Sarah Leach and Gemma Clifford NHS England Comprehensive model of personalised care: Personal Health Budgets and integrated budgets     Sarah Leach and Gemma Clifford

Objectives To develop an understanding of the Personalised Care comprehensive model and how this relates to cancer To develop an understanding of personal health budgets and what tools and resources are available to support the implementation of this locally To explore how this can be implemented in local systems and have the opportunity to share examples of this is practice

What is Personalised Care? Personalised care helps a range people - from people with chronic illness and complex needs to those managing long term conditions and those with mental health issues or struggling with social issues which affect their health and wellbeing.  It helps them make decisions about managing their health so they can live the life they want to live based on what matters to them, working alongside clinical information from the professionals who support them. This is in response to a one-size-fits-all health and care system that simply cannot meet the increasing complexity of people’s needs and expectations.  Evidence shows that people will have better experiences and improved health and wellbeing if they can actively shape their care and support.

Personalised care brings together 6 different components Shared decision making Personalised care and support planning Enabling choice, including legal rights to choice Social prescribing and community-based support Supported self-management Personal health budgets and integrated personal budgets

Comprehensive Model for Personalised Care All age, whole population approach to Personalised Care TARGET POPULATIONS INTERVENTIONS OUTCOMES People with long term physical and mental health conditions 30% Specialist Integrated Personal Commissioning, including proactive case finding, and personalised care and support planning through multidisciplinary teams, personal health budgets and integrated personal budgets. Empowering people, integrating care and reducing unplanned service use. People with complex needs 5% Plus Universal and Targeted interventions Supporting people to build knowledge, skills and confidence and to live well with their health conditions. Targeted Proactive case finding and personalised care and support planning through General Practice. Support to self manage by increasing patient activation through access to health coaching, peer support and self management education. INCREASING COMPLEXITY PEOPLE MOVE AS THEIR HEALTH AND WELLBEING CHANGES Plus Universal interventions Universal Shared Decision Making. Enabling choice (e.g. in maternity, elective and end of life care). Social prescribing and link worker roles. Community-based support. Supporting people to stay well and building community resilience, enabling people to make informed decisions and choices when their health changes. Whole population 100%

NHS LTP: Specific Personalised Care commitments Provide people with a wide choice of options for quick elective care, including choice at point of referral and proactively for people waiting for six months (para 3.109) Use decision-support tools to augment the ability to deliver personalised care (para 3.106), and ensure the least effective interventions are not routinely performed, or only performed in more clearly defined circumstances, potentially avoiding needless harm to people and freeing up scarce professional time (para 6.17viii)) Put in place over 1,000 trained social prescribing link workers by 2020/21 and over 900,000 people referred to social prescribing link workers by 2023/24 (para 1.40) Ramp up support for people to self-manage their own health (para 1.38) Accelerate the roll out of Personal Health Budgets to give people greater choice and control over how care is planned and delivered. Up to 200,000 people will benefit from a PHB by 2023/24 (para 1.41) Support and help train staff to have personalised care conversations (para 1.37)

LTP: other commitments that depend on Personalised Care Significant commitments to support care quality and outcomes, including applying the Comprehensive Model of Personalised Care to end of life care (para 1.42), dementia (para 1.20) and cancer (para 3.64) Enabling more personalised care and choice and control for people with learning disabilities, autism or both (para 3.34), children and young people (para 3.47), and people with mental health conditions (para 3.106) Personalised care and support planning approaches in maternity (para 3.13), CVD (para 3.70) and to support people to manage their condition in work (appendix on health and work) Expand supported self-management for people with long-term conditions (para 2.2), including diabetes (paras 3.79, 5.13), respiratory disease (para 3.85) and MSK conditions (para 3.107) Community pharmacies will also promote and support self-management for people (para 1.10) In addition to the above, personalised care is: Recognised as enabling the shift to digital and vice versa (para 5.8-5.9) Recognised as a practical enabler of integration (para 1.58) To be supported and enabled through the revised QOF (para 1.11)

Aim of Personal Health Budgets To give people greater choice, flexibility and control over the health care and support they receive An opportunity for people to work in equal partnership with the NHS about how their health and wellbeing needs can best be met Personal health budgets are not about new money, but about using resource differently

Principles of PHBs NHS values still hold No entitlement to more, it should be safe and effective services Personal health budgets should be a positive experience Access to services that best suit the individual Control over decision making Not mandatory (exception CHC default homecare) Support planning is key

Who is eligible? Individuals eligible for CHC and CC have had a right to have since 2014 CCGs can develop their own local offer to other cohorts of patients. Long term plan announced intentions to expand into S117 and Wheelchair services. Also announced plans to explore the use of PHBs in CHC Fast Track and Children and Young People’s Continuing Care.

Pilot Overview 5 CCGs tested the implementation of PHBs across a range of cohorts in the end of life pathway 2 CCGs focused on Fast Track The 3 others focused much earlier in the pathway - the last 12 months of life and multiple long term conditions Regular reporting led to two reports being published on the findings – learning network

Warrington CCG expansion of Fast Track PHBs Year 1 Worked with local hospice Training of hospice staff and CCG staff Paperwork and processes shortened Problem solving and system testing Feedback from staff, patients and families 35 people received a PHB Year 2 Began working with District Nurses and Further engaging of wider interested parties Training of District Nurses from PHB lead and hospice nurses Funded PHB Information Service 130 people received a PHB

Pilot Learning In Year 1 of pilot in Warrington – no one designed their care to look like the traditionally commissioned offer NEW Devon were able to prove that Direct Payments were possible but that not everything can be sped up South Derbyshire utilised their process to support people with small amounts of legacy money to purchase items/support in the last year of life – difficult to sustain CCGs looking further upstream struggled to identify where they could free up funding during the life of the project

Benefit for patients Increased choice and control about care and support available No longer ‘one size fits all’ Continuity of care More balanced, holistic conversation – equal partners Patient Example: Brenda Patient Example: Robyn

CCG Processes Many CCGs utilise the relationships that hospices and district/community nurses build up with eligible patients Increased engagement and use of VCSE organisations Staff supported to think differently to meet outcomes Bolton CCG trialling the use of the GSF register to identify people in the last year of life and offer them a PCSP which might lead to a PHB further on Increased market development to get care providers more engaged and involved with personalisation and to improve choice in the market

Next Steps

Delivery Support Access to NHS England PHB team and its resources Workshops and bespoke events Mentoring Cohort specific support for expansion of PHBs beyond continuing healthcare Online Learning Network, with discussions and FAQs Practical tools, guides and stories

Further information and support NHS England website https://www.england.nhs.uk/healthbudgets/ Personal Health Budgets Learning Network www.personalhealthbudgets.england.nhs.uk/login Personalised Health and Care Framework https://www.england.nhs.uk/personalised-health-and-care/

Thank you England.personalhealthbudgets.nhs.net