1. Personal Health Budgets for Mental Health:
Getting ready and getting it right
Vidhya Alakeson and Alex Mycawka
7th
May 2014

2. How to participate today

3. Contents
1. What is a personal health budget – a quick
recap
2. Experience and evidence from the national pilot
programme
3. Roll out and the mental health demonstrator
programme
4. Opportunities in mental health
5. Challenges in moving forward

4. WHAT IS A PERSONAL
HEALTH BUDGET?

5. What is a personal health budget?
 An allocation of NHS resources to meet
identified health and well being needs
 A route to increase individual choice and control
in decision-making about healthcare
 A means to create greater shared decision-
making in the NHS
 A tool to support individual recovery

6. 5 features of a PHB as defined by NHS
England
 The person with a PHB:
1. Is able to choose the health and wellbeing outcomes
they want to achieve
2. Knows how much money they have for their health
care and support
3. Is enabled to create their own care plan
4. Is able to choose how their budget is held and
managed
5. Is able to spend the money in ways and at times that
make sense to them

7. THE NATIONAL PILOT
PROGRAMME

8. Examples from national pilot programme
 Recovery budgets in Merseyside
 PHBs for dementia in continuing healthcare
 IAPT pilot in Eastern and Coastal Kent
 Substance misuse treatment and recovery pilot
in Croydon
 Community mental health team pilot in
Northamptonshire

9. Positive findings from the national PHB
evaluation
 Significant improvements in care-related quality of life
and psychological well being
 No impact on health status or on clinical measures
 No significant differences by age, sex or socio-economic
status
 Lower costs of inpatient care compared to the control
group - £1400 per person per year.
 Overall more cost effective than conventional service
delivery
 Particularly positive effects for CHC, mental health, for
larger PHBs over £1000 and for PHBs that were
implemented flexibly.

10. Implementation matters: Do it right or
not at all
• The national evaluation is clear: how personal health
budgets are implemented has a real impact on outcomes
• Most positive outcomes depend on flexibility over:
– how PHBs can be used – individual creativity not
menus
– how the money can be held – full range of options
needs to be available
• Restrictive implementation can result in negative impact
on budget holders

11. ROLL OUT AND THE
DEMONSTRATOR SITES

12. NHS mandate commits to roll out
 Option for people with long term physical and mental
health conditions who could benefit from April 2015
 “I’m pleased to see the work that NHS England is doing
with clinical commissioning groups on the use of
personal health budgets within mental health services. I
hope that the experience drawn from this work will
enable the roll out of their use in mental health services
across the country” (Norman Lamb MP, Dec 2013)

13. Mental health demonstrator programme
 Launched by Norman Lamb MP in December 2013 – 18
month programme
 13 sites – mix of former pilot sites and new local
partnerships
 High cost populations: out of area placements, high cost
residential placements, frequent users of inpatient or
A&E services, primary care mental health services.
 Focus is on how to implement personal health budgets
sustainably within the mainstream NHS – no longer a
pilot

14. THE OPPORTUNITIES

15. Supporting individual recovery journeys

16. Providing alternative crisis care

17. Preventing hospitalisation and crisis
Participant Total costs of care
2010-11 (excluding
meds)
Total costs of care
2011-12 (excluding
meds)
Difference in
costs
A £19,464.75 £14,207.36 - 5,257.39
B £56,291.89 £16,903.11 - 39,388.78
C £6,263.24 £11, 068.84 + 4805.60
D £40,934.71 £4,259.08 - 36,675.63
E £15,527.88 £3,056.16 - 12,471.72
Total £138,482.47 £49,494.55 - 88,987.92
Costs for individuals before and after receiving a personal health
budget, Northamptonshire

18. Providing integrated whole person care

19. THE CHALLENGES

20. Allocating resources to individual
 Use costs of previous year’s community mental
health service costs?
 Include some of the costs of inpatient and crisis
services?
 Base personal health budgets on mental health
cluster costs?
 Invest in an off-the-shelf resource allocation
package?

21. Unlocking money from existing contracts

22. Agreeing the scope of personal health
budgets
 Only a few sites in the pilot programme included
all outpatient clinical services in a personal
health budget e.g. Northamptonshire, Croydon
 Most sites offered limited choice, restricted to
support services
 Range of reasons for limiting clinical services,
including getting buy-in from trust
What do you think should be in and out of
a personal health budget?

23. Achieving the necessary culture
change
 ‘I’m a highly trained, highly expert specialist in a field
which has involved many, many years of training, many
years of clinical experience, and my job is to know the
best evidence and best practice for the kind of
presentations that I’m expected to see within my field. It
would be completely against my code of practice to say
to a young person, yes, go ahead and spend money on
something that has no evidence base’
(Psychiatrist)

24. Alex Mycawka

25. Any questions?

26. Further information
www.in-control.org.uk/health
www.in-control.org.uk/webinarschedule2014
www.in-control.org.uk/stayconnected
health@in-control.org.uk
alakesonvidhya@yahoo.co.uk