Personal Health Budgets: Meeting the Mandate Commitment

Colin Royle, Alison Austin and Zoe Porter

@NHSPHB

Structure of presentation

2

1. Colin’s story

2. The commitments

3. The policy: past, present and future

4. Practical implications & support

Malcolm’s story

Colin Royle, carerCo-founder, Peoplehub

About Malcolm• Is 69 years of age• Has been married for 42 years• Is father to two children• Spent most of his career in sales • Retired in 2005 to spend more time with Anne (Malcolm’s wife/my mother)

Becoming ill

• Started becoming ill immediately after retiring• Was sectioned (3) in February 2008• Diagnosed with right frontal lobe dementia in June 2008.• Only one in a million people suffer with this form of dementia

Initial signs and symptoms

• Withdrawal from activities • Became more self-involved• Some memory loss• Confused and disinhibited

Complex needs• Became doubly incontinent• At high risk of choking (dysphagia)• No longer able to understand what was being said• Unpredictable behaviours and aggression

Care packages

• Eligible for NHS Continuing Health Care (CHC) upon discharge from hospital August 2008

• I became Malcolm’s full time carer• Initially attended daycentre Mon – Thurs 8am – 5pm• Started receiving personal health budget in 2009

What helps dementia sufferers• Consistency• Routine• Familiarity• Living at home• Clear and simple language• Appropriate levels of medication

How Malcolm’s budget has been used

• Employ five members of staff to care for Malcolm• We chose rates of pay for carers• Has stopped attending daycentre• More flexibility in hours of support• Used for all of Malcolm’s life needs, including health• Purchased Sky+ box, rented a flat, bought a fence amongst others

£ versus the £

Daycentre - £28,500• Didn’t understand his needs• Generic activities• Lack of choice• Lots of anxiety• Highly medicated

Sky + box - £35• Provides choice• Stimulates him• Keeps him calm• Keeps him engaged• Keeps him safe

And now . . . . . .

• Malcolm’s medication has reduced by 2/3 in the past four years• Has more consistency in his care• Staff understand his needs and communicate effectively• Has more choice in activities• No longer requires support from consultant or care manager• Is still living at home some five and a half years after being discharged from

hospital

Dr Alison AustinPersonalisation and Control LeadPatients and Information DirectorateNHS England

Personal Health Budgets: The Commitments

NHS Mandate Objective: “by 2015… more people managing own health… everyone with LTCs including MH, offered a personalised care plan… patients who could benefit have the option to hold a personal health budget… information to make fully informed decisions.”

Legal Duties: from April 2014 everyone receiving NHS Continuing Healthcare will have the “right to ask” for a personal health budget. From October 2014 this will be a “right to have”. CCGs have to have processes in place to deliver them by April 2014

The independent evaluation showed that they can lead to improved quality of life whilst meeting health needs, that they can be cost effective and reduce hospital admissions

In addition a subsequent survey of personal health budget holders and their carers showed:• 73% reported a positive impact on independence• 69% reported a positive impact on health• 70% carers reported a positive impact on their own quality of life

2009-2012 personal health budget pilot programme

What we know:• they work best for those with higher levels of need• people with higher levels of need are more likely to need both health and

social care support• They are applicable to mental and physical health• They are not right for all NHS Services

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What the Mandate means: Who benefits?

What the Mandate means: Who benefits?

What we are working on:• Who “benefits”,• Going further faster – including people who use mental health services,

people with learning disabilities and other people with long term conditions,

• Integration pioneers,• Mainstreaming,

We know the challenges facing the NHS…… personal health budgets are part of the solution.

They help people live with their long term conditions and say out of hospital:• Change the relationship• enable people to use NHS funding in different ways, not new monies,• focus on outcomes,• centre around a care plan which is agreed by NHS,• are regularly reviewed to ensure needs are being met and money is

spent as agreed,• Facilitate integration across health and social care

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House of Care

Wider context of personalisationParity of Esteem: Mental health &

learning disabilities

Personal health budgets

Year of Care Finance& value

programme

Integration & Better Care Fund

SEND & Children

Personalised care & support planning

Services which are excluded:• GP services (GP contract),

• Acute unplanned care (including A&E),

• Surgical procedures,

• Medication,

• NHS charges eg prescription charges

• vaccination/immunisation,

• screening,

What is excluded?

What can they be spent on?They can be spent on anything agreed in a care plan which will meet health and wellbeing objectives

• Equipment• Personal care• Physiotherapy• Complementary therapies• Supportive technology (eg computers, ipads, kindles)

Services should be appropriate for the state to provide – not gambling, debt repayment, alcohol, tobacco

Zoe PorterProgramme Delivery ManagerPersonal Health BudgetsNHS England

Evaluation - benefits of personal health budgets depend on how they were introduced. Best results – people know budget up front; advice and support available; choice and flexibility over how to spend budget , choice on how it is managed. Scale-up - challenge of maintaining the integrity of the values.To work well, personal health budgets need: good support from all parts of the system co-production with people with direct experience

Meeting the Mandate commitment: If you’re going to do it, do it right

Getting ready in NHS Continuing Healthcare

• Every CCG (211) signed up to support programme

• Over 170 CCGs have attended the accelerated development programme

• 188 have accessed small amount of additional funding

• Markers of Progress – currently being used by over 80%

Nikki spent over 6 months in hospital the year before getting her budget.

• She now has responsive and personalised support

• The result is fewer crises and much less use of hospital

• But how to scale up?

Beyond NHS Continuing Healthcare

• Big benefits when targeted at people who make high use of the NHS – better outcomes and quality of life plus large reductions in use of hospital after getting a personal health budget – between £1,300 and £4,000 per year

• People with long term conditions and those using mental health services benefit the most.

The potential - if done well

•But… if you’re going to do it, do it right

•Needs to be staged and targeted at those who would benefit most – risk modelling

• Coming soon – calls for early adopter CCGs to join the Going Further Faster Programme to test out strategies for change

Staged roll-out strategy

To find out more:

Personal health budgets

•www.personalhealthbudgets.england.nhs.uk

•Twitter: @NHSPHB

•Email: england.personalhealthbudgets@nhs.net

Wider individual and public participation

• http://www.england.nhs.uk/2013/09/25/trans-part/

• #NHSParticipation30