Payment by results: Challenges and conflicts for the Therapeutic Community

Abstract

Gosling, HJ Payment by Results. Challenges and Contradictions for the Therapeutic Communityhttp://researchonline.ljmu.ac.uk/3120/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LJMU Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription.For more information please contact researchonline@ljmu.ac.uk http://researchonline.ljmu.ac.uk/ Citation (please note it is advisable to refer to the publisher's version if you intend to cite from this work) Gosling KeywordsPayment by results, therapeutic community, recovery, outcome-based funding. A change in the tideThe 2010 Drug Strategy Reducing demand, Restricting supply, Building recovery: Supporting people to live a drug free life outlined the Coalition Government's approach to tackling substance use in the United Kingdom (Her Majesty's Government, 2010). The Strategy called for more responsibility to be put on the individual, placed more power and accountability into the hands of local communities and advocated a whole person approach to substance use in which an individual's level of recovery capital is recognised as one of the best predictors of sustained recovery 1 . To achieve the aims and objectives of the Strategy, the Government outlined plans to reform the way in which programmes that cater for substance users were paid for their services. Although not an entirely new initiative, the Government made clear their interest in an outcome-based payment scheme, known as Payment by Results, colloquially referred to as PbR. 2PbR was first introduced to the United Kingdom in 2000 by the Labour Government's National Health Service (NHS) plan, which set out to link the allocation of funds to the activities that hospitals undertook. This marked a departure from previous funding arrangements in which hospitals were paid according to block contracts, which involves a fixed payment for a broadly specified service (Battye and Sunderland, 2011). Generally speaking, PbR was designed to pay providers on the basis of the outcomes that they achieved rather than the activities undertaken.The fundamental aim of PbR was to improve service quality by offering bonuses to service providers for performance improvement or withholding payments for poor performance, population engaged with services in the local area, the maturity of the local system of support and the different speeds at which each area was expected to achieve full implementation (Departmen...

Inpatient Institutional Care: The Forced Social Environment

“…(Chandley and Rouski, 2014, p.87), and while it is recognised that adopting service user involvement principles is complex within secure environments, such principles have been found to be successfully adopted benefitting both service users and staff (McKeown et al, 2016b). However, consideration must be given when implementing therapeutic community principles within the modern healthcare landscape of payment-by-results directives (Gosling, 2016). Nonetheless, the power of supportive relationships which 'are undoubtedly integral features of mental health and well-being' (Middleton, 2017, p.264) should continue to be part of the debate as we move towards 'new meaning and purpose [as society] grows beyond the catastrophic effects of ' the global pandemic (Anthony, 1993, p.527).…”

Factors influencing recording of drug misuse in primary care: a qualitative study of GPs in England

“…27 A pilot study of payment by results is currently evaluating incentives for delivery of recovery for drugs and alcohol in primary care. 28 If implemented, recording of drug misuse may improve. However, this could negatively impact the GP-patient relationship.…”

Professionalism, Payment by Results and the Probation Service: A Qualitative Study of the Impact of Marketisation on Professional Autonomy

“…Analysing a PbR pilot scheme for 182,447 service users receiving treatment for drug dependency, Mason et al (2015: 1126) found that those ‘treated in pilot areas were significantly less likely to complete treatment’. Gosling (2016) states that PbR has commodified alcohol and drug treatment, diluting the values intrinsic to working with substance users due to the need to evidence results. Clist (2016: 290), moreover, argues that there is ‘very little related empirical evidence’ for PbR in the international development sector.…”

“…Robust measures of success can be difficult to discern, with PbR schemes exhibiting negligible differences with other international development projects (Clist, 2018). Accordingly, the evidence suggests that, under PbR, autonomy and innovation are ‘suffocated rather than promoted’ (Gosling, 2016: 529).…”