Palliative & End of Life Care: Supporting Patient Choice

1. www.england.nhs.uk
A personalised NHS
“I can plan my care with people who work together to
understand me and my carer(s), allows me control, and
bring together services to achieve the outcomes
important to me.”
National Voices, 2013

2. www.england.nhs.uk
Choice and Personalisation leads to
Personal budgets - health or social care or integrated
A transformational change for:
 Clinical staff
 Systems
 Patients, their families and the wider public
Delivering Choice and Personalisation

3. www.england.nhs.uk
“A personal health budget is an amount of
money to support a person’s identified health
and wellbeing needs, planned and agreed
between the person and their local NHS team”.
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What is a personal health budget?

4. www.england.nhs.uk
• Radically change the relationship
between the health professional and
patient to a much more equal one.
• Centre around a support and care
plan and focus on outcomes
• Delivers integration at individual level
and higher quality care.
• Works well for people with the highest
support needs.
• Enable a wider range of possible
solutions than traditionally
commissioned services. Not new
money
• Promotes self-management and
reduces reliance on NHS services.
Personal health budgets

5. www.england.nhs.uk
Personal health budgets – Accelerated development programme
Evidence from the national
evaluation 2009-2012
• Positive impact on care-related quality of life and
psychological well-being.
• Did not have an impact on health status or health-related
quality of life (positive or negative).
• Positive impact on people’s outcomes with budgets of
£1000 or more.
• Overall personal health budgets were cost effective-
particularly in the Continuing Healthcare and mental health
subgroups.
• Positive impact on people’s outcomes when there is more
choice and control

6. www.england.nhs.uk
• Continuing Healthcare: since Oct 2014 adults receiving NHS
Continuing Healthcare (and children receiving continuing care)
have had the right to have a personal health budget.
• Children and Families Act 2014: children who have special
educational needs should have a single assessment, an
Educational, Health and Care (EHC) Plan and the option of a
personal budget.
• The NHS Mandate 2020: sets the expectation that by 2020,
50-100,000 people will have a personal health budget or
integrated budget. This could include people with learning
disabilities, beyond the Transforming Care cohort.
National policy context

7. www.england.nhs.uk
• The 2016/17 Planning Guidance: CCGs to develop
‘Sustainability and Transformation Plans’ (STP) and
sets the expectation that personal health budgets
and integrated budgets should be an integral part of
these plans.
• Transforming Care: Implementing personal health
budgets and integrated budgets are a key part of
realising the ambitions.
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National policy context cont.

8. www.england.nhs.uk
Aim:
To test over a year the application and
advantages of using personal health budgets
with individuals and their families in the final
stages of life.
The national pilot to deliver personal
health budgets in End of Life Care

9. www.england.nhs.uk
• To test where personal health budgets improve the outcomes for
people and their families at the end of life.
• To test in what circumstances the use of a personal health budget
actually makes no difference or makes the outcomes worse.
• To see how personal health budgets improve choice and what these
choices are.
• To develop good practice guidance to inform other CCGs in England
where personal health budgets improve and do not improve
outcomes
• To publish a simple end-to-end processes model to illustrate how to
introduce personal health budgets well for people using end of life
services
• To inform national policy on the use of personal health budgets
Objectives

10. www.england.nhs.uk
1. East Lancashire CCG
2. Warrington CCG
3. South Derbyshire CCG
4. New Devon CCG
5. Mid Sussex and Horsham CCG with Crawley CCG
The five sites

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• Birmingham Cross City CCG
• Islington CCG
• Oxfordshire (CHC Team in Oxford Health NHS FT and commissioners at CCG)
• SW Strategic Clinical Network Lead
• Suffolk CCG and Ipswich CCG
• Camden LA
• Swindon CHC Team
• Luton IPC lead
• Independent Lives West Sussex
• NEL commissioning Support Unit – Norfolk
• Commissioner from West London CCG
• John Taylor Hospice, Community Interest Group
• Hull CCG
• Gloucestershire CCG
• Lewisham CCG
• South Cheshire CCG
• Macclesfield CHC team
• South Worcestershire CHC team
Networked organisations – so far

12. www.england.nhs.uk
1. Interim report distributed on
“How to Successfully Deliver Personal Health
Budgets for the Fast Track Pathway of NHS
Continuing Healthcare”
2. Early learning from sites
3. Stakeholders event in London on 19 October 2016
In the first six months

13. www.england.nhs.uk
East Lancashire CCG –
• working in Ribblesdale, very rural and poorly served area
for Hospice & Nursing Home provision. To develop new
ways of delivering EOL care as part of their Integrated
Community Team. Full sign up of the 4 GP practices,
linking work with advanced care planning, and looking to
take budget management to practitioner level.
• Following workshops and training in PHBs and
Personalisation they have identified nine people who they
have started working with.
Local plans & progress

14. www.england.nhs.uk
• Refining existing Continuing Healthcare Fast
Track Processes for PHBs, shorting the
pathway and processes. They have delivered
10 PHBs in the new pathway.
• Linking with local hospice to identify people
early to ensure continuity of care
• Looking at joint care navigator role between
health and social care for this area
New Devon CCG

15. www.england.nhs.uk
• Their vision is to reduce pressure on Fast Track CHC
by developing innovation and upstream skills,
knowledge and confidence around EOL
• Working with the COPD team and the Heart Failure
team
• Working with local community integrated health teams
• Early engagement across provider and CCG as to
how contracts could be looked at differently with the
development of PHBs
Horsham and Mid Sussex CCG with
Crawley CCG

16. www.england.nhs.uk
• Working with St. Rocco’s Hospice, with people eligible for
Fast Track CHC who wish to return home for their EOL
care.
• Had traditional package of 4 visits a day and 3 overnights
– of the 17 PHBs set up so far none have opted for this.
What people really want has been very different and up to
£300 a week less expensive.
• Very positive response from Hospice staff and families
• Looking to roll out approach to District Nursing Teams and
acute Hospital Discharge Team in the next few months
Warrington CCG

17. www.england.nhs.uk
PHB in EoL Care in Southern
Derbyshire
Our Journey So
Far -

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The Challenge!

19. www.england.nhs.uk
Engagement

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Challenges
Person
Centred
Care

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The Future

22. www.england.nhs.uk

23. www.england.nhs.uk
• Personal Health Budget NHS Learning Network
www.personalhealthbudgets.england.nhs.uk
• People hub www.peoplehub.org.uk
• The independent PHB evaluation www.phbe.org.uk
• Collation for Collaborative Care:
www.coalitionforcollaborativecare.org.uk
• Care planning guidance:
http://www.england.nhs.uk/resources/resources-for-ccgs/out-frwrk/dom-
2/ltc-care/
• Integrated Personal Commissioning:
https://www.england.nhs.uk/commissioning/ipc
• Suzanne.jones20@nhs.net
• England.personalhealthbudets@nhs.net
• Twitter @NHSPHB #NHSPHB
More information