Meeting urgent demand with new models of care and individual service funds

Meeting urgent demand with new models of care and individual service funds
Institute of Public Care May 2020

• There has been an explosion over the past few years in new types of locally based care, support and training delivered by personal assistants (both employed and self-employed), micro enterprises and umbrella organisations (who often act as matching and coordination agents for a fee).
• This paper explores how these new models of care could be supported by local commissioners to meet additional demand using individual service funds.

RCGP Person-Centred Care Toolkit

Person-Centred Care Toolkit
RCGP ongoing

• The Person-Centred Care Toolkit has been developed with NHS England to support GPs and primary care teams deliver person-centred care. The person-centred care approach gives people more choice and control in their lives by providing an approach that is appropriate to the individual's needs. 
• Includes The conversations, social prescribing, health literacy, shared decision making, health coaching, personal health budgets, the consultation. Also a short evidence listing to support PCP.

Oversight arrangements for managing a personal health budget

Table talk: commissioners beware, direct payments for funding care packages do have limitations
Mills & Reeve 10 June 2019

• A new decision from the Court of Protection raises important issues in relation to getting the financial and “care management oversight” right.
• The court found that a brokerage arrangement for delivering an extensive package of care was in the best interests of a young man (P) who lacked capacity to make decisions about where he should live, with whom he should live and the package of care and clinical treatment he required.

Universal Personalised Care: Implementing the Comprehensive Model

Universal Personalised Care: Implementing the Comprehensive Model
NHS England 31 January 2019

• This document sets out how the NHS Long Term Plan commitments for personalised care will be delivered. It establishes the Comprehensive Model for Personalised Care, comprising six, evidence-based standard components, and the detailed 21 actions to achieve its systematic implementation, right across the country. Implementation will be guided by delivery partnerships with local government, the voluntary and community sector and people with lived experience.
• The components are:

1. Shared decision making
2. Personalised care and support planning
3. Enabling choice, including legal rights to choice
4. Social prescribing and community-based support
5. Supported self-management
6. Personal health budgets and integrated personal budgets

Personal Health Budget Experience Survey

Personal Health Budget Experience Survey
Quality Health November 2018

• A survey of people with a personal health budget (n=390) carried out for NHS England shows that:
• 89% of respondents said that their personalised care and support plan reflected what mattered to them, to some extent or completely.
• 86% of respondents  said that they had achieved what they wanted as a result of their plan, to some extent or completely.
• 77% of respondents said they were likely or extremely likely to recommend a PHB/IPB to someone else.
• The report also showed scope for improving support to people, particularly in the information provided to those who were interested in a PHB and the time taken to set one up.

IPC and Personal health budget support and development programme

IPC and Personal health budget support and development programme: Learning and next steps
National Voices 8 June 2018

• This report describes the role that the voluntary, community and social enterprise sector has to play in delivering personalised care, and shows what needs to happen at a local level to realise this potential. It sets out how personal health budgets are enabling people to make new choices and share responsibility for their own health and wellbeing, while helping them to be active citizens, included in the lives of their communities. (Kings Fund summary)

Harnessing technology for personalised care

Harnessing technology for personalised care
NHS England 26 September 2017

• The Final report on the national IT Challenge for Personalised Care launched in February 2017 to support the expansion of personal health budgets and Integrated Personal Commissioning.
• This report specifies which IT solutions fulfill the requirements and proposes actions for CCGs and partners to help procure high quality systems to support personalised care.
• The report highlights actions for CCGs: decide on NHS geography, join up with local authorities in the same geography, evaluate existing local systems, decide whether to develop or procure, establish a business case and funding model

Personal Health Budgets: Support for CCGs

Personal Health Budgets: Refreshed programme of support for CCGs
NHS England August 2017

• NHS England are running a number of workshops and webinars from September 2017 to give CCGs the tools and expertise needed to provide personal health budgets.

PHB and IPC quick guide: CHC

Personal health budgets and Integrated Personal Commissioning quick guide: NHS Continuing Healthcare
NHS England, June 2017

• The IPC and PHB quick guide to NHS Continuing Healthcare describes how integrated personal commissioning and personal health budgets can benefit and be delivered to those in receipt of NHS Continuing Healthcare.

Personalised Health and Care Framework

Personalised Health and Care Framework
NHS England June 2017

• The framework provides advice and practical guides for the NHS and local government to support progress with Integrated Personal Commissioning and personal health budgets. 
• It updates the personal health budgets toolkit, building on learning from implementation since 2012 and from the Integrated Personal Commissioning programme.
• See all of the Integrated Personal Commissioning documents here.

NHS England Board meeting 15 December 2016

NHS England Board meeting 15 December 2016

• Papers available here.
• Video will be available here

Agenda

• Minutes of meeting 29 September 2016
• Item 2: Chairman’s Report – Verbal report
• Item 3: Chief Executive’s Report – Verbal report
• Item 4: Taking the cancer strategy forward: programme update
• Item 5: Update on the 17/18-18/19 operational planning and contracting round
• Item 6: Sustainability and Transformation Plans
• Item 7: NHS England Corporate and NHS Performance Report
• Item 8: NHS Finance Report
• Item 9 ia: Commissioning Committee on 28 September 2016
• Item 9 ib: Commissioning Committee on 13 October 2016.
• Item 9 ic: Commissioning Committee on 17 November 2016.
• Item 9 ii: Investment Committee 
• Item 9 ii: Specialised Services Commissioning Committee

Highlights :

Adult social care: market shaping - Guidance

Adult social care: market shaping: Guidance
Department of Health, 11 November 2016

• This guidance is aimed at people who buy social care services, including local authority and CCG commissioners, as well as personal budget holders and people who fund their own care, care service providers and potential investors in the care sector.
• The adult social care market refers to independent care sector providers and support organisations – those that provide CQC regulated services, such as care and home care, as well as unregulated care, such as personal assistants, volunteers and communities and informal family carers, and wider support services.
• Contents
• Overview: adult social care market shaping
• Adult social care market roles and responsibilities
• Market demands and trends
• Quality ratings and characteristics of adult social care providers
• Datasets to support market intelligence
• Market development – guidance and resources
• Market oversight
• Contingency planning
• Resources for commissioners
• Workforce aspects of the care market
• Market shaping in practice – examples
• Five Year Forward View - NHS enhanced health in care home vanguards
• NHS quick guides: transforming care services in England
• Access to funding streams

Jeremy Hunt - evidence to the HSC 15 September 2015

Jeremy Hunt - Oral evidence to the Health Select Committee 15 September 2015

Highlights:

• Financial pressures on the NHS are the “worst they have ever been”
• Mr Hunt mentioned on a number of occasions that he is confident that the £22bn efficiency savings planned by the end of the parliament can be achieved and that higher quality services cost less.
• The DH is currently going through an exercise across NHS to see where it can find savings. Findings will be made public in due course.
• The priorities for the Comprehensive Spending Review return around health and social care submitted by the DH are:
• Need enough to secure NHS performance basics.
• Transformation of GP – recruitment 
• Mental health services
• Integration of H&SC systems 
• Progress on Safer care from Mid Staffs
• There was extensive discussion around 7 day services which is predicated by three principles:
• Rethinking in terms of hospital care model
• Primary care – capacity issues 
• The confusion around Urgent care
• The DH is addressing the inherent inefficiencies around not using hospitals 7 days per week and will be shortly publishing detailed plans for a staged rollout of 7 day care. The importance of Electronic Health Records to support 7 day services was mentioned several times. Centralisation of hospital services is being considered. While there will be up front costs Mr Hunt expects that these will be balanced by cost reductions resulting from higher quality services.
• “Need to change way we commission services to a population based model based on capitation fees rather than payment by results.”
• It is planned to publish data on avoidable deaths by hospital trust by Spring 2016.
• The Better Care Fund will continue as a transitional arrangement in the move to full integration of H&SC system towards fully pooled budgets, full sharing of EHR, accountable doctors across H&SC system. 
• “Personal health budgets are very important part of putting patients in the driving seat of their health care.”
• Mental health - Data around waiting times for MH services is now being collected, and will be used to support the new waiting time targets for early interventions.
• Spending on management consultant staff in NHS – a freeze on spend has been introduced and approval threshold for new contracts will probably continue.
• “Too often the reflex when a difficult change needs to be made is to hire someone from outside. The best people to decide what needs to be done are the ones who work inside an organisation.”
• Procurement – there are plans to develop work by Lord Carter through sharing data on hospital spend. By the end of September trusts will be told how much they should be able to spend on supply procurement and asked to set targets for savings.
• Concerning General Practice finances, the DH is to write to every GP surgery at end of year following the spending round, outlining spending profile for GP over next few years.

Maximising personal (health) budgets for older people

Getting Better Outcomes for Older People using personal budgets
TLAP, 5 March 2015

• Recent work of the Think Local Act Personal partnership to highlight what does and doesn't work well for older people using personal budgets, and what can be done to improve practice. 
• Includes case studies from councils across England.
• Common themes which appear to have fostered the right conditions for the provision of personal health budgets for older people across demonstrator sites (Oxfordshire, Central Manchester, Nottingham City) are outlined.
• The report concludes that Personal Health Budgets can work effectively for older people,  and can allow older people and their carers to maintain their chosen care and support when transitioning to Continuing Health Care.

Personal Health Budgets - Q&As from NHS Confederation

A wealth of information: your questions on personal health budgets answered
NHS Confederation, 4 September 2014

• Practical information for commissioners and providers of NHS-funded care, as they introduce personal health budgets. 
• Common themes from discussions with NHS leaders and managers including:
• how to deliver personal health budgets in ways that support integrated, personalised care
• how much implementation would cost
• how to identify and prioritise those groups who would benefit most, for offering personal health budgets beyond continuing healthcare
• how to avoid double running costs and prepare for the services and interventions people will want
• how to manage risk.

Personal health budgets for those with learning disabilities

Personal Health Budgets: including people with learning disabilities
Think Local Act Personal, 11 March 2014

• From April 2014 CCGs will need to be able to offer personal health budgets, initially to people who are eligible for NHS Continuing Healthcare  funding and others with long term conditions
• This report recommends that personal health budgets could and should be offered routinely to:
• Young disabled people who are moving towards adult life 
• People being moved from unsuitable placements as part of the Winterbourne View action plan 
• Other people with learning disabilities or autism who have high support needs and are not well served by conventional service approaches

PHB demonstrator sites for people who use mental health services

Personal health budget demonstrator sites
NHS England 6 December 2013

• Seven new sites have been set up to look at rolling out personal health budgets to people who use mental health services.
• Special demonstrator sites across the country will work with people using services, commissioners, GPs and other health workers to understand more about how the budgets could help keep people well.

Personal Health Budgets - website

Personal health budgets - a website
NHS England / DH

• This website provides information and news about the Department of Health's personal health budgets policy being rolled out nationally in the NHS; and is home to a learning network for NHS and social care professionals involved in personal health budgets
• Our vision for personal health budgets is to enable people with long term conditions and disabilities to have greater choice, flexibility and control over the health care and support they receive.

Personal Health Budgets - what do they mean for CCGs?

Five Minute Digest: Personal health budgets - what will they mean for GP commissioners?
Pulse 24 September 2013

• Personal health budgets come into force in the health service from April 2014.
• They are designed to enable people with long-term conditions and disabilities to have greater choice, flexibility and control over the healthcare and support they receive.
• People who are already receiving NHS Continuing Care will have a right to ask for a personal health budget from April 2014 and CCGs will be able to offer personal health budgets to others with the aim of making them available to anyone with a long-term condition who could benefit by 2015.

Personal health budgets - examination of the evidence and issues by Nuffield Trust

Personal health budgets: challenges for commissioners and policy-makers - Research summary
Nuffield Trust, 28 August 2013

• An examination of personal health budgets - at what they are, how they will work in practice, and the issues they raise. 
• Includes evidence from the national evaluation and an exploration of some of the issues that will be raised for commissioners and policy-makers as personal health budgets are rolled out.
• Key Points
• To date, the numbers of personal health budgets implemented in each local area has barely exceeded 100 people. Their extension to people in receipt of continuing care, and after that to those with long-term conditions, presents a much larger challenge for commissioners, who will need to reassure themselves that a wider range of providers demonstrate sufficient quality to merit inclusion.
• Clinical commissioning groups will also need to be ready to decommission services not chosen by budget holders; but at a pace that allows providers the chance to adapt and minimises the risk of market shrinkage (leaving individuals with fewer choices than before). Likewise, efforts aimed at diversifying the market of providers need to be carried out with care to avoid destabilising existing providers.
• For the system to work, new infrastructure around budget setting, care planning and system monitoring is required; funding for which would need to be found in existing budgets. There is some evidence to suggest that some efficiency can be achieved by ‘piggy-backing’ on the systems that already exist to support personal budgets in social care.
• Policy-makers need to be aware that there is a risk of a postcode lottery emerging, with much of the decision-making as to whether to offer personal health budgets, for whom and at what pace remaining in the hands of clinical commissioning groups. Not only will the value of a personal health budget be different in each area, but also the availability of personal health budgets for particular conditions is likely to vary.
• Bringing personal health budgets together with personal budgets in social care to create integrated individual budgets potentially offers a new route to service integration at the level of the user and carer. A ‘dual carriageway’ approach which brings together the referral, assessment, budget setting, planning and monitoring of different budgets without the complexities of structural integration between organisations and government departments may be helpful in this respect.