Five Year Forward View: Personal Health Budgets and Integrated Personal Commissioning Jess Harris January 2016

Personal Health Budgets Stems from an existing policy in social care - personal budgets. Evaluation showed that individuals were given more choice and control over the care services they received, improved outcomes and it was a better use of money. Not introducing new money, provides the opportunity to use existing resources in a different way.

What is a personal health budget 5 essential features of a personal health budget: 1.know upfront how much money they have available for healthcare and support; 2.be enabled to choose the health and wellbeing outcomes they want to achieve, in dialogue with one or more healthcare professionals; 3.be involved in the design of their care and support plan; 4.be able to request a particular model of budget that best suits the amount of choice and control with which they feel comfortable; and 5.be able to spend the money in ways and at times that make sense to them, as agreed in their plan.

Pilot Evaluation An independent evaluation by the University of Kent found personal health budgets: Helped to improve outcomes for patients through providing more tailored services and facilitate greater individual engagement; Helped to improve self-management and compliance through greater individual engagement; Enabled a greater diversity of goods and services purchased to meet care and support needs; Improvements in satisfaction with services; Evidence of reduced GP visits and hospital admissions; and Cost savings for high cost, highly complex cases.

Who can have a personal health budget? NHS policy introduced a ‘right to ask’ for a personal health budget for those eligible for NHS Continuing Healthcare (CHC) from 1 April A ‘right to have’ for this cohort has existed since 1 October More information about CHC - services/help-and-support/continuing-healthcare/ services/help-and-support/continuing-healthcare/

Nikki’s Story NHS/Yourchoices/personal- health-budgets/Pages/about- personal-health-budgets.aspxhttp:// NHS/Yourchoices/personal- health-budgets/Pages/about- personal-health-budgets.aspx You can also use the above link access more patient stories…

Bristol CCG Key things we needed to support the introduction of CHC PHBs: Project lead to get it started and develop processes, policy, templates, problem shooting... A different way in which clinicians work when supporting a personal health budget holder. Brokerage and Support Services to provide support for employers e.g. payroll, pensions, employment law advice. Training for personal assistants. Efficient systems to deliver finance. Good communications internally and externally. Person led care and support planning.

Bristol CCG PHB user perspective: 24 personal health budgets 15/16. Evaluation using Patient Outcome Evaluation Tool developed by In Control to gather patient, carer and professionals perspective of having a personal health budget. + Like the flexibility + Like the care and support planning + More choice and involvement in how their care and support needs are met. -Responsibility of being an employer. -Concerns around new pension law and how it affects personal assistants. Equality evaluation showed that so far a fair balance with those with who had a primary health need identified as a learning disability, mental health or physical disability accessing a personal health budget. Also a good range of those of varying age, gender and mental capacity accessing a personal health budget.

Bristol CCG Project lead perspective: Challenging to implement but once processes & policy are up and running it gets easier. Significant culture change, especially in terms of approach to risk and control. Allows more incorporation of self management, listening skills, activated patients and use of voluntary and community sector. Commissioner and Provider roles. Some individuals have been able to get more out of budget than what we would have commissioned. Enabled people to commission care to fit around their own life by employing personal assistants. Back office processes are still work in progress and can hinder progress and experience of PHBs. Constantly learning and developing, especially using feedback from service users.

So what is next?

Policy NHS England Forward View in Action 2015/2016 set out the expectation CCGs to lead major expansion of personal health budgets outside of NHS Continuing Healthcare and introduce integrated budgets. Learning disability and children cohorts specifically mentioned. Also stated requirement for CCGs to set out a local offer explaining how they are expanding personal health budgets and integrated budgets to be published by Health and Wellbeing Boards.

NHS Mandate Goal by 2020 for 50, ,000 people to have a personal health budget or integrated personal budget (up from current estimate of 4,000). Much more difficult to implement outside of NHS Continuing Healthcare due to existing large contracts.

How?

Integrated Personal Commissioning (IPC)

South West Integrated Personal Commissioning (SWIPC) Bringing together local government, voluntary and community sector and the NHS to work differently to support people with complex care needs. IPC aims to use person led approaches, with the option of a budget to integrate support for people. People will have one care plan focused on what matters to the person.

South West Integrated Personal Commissioning (SWIPC) Cohorts - children, learning disabilities, mental health and long term conditions. Multiple work streams, working groups & action learning sets across the region to develop how this will work and to overcome barriers. Will link with other change programmes in the region; Transforming Care, Better Care Fund and Vanguard sites for new models of care.

SWIPC Approach Starting with small scale implementation sites across the region, testing and learning in different settings, working with people with different needs. Developing a systems change programme, taking the learning from sites and making the changes needed to scale up. Cross regional work to develop a capitated budget model to support wider roll out in the future.

More Information CCG website services/help-and-support/personal-health-budgets/ NHS England South West Integrated Personal Commissioning