Personal Budgets supporting health and social care integration

Zoe Porter

The story so far – personal health budgets

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• Pilot programme - large scale controlled trial evaluation 2009-2012.

• Results - better outcomes, reduced use of hospital, cost effective especially for people with the highest needs.

• Right to ask from April 2014 - in NHS Continuing Healthcare (includes children).

• NHS Mandate - will be an option for people with long term physical and mental health conditions who could benefit from April 2015.

• Direct payment regulations– NHS everywhere in England can offer direct payments from August 2013.

If you’re going to do it… do it right

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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

What do we have already?

•We have leaders from pilot areas

•We have 3 years of learning, captured in our on-line toolkit

•We have a number of ‘early adopter’ sites who are able to help us address key issues

•We have a policy position which means personal health budgets will be demand led, rather than imposed from above

•We have 160 CCGs signed up to our support programme to help them introduce personal health budgets in CHC by April 2014

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What is our business?

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2000 2008 2016

Nu

mb

er w

ith

lo

ng

-ter

m c

on

dit

ion

s (m

illi

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One LTC Two LTCs Three+ LTCs

Sources: ONS population projections and General Household Survey

• 15m with LTCs• Massive rise in

population with a co-morbidity

• Most GP sessions LTCs

• 77% bed days• 70% spend• Mostly self

manage, 5800 waking hours pa

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What would it take to drive personal health budgets?

• What problem does this solve?

• Next policy steps

• Values led leadership from all sides that includes investing in real co-production with people who might be recipients of budgets

• Enabling factors – delivery support; mechanisms to free up money; alignment of incentives and levers

Challenges and opportunities

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• Challenge 1: Little traction as yet in the NHS

• Challenge 2: Its difficult – unpicking parallel systems to create one new, counter cultural one in pressured times

• Opportunity 1: Personal health budgets in NHS CHC – what about people just under the CHC threshold who also get social care? People using mental health services?

• Opportunity 2: Real potential to transform peoples’ lives plus reduced use of in-patient services and GP visits – this could be a win-win – with potential to link other initiatives seeking to achieve the same – integration pioneers; post-Winterbourne etc?

To find out more:

•www.personalhealthbudgets.england.nhs.uk •Twitter: @ZoeCPorter•Email: england.personalhealthbudgets@nhs.net

•National delivery team:•Zoe Porter•Martin Cattermole•Trudy Reynolds (p/t)•Natasha Ali

•Plus colleagues across the country: London – Smriti Singh; North: Steph Carson and Carey Bamber; South: Liz Little and Trudy Reynolds; Midlands and East: Sarah Walker

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