1. 1 Citizens Commissioning for health : practical possibilities

2. 2 What’s this workshop all about? This workshop is an invitation to think through some of the issues relating to holding and managing a personal health budget. There’s a lot to think about together!

3. 3 We think… that the success of personal health budgets will depend on citizens co-designing and co-producing the developing market because….. citizens are the people who know best what their needs are and what will meet them

4. 4 This will mean… Citizens working in partnership with: Primary Care Trusts Local Authority commissioners User-led organisations Providers So, we need to be clear about what’s important and why.

5. 5 So, what are we talking about? The ways of holding and managing a personal health budget and their potential impact on the experience. 1. Notional budget (no money changes hands) 2. Real budget held by a third party. 3. Direct payment. (Being piloted this year).

6. 6 True or false ? Does having a personal health budget give you choice and control ?

7. 7 Yes? The answer should be a resounding yes! But….. We think that being given a personal health budget is only the beginning. Having more choice and control isn’t just about having a budget to plan with; it’s also about day-to-day decision-making.

8. 8 So, let’s think about it Sally is 22 years old and has complex health needs. She has a personal health budget. Her mum, Margaret, is recruiting staff for Sally’s team. The manager of the agency which is holding Sally’s budget suggests she helps with the recruitment process. She also suggests that the area manager gets involved too.

9. 9 The shortlisted interviewees Hayley Mary

10. 10 Who decides ? Margaret is keen to employ Hayley because she is Sally’s choice. Since the agency is holding Sally’s budget, they are the legal employer’s of Sally’s staff. Who should have the final say?

11. 11 What’s the deal? Notional budget – No money changes hands but an individual understands their budget and has a say in how it’s spent. Direct payment – gives an individual maximum choice and control but also brings responsibilities (although there is help and support available.)

12. 12 What are the third party options? Whilst every option should enable the same amount of choice and control, the locus of control will be different depending on the arrangement.

13. 13 Practical Possibilities Vs Potential Pitfalls

14. 14 An Independent User Trust (also known as Independent Living Trusts) Practical Possibilities: Puts the individual at the heart of the decision- making process. Friends, family members, advocates or others can be trustees. The trust follows the rules set out in the trust deed and can employ staff. Potential Pitfalls: Not everyone has an established circle of support. Trustees may see the responsibility as too onerous.

15. 15 A community interest company (a type of social enterprise) Practical Possibilities: They are quite easy to arrange and are not-for-profit. Families could join together to set up their own CIC. The DH is encouraging the use of CIC’s so there should be help available. Potential Pitfalls: A CIC for more than one person would need to be CQC registered and the individual focus would be lost. You will probably need funding for start-up costs

16. 16 User-led Organisation Practical Possibilities: All Local Authorities are now required to support the development of a user-led organisation in their area. The locus of control lies with citizens Potential Pitfalls: May have a wide remit and lots of clients

17. 17 Voluntary Organisation Practical Possibilities : Good source of advice, information and support Good networks and more community-based CQC registration Not-for-profit Potential Pitfalls: Budget holder’s voice weakened Organisation may have a wide remit and many clients. Likely to be bureaucratic.

18. 18 Private Sector Practical Possibilities : Commercial drive Service development CQC registration Potential Pitfalls: Budget holder’s voice weakened Organisation may have a wide remit and many clients. Likely to be bureaucratic. Profit motive

19. 19 What are the ingredients of a good third party arrangement? Guiding Principles Self- determination Transparency Choice and Control Three guiding principles in “Managing the Money: Resource Development Options for Personal Budgets”(CSIP)

20. 20 Self-determination: Decision-making should be as close to the individual as possible remembering that involving them is not the same as sharing power.

21. 21 Transparency The individual should:  know the sum of money available to them to meet their outcomes.  be central to decision-making on financial matters  Have easy access to detailed income and expenditure The budget: has to be separately accounted for within the third party banking arrangement.

22. 22 Choice and Control Promotes citizenship Puts the emphasis on flexibility Focuses on outcomes.

23. 23 What are other people doing? Malcolm’s Story (an example of a not-for-profit registered charity holding and co-managing a personal health budget)

24. 24 For You To Take-away We need to make sure that decision-making is as close to the person as possible. Citizens need to be involved as commissioners in third-party arrangements. We need to make sure the shift in power is real.

25. 25 What else do we need to consider? 1. How can we begin to shape the developing market? 2. How do we know who to trust? 3. ? 4. ? 5. ?

26. 26 Our To-Do List 1. Find out who is interested in shaping developing the market. 2. Find out which social enterprises, user-led organisations and providers are already working on issues relating to personal health budgets. 3. ? 4. ? 5. ?