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Alison Austin, Personalisation and Control Lead at NHS England

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Realising the potential of people, improving outcomes through transforming partition.

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Alison Austin, Personalisation and Control Lead at NHS England

  1. 1. Realising the Potential of People Dr Alison Austin Personalisation Lead, NHS England Alison.austin4@sky.com @ www.england.nhs.uk
  2. 2. Structure of presentation 1. The Challenges facing the NHS 2. The Mandate for Change 3. Patient Activation 4. Person-centred care and support planning 5. Personal Health Budgets 6. Integrated Personal Commissioning 2
  3. 3. The Challenges 1. Increasing numbers of living with more than one LTC – increasing demand on services 3 2. Safety – Francis, Berwick & Winterbourne 3. Face decade without any increase in spending, unprecedented in NHS history, set against rising demand (4% pressure pa)
  4. 4. Traditional NHS models will need to be radically rethought. •Financial case. Efficiency will not be enough. We need new sources of value, increasing the outputs/outcomes, not just more efficient staff. •Model of care must change. Acute focused, episodic single disease models will not work. We need active patients, self-managing multiple long term conditions and supporting each other. We will need proactive, personalised care planning to support & manage multiple morbidities. •Recognition that People are greatest untapped source of expertise & value. They need to be ACTIVE PARTNERS in control of their care and health 4 www.england.nhs.uk
  5. 5. Future Direction The NHS Mandate Objective: • “To ensure the NHS becomes dramatically better at involving patients… empowering them to manage and make decisions about their own care and treatment.” • “by 2015… more people managing own health… everyone with LTCs including MH, offered a personalised care plan… patients who could benefit have the option to hold a personal health budget… information to make fully informed decisions.” • Shared decision making, self-management, PHBs, information and personalised care planning all linked The Five Year Forward View • “Patients will gain far greater control of their health own care –through the option of a shared health and social care budget.” • “We will also introduce integrated personal commissioning” 5
  6. 6. www.england.nhs.uk 6 Having more control being an active partner means- Two experts in the room. Clinician • Diagnosis • Disease aetiology • Prognosis • Treatment options • Outcome probabilities Patient • Experience of illness • Social circumstances • Attitude to risk • Values • Preferences • Goals Reference: adapted from Angela Coulter
  7. 7. What is Patient Activation? Patient Activation – knowledge, skills and beliefs Knowing something with help/harm health is not enough
  8. 8. Evidence strong that ‘Patient Activation’ leads to better outcomes & lower costs Reduced service use Able to Active and empowered patient Engage with clinician more work more Meds use improves Lifestyle improve ments e.g. diet Info seeking Better disease manage ment Study of 25,047 patients showed greater levels of activation experienced better health. Other studies show improved self-management behaviours and reduced service utilisation. Personal Health Budget trial of 2000 people showed improved quality of life and ‘Patient Activation’ a term for confidence, skills & knowledge fewer admissions
  9. 9. Equal Partners through: Shared Decision Making, including Patient Decision Aids • Better experience of care, some reduction in use of services, less surgery. Personal Health Budgets & personalised care planning • RCT: cost effective, improved Quality of Life, best for high needs. Other studies show impact on carer well-being Self-Management Support, such as Expert Patient • Impact of behaviours, Quality of life, symptoms and better use of resources. • Not just technical information, but behaviour change NHS | Presentation to [9 XXXX Company] | [Type Date]
  10. 10. Personalised care planning, the House of Care and system change 10 Left wall – engaged, informed individuals & carers Right wall – health & care professionals committed to partnership working Foundations – commissioning, metrics, incentives Roof – organisational & clinical processes
  11. 11. No single organisation can make the change happen in isolation 1 1
  12. 12. • help people live with their long term conditions and stay out of hospital, • change the relationship, • enable people to use NHS funding in different ways, not new monies, • focus on outcomes, • centre around a care plan which is agreed by NHS, • are regularly reviewed to ensure needs are being met and money is spent as agreed, • are not suitable for all NHS Care www.england.nhs.uk 1 2 Personal health budgets – new for the NHS
  13. 13. The independent evaluation of personal health budgets has shown that they can lead to improved quality of life whilst meeting health needs and being cost effective (even saving money for some)
  14. 14. In addition……. The national personal budget survey (POET) involving 195 PHB holders and 117 carers across 12 sites showed that: • 73% reported a positive impact on independence • 69% reported a positive impact on health • 70% carers reported a positive impact on their own quality of life • Knowing the budget up front is important A staged approach is being taken to rollout across England
  15. 15. Personal Health Budgets: The Commitments NHS Mandate Objective: “by 2015… more people managing own health… everyone with LTCs including MH, offered a personalised care plan… patients who could benefit have the option to hold a personal health budget… information to make fully informed decisions.” Legal Duties: from October 2014 everyone receiving NHS Continuing Healthcare will have the “right to have” for a personal health budget. 5 Year Forward View: Integrated Personal Commissioning will include the option of a “budget that will be managed by people themselves” www.england.nhs.uk
  16. 16. What we know: • they work best for those with higher levels of need • people with higher levels of need are more likely to need both health and social care support • They are applicable to mental and physical health • They reduce unplanned care • They are not right for all NHS Services www.england.nhs.uk 16 What the Mandate means: Who benefits?
  17. 17. If you’re going to do it… do it right 1 7 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
  18. 18. Meeting the Mandate commitment: Getting ready in NHS Continuing Healthcare • Every CCG (211) signed up to support programme • Over 170 CCGs have attended the accelerated development programme • 188 have accessed small amount of additional funding • Markers of Progress – currently being used by over 80% www.england.nhs.uk
  19. 19. Integrated Personal Commissioning (IPC) Builds on 2 Core elements: • Care model: Person-centred care and care planning, combined with an optional personal health and social care budget • Financial model: An integrated, “year of care” capitated payment model Aims to: • Improves quality of life and increase person-centered care • Reduce crisis and unplanned care • Increase integration Aimed at: • Children and young people with complex needs • People with LTCs and complex needs • People with learning disabilities with high support needs • People with significant mental health needs Joint working NHS England will work in partnership with range partners including: • LGA, ADASS, TLAP • Monitor, PHE, NHS IQ • Voluntary sector including Strategic Partners, & National Voices • People with lived experience Programme Board and Governance is being established Core Implementation Group developing plans, working with range partners Timeline • IPC announced on 9 July • Prospectus published on 4 Sept • Applications in by 7 Nov • Selection process complete Dec 2014 • Models to be operational by April 2015
  20. 20. Where to get more information 2 0 • Personal Health Budget Learning Network www.personalhealthbudgets.england.nhs.uk • Wider individual and public participation http://www.england.nhs.uk/2013/09/25/trans-part/ • The Coalition for Collaborative Care http://coalitionforcollaborativecare.org.uk/ • Integrated Personal Commissioning http://www.england.nhs.uk/wp-content/ uploads/2014/09/ipc-prospectus-updated.pdf • NHS Improving Quality www.nhsiq.uk

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