1. Extending PHBs to Other
Groups
26 June 2015
Steven Pruner
Commissioning Manager

2. The beginning
Starting the journey
Personal Health Budgets in the NHS
•Personal Health Budgets (PHB) are relatively new in the NHS
•Eligible for Continuing Healthcare (CHC): right to ask and receive a PHB
exists
•Long Term Conditions (LTC): from April 2015
•Islington CCG became a pilot site to test out how PHBs might work for
LTC
•Pilot in primary care: 6 GP practices; 13 patients; chronic pain and
depression; also in CAMHS Transitions Team
•CCG uses Council’s systems to process and administer PHBs for CHC
and Pilot

3. What we did - 1
The Pilot
Chronic Pain / Depression
•GPs identified patients using broad eligibility criteria: patients with chronic
pain / chronic pain & depression who are likely to benefit from having PHB
•GPs were asked to identify up to 2 patients each and discuss option with
patient
•GPs able to take their own approach to selecting patients, often based on
those who had tried a range of traditional treatments but still unable to
control symptoms
•Patient motivation a factor: must have some degree of willingness to want
to have the flexibility to self-manage with other non-traditional approaches
•Indicative budget set at £2,000 for the year (or course of treatments)

4. What we did - 2
The Pilot
Chronic Pain / Depression
•Types of conditions (health needs): fibromyalgia, depression, thoracic
scoliosis, chronic pain, spinal injury (numbness)
•Chronic pain the health need being addressed but other underlying
conditions contributing to pain (spinal arthritis, cerebral palsy, severe
anxiety, COPD, Crohn’s Disease, neuropathy)
•Patient activation varied (high to low,) but those with the highest patient
activation benefited the most
•Median age 51, vast majority female
•PHB used for: acupuncture, reflexology, swimming, massage, health
supplements, yoga, adjustable bed, dishwasher, hydrotherapy, meditation,
scooter, PA, hospital bed, pay a carer

5. What we did - 3
Pilot in MH Transitions
Young people transitioning from CAMHS to AMHS
•Pilot in mental health with young people transitioning from CAMHS to
AMHS
•Care co-ordinators identified young people who might benefit –all those
transitioning were considered
•20 young people identified through discussions with them about future
plans and transitioning
•To date one has been issued with a “holding PHB” – the practitioner holds
the payment card and makes the purchase on behalf of the individual
•Purchased a camera
•Pilot will continue for at least another year, as funding was set aside for the
whole transitions pilot which runs for 2 years

6. Provision of the funding
Council’s Payment Card
Payment card issued to individual who can use it as pre-paid credit card
Patients will get a pre-paid card that works just like a debit
card:
London Borough of Islington sets up the card on the patient’s
behalf
Patient’s budget is loaded onto the card every 4 weeks
Patients can use money to purchase goods/services identified in
their support plan either via:
MasterCard Chip & pin (free!)
Online (35p)
Over the phone (65p)
Bank transfer (35p)
Standing order/Direct Debit (35p)
Transaction costs will be included in the budget
Patients can only spend what is on the card – they are
protected from going into debt

7. Next steps
Rolling out PHBs in long term conditions
Chronic pain and chronic pain-depression
•From April will offer PHB to patients with chronic pain
•Estimates of 160 patients eventually will come forward seeking one
•Estimate it may cost about £410,000 per year to fund PHBs (not include
administrative costs to administer)
•Currently developing branding, policy, eligibility criteria, leaflets
•Intend to continue using local authority payment systems