Personal Health BudgetsGetting to the Good Stuff        “Opportunities”Jay Dobson, Personal Health Budget Lead     NHS Mid...
IntroductionPurpose of Presentation…•Develop understanding of the opportunities of PHB’s  • The Team    • Nottingham City ...
PHB Context - “No decision about me, without me”
The National Personal Health      Budget Pilot Programme                  Gemma Newbery   ‘NHS Personal Health Budget’ Pil...
PHBs in Nottingham –   What Next?   “To build on the findings and lessons learnt throughout   the Personal Health Budget p...
Problems When Not   Joint Working     –Confusion for patients     –Duplicating work     –Wasting resources     –Health not...
Perceived Barriers 1   •   Legality   •   Pooled budgets   •   VAT   •   Accounting   •   Different Funding Streams   •   ...
Perceived Barriers 2   •   Assessment and Care and Support Planning   •   Resource Allocation   •   Sign Off   •   Panels ...
Joint Working –   Nottingham’s Solutions   •   One process map detailing how to provide joint budgets   •   One brokerage ...
Mainstreaming Personal Health             Budgets    LTC integrated model testing in the         new landscape of clinical...
Learning from PHB   • Health professionals/patients working in partnership,     different conversations, real choice & con...
New County Landscape   • CCGs x 2   • Nine localities   • Mirrors local authorities boundaries   • NHFT (community service...
HOUSING       VOLUNTARY           NEIGHBOURHOOD TEAM            SOCIAL SERVICES                                   INDIVIDU...
LTC integrated model pilots        Three pilots in Northamptonshire working from one                        agreed model c...
The Staffordshire WayPersonal Health Budgets and what it can lead to!
Staffordshire and Stoke-on-TrentPartnership NHS Trust   From 1st April the Staffordshire and Stoke-on-   Trent Partnership...
1000 social care staff and a budget of £153million transfer from the county council to thenew organisationFaster, more eff...
There are over 5,000 staff from: North Staffordshire Community Health Care(Provider Arm) South Staffordshire Primary Car...
The Staffordshire Personal HealthBudgets (PHBs) pilot began in April2010 and became one of approximately60 pilot sites acr...
The Gnosall Pilot   Dr Ian Greaves - previous project to   provide Dementia Services.   Dr Greaves agreed to be the clinic...
Key milestones  January 2011  A showcase event was organised in  January 2011 to bring social care and  health executives,...
Collaborating across Staffordshireevent   A countywide networking event was held in April 2011   attended by 75 people inc...
On April 4th 2011, the Long TermConditions team met with Sir JohnOldham as part of his tour ofStaffordshire to promote his...
Come to Staffordshire!   Professor Stephen Field, Chair of the   Governments NHS Future Forum visited   Gnosall Surgery on...
The Gnosall Practice Pilot   Involved 154 patients looking at case management   Also countywide, 12 CHC patients had / hav...
Development of an anticipatory caremodel   Deploying resources to prevent illness and   dependency   “The ageing populatio...
LGA bid success£20,000 from the Local Government Association EfficiencyProgramme.The programme will take wider scale, cove...
Year of Care Funding model  1 of 6 prestigious national Early Implementer sites for The Year of  Care Funding Model  The S...
THE QUIZ!claudia.brown@staffordshire.gov.uk
Examples of Uses of Personal Health Budgets (forpeople with long term health conditions)      Purchase of personal exerci...
   Any questions
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Opportunities arising from Personal Health budgets

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presentation by:
Gemma Newbery
NHS Personal Health Budget Pilot Project Manager
NHS Nottingham City

Gill Ruecroft
Northamptonshire Personal Health Budget Pilot Lead
Northampton CCG

Claudia Brown
Commissioning Manager (Long Term Conditions)
Joint Commissioning Unit – Staffordshire County Council

Jay Dobson
Personal Health Budget Programme Lead
NHS Midlands and East SHA Cluster

Published in: Health & Medicine
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  • We had one occasion when a patient had two different brokers, both writing support plans detailing how different outcomes would be met using different budgets. Both support plans went through a different approval process and both support plans were implemented. The patient ended up very confused and didn’t know what the money was for what and what they were supposed to be doing. This caused huge resource issues and could have easily been prevented. We have had many occasions where social care have been to review a patient on their own. Following the review they have decided to increase or decrease the patients support accordingly. They haven’t always let health know. Not only does this have budgetary implications, it also raises issues in relation to whether or not a clinician believes the support to be appropriate/adequate to meet health needs (especially where budgets are reduced).
  • These barriers have mainly come from the draft Myth buster document written by Groundswell. Below are details of the perceived risks. Legality – We cannot give the LA money to pay on our behalf because this means they are providing NHS services, which is illegal Pooled Budgets – Pooled budgets are the only way to provide integrated personal budgets VAT – Different rules regarding VAT get in the way of integrating personal health budgets Accounting – It’s not worth it – different accounting and financial governance requirements for statutory partners make budget pooling just too difficult. Different Funding Streams – The rules about personal budgets expenditure are different in health and social care, which means you cannot integrate them Means Tested vs Free at the Point of Delivery – You can’t integrate PHBs because social care is means tested and the NHS is free at the point of delivery Risk Aversion – Approaches to risk are very different between health and social care and it wouldn’t be possible to bring these together Clinical Evidence – NHS money can’t be used for treatments and services not endorsed by NICE or a clinician and integrated personal health budgets make it more difficult to ensure this happens. Clinical Engagement – PHBs will fail because they are not supported by health clinicians or commissioners Medical Model – There is an unbridgeable gap between the medical and social models of care which makes integration impossible Co-Production – Meaningful engagement with people is easier in social care – health people are ill and do not want to engage in this way
  • Assessment and Care and Support Planning – Health professionals don’t have the skills needed or the training available to provide an integrated approach to assessment or care and support planning. Resource Allocation – You need an integrated approach to budget setting in order to deliver integrated PHBs – this is way too complicated. Sign Off – An individual worker cannot sign off an integrated package because they will not understand noth the health or social care components Panels – Integrated PHBs will mean more time spent at penal meetings Joint Teams – You need joint teams to provide integrated personal budgets Joint Working – Joint working is complicated and time consuming – it’s much simpler in practice to delegate responsibility to one party Planning and Reporting – The differences in strategic and financial planning cycles and priorities make integration difficult Confidentiality – Sharing information between health and social care is difficult and this undermines integration IT Systems – It is pointless trying to integrate PHBs because none of our IT systems speak to one another Performance – The quality and performance regimes in health and social care are different which makes integration difficult Outcomes – Health outcomes are often very specific and can’t be integrated with other health outcomes or with social care
  • By working together the workload can be halved. Patients are less confused. They are able to make better use of their money and use it to achieve agreed health and social care outcomes. As long as the right people are involved in the budget setting and support planning process, there shouldn’t be any barrier to patients receiving a joint budget.
  • Opportunities arising from Personal Health budgets

    1. 1. Personal Health BudgetsGetting to the Good Stuff “Opportunities”Jay Dobson, Personal Health Budget Lead NHS Midlands and East RegionNHS Midlands and East is a cluster of SHAs comprising NHS East Midlands | NHS East of England | NHS West Midlands
    2. 2. IntroductionPurpose of Presentation…•Develop understanding of the opportunities of PHB’s • The Team • Nottingham City – Jay Dobson (Gemma Newbury) • Northamptonshire - Gill Ruecroft • Staffordshire - Claudia Brown
    3. 3. PHB Context - “No decision about me, without me”
    4. 4. The National Personal Health Budget Pilot Programme Gemma Newbery ‘NHS Personal Health Budget’ Pilot Project ManagerWorking together for a healthier Nottingham
    5. 5. PHBs in Nottingham – What Next? “To build on the findings and lessons learnt throughout the Personal Health Budget pilot to develop a sustainable, efficient and effective process for providing patients with a PHB in Nottingham.” Working with: - Continuing Health Care - Joint Funded patients - Children’s Continuing Care - MacMillan Close - Working Age Dementia - Neurological ConditionsWorking together for a healthier Nottingham
    6. 6. Problems When Not Joint Working –Confusion for patients –Duplicating work –Wasting resources –Health not knowing what social care are providing for a patient and visa versa –Lack of communication – e.g. social care increasing or decreasing a patients care package without informing healthWorking together for a healthier Nottingham
    7. 7. Perceived Barriers 1 • Legality • Pooled budgets • VAT • Accounting • Different Funding Streams • Means Tested vs Free at the Point of Delivery • Risk Aversion • Clinical Evidence • Clinical Engagement • Medical Model • Co-ProductionWorking together for a healthier Nottingham
    8. 8. Perceived Barriers 2 • Assessment and Care and Support Planning • Resource Allocation • Sign Off • Panels • Joint Teams • Joint Working • Planning and Reporting • Confidentiality • IT Systems • Performance • OutcomesWorking together for a healthier Nottingham
    9. 9. Joint Working – Nottingham’s Solutions • One process map detailing how to provide joint budgets • One brokerage team • One support plan for health and social care (and education?) • One budget to meet health and social care outcomes • One approval process • One list of approved direct payment support service providers • One direct payment agreement form • One bank account to receive a direct payment • One team administrating joint direct payments • One direct payment account monitoring process • Section 75 agreement to formalise joint working arrangements • One review processWorking together for a healthier Nottingham
    10. 10. Mainstreaming Personal Health Budgets LTC integrated model testing in the new landscape of clinical commissioning Gill Ruecroft, Northamptonshire PHB PilotNorthamptonshire Integrated Care LeadPartnership gill.ruecroft@ nhs.net 01604 651121
    11. 11. Learning from PHB • Health professionals/patients working in partnership, different conversations, real choice & control • The plan is the key to coordinate integrated services • New role required - support, brokerage and advocacy • Improved quality = reduced demand on services • Tension – current service provision/decommissioning to make savings real • This was much more complex and difficult to implement than we envisaged – its not a QIPP fix!Northamptonshire Integrated CarePartnership
    12. 12. New County Landscape • CCGs x 2 • Nine localities • Mirrors local authorities boundaries • NHFT (community services provider) provision locality based • 3rd sector tend to be locality based • Health & Well Being Fora in each localityNorthamptonshire Integrated CarePartnership
    13. 13. HOUSING VOLUNTARY NEIGHBOURHOOD TEAM SOCIAL SERVICES INDIVIDUAL PLAN FRIENDS FAMILY MENTAL HEALTH NURSES MDT H&SC NEEDS H&SC OUTCOMES TO ACHIEVE THERE IS NO “CURE”… THIS IS ABOUT MANAGING AND LIVING YOUR LIFENorthamptonshire Integrated CarePartnership
    14. 14. LTC integrated model pilots Three pilots in Northamptonshire working from one agreed model concept • Daventry – Risk stratification approach – Based on MDT and use of specialists – Centralised in the locality • Kettering – Not condition specific, high users of emergency services – Generic team who coordinate an individualised MDT – Practice based • Northampton – Development of an education/community centreNorthamptonshire Integrated CarePartnership
    15. 15. The Staffordshire WayPersonal Health Budgets and what it can lead to!
    16. 16. Staffordshire and Stoke-on-TrentPartnership NHS Trust From 1st April the Staffordshire and Stoke-on- Trent Partnership NHS Trust became responsible for adult social and community healthcare within Staffordshire and all community healthcare in Stoke-on-Trent, delivering everything from physiotherapy to day care opportunities.
    17. 17. 1000 social care staff and a budget of £153million transfer from the county council to thenew organisationFaster, more efficient patient focused healthand social care, more streamlined delivery ofintegrated care and a reduction in theinefficiencies which can lead to unnecessarydemand on care services and delays forpatients.
    18. 18. There are over 5,000 staff from: North Staffordshire Community Health Care(Provider Arm) South Staffordshire Primary Care Trust(Provider Services) Stoke on Trent Community Health Services(Provider Arm) Staffordshire County Council(Adult Social Care and some support services staff )
    19. 19. The Staffordshire Personal HealthBudgets (PHBs) pilot began in April2010 and became one of approximately60 pilot sites across the country.
    20. 20. The Gnosall Pilot Dr Ian Greaves - previous project to provide Dementia Services. Dr Greaves agreed to be the clinical lead for a PHB pilot project within Gnosall Surgery – focused on patients who have one or more Long Term Condition with a high dependency on their GP or secondary care.
    21. 21. Key milestones January 2011 A showcase event was organised in January 2011 to bring social care and health executives, Cabinet Members and Department of Health officials together to promote the good practice linked to the Personal Health Budget Project.
    22. 22. Collaborating across Staffordshireevent A countywide networking event was held in April 2011 attended by 75 people including over 40 GP’s Speakers; National Clinical Director of Public Health for England Dr David Colin-Thomé OBE Local GPs Dr David Hughes from Leek and Dr David Palmer from Stafford. Included a market place of 18 information stalls featuring local public and voluntary sector services to promote the wider wellbeing agenda beyond health and social care.
    23. 23. On April 4th 2011, the Long TermConditions team met with Sir JohnOldham as part of his tour ofStaffordshire to promote his newpathway for Long Term Conditions.June 2011 - first child PHB in thecountry
    24. 24. Come to Staffordshire! Professor Stephen Field, Chair of the Governments NHS Future Forum visited Gnosall Surgery on 12th August 2011 More recent visitors – John Wilderspin, National Director for Health & Wellbeing Board Implementation Baroness Jolly, Co-Chair of the Parliamentary Party Committee on Health and Social Care
    25. 25. The Gnosall Practice Pilot Involved 154 patients looking at case management Also countywide, 12 CHC patients had / have a PHB Plans for a further 11 pilots with GPs around the county focusing on a wide variety of areas such as medicine management, COPD patients, acquired brain injury (with Headway) and substance misuse.
    26. 26. Development of an anticipatory caremodel Deploying resources to prevent illness and dependency “The ageing population and increased prevalence of chronic disease requires a strong re-orientation away from the current emphasis on acute and episodic care towards prevention , self-care, more consistent standards of primary care and care that is well coordinated and integrated.” Transforming our health care systems. Ten priorities for commissioners. Imison et al, King’s Fund 2011
    27. 27. LGA bid success£20,000 from the Local Government Association EfficiencyProgramme.The programme will take wider scale, covering the broad range ofwork that is already being done, and being extended, where aPersonalised approach is being encouraged. Within Staffordshirethere is a emphasis to encourage greater control and self-care forindividuals, PHBs and work being done by Dr Greaves with peoplewith dementia. The impact of the subsequent interventions theseprogrammes have can then be assessed by looking at theimproved outcomes for individuals. This can be done by looking atareas such as the number of admissions to long-term care forpeople with dementia, reductions in hospital admissions for peoplewho take a Personal Health Budget.
    28. 28. Year of Care Funding model 1 of 6 prestigious national Early Implementer sites for The Year of Care Funding Model The Staffordshire application was fronted by Staffordshire and Stoke NHS Partnership Trust and the Fit for the Future Programme in the North of the county with support from the Joint Commissioning Unit The aim is to have a national funding model that facilitates the delivery of integrated health and social care for people with a LTC based on need rather than disease. This is in line with recommendations made by the NHS Future Forum on aligning financial incentives to enable integration of care where appropriate.
    29. 29. THE QUIZ!claudia.brown@staffordshire.gov.uk
    30. 30. Examples of Uses of Personal Health Budgets (forpeople with long term health conditions)  Purchase of personal exercise equipment, including treadmill, exercise bike, bicycle  Personal Health Trainer  Massage to improve circulation and pain relief  Alternative therapies such as aromatherapy for pain relief and relaxation (reduce anxiety)  Alternative approaches to smoking cessation  Ways of promoting healthy eating and/or weight loss, for example kitchen equipment, bathroom scales, cost of joining a slimming club  Ways of reducing social isolation, especially for those who are depressed. This could include funding leisure activities/hobbies that keep people occupied/stimulated and involve accessing the local community (providing opportunities to socialise)  Equipment required to undertake leisure activities/hobbies (see above) for example art materials or sporting equipment.  Travel expenses to access universal services or to pursue leisure activities (see above)  To enable the service user to be accompanied on an activity, where this is necessary  Purchase of air-conditioning or de-humidifying equipment (for people with breathing difficulties)  Equipment to improve access around the home, for example modular ramps to improve access to different parts of the home or garden for wheelchair users http://www.supportplanning.org/Support_Planning_Downloads/%20Personal%20Health%20Budgets,%20whats%20in%20and%20whats %20out%20(draft)v2.doc
    31. 31.  Any questions

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