Personal Health Budgets Evaluation Evaluation of the Personal Health Budgets Pilots Julien Forder 1, Karen Jones 1, James Caiels 1, Paul Dolan 2, Caroline Glendinning 3, Dominic King 4 and Karen Windle 1 Personal Social Services Research Unit 1 (Kent) Department of Social Policy 2 (LSE, London) Social Policy Research Unit 3 (York) Imperial College, London 4

Personal Health Budgets Evaluation Personal Health Budgets (PHBs) Central to the government’s ambition to ‘modernise’ health care … … at the heart of the ‘personalisation’ agenda … … to promote choice Build on experiences from social care and Individual Budgets In 2009 – DH invited PCTs to become pilots

Personal Health Budgets Evaluation Promoting choice Diversity Information Empowerment Control

Personal Health Budgets Evaluation Hypothesised benefits of PHBs … Wider choice of options for spending to give flexibility … … and more control over resources so people can access them Greater personal freedom and independence Self-esteem and sense of identity would be greater Quality of life would be improved … … cost-effectively

Personal Health Budgets Evaluation Aims of the evaluation CORE QUESTION  Do PHBs ensure better health and social care outcomes when compared to conventional service delivery If they do work, how best can PHBs be implemented User experience Carer impact Workforce Commissioning/Provider impact Outcomes Costs Cost effectiveness Evaluation dimensions

Personal Health Budgets Evaluation Design Controlled trial without randomisation across 20 PCTs Overall sample – 2000 across different deployment options and health conditions – NHS Continuing Healthcare – Diabetes – Chronic Obstructive Pulmonary Disease – Stroke – Mental health – Long-term neurological conditions 1,000 patients will be recruited to the PHB group 1,000 patients will be recruited to the comparison group Two specialist services: end of life and maternity

Personal Health Budgets Evaluation Recruitment Process Different groups of HPs to decide and recruit – A group of HPs offer PHBs and recruit to the PHB group – In same site, a different group of HPs decide who is approached to be in the Comparison Group – Min of 75 to be recruited to the PHB and Comparison Group Same group of HPs to decide and recruit to both groups – Selection bias more of a problem – Randomisation before the offer of PHB – Min of 75 to be recruited to the PHB and Comparison Group

Personal Health Budgets Evaluation Importance of the recruitment process Robust evaluation key to understanding the impact of PHBs – whether they work – for whom they work – whether they are the most effective way of providing services – how to make them work best

Personal Health Budgets Evaluation Individual Level Data Collection Qualitative interviews about user experiences (55 PHB holders & carers) 1. Outcome data 2. Medical records 3. HES data 1. Outcome data 2. Medical records 3. HES data 4. Care plans (PHB holders) 3 months Outcome data 9 months Qualitative interviews about user experiences (55 PHB holders & carers) 6 monthsBaseline12 months

Personal Health Budgets Evaluation Specialist Services 10 in-depth interviews with budget holders using maternity services – after the birth 10 in-depth interviews with carers of PHB holders - end of life services – 6 months after the death of the budget holder

Personal Health Budgets Evaluation Organisation Level Data Collection Web-based questionnaire – front-line operational staff Face to face interviews - Implementation 1. Face to face interviews – perceived success 2. Face to face interviews - Impact on organisations 3. Web-based questionnaire – impact on the workforce 3 months Face to face interviews – project leads 15 months Telephone interview – progress of implementation 12 months3 months24 months

Personal Health Budgets Evaluation Research design … … a few challenges Broad range of policy aims to be evaluated Variety of patient groups Need to collect data from busy people Diversity in local information systems The world is not standing still …control group

Personal Health Budgets Evaluation Evaluation progress to date Research and Development approvals Implementation interviews Impact on workforce – operational staff: to begin

Personal Health Budgets Evaluation Some key dates… Recruitment begins April 2010; ends April 2011 Fieldwork to end by April 2012 Interim reports: – 1 st - Early implementation issues: June 2010 – 2 nd – All implementation issues: November 2010 – 3 rd – Cost of implementing PHBs: May 2011 – 4 th – Early experiences of PHB holders and carers: July 2011 – 5 th – Satisfaction of PHB holders and carers: May 2012 Final report due in October 2012