opportunities arising from personal health budgets

NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands | NHS East of England | NHS West Midlands

Jay Dobson, Personal Health Budget Lead

NHS Midlands and East Region

Personal Health Budgets

Getting to the Good Stuff

“Opportunities”

Introduction

Purpose of Presentation…

•Develop understanding of the opportunities of PHB’s

• The Team

• Nottingham City – Jay Dobson (Gemma Newbury)

• Northamptonshire - Gill Ruecroft

• Staffordshire - Claudia Brown

PHB Context - “No decision about me, without me”

Working together for a healthier Nottingham

The National Personal Health Budget Pilot Programme

Gemma Newbery‘NHS Personal Health Budget’ Pilot

Project Manager


PHBs in Nottingham – What Next?

“To build on the findings and lessons learnt throughout the Personal Health Budget pilot to develop a sustainable, efficient and effective process for providing patients with a PHB in Nottingham.”

Working with:- Continuing Health Care- Joint Funded patients- Children’s Continuing Care- MacMillan Close- Working Age Dementia- Neurological Conditions


Problems When Not Joint Working

–Confusion for patients–Duplicating work–Wasting resources–Health not knowing what social care are providing for a patient and visa versa–Lack of communication – e.g. social care increasing or decreasing a patients care package without informing health


Perceived Barriers 1

• Legality• Pooled budgets• VAT• Accounting• Different Funding Streams• Means Tested vs Free at the Point of Delivery• Risk Aversion• Clinical Evidence• Clinical Engagement• Medical Model• Co-Production


Perceived Barriers 2

• Assessment and Care and Support Planning• Resource Allocation• Sign Off• Panels• Joint Teams• Joint Working• Planning and Reporting• Confidentiality• IT Systems• Performance• Outcomes


Joint Working – Nottingham’s Solutions• One process map detailing how to provide joint budgets• One brokerage team• One support plan for health and social care (and education?)• One budget to meet health and social care outcomes• One approval process• One list of approved direct payment support service providers• One direct payment agreement form• One bank account to receive a direct payment• One team administrating joint direct payments• One direct payment account monitoring process• Section 75 agreement to formalise joint working arrangements• One review process

Northamptonshire Integrated Care Northamptonshire Integrated Care PartnershipPartnership

Mainstreaming Personal Health Budgets

LTC integrated model testing in the new landscape of clinical commissioning

Gill Ruecroft, Northamptonshire PHB Pilot [email protected] 01604 651121

mailto:[email protected]


• Health professionals/patients working in partnership, different conversations, real choice & control

• The plan is the key to coordinate integrated services• New role required - support, brokerage and advocacy• Improved quality = reduced demand on services• Tension – current service provision/decommissioning

to make savings real• This was much more complex and difficult to

implement than we envisaged – its not a QIPP fix!

Learning from PHB


• CCGs x 2• Nine localities• Mirrors local authorities boundaries• NHFT (community services provider)

provision locality based• 3rd sector tend to be locality based• Health & Well Being Fora in each locality

New County Landscape


THERE IS NO “CURE”… THIS IS ABOUT MANAGING AND LIVING YOUR LIFE

INDIVIDUAL PLAN

NEIGHBOURHOOD TEAM

FRIENDS

FAMILY

VOLUNTARY

HOUSING

SOCIAL SERVICES

MENTAL HEALTH NURSES

MDTH&SC NEEDS

H&SC OUTCOMES TO ACHIEVE

MDTH&SC NEEDS

H&SC OUTCOMES TO ACHIEVE


Three pilots in Northamptonshire working from one agreed model concept

•Daventry– Risk stratification approach– Based on MDT and use of specialists– Centralised in the locality

•Kettering– Not condition specific, high users of emergency services– Generic team who coordinate an individualised MDT– Practice based

•Northampton– Development of an education/community centre

LTC integrated model pilots

The Staffordshire Way

Personal Health Budgets and what it can lead to!

Staffordshire and Stoke-on-Trent Partnership NHS Trust

From 1st April the Staffordshire and Stoke-on-Trent Partnership NHS Trust became responsible for adult social and community healthcare within Staffordshire and all community healthcare in Stoke-on-Trent, delivering everything from physiotherapy to day care opportunities.

1000 social care staff and a budget of £153 million transfer from the county council to the new organisation

Faster, more efficient patient focused health and social care, more streamlined delivery of integrated care and a reduction in the inefficiencies which can lead to unnecessary demand on care services and delays for patients.

There are over 5,000 staff from: North Staffordshire Community Health Care

(Provider Arm) South Staffordshire Primary Care Trust

(Provider Services) Stoke on Trent Community Health Services

(Provider Arm) Staffordshire County Council

(Adult Social Care and some support services staff )

The Staffordshire Personal Health Budgets (PHBs) pilot began in April 2010 and became one of approximately 60 pilot sites across the country.

The Gnosall Pilot

Dr Ian Greaves - previous project to provide Dementia Services.

Dr Greaves agreed to be the clinical lead for a PHB pilot project within Gnosall Surgery – focused on patients who have one or more Long Term Condition with a high dependency on their GP or secondary care.

Key milestones

January 2011

A showcase event was organised in January 2011 to bring social care and health executives, Cabinet Members and Department of Health officials together to promote the good practice linked to the Personal Health Budget Project.

Collaborating across Staffordshire event

A countywide networking event was held in April 2011 attended by 75 people including over 40 GP’s Speakers;National Clinical Director of Public Health for England Dr David Colin-Thomé OBE Local GPs Dr David Hughes from Leek and Dr David Palmer from Stafford. Included a market place of 18 information stalls featuring local public and voluntary sector services to promote the wider wellbeing agenda beyond health and social care.

On April 4th 2011, the Long Term Conditions team met with Sir John Oldham as part of his tour of Staffordshire to promote his new pathway for Long Term Conditions.

June 2011 - first child PHB in the country

Come to Staffordshire!

Professor Stephen Field, Chair of the Governments NHS Future Forum visited Gnosall Surgery on 12th August 2011

More recent visitors –

John Wilderspin, National Director for Health & Wellbeing Board Implementation

Baroness Jolly, Co-Chair of the Parliamentary Party Committee on Health and Social Care

The Gnosall Practice Pilot

Involved 154 patients looking at case management

Also countywide, 12 CHC patients had / have a PHB

Plans for a further 11 pilots with GPs around the county focusing on a wide variety of areas such as medicine management, COPD patients, acquired brain injury (with Headway) and substance misuse.

Development of an anticipatory care model

Deploying resources to prevent illness and dependency

“The ageing population and increased prevalence of chronic disease requires a strong re-orientation away from the current emphasis on acute and episodic care towards prevention , self-care, more consistent standards of primary care and care that is well coordinated and integrated.”Transforming our health care systems. Ten priorities for commissioners. Imison et al, King’s Fund 2011

LGA bid success

£20,000 from the Local Government Association Efficiency Programme.

The programme will take wider scale, covering the broad range of work that is already being done, and being extended, where a Personalised approach is being encouraged. Within Staffordshire there is a emphasis to encourage greater control and self-care for individuals, PHBs and work being done by Dr Greaves with people with dementia. The impact of the subsequent interventions these programmes have can then be assessed by looking at the improved outcomes for individuals. This can be done by looking at areas such as the number of admissions to long-term care for people with dementia, reductions in hospital admissions for people who take a Personal Health Budget.

Year of Care Funding model

1 of 6 prestigious national Early Implementer sites for The Year of Care Funding Model

The Staffordshire application was fronted by Staffordshire and Stoke NHS Partnership Trust and the Fit for the Future Programme in the North of the county with support from the Joint Commissioning Unit

The aim is to have a national funding model that facilitates the delivery of integrated health and social care for people with a LTC based on need rather than disease. This is in line with recommendations made by the NHS Future Forum on aligning financial incentives to enable integration of care where appropriate.

THE QUIZ!

[email protected]

Examples of Uses of Personal Health Budgets (for people with long term health conditions)

Purchase of personal exercise equipment, including treadmill, exercise bike, bicycle Personal Health Trainer Massage to improve circulation and pain relief Alternative therapies such as aromatherapy for pain relief and relaxation (reduce anxiety) Alternative approaches to smoking cessation Ways of promoting healthy eating and/or weight loss, for example kitchen equipment,

bathroom scales, cost of joining a slimming club Ways of reducing social isolation, especially for those who are depressed. This could include

funding leisure activities/hobbies that keep people occupied/stimulated and involve accessing the local community (providing opportunities to socialise)

Equipment required to undertake leisure activities/hobbies (see above) for example art materials or sporting equipment.

Travel expenses to access universal services or to pursue leisure activities (see above) To enable the service user to be accompanied on an activity, where this is necessary Purchase of air-conditioning or de-humidifying equipment (for people with breathing

difficulties) Equipment to improve access around the home, for example modular ramps to improve

access to different parts of the home or garden for wheelchair users

http://www.supportplanning.org/Support_Planning_Downloads/%20Personal%20Health%20Budgets,%20what's%20in%20and%20what's%20out%20(draft)v2.doc

Any questions

opportunities arising from personal health budgets

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