nhs southern derbyshire clinical commissioning group implementing personal health budgets

NHS Southern Derbyshire Clinical Commissioning Group

Implementing Personal Health Budgets

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Where do personal health budgets come from?

• 1970s – People with a disability wanted greater:

Choice, Control and Independence• 1990s – Various social care legislation• Now Care Act, Children’s & Families Act, SEND Reforms• Evidence of success- personal budgets in social care• 2009- 2012 – PHBs trialed in NHS• From October 2014 NHS legislation for PHBs available to people

accessing continuing health care• From April 2015 NHS legislation for PHBs available to eligible

people with a Long Term Health Condition• Currently just over 4000 PHBs in place nationally• Linked to recommendations made in Stephen Budd’s report and

transforming care for people with LDs, PHBs for those people will scale up from 2016


NHS: A duty to involve

• There are two specific legal duties that the NHS must respond to:

“Must promote the involvement of patients and carers in decisions that relate to their treatment or care” e.g. care planning, personal budgets, shared decision making, self management.

“Must ensure public involvement and consultation in commissioning processes and decisions”


Legal duties: NHS Continuing Healthcare Rights and personal health budgets

The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2013 sets out CCGs’ legal duties including:

• Duty to consider any request for a personal health budget;

• Duty to inform people eligible of their right to ask for a

personal health budget;

• Duty to provide information, advice and support in relation to

personal health budgets


Personalisation


Why is the NHS implementing personal health budgets?

People want:• More say over their care and support• Choice • High quality

Doing nothing is not an option!Personal health budgets uses existing NHS money, not new money

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Why is the NHS implementing personal health budgets?

Continued:

• Efficiency will not be enough, we need to unlock the power of people and communities;

• People must be active partners in their own care and support – better for the system, but also better for people;

• The NHS can no longer adopt a paternalistic approach to healthcare;


Person Centred Care

• Workforce development and adopting a step wise rise approach in strengthening the ability and confidence of staff across the health and social care sector is important.

• This will mean all concerned have a shared understanding of what it is to be person centred, and to begin to understand the benefits to care delivered in a self-directed support manner.

• "For the people we support to engage in meaningful relationships and activities"

• "Ensuring that the people we support and listened to and have a choice in their everyday lives"

• "Putting people at the centre of their support."


Personalisation – What does it mean?

• Ensuring we work with the person to make sure we are meeting their specific needs"

• "To meet the needs of the individuals in ways that are best for them and for their wellbeing"

• "For the people we support to engage in meaningful relationships and activities"

• "Ensuring that the people we support are listened to and have a choice in their everyday lives"

• "Putting people at the centre of their support."


Person Centred Care• Give people confidence in person centred care and

to better understand how resilience works and create the landscape for peer support.

• The development to be able to introduce the conversation about personalisation and increasing self-efficacy and resilience moving to how would they do things differently

• Moving to personal health budgets if suitable and starting to equip staff to support PCC care plans and a better understanding of the voluntary sector.


Personal health budgets (PHBs): the opportunities

• Helping people manage their health better

• Part of meeting the identified need, is enabling a person to do things differently and then a monetary solution can be agreed.

• Using existing money more efficiently

• Joining up services around the individual

• Reducing hospital admissions


What is a PHB?

A personal health budget is a mechanism to support a person’s identified health and wellbeing needs, the application of which is planned and agreed between the individual, their representative or, in the case of children, their families or carers and the local NHS team.

It is not new money but it is money that would normally have been spent by the NHS on a

person’s care, being spent more flexibly

to meet their identified needs.”


SDCCG’s Local Offer

• NHS England expect all CCGs to have a Local Offer in place during 2015/16.

• Based on evidence available from pilot sites, SDCCG’s local offer will focus on individuals accessing MH and / or LD services. Where evidence exists to support significant improvements to people’s health and wellbeing.

• Outside of this offer individuals with a LTC[s] who are eligible and can benefit can access a PHB.

• Take up is difficult to predict, evidence suggests take up will be slow initially – SDCCG predict 25 PHBs in 2015/16


Distinctive features• The person knows how much money they have

upfront .

• The person chooses the outcomes to be achieved, in

agreement with their health professionals.

• The person is enabled to create their own support plan,

with whatever support they may want.

• The person freely chooses the way in which their

budget is held and managed.

• Whichever option is chosen to hold and manage the

money, the person is able to spend it flexibly, to

achieve their planned outcomes.


The Forward View into Action: NHS Planning Guidance

* To give patients more direct control, we expect CCGs to lead a major expansion in 2015/16 in the offer and delivery of personal health budgets to people, where evidence indicates they could benefit. • As part of this, by April 2016, we expect that personal health budgets or integrated personal budgets across health and social care should be an option for people with learning disabilities, in line with the Sir Stephen Bubb’s review. • To improve the lives of children with special educational needs, CCGs will need to continue to work alongside local authorities and schools on the implementation of integrated education, health and care plans, and the offer of personal budgets. • CCGs should engage widely and fully with their local communities and patients, including with their local Healthwatch, and include clear goals on expanding personal health budgets within their published local Joint Health and Wellbeing Strategy.


What can a budget be spent on?Traditional services do not always fit with the way a person lives their life, this flexibility can support the person to start making their own decisions, live independently, move away from institutional care, in some cases return to work and significantly improve their and their carer, friends and family’s quality of life and wellbeing.

Anything agreed in a care plan which will meet health and wellbeing objectives

• Equipment• Personal care• Therapies• Complimentary therapies• Supportive technology (eg computers, ipads, kindles)


PHB EMarketplace

• NHS Share Business Services is working on an exciting new development to provide a PHB eMarketplace.

• Offers an online portal for PHB patients to order goods and services from their PHB allocation.

• Will provide a professional front-end to the service and will simplify the buying and engagement experience for PHB recipients whilst improving visibility of spend for CCGs.

• Goes live Summer 2015.


What a Personal Health Budget can’t be spent on

• Primary medical services provided by GPs• Vaccination or immunisation• Screening • The national child measurement programme • NHS Health Checks • Urgent or emergency treatment services • Surgical procedures • NHS charges, such as prescription or dental charges • Alcohol or tobacco; • Gambling; • To repay a debt (with the exception of debts relating

to services specified in the care plan). • Anything illegal or unlawful.

Guidance on Direct Payments for Healthcare: Understanding the Regulations, March 2014


Once the level of need has been agreed there are 4 stages to a personal health

budget


PersonalCare &

Support plans

Notional individual

budget

Real budget held on the individual’s

behalf

Direct payment – cash held by

patient

Mo

re direct co

ntro

l to

ind

ividu

als

Different ways of delivering a personal health budget


Next Steps Locally

• How could my practice or I get involved?

• What would we want to overhear people saying about PHBs locally?

• What do you think the risks are regarding PHBs


Contact Details

Name: Joanne Goodison

Title: Commissioning Manager Personal Health Budgets

Tel: 01332 868727 M 07795 887851

Email: [email protected]

Web: www.southernderbyshireccg.nhs.uk

nhs southern derbyshire clinical commissioning group implementing personal health budgets

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