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Needs led person centred services are the hallmark of high quality intellectual disability services. Commissioning mechanisms such as Payment by Results (PbR) have been established in acute health services. An outcome focussed version of PbR will be implemented nationally from 2012 in an incremental manner in mental health services for adults and older people. Though intellectual disability services are currently excluded, it is proposed that needs led approaches would improve the quality and efficiency of specialist intellectual disability services. This paper aims to suggest that this approach could be the key to commissioning and designing personalised pathways of care.

Health needs are scoped and care pathways are defined as primarily consisting of Needs, Interventions and Outcomes. The mandated cluster groups to be used for PbR in adult mental health and older people's services are extended to cover the non overlapping needs of people with intellectual disability to provide an integrated framework of health needs usually met by specialist services. A framework of interventions is suggested and components of “assessment” and “therapeutic” activities are outlined. An outcome framework is described. A case example illustrates the application of these components to design a care pathway to provide a personalised, needs led service.

It is possible to use the principles underlying PbR to commission personalised services of high quality, improved efficiency and thus greater value.

The principles underlying PbR can be used to commission personalised pathways of care in intellectual disability services at a time when this approach is being extended to mental health services nationally.

Children and young people with learning disabilities and mental health problems from black and minority ethnic communities face barriers in accessing services. This paper describes a mapping of services used by young people with learning disabilities and mental health problems from Pakistani and Bangladeshi communities. Overall the participants accessed primary health care services through their GPs, had contact with Social Services for support and benefits and the voluntary sector for culturally appropriate services. Most participants did not access statutory child or adult mental health services, or professionals such as psychologists or behaviour nurse specialists. Families reported key barriers such as lack of awareness of services, language difficulties in communication and lack of culturally sensitive services.

Through a literature review, this paper demonstrates that there is a lack of knowledge about quality management within the mental health services. Ideas about quality from the wider services sector are then discussed, and a case study of a mental health scenario is provided. It is argued that health services generally, and mental health services in particular, have much to gain from becoming more closely aligned with the wider field of knowledge of quality management. Concludes that the wider techniques of managing service quality may prove useful, particularly in mental health services, due to the nature of such services and their inherent variability.

Green Light was developed to enable service providers to implement the National Service Framework for Mental Health (NSF MH), and asks how good your mental health services are for people with a learning disability. A multi‐agency user and carer project in Hampshire has evaluated and improved the quality of existing service provision for adults with learning disabilities who also have a mental health problem.

The structure of health care financing, the lack of vertical and horizontal integration, and the slow translation of basic research into meaningful health outcomes for the population conspire to make innovation in health service delivery a difficult task. However, health service organizations that can more effectively and systematically understand patient needs – needs that are now poorly understood and often unarticulated – have an intrinsic advantage in delivering high value care. This ‐paper aims to describe a program for translating those needs into health services innovations.

The Mayo Clinic, a large integrated multispecialty medical group based in Rochester, Minnesota developed an in‐house design program, the SPARC Innovation Program, to bring design thinking and business analysis together to develop innovations in care delivery. A project example is described to illustrate how designers, business strategists, health care professionals, and patients create new high‐value health care experiences.

The paper finds that health service organizations need to pay more attention to the patient experience if they are to meet patient needs. The design program described here is one approach that organizations can take if they are serious about deeply understanding patient needs and developing innovations to address them.

While the discipline of design is the core of innovation in many industries, it is not widely known or practiced in health service organizations despite a natural affinity between design and medicine. Understanding and employing the power of design in health services will allow medical institutions to develop more effective health services, enhance patient satisfaction, and meet important human needs.

Integration is a watchword in Government policy, designed to give more seamless, and therefore more effective, services to people in need. One concern, though, is that this is merely a ‘structural’ approach that just rearranges the deckchairs. This paper gives a practical example of a positive, local leadership approach to integration within a national context.

This paper seeks to describe the New Zealand Ministry of Health District Health Board (DHB) Mental Health Service Profile, which for the first time compares performance on a number of quality indicators for the populations of 21 DHBs.

The background, theory and development of the Ministry of Health Mental Health Directorate DHB Mental Health Service Profile (Profile) is discussed and example pages from the Profile are included

The DHB Profile overcomes the problem of setting arbitrary benchmarks by using the range of current practice across the sector. The profile demonstrates that certain levels of performance can be achieved and, given a better understanding of the long‐term client group, is potentially a very powerful tool for encouraging improved service delivery. Improved data quality is also likely to be a spin‐off from the use of the Profile in the sector.

Having key DHB mental health quality information in one place and being able to compare individual DHB performance with minimum, medium and maximum values for all DHBs are a significant step to improving information use and understanding DHB service and quality issues.

Young people can often “fall through the gaps” between Child and Adolescent Mental Health services (CAMHS) and Adult Mental Health services (AMHS). This discursive viewpoint study aims to reflect a conversation among the authors on how CAMHS and AMHS psychiatry came together to develop and embed a UK community “Youth Mental Health Service”.

This reflective viewpoint study explores the perspectives of three of the lead CAMHS and AMHS psychiatrists from the implementation phase of a community youth mental health service. It explores, in a discursive way, these individuals’ views on some of the key facilitators and barriers in the development of the service that aimed to “bridge the gap” for young people.

These clinicians’ reflections recognise the importance of strong clinical leadership in enabling a youth/young adult model of mental health to be implemented. They also recognise how culture internal and external to a service has a key role to play in the success and sustainment of implementing an innovative model. This study describes a merging of CAMHS and AMHS psychiatry to meet the needs of young people in the most developmentally appropriate way.

This reflective study highlights the need for services and systems to think creatively about how they can allow flexibility for CAMHS and AMHS psychiatrists to learn and plan together, as well as gain experiences across the age ranges, to facilitate collaborative working that is developmentally appropriate and meets the needs of young people in a way that is accessible to them.

This study aims to explore the influence of health-care service quality on customers’ perceived value, satisfaction, effectiveness and behavioural intention concerning district health centres (DHCs) in Hong Kong. This research also intends to assess customers’ perception of the subsidy scheme and its influence on the relationships amongst the aforementioned constructs.

The convenience and snowball sampling approaches were adopted, and the self-administered questionnaire was sent to 309 customers of DHCs.

Service quality attributes in terms of staffing and procedures positively increased customers’ perceived value and staffing, procedures and operations. Physical facilities positively promoted customers’ satisfaction, consequently improving DHCs’ effectiveness and behavioural intention. However, core treatments and services of DHCs did not impact customers’ perceived value and satisfaction. Furthermore, customers receiving subsidies exhibited a more positive perception than those without subsidies.

Health-care organisations are advised to strategically allocate resources (staffing, facilities and procedures and operations management) to optimise overall performance outcomes. DHC operators could reinforce the core services of DHCs and health-care voucher subsidies to local citizens so as to enhance the effectiveness of DHCs and behavioural intention of customers.

This study integrates the input–process–output approach in measuring the effectiveness of and customers’ behavioural intention towards newly established DHCs.

Peer work would previously have been associated with having a lived experience of mental health conditions and working with people in a relatable way to model that context. However, peer support work has since embraced a wider composition from the generic context, seeing that ethnic minorities face many health, social and psychological challenges, especially those deemed Refugees/Asylum Seekers (International Protection Applicants) on their journey to resettlement in host countries. The Health Service Executive's Social Inclusion office plays a crucial role in responding to the health needs of service users from underserved communities. The health and care needs of people from diverse ethnic, cultural and religious communities fall within the remit of the Health Service Executive Social Inclusion office nationally. The context for peer work in ethnic minority communities is that it is a pilot programme evaluated and endorsed as a national programme by the National Intercultural Health Group. It is evidence-based and aligned with national strategy/policy, with training options available to peer support workers. In the Southeast region of Ireland, communities vulnerable to health inequality targeted by the Social Inclusion team would range from Roma to Refugees and International Protection Applicants – formally known as Asylum Seekers. This chapter will focus on these ethnic populations and how peer support work is delivered in these contexts.