Personal Wheelchair Budget Programme 24th October 2016 Overview

Introduction Personal Wheelchair Budgets On 18th May 2016 NHS England announced that personal health budgets would replace the current wheelchair voucher scheme to improve choice and control for estimated 1.2 million people that currently use wheelchairs. This is being led by the Personalisation and Choice team and aligned with NHS England’s broader Wheelchair Improvement Programme. https://www.england.nhs.uk/healthbudgets/understanding/wheelchair -budgets/

The Personalisation and Choice group is working with partners across the health and social care system to enable patients to personalise their care; in order to better meet their needs and preferences and enhance their choice and control. The group is responsible for the delivery of three distinct, but interdependent programmes: Personal health budgets (PHB) Integrated Personal Commissioning (IPC) Patient Choice Personalisation and choice form part of the ‘Transforming commissioning’ priority of NHS England’s business plan for 2016/17, and the Group plays a key role in taking forward the vision of the Five Year Forward View to empower patients to have far greater control over their own care, and break down barriers between health and social care.

Test and Learn and Share sites: Gloucestershire Clinical Commissioning Group Hertsfordshire Valley Clinical Commissioning Group Tower Hamlets Clinical Commissioning Group South Derbyshire Clinical Commissioning Group Sites provide varied commissioning configuration and selection of both NHS and Independent providers

Voucher Scheme Introduced in 1996 Partnership Voucher (top up) Independent Voucher (funding released wheelchair owned by service user) with amount for maintenance and repair included Issues: Predominately Provider driven with little or no evidence of commissioner involvement in governance or budget setting No data available, assumption is national variation of voucher offer and low take up figures

Aim for Personal Wheelchair Budget to: align to wider Personal Health Budget policy and regulations and Choice policy form part of local offer for CCG’s form part of Integrated Personal Commissioning offer thus providing opportunities for blended budgets and whole system integration deliver personalised and outcome based services improving both patient and staff experience demonstrate efficiencies by meeting whole needs

Essential features to design a Personal Wheelchair Budget Model

Steps to include in Personal Wheelchair Budget process

Sites are mapping, questioning current provision and voucher system and testing… ….Are any of the essential features already being delivered? How can the essential features be delivered within Wheelchair services? Workforce skills/training? What are the risks? Who owns the risk? Do services have capacity? What about ownership, maintenance and repair? Will it improve peoples/staff experience? Will people with complex needs have their health and wellbeing outcomes better met using this process? Will efficiencies be demonstrated? Are there any unintended consequences?

How can the essential features be met within Wheelchair Services? Current voucher system Maintenance and repair Know upfront how much money they have available for their health care and support (wheelchair) How and Who sets the amount? Are budgets/amounts shared upfront? How are budgets set for Maintenance and repair? Blended budgets across services? Questions

How can the essential features be met within Wheelchair Services? Current Assessment process? Prescription? Is this outcome based, do we use outcome measures? Be enabled to choose Health and Wellbeing and outcomes they want to achieve, in dialogue with one or more health care professionals What does wellbeing mean? Are services commissioned for this? Who is clinically accountable if wider needs met, not just clinical and postural? Do we have capacity to do this? Will it raise expectations? Questions

How can the essential features be met within Wheelchair Services? Are people currently asked to contribute to assessment and prescription decisions? Do services contribute to wider care plans i.e. EHCP plans? Be involved in the design of their care plan If no other care needs what will wheelchair care plan look like? Peer Support available? Capacity issues? Workforce skills in care plan creation? Questions?

How can the essential features be met within Wheelchair Services? Independent voucher (outside NHS Provision) Partnership voucher (within NHS provision top-up) Be able to request a particular model of budget that best suits the amount of choice and control with which they feel comfortable with? Does the Independent voucher meet the Direct Payment regulations? Are there options for voluntary sector to manage PWB? Questions?

How can the essential features be met within Wheelchair Services? Independent Voucher, clinically assessed as appropriate by clinician Be able to Spend the money in ways and at times that make sense to them, as agreed in their plan Do Therapist agree choice? Maintenance and repair? Questions

Personal Health Budget Deployment Options

National Engagement themes Raising expectations Equity Risk ownership Capacity Increased activity outside of NHS Stock Training Maintenance and repair Voluntary Sector knowledge Peer Support Independent suppliers credibility

Personal Wheelchair Budget National Steering Group The PWBNSG will provide expert knowledge and support in the design and delivery of the Personal Wheelchair Budget programme Act as a vehicle for clinically led and owned delivery of emerging issues identified by the PWB programme in particular where clinicians require professional support in delivery of the PWB model Work as a collective voice for all stakeholders, raising issues and disseminating appropriate information to wider audience   Support and share the learning from the PWB Programme providing expert advice and or support to relevant work streams within the programme