Personal health budgets

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• Personal health budgets
• ADP meeting 9 June 2009

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What are personal health budgets?

• A way to help people get the services they need,
  to get the health and wellbeing results they
  want.
• A means to allow people to take more control
  over how money is spent on their care.

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Background

• Personal budgets working well in social care-
  lots of positive stories, especially for people
  with learning disabilities
• Some evidence of success in other countries, e.g.
  Florida.
• Many people suggested personalisation and
  personal health budgets in the consultation for
  the Next Stage Review.
• Pilot programme promised in High Quality Care for
  All.

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Personal health budgets first steps

• SIX PRINCIPLES
• Upholding NHS values
• Quality is key!
• Tackling inequalities and protecting equality
• Personal health budgets are voluntary
• Decision making close to the individual
• Partnership

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Who, What?

• Which patient groups?
• No restrictions. Needs such that a budget can be
  set
• Which services?
• Not emergency care or primary medical services
• Agreed care plan with agreed health and wellbeing
  objectives
• Services should be appropriate for the state to
  provide not gambling, debt repayment, alcohol,
  tobacco

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How? Managing a personal health budget
Notional individual budget
Already legally possible
Personal care plans
More direct control to individuals
Real budget held on the individuals behalf
Direct payment cash held by patient
Health Bill would enable
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Support?

• Proper support will be vital!
• An enabling approach to risk with proper
  safeguards
• Prospective pilots proposing a number of options,
  e.g.
• Person centred planning
• Advice and information
• Peer support and expert patients
• Advocacy and brokerage

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Why pilot personal health budgets?

• Success with direct payments, self directed
  support and individual budgets in social care and
  other countries- esp. People with learning
  disabilities- but not much evidence in healthcare
• People want to shape their health services in
  different ways- using a range of options- may
  work for different people
• May be useful for people suffering a range of
  conditions
• Very new to NHS many challenges

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Timeline
2012/13
2008/09
2009/10
2010/11
2011/12
Engagement,
Pilot
design,
programme
Year 2
Year 3
first steps
year 1
Pilot of direct
Evaluation period
payments from
ends
Summer 2012
Summer 2010
Summer/Autumn
Jan
March
Feb
April
May
Call for
Regional
expressions
events,
Pilots get
Co-develop
of interest
completion
underway
bids
(
EOIs
)
of
EOIs
May 09
Applications
First Steps
Provisional pilot sites announced
due end
March 09
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Pilot proposals
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Provisional pilots

• Lots of good ideas, enthusiasm and energy
• Large variation in confidence and robustness
• 70 proposals now provisional pilots
• 77 PCTs across all SHAs
• Seventeen PCTs looking at learning disabilities-
  ¼ of PCTs
• Range of conditions, services and groups
• Range of geographical and social contexts

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London Provisional Pilots
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What happens next

• Full pilot status subject to progress check later
  this year
• Support to develop proposals
• Policy team
• Putting people first
• Each other learning network

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Evaluation

• Looking for an evaluation team.
• Will report at intervals over 3 years, to
  include

Health, wellbeing, experience and access
Variation by condition and background
Financial impact
Effect on NHS services
Impact on staff
Practical what works, what doesnt?
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Questions?

• Wed be very happy to hear from you any time.
• Contact
• personalhealthbudgets_at_dh.gsi.gov.uk 0207 210 5140

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Health Scenarios

• 1. Heather has a complex lung condition and was
  provided with a CPAP machine to help her breathe
  at night but each time she needed the setting
  changed she had to travel up to a London hospital
  to get this done.
• 2. Mary has complex health needs and is
  ventilator dependant and has personal assistants
  funded by continuing care thought a nursing
  agency. This arrangement does not work very well
  as Mary is unable to travel to visit her family
  as her PAs are not allowed to work outside the
  county.

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Health Scenarios cont.

• 3. Jane has cancer and is currently in hospital.
  She now needs a hoist in order to move from bed
  to chair and toilet so is being assessed to move
  into a nursing home. She does not want to make
  this move and would prefer to return to her home
  but will need considerable support to achieve
  this. The nurses feel she will be safer in a
  nursing home.
• 4. Sally has MS and is no longer able to speak.
  She has a team of PAs to support her at home.
  She is unexpectedly admitted to hospital and
  wants her PAs to help her with communication and
  personal care while she is there. The PCT are not
  able to allow help with personal care as the PAs
  would not be insured to use the hospital
  equipment and Sally is not allowed to bring in
  her own equipment. They also do not have any room
  for the PAs to stay during the night.