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In December 2010, the Ministry of Justice published its criminal justice reform green paper, Breaking the Cycle: Effective punishment, rehabilitation and sentencing of offenders, which sets out the government's ambition for all criminal justice services to be delivered according to payment by results principles by 2015. This article describes the proposals contained in the green paper to implement a process of payment by results across the criminal justice system, examines some existing examples of payment by results‐based projects, and discusses some of the key questions that need to be resolved in the development of this new approach.

This paper aims to give an insight into the process behind Payment by Results (PbR) by looking at the detail involved in the pilot areas for Recovery PbR for drug services. Questions asked include how PbR could work in practice, the national outcomes by which providers will be measured, the Co‐design process and a brief comparison to PbR in alcohol and mental health. An illustrative case study from one of the PbR pilots is included to provide further detail.

The paper was written by a member of the Co‐design group for the PbR pilots and used first‐hand anecdotal knowledge of the process and a former government civil servant with first‐hand experience of PbR in development. The minutes of previous co‐design and steering group meetings were referred to for further details and the NTA was consulted to ensure factual accuracy. The approach was to provide a factual breakdown of PbR and let readers come to their own conclusions about the topic. PbR is still in early stages and it would be inappropriate to pre‐judge the success at this stage.

A number of discussion points centered around the differences between the pilot areas, i.e. whether they were a prime provider or multiple provider model, whether they are including tier 4 (residential rehab), and if pilots are choosing to include an employment outcome. As mentioned before, it is too early to pre‐judge the success of PbR and the pilots – the paper aims to provide information for the reader, who may draw their own conclusions.

This is a substantial paper looking at PbR from the perspective of the pilot areas – a lot of the information is as up‐to‐date as possible in terms of where pilots are in their development. It is a valuable starting point for anyone who wants to understand PbR and its wider implications. It also provides practical information for commissioners and providers who are interested in what PbR will look like in practice.

The criminal justice system in England and Wales is being reconstructed on a new operating platform of which Payment by Results (PbR) is the material signifier. This critical historic transformation is occurring during a period of radical economic disruption and political restructuring after 2007-2008. PbR signals the deeper penetration of the core principles of capitalism into the body of the state and its welfare and criminal justice system. Conceptually a Lacanian-Žižekian framework is put to work to theorise these important transformations. The paper aims to discuss these issues.

The design and methodology of this research paper utilises open sources and documentary materials on the development of PbR, in its application primarily to the criminal justice system.

There is evidence that PbR, located within the wider context of capitalist reconstruction, is radically transforming the delivery of criminal justice services.

This is the first critical analysis of PbR located within the context of late modern capitalism.

This paper draws on economic theory and empirical evidence in order to explore the role of incentives and information in the successful implementation of the new hospital funding system in the NHS.

The research is based on case studies in two strategic health authorities comprising in‐depth interviews with key stakeholders and analysis of background statistics and documentation.

The structure of tariffs under payment‐by‐results (PbR) provides high‐powered incentives for providers to increase activity because they are rewarded for hospital activity, and payments for increases in activity are made at full average cost. However, there is a danger that hospitals will increase activity beyond affordable levels and possibly induce demand inappropriately.

In future, as PbR is extended, it will be important to monitor its intended and unintended effects. Such evaluation should consider the extent to which commissioners are able to live within their budgets and whether hospitals are engaging in opportunistic behaviour and gaming the new funding system.

This study has shed light on the incentive structure of PbR for NHS organisations and has provided insights for the development of information strategies for providers and commissioners in the NHS market. It also highlights a number of policy issues that need to be addressed as PbR is rolled out nationally as well as several important gaps in knowledge that are in need of more sustained investigation.

The purpose of this paper is to present findings from two studies exploring the Health of the Nation Outcome Scale’s (HoNOS) utility within a new payment by results (PbR) system for mental health services in England.

In the first study principal axis factoring extraction was used to explore a sample of 23,641 HoNOS ratings. In a second study confirmatory factor analysis was used to evaluate four subscale structures on a new sample of 34,716 HoNOS ratings.

No HoNOS factor structure evaluated in this study demonstrated adequate fit statistics across several clinical presentations. A new four-factor model was the only structure to achieve fit statistics across all clinical populations, but can only be championed on a “best fit” basis as opposed to “good fit” at the present time.

Data used in the current studies relate to six NHS mental health service providers. Replication using a national sample is recommended. Exploration of different HoNOS factor structures for different mental health clusters within the PbR system in England is also recommended. However, it is also possible that removing redundant or adding new items may result in a more stable HoNOS generic factor structure.

This is the first HoNOS evaluation as a generic outcome measure for use within a PbR system and provides important insights into its mental health utility and limitations. The findings have significant implications for those developing the national PbR quality and outcomes framework for England’s mental health services. However, there are also implications for all nations in which HoNOS is used to report mental health outcomes.

The purpose of this paper is to explore the issues surrounding a long planned expansion of Payment by Results (PbR) into mental health services and to highlight the factors responsible for the delay.

PbR relies upon “standardisation” of conditions and treatments. This depends upon a scheme of classification that can realistically predict resources required to execute treatment of any one case. Plans to fund NHS mental health services on the basis of tariffs derived in this way have been delayed, and a key reason is the lack of high-quality data. This would require effective “standardisation-to the-average” of both a system of classification and a repertoire of costed treatment pathways. This paper investigated the delay implementation by exploring the difficulties in applying standardisation principles to service provision and tariff calculation.

The paper identified the fundamental difficulty with PbR’s implementation in applying “standardisation” to practice. This is defining the mental disorder that the patient is suffering and designing care pathways at clinical level considering the balance between practical applicability and conceptual/constructional validity. This is necessary to enable the calculation of a national tariff. The conceptual flaws of the Health of the Nation Outcome Scale led to the constructional shortcomings which compromised the credibility and validity of Mental Health Clustering Tool regarding making accurate classification in a standardised way. The validity and credibility of calculating a national tariff thus became contentious on the basis of this inaccurate clinical classification system.

This paper explored the driving factors of delay in implementing PbR in mental health through connecting the recent reform with the fundamental assumptions of “standardisation-to the-average”, which provided another perspective to illustrate the current obstacles.

This paper aims to critically examine the emerging policy agenda of payment by results (PbR) and care clusters in order to identify how to engage with it to ensure it is supportive of social inclusion and recovery.

Care clusters and PbR for mental health care are critically examined.

There is scope in the ongoing development of care clusters and associated pathways to continue the progressive developments towards recovery and social inclusion in the commissioning and delivery of mental health care, but they need to be nurtured and actively pursued.

The care clusters and developments building on them provide scope for supporting social inclusion and recovery practice, but also some risks; hence, those with an interest in furthering such practice need to engage now locally and nationally with care clusters developments.

PbR is being pursued as a policy for commissioning mental health care in England, based on a model of care clusters. This paper discusses the move to PbR and its possible implications for the recovery and social inclusion agenda.

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.

The article aims to discuss the process of assessment within the developing model of care clusters for mental health being implemented in England as a potential basis for a payment by results (PbR) system. Assessment, leading to allocation to care cluster, determines the care package individuals receive from services. Hence, assessment needs to be thorough and holistic and, it is argued, grounded in the philosophy upon which all care processes should be based.

The process of assessment is critically reviewed in the context of allocation to care clusters. An innovative approach of recovery focused conversations (RFCs) is outlined, along with its theoretical grounding in Buber's philosophy of “dialogue”, to help ensure assessment processes in PbR are fit for purpose.

Care clusters present opportunities to deliver high quality care, actively engaging people in their care and supporting their recovery. These are not a given, though. Further means are required to operationalise all the desirable ingredients of what care is delivered and how it is done. RFCs are outlined as an addition to the care cluster to ensure that care planning starts from a co‐produced understanding between professionals and service users.

RFCs are a technology for delivering assessment and cluster allocation with mutually respectful dialogue between professionals and people with mental health problems, and that promotes a recovery oriented approach throughout the subsequent care pathway.

This is the first critical review of assessment processes in care cluster allocation and first description of RFCs as an inclusive, integrative approach.