Personal Health Budgets Evaluation

Evaluation of the Personal Health Budgets Pilots

Julien Forder1, Karen Jones1, James Caiels1, Paul Dolan2, Caroline Glendinning3, Dominic King4 and Karen Windle1

Personal Social Services Research Unit1 (Kent)Department of Social Policy2 (LSE, London)Social Policy Research Unit3 (York)Imperial College, London4

Personal Health Budgets Evaluation

Personal Health Budgets (PHBs)

Central to the government’s ambition to ‘modernise’ health care …

… at the heart of the ‘personalisation’ agenda …

… to promote choice

Build on experiences from social care and Individual Budgets

In 2009 – DH invited PCTs to become pilots

Personal Health Budgets Evaluation

Promoting choice

Diversity

Information

Empowerment

Control

Personal Health Budgets Evaluation

Hypothesised benefits of PHBs …

• Wider choice of options for spending to give flexibility …

• … and more control over resources so people can access them

• Greater personal freedom and independence

• Self-esteem and sense of identity would be greater

• Quality of life would be improved …

• … cost-effectively

Personal Health Budgets Evaluation

Aims of the evaluation

CORE QUESTION Do PHBs ensure better health and social care outcomes when compared to conventional service delivery

If they do work, how best can PHBs be implemented

User experience

Carer impact

Workforce

Commissioning/Provider impact

Outcomes

Costs

Cost effectiveness

Evaluation dimensions

Personal Health Budgets Evaluation

Design• Controlled trial without randomisation across 20 PCTs• Overall sample – 2000 across different deployment options and health

conditions– NHS Continuing Healthcare– Diabetes– Chronic Obstructive Pulmonary Disease– Stroke– Mental health– Long-term neurological conditions

• 1,000 patients will be recruited to the PHB group • 1,000 patients will be recruited to the comparison group

• Two specialist services: end of life and maternity

Personal Health Budgets Evaluation

Recruitment Process• Different groups of HPs

to decide and recruit– A group of HPs offer PHBs and

recruit to the PHB group– In same site, a different group

of HPs decide who is approached to be in the Comparison Group

– Min of 75 to be recruited to the PHB and Comparison Group

• Same group of HPs to decide and recruit to both groups – Selection bias more of a

problem– Randomisation before the offer

of PHB– Min of 75 to be recruited to the

PHB and Comparison Group

Personal Health Budgets Evaluation

Importance of the recruitment process

• Robust evaluation key to understanding the impact of PHBs

– whether they work– for whom they work– whether they are the most effective way of providing

services– how to make them work best

Personal Health Budgets Evaluation

Individual Level Data Collection

Qualitative interviews about user experiences (55 PHB holders & carers)

1. Outcome data2. Medical records3. HES data

1. Outcome data2. Medical records3. HES data4. Care plans (PHB holders)

3 months

Outcome data

9 months

Qualitative interviews about

user experiences (55 PHB holders

& carers)

6 monthsBaseline 12 months

Personal Health Budgets Evaluation

Specialist Services• 10 in-depth interviews with budget holders

using maternity services – after the birth

• 10 in-depth interviews with carers of PHB holders - end of life services – 6 months after the death of the budget holder

Personal Health Budgets Evaluation

Organisation Level Data Collection

Web-based questionnaire –

front-line operational staff

Face to face interviews -

Implementation

1. Face to face interviews – perceived success2. Face to face interviews - Impact on organisations3. Web-based questionnaire – impact on the workforce

3 months

Face to face interviews – project

leads

15 months

Telephone interview – progress of

implementation

12 months3 months 24 months

Personal Health Budgets Evaluation

Research design …… a few challenges

• Broad range of policy aims to be evaluated

• Variety of patient groups

• Need to collect data from busy people

• Diversity in local information systems

• The world is not standing still …control group

Personal Health Budgets Evaluation

Evaluation progress to date• Research and Development approvals• Implementation interviews• Impact on workforce – operational staff: to

begin• www.phbe.org.uk

Personal Health Budgets Evaluation

Some key dates…• Recruitment begins April 2010; ends April 2011• Fieldwork to end by April 2012• Interim reports:

– 1st - Early implementation issues: June 2010– 2nd – All implementation issues: November 2010 – 3rd – Cost of implementing PHBs: May 2011 – 4th – Early experiences of PHB holders and carers: July 2011– 5th – Satisfaction of PHB holders and carers: May 2012

• Final report due in October 2012