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Monitoring mental health patient outcomes via care clusters

Adult and Older Adult Mental Health services are currently going through a change in the way they are organised and funded; a national initiative known as “Payment by Results” is at the heart of this change. Oxford Health NHS Foundation Trust, along with all other Trusts responsible for providing mental health care across the country, is engaged in the implementation of this new initiative.

So, what does it all mean?

  • Payment by Results is about how care is organised and funded.
  • Patients will be allocated to one of 21 “clusters” each of which will have a clear explanation as to what treatments are on offer and what they can expect. Mental Health Care Clusters are ‘groupings of mental health patients based on their characteristics, and are a way of classifying individuals utilising Mental Health Services that forms the basis for payment’1. For example, Care Cluster 1 groups patients who have a common mental health problem, such as depression or anxiety, who do not present with any psychotic symptoms, and of which the symptoms are of low severity (i.e. have minor impact on day-to-day living).
  • Allocating patients to clusters can be seen to enable trusts to better monitor outcomes and to respond by improving services to ensure they are consistently of a high quality.
  • Once allocated to a cluster, patients will be offered choice in the treatments they receive.

What is a care cluster?

A care cluster is a grouping of patients of similar clinical needs, taking into account the complexity and severity of an individual’s need, the anticipated course of the illness, individual circumstances and diagnosis. Each patient will be assessed using the Mental Health Clustering Tool and following this detailed assessment will be assigned to a care cluster.

The Mental Health Clustering Tool is the assessment tool which will be used by all clinicians to assess the needs of an individual and to collect all of the necessary information in order to allocate them to a care cluster. It provides a brief description of the needs of people entering into mental health services for the first time or presenting with a possible need for change in their care or treatment. It allows professionals from a range of backgrounds to summarise their assessments in a shared format.

What is a package of care?

The care package (treatments) is designed to meet the needs of people with similar problems. There are similarities in the care packages; for example, all packages contain interventions related to mental health, physical health, meaningful activity, making safe and keeping safe, needs of carers and rights and responsibilities. Other interventions will be more specific and will be designed to meet the needs of people in a particular cluster with particular needs.

The care packages provide a framework based on evidence and good practice within which individual care plans can be agreed.

Monitoring Outcomes

The aim of the care packages is to achieve the expected outcomes in relation to a patient’s recovery. The specific outcome measures to be used are still being agreed, but they will include a patient outcome measure and a clinician reported outcome measure.

More information about Care Clustering and Care Packages can be found at: and

1 Health and Social Care Information Centre, 2013. (accessed 02/06/13)

Publication date: June 2013.

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