Personal Health Budgets and Continuing Healthcare

Gill Ruecroft, Commissioning Manager PHB/CHCgill.ruecroft@neneccg.nhs.uk 01604 651121

Debbie Quinn QN, MS Specialist NurseNorthamptonshire Healthcare NHS foundation Trust

Follow this link for the Northamptonshire PHB DVD, patients and staff describing their experience and the benefits of PHBs www.neneccg.nhs.uk/personal-health-budgets

Aims and Objectives• To provide attendees with an overview of

PHB’s• To demonstrate effectiveness of PHB’s

through case studies• To provide attendees with an overview of CHC

funding• To provide attendees with an opportunity to

discuss cases and share ideas

Plan for the session• Gill - Overview of PHBs, national and local

implementation, learning from pilot• Debbie – clinicians experience of a patient

with a PHB• Gill & Debbie – All about CHC, eligibility,

process • Break out sessions – how could this work in

practice?

A personal health budget makes it clear to a person and the people who

support them how much money is available for their health care so they

can discuss and agree the best way to spend it.

What is a Personal Health Budget (PHB)?

• PHBs improved people’s quality of life and wellbeing• Benefits more marked where;

o There were higher levels of needo Higher value budgetso People had most choice and control, least restrictions

• PHBs are cost effective, particularly for CHC and MH• Reduction in inpatient costs• Reported positive impacts for carers and family members• Reported changes in relationships with health

professionals

PHB Pilot – National Evaluation Findings

National Policy for PHB roll outIn November 2012 the government announced that from April 2014, people receiving NHS Continuing Healthcare and families of children receiving continuing care, will have the right to ask

for a personal health budget.

On 9 October 2013 Care and Support Minister Norman Lamb announced that from October 2014 this right will be

strengthened and will become a right to have a personal health budget.

Norman Lamb has also described that from 2015 the government want to see PHBs available for more people with

LTCs

Meet DaveDave has MS and is eligible for CHC funding. He lives with his partner who, with his mother, provide him with quite a lot informal care. He has a supra

pubic catheter and a voice amplifier

Measurable Outcomes from the Dave’s PHB plan:

• To improve my independence

• To improve the consistency and quality of my care

• To increase my opportunities for social interaction/activity

• To have better control of my bladder spasms

• To reduce my pain

Is Dave making progress?• I feel better cared for, better looked after

• I don’t think we have completely eradicated all my pain but it is much easier to control now

• I have definitely got more independence, definitely, I have got more control

• Having Paul coming in every morning makes a huge difference than waiting for carers to come from Kettering or Northampton

• This PHB has had a knock on effect on my kids, I am less angry and they are here quite a bit

• Now I am a lot more chilled and relaxed

PHB High Level Process1. Patient Identification 2. Assessment

4. Personal Planning

5. Agreement – ‘contract’6. Managing the money

7.Monito

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n3. Indicative Budget

Things we learnt from the PHB pilot• Most patients/representatives do understand PHBs• Hard to identify and release indicative budgets• Most people are very responsible with the money• It is easier than we thought to identify measurable outcomes• Important to focus on outcomes not on what they are buying• The personal plan is the key to the best results• Patients must be involved in the design of the processes/systems to

get them right• Tension – current provision/decommissioning to release savings• This is much more complex and much harder to implement than we

envisaged!

Clinicians Experience Case Study• Daisy, 46 years old with progressive MS• Nursed in bed• Severe ataxia• Parents carry out a lot of care with agency

support• Frustrated with limitations of agency and

changing staff• 2 weeks holiday a year from 25% SC&H funding

Parents feelings

The CHC PHB option• Changed to 100% CHC funding • Parents wishing to employ own team of carers with

their support to have consistency for daughter• Could incorporate well being – hair, nails• Allow freedom for parents and respite at home• Care provided around needs and wishes

Options for clinicians

• Smaller packages – look at shared carer options

• Flexibility with arrangements• More hours to attract future carers• Enhanced care provided by carers who know

clients• Choice

Choice and tailoring individual needs

PHB Questions?

What is Continuing Healthcare (CHC)?

NHS Continuing Healthcare is an ongoing package of health and social care that is

arranged and funded solely by the NHS where an individual is found to have a ‘primary health need’. Such care is provided to an individual

aged 18 or over, to meet needs that have arisen as a result of disability, accident or illness.

Some facts• Northamptonshire has a population of around

700,000• At any one time there will be approx. 650

people eligible • 150 of these will be fast track – i.e. end of life• This equates to in the region of 0.1% of the

population being eligible for CHC funding

Primary Health Need

• A primary health need is not about the reason why someone requires care or support, nor is it based on their diagnosis; it is about their overall actual day-to-day care needs taken in their totality

• It is the level and type of needs themselves that have to be considered when determining eligibility for NHS continuing healthcare

Assessment and decision making

To determine that the care required is more than the limits of the Local Authority’s responsibilities:•Nature – characteristics and type of need•Intensity – extent, severity and continuity (ongoing needs)•Complexity - skills required to monitor, treat and/or manage the care •Unpredictability - the degree to which needs fluctuate or deteriorate and the challenges in managing them

Delivery of NHS CHC

National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care

November 2012 (Revised) National tools:•CHC checklist (screening tool)•Decision Support Tool (DST)•Fast track pathway tool (End of life)

https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care

Decision Support Tool (DST)• Supports/facilitates a full assessment for eligibility NHS

continuing healthcare • A comprehensive multidisciplinary assessment of a person’s

health and social care needs and their desired outcomes• The person is given every opportunity to participate in the

assessment, plus the option of being supported by an advocate• Existing specialist assessments are used and/or referrals made

for other specialist assessments where appropriate • Unless there are valid or unavoidable reasons, time from

checklist to funding decision will not exceed 28 days • 12 domains/areas of need + nature, intensity, complexity,

unpredictability

CHC – a clinicians guide• ‘Specialist care’• Primary health needs• Intense, complex and unpredictable• Utilise Community services –

Communicate• Family/home situation• Checklist

Examples• Pressure sores – due to severe spasticity,

requiring regular monitoring and position changes

• Swallowing – choking, monitoring, cough assist

• Mood – high levels of changes, loss of consciousness, awareness

Examples• If only one of the example domains is met

then CHC may fund some of a care package jointly with Social Care and Health (i.e. 50/50)

• If more of the domains are met this could lead to a package being offered by CHC

Process – clinicians guide

• Checklist• Assessment - invitation can take 3 hours• Involvement of all MDT – evidence• Decision making – outcome• Reviews

CHC Questions?

Break out session 1• John is 65 years old, he has progressive MS

and is cared for by his wife. He is a wheelchair user. His wife assists with his personal care. He has mild spasticity, occasionally chokes on dry foods and all pressure areas are in tact.

• Does John require a CHC assessment and if so, why?

Break out session 2• Diane is 40 years old, has secondary

progressive MS and is cared for by her family members with a small social care package. She has a PEG insitu, is cared for in bed and has contractures. She has a grade 3 sacral sore, has frequent UTI’s and aspiration pneumonia.

• Does Diane require a CHC assessment and if so on what grounds?

Other options!

Think of both the cases discussed and discuss how a personal budget (PB) from either social care or health could benefit each person