Personal Health Budgets and Integrated Personal Commissioning Rich Watts Steven Pruner 19 May 2016

What is a personal health budget? 2 A personal health budget is an amount of money to support a person’s individual health and wellbeing needs, as agreed between the individual and their local NHS team.

Personal health budgets – Accelerated development programme

Budget spend YES Services agreed in a care plan which will meet health and wellbeing objectives Services should be appropriate for the state to provide NO GP Services Acute unplanned care (including A&E) Surgical procedures Medication NHS charges e.g. prescription charges, Vaccination/immunisati on /Screening Gambling, debt repayment, alcohol, tobacco

NHS Continuing Healthcare: ‘Right to have’ in NHS Continuing Healthcare and children’s continuing care since October 2014 Children and Families Act 2014: Children who have special educational needs should have a single assessment, an Educational, Health and Care Plan and the option of a personal budget The NHS Mandate : From April 2015, people with long term conditions who could benefit should have the option of a PHB The 2015/16 Planning Guidance: CCGs to lead a major expansion in 2015/16…engage widely …include clear goals on expanding PHBs within their published local Joint Health and Wellbeing Strategy The NHS Mandate : ,000 people to have a PHB or integrated personal budget by 2020…produce a plan with specific milestones for improving patient choice by 2020 particularly in …personal health budgets The 2016/17 Planning Guidance: Plans for personal health budgets must be included in Sustainability & Transformation Plans (STPs) Personal health budgets are part of mainstream NHS

Published February 2016: “I am able to access a personal budget for my support needs on an equal basis to people with physical health problems for example, to help my recovery or to stay well”. So, CCGs need to ensure they are considering equally the access to PHBs for mental health Five Year Forward View

Why focus on mental health? Mental health is a significant cost to NHS Mental health is the single largest cause of disability in the UK Prevalence is widespread and common Every year 1 in 4 adults experience a least one mental disorder Mental health impacts on life expectancy Average life expectancy is lower, poorer outcomes and higher costs for physical conditions Mental health problems develop at a young age 1 in 5 children have a mental health problem in any given year First experience of mental health issues 59% by age 14, 75% by age 25 Source: Achieving parity of esteem; transformative ideas for commissioners

Patient reported experience of mental health services Lack of information: GPs often lacked understanding of MH problems and treatments and didn’t know where to signpost people for help Long waits for psychological therapies: long waits in some areas left medication as the only option Lack of choice: limited range of services available Lack of involvement: people didn’t feel they had any say in their care and their views were not included Not listened to: people felt they were not treated with dignity and their concerns were not taken seriously Source: MIND Personal health budgets – making them work for mental health

Benefits of personal health budgets More choice and control Ability to tailor care and support to meet individual needs in a way that fits with their life Linked to better outcomes Shared decision-making and shift in balance of power MIND reported 45% of respondents to their survey said they were rarely involved or not involved in decisions about their care Focus on health outcomes rather than services PHBs can be used to support health and wellbeing outcomes and therefore bring together funding from health and social care sources Source: MIND Personal health budgets – making them work for mental health

Benefits…continued Radically change the relationship between the health professional and patient to a much more equal one Deliver integration at an individual level and higher quality care Work well for people with the highest support needs Enable a wider range of possible solutions than traditionally commissioned services Promote self-management and reduce reliance on NHS services

Personal health budgets – Accelerated development programme 13 Evidence from the National Evaluation Positive impact on care-related quality of life and psychological well-being Did not have an impact on health status or health-related quality of life (positive or negative) Positive impact on people’s outcomes with budgets of £1000 or more Overall personal health budgets were cost effective- particularly in the continuing healthcare and mental health subgroups Positive impact on people’s outcomes when there is more choice and control

Who could benefit? Benefit is linked to the level of need rather than on a particular diagnosis or having a particular condition. Groups who may benefit include: people receiving NHS continuing healthcare people who do not qualify for NHS CHC, but who have health needs which would be suitable children with education, health and care plans, who could benefit from a joint budget including money from the NHS people with learning disabilities and high support needs people who make ongoing use of mental health services people for whom current services don’t work, so end up accessing acute services more people who need high cost, longer term rehabilitation e.g. people with an acquired brain injury, spinal injury or mental health recovery

Challenges Who benefits / agreeing the scope Developing supportive infrastructure Capacity Workforce development. Ensuring equity Managing expectations. Maintaining values, principles and integrity of the NHS Co-production Lack of demand Lack of preventative support Cost pressure of funding previous unassessed / unmet need Developing the market. Culture change Risk management Information governance Measuring success **Disaggregation of block contracts **Delegation of healthcare tasks

All offers should include: Those eligible for adult NHS continuing healthcare & children’s continuing care Children with special educational needs and disabilities Adults and children with learning disabilities CCGs will want to explore other areas in order to meet the commitment of a major expansion: 1-2 in 1,000 people ( % of the population) 50, ,000 personal health budgets or integrated personal budgets by 2020 What CCGs need to do

What IPC is trying to achieve People with complex needs and their carers have better quality of life and can achieve the outcomes that are important to them and their families through greater involvement in their care, and being able to design support around their needs and circumstances. Prevention of crises in people’s lives that lead to unplanned hospital and institutional care by keeping them well and supporting self-management as measured by tools such as ‘patient activation’ – so ensuring better value for money. Better integration and quality of care, including better user and family experience of care.

IPC demonstrator sites

Five key shifts of IPC

PHB / IPC are part of the jigsaw to deliver personalisation PHB / IPC is a lever for achievement, not a service Doesn’t always mean money – directly Focused on outcome delivery not traditional service configuration Challenges providers to personalise support – one size doesn’t fit all Summary

To find out NHS England websites: NHS Choices: