|Cost per day variation across Trusts — within a single Cluster|
- Wrong Clusters: the clinician’s assessment is incorrect. In this context, a speaker at the conference mentioned the ‘Richmond-Lambeth’ syndrome: mental health problems tend to be far more pronounced in the under-privileged London borough of Lambeth than in relatively well-heeled Richmond; will that lead psychiatrists in Richmond to include in the more severe Clusters service users who may be more seriously ill than many others of their case mix, but far less than those included in similar Clusters in Lambeth? Even without such general trends, it is of course possible that individual cases can slip into an inappropriate Cluster.
- Poorly-defined Clusters: some of the Clusters may be too broadly defined and therefore cover cases that are not entirely homogeneous, but include service users whose condition differs too much in severity for their treatment to be comparable.
- There are genuine variations in clinical practice within a Cluster of reasonably homogeneous service users.
A refreshing view, and one that fits well with the package of care approach. After all, how do you know a package is complete except when the patient has recovered?
But can you imagine the impact on healthcare if remuneration started to be based on outcome?