Preparing for 2014 and beyond - Implementing Personal Health Budgets Trudy Reynolds Delivery programme, personal health budgets

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

Steps towards PHB process 3

Options for holding the budget 4

The story so far – personal health budgets 5 Pilot programme - large scale controlled trial evaluation Over 2000 people involved. Results - better outcomes, reduced use of hospital, cost effective especially for people with the highest needs. Right to ask from April in NHS Continuing Healthcare (includes children). Right to have from October 2014 NHS Mandate - will be an option for people with long term physical and mental health conditions who could benefit from April Direct payment regulations– NHS everywhere in England can offer direct payments from August 2013.

If you’re going to do it… do it right 6 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

7 They’re not easy to introduce… Highly counter cultural a new relationship between patients and professionals easy to implement badly Complex technical and practical challenges Budget setting and financial flows; risk and accountability; support planning and brokerage… Need dedicated time and energy Still at relatively early stage of development

But there are people who have been there and done it: 8

And written the book… Developing the market Co-productionDirect payments Sustainability Integration Communications Workforce Managing risk People storiesInformation Care planning Managing the money Setting budgets

(of 211) CCGs have signed up to our support programme Of the155 who took part in our ‘Markers of Progress’ self-assessment: Will we be ready for April 2014?

Accelerated Development Programme 8 courses of 6 days (over 6 months) across the country The programme is for those areas who have not taken significant action in this area, and others who may get some value from it It aims to ensure that people have a positive experience, whilst building understanding and learning for more significant scale up as demand grows Delivered with regional personnel, local personal health budget leaders and members of our national peer network of people with personal health budgets Change management approach: people, process and culture – avoids risk of changing only the paper People ProcessesCulture

And how will we know if we’re doing it right? POET survey adapted for personal health budgets and available to all signed up through the support programme 12

Where next? 13 People who use mental health services? People living with complex long term conditions? People getting joint health and social care support?

Going Further Faster Leading sites committed to exploring personal health budgets at scale beyond NHS Continuing Healthcare Includes: Tees; Manchester; Hull; Nottingham City; Northamptonshire; Lambeth; Oxfordshire; Dorset; Kent… plus more mental health sites to join Working this year on – building and demonstrating the financial and business case for extending personal health budgets; equal access; PA training; integrated budgets 14

Personal health budgets in Oxfordshire - Successes In-depth pilot – focus on CHC PHBs now business as usual in CHC Freedom and choice More time & opportunity to talk through options for care – changed relationship between CHC and client Move towards outcome based support planning Honest dialogue about money and services Local integration between health and social care Budgets are being set in a fair and transparent way Positive impact on budget setting for non-PHB clients Faster processes with larger pool of resources 15

Personal health budgets in Oxfordshire – key challenges Well developed supportive infrastructure needed – cost implications / time required / sustainability Time consuming, particularly where clients have complex care needs Difficult to provide objective measures of success PHBs do not necessarily reduce health and social care costs in the long-term Setting budgets for services purchased through block contract arrangements is proving challenging 16

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