Shared learning database

Rotherham Doncaster and South Humber NHS Foundation Trust
Published date:
February 2008

To ensure relevant NICE guidance is robustly implemented via a needs-lead Payment by Results classification system and service model.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

To ensure relevant NICE guidance is robustly implemented via a needs-lead Payment by Results classification system and service model. 1. To robustly identify the appropriate best practice for all of the trust's adult service users and identify which NICE guidance applies to particular needs-based clusters / groups of service users. 2. To create care pathways for each cluster that include the standards from NICE guidance and other best practice guidance that are relevant to the needs of each cluster / group of service users. 3. To maximise the ability of staff to meet the identified standards by creating an IT solution to the monitoring of adherence with the agreed care pathways and the standards of care they set out.

Reasons for implementing your project

The recording of mental health diagnosis is problematic nationally with only around 10% of service users receiving a formal diagnosis. This issue is likely to be compounded by New Ways of Working, where psychiatrists will adopt a more consultative role, seeing and hence only able to give a diagnosis to fewer, more complex cases. This creates an additional challenge when implementing and monitoring diagnostically driven mental health NICE guidance as relatively few service users will be given the trigger (diagnosis) that will allow the standards of care that specifically apply to them to be identified. As a consequence, monitoring adherence becomes a sterile, retrospective process rather than something that guides contemporaneous care delivery during a service user's journey through a service. Through its involvement in developing the Pathways and Packages approach to Mental Health Payment by Results, the trust has comprehensively mapped its working age service users according to their needs. Any professional can undertake this classification process and hence all service users are routinely receiving a potential trigger (allocation to a cluster of need) that could be used to identify which standards apply to their care needs.

How did you implement the project

1. Significantly more service users are attributed to a needs-based cluster (approximately 85% compared with 10% for formal diagnosis). 2. Each needs-lead cluster has explicit standards of care derived from any number of pieces of NICE guidance and other relevant best practice publications. 3. These standards are conveyed in the form of a comprehensive range of care pathways with measurable objectives that have been produced by practitioners with expertise in each service user group. 4. The care pathways are being embedded within the trust's electronic record system so that practitioners will have a clear understanding of the standards they are expected to meet for individual service users whilst they are responsible for their care, rather than being given retrospective feedback.

Key findings

The IT system is being set up in a way that will allow adherence to the standards to be aggregated by cluster, practitioner, service or at a trust-level in order to provide assurance to a range of stakeholders from team managers (for supervision purposes) to commissioners (as part of the development of a Payment by Results system that will ultimately replace block contracting).

Key learning points

1. A needs-based approach to describing mental health service users has utility for Payment by Results, but also for the monitoring and improvement of the quality of care. 2. It is possible to integrate diagnostically driven NICE guidance into a primarily needs-lead approach to care delivery and service redesign. 3. Practitioner engagement is key to success. 4. Mental health clinical information systems are an obvious way to monitor standards of care, but will often need considerable development to meet the increased demands of this type of initiative.

Contact details

Jon Painter
Care Pathways Lead
Rotherham Doncaster and South Humber NHS Foundation Trust

Secondary care
Is the example industry-sponsored in any way?