Understanding the average cost of cluster days is a

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in Table 1 for episodes of care and year of care. Understanding the average cost of cluster days is a helpful starting point, but in developing the episode price, organisations should look at the average duration of a cluster locally. If a patient is identified as needing to change cluster before the cluster episode is completed, commissioners need to be aware that in many cases the costs of delivering care may be front-loaded and it may be appropriate to pay most if not all of the agreed local cluster price. For example, for a patient who is identified as being in cluster 18, ongoing care could be limited to attendance at a memory clinic once a year. So in that case, all the costs are incurred at the start of the episode. In some cases the patient could deteriorate rapidly during the year, be re-clustered and found to be in cluster 20, where a different and more expensive package of care will be required. It is entirely appropriate to pay the full price of cluster 18 as well as start to pay for cluster 20 during the same year. In some cases patients typically remain in a cluster for several years after the initial cluster assignment. 6 It may be the case that the first year is much more expensive than subsequent years in terms of the intensity of care required. Providers should use evidence from their patient systems to demonstrate whether this is the case and share their findings with commissioners to reach an agreement on whether year 1 for such patients should attract a higher price. Whether care is usually delivered in an inpatient or community setting will affect costs. However, providers and commissioners need to be working towards delivering care in the least restrictive setting appropriate and wherever possible and cost- effective in the community. Reference cost data can provide useful information for benchmarking purposes. However, commissioners and providers should bear in mind that the reported costs of each cluster may vary from provider to provider because of different service specifications, and different levels of investment into mental health. 6 The clustering booklet provides information on likely duration of care.
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15 2.4 Determine the costs of delivering NICE-concordant care Providers and commissioners should identify whether what is currently offered delivers appropriate NICE-concordant packages of care, or whether changes are required to deliver these. 7 The Mental Health Task Force has made it clear that, as a minimum, patients should expect to receive care that meets this standard. Where this is identified as not the case, it may impact not only on the resource relativities between the mental health clusters but on the absolute funding that should be invested in mental health services. The exact package of care should wherever possible be agreed with each patient, and should reflect their personal aspirations and goals in accordance with the empowerment and involvement principle in the Mental Health Act 1983 code of practice.
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  • Fall '19
  • mental health, Health care provider, National Health Service

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