlined as an addition to the care cluster to ensure that care planning starts from a co-produced understanding between professionals and service users. Practical implications - RFCs are a technology for delivering assessment and cluster allocation with mutually respectful dialogue between professionals and people with mental health problems, and that promotes a recovery oriented approach throughout the subsequent care pathway. Originality/value - This is the first critical review of assessment processes in care cluster allocation and first description of RFCs as an inclusive, integrative approach.