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NHS England Chief offers local government leaders radical new health and social care integration option

High-need individuals to be offered ability to control their own blended NHS and community care, in partnership with voluntary sector.

The NHS will offer local councils across England a radical new option in which individuals could control their combined health and social care support, Simon Stevens CEO of NHS England will announce today.

Speaking at the annual conference of the Local Government Association in Bournemouth, Stevens will set out plans for a new Integrated Personal Commissioning (IPC) programme, which  will for the first time blend comprehensive health and social care funding for individuals, and allow them to direct how it is used.

Four groups of high-need individuals are likely to be included in the first wave from next April 2015, although councils, voluntary organisations, and NHS clinical commissioning groups may also propose others. These are:

  • people with long term conditions, including frail elderly people at risk of care home admission
  • children with complex needs
  • people with learning disabilities, and
  • people with severe and enduring mental health problems.

At the same time, voluntary/Third Sector organisations will be commissioned locally to support personal care planning, advocacy and service ‘brokerage’ for these individuals enrolled in the IPC programme.

This new approach builds upon, but is in addition to, the constructive joint work now under way locally on the groundbreaking Better Care Fund.

It also extends and combines current work on ‘year of care’ NHS commissioning, personal budgets in ‘continuing care’, and the early experience of 14 ‘integrated care pioneers‘. The new IPC programme does not require any structural reorganisation in either the NHS or local authorities.

In his speech today Simon Stevens will say:

“Patients, service users and carers have the biggest interest in getting things right, but they can only do so if we give them real power to shape their own care.

“If Beveridge was alive today he’d clock the fact that – given half a chance – people themselves can be the best ‘integrators’ of the health and social care they are offered.

“We need to stop treating people as a collection of health problems or treatments. We need to treat to them as individuals whose needs and preferences should be seen in the round and whose choices shape services, not the other way round.

“That’s the big offer the NHS increasingly has to make to our fellow citizens, to local authorities, and to voluntary organisations. We need a double N in ‘NHS’ – a National Health Service offering more Neighbourhood health support.”

Under the new IPC programme, a combined NHS and social care funding endowment will be created based on each individual’s annual care needs. This will blend funds contributed from local authorities and NHS commissioners (CCGs and NHS England). Individuals enrolled in the programme will be able to decide how much personal control to assume over how services are commissioned and arranged on their behalf.

NHS care will in all cases remain free at the point of use, and available according to individual need.

NHS England will now work with partners in local government, CCGs, patient groups and the voluntary sector to develop an IPC Prospectus which will be published at the end of July. This will formally invite local expressions of interest in jointly developing and participating in the IPC programme from April 2015.

NHS England will provide technical support to develop projects, and fund independent evaluation. Wider scale rollout of successful projects is envisaged from 2016/17.

Experience with pilots have shown that this approach has the potential to join-up services and funding at the level of the individual, for people who often need multiple services. It gives control to those people who have the biggest interest in getting things right – people receiving services and their carers. It often brings in peer support, and is a source of innovation and expertise on what really works in practice. It allows people to flex support over the year as conditions get better or worse, and brings different expertise to the care planning process.

Case studies on personally-directed health and care

These actual case studies illustrate a number of factors that explain how individually-directed commissioning can make a difference:

  • Nikki has childhood onset rheumatoid arthritis with severe flare-ups. Normal NHS services were often unable to provide immediate care, so Nikki had frequent prolonged stays in hospital. Nikki uses her personal health budget to employ three carers on a flexible basis. When a flare-up occurs they are able to reach her within 30 minutes, and between them can provide 24 hour care for several weeks if needed. Nikki’s medication can be administered at home by the NHS. Nikki’s flare-ups are much shorter, she has fewer hospital admissions, and a better quality of life.
  • Tom, 18, lives and works on the family farm. Tom lost the use of his left side after a brain haemorrhage. With his personal health budget, he was able to rehabilitate at home, rather than in hospital. Combined with a return to physical work on the farm, this approach helped Tom’s left-side functioning improve dramatically. He returned to work eight months earlier than expected.
  • David, aged 34, has cerebral palsy with severe developmental delay and epilepsy. He lives with his parents and is a fulltime wheelchair user. He is totally dependent for all his needs. David’s father Martin explains how a personal health budget has been beneficial because it enabled the introduction of one-to-one care workers for David, physiotherapy, and a tutor to help David. See the full case study for David and Martin.
  • Katy, aged 24, lives with her parents. She has profound learning disabilities with complex health needs. She needs support 24 hours per day for seven days a week. Katy’s personal health budget was used to prevent her moving into permanent residential care, and to pay for person-centred care at home including for her psychological wellbeing, weight and vulnerability to infections. See the full case study for Katy.
  • Jason lived in a long stay in-patient unit for 22 years. When he first moved out, some of the staff transferred to a support agency to provide his care. This did not work very well: the system was institutional and inflexible. Jason’s sister asked about a personal health budget, as she had heard about the impact a personal health budget had had on a patient in the national pilot. Over the next few months things changed considerably for Jason. His sister became his appointee. With help from an independent support agency she was able to recruit a whole staff team and give the team leader more autonomy in developing a care plan that allowed both flexibility and creativity. Jason is now fully involved in his own care planning. He has moved from his original rented home with all its restrictions to a self-contained bungalow. Since moving to his new home there have been no incidents of self-harm, and there has been a significant reduction in the frequency and duration of Jason’s seizures. Jason’s challenging behaviour has ceased and there is no need for 2:1or 3:1 staffing. He is now part of the local community and is a frequent visitor to the local pub and social events in the village, supported by one of his team of local workers. Jason continues to have his problems, but his sister reports that his life now has far more meaning.

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8 comments

  1. We welcome a combined social/health approach to funding as Local Authorities such as Birmingham have suffered such disproportionate government cuts. Birmingham is struggling to cope with such large and diverse social care needs. Adults with learning disabilities need to be in worthwhile environments outside of their home so that their health, wellbeing and independence can be maximised through developmental activities. This has huge potential economic and social advantages for their families/carers in terms of work and health opportunities. Not financially supporting the families with appropriately funded opportunities will have long term detrimental consequences. A holistic, person centred approach to the individual’s learning , health and wellbeing along with that of their family has been found to be life changing. This will reduce the pressures in other areas of the health service and criminal justice system. Health and social services need to take a proactive , preventative approach towards supporting adults with learning disabilities rather than passing on the problem to future generations. We cannot build an provider infrastructure based on grants, donations and inconsistent statutory funding.

  2. Nick Pahl says:

    This seems a useful initiative – many of our members could support people with long term conditions avoid hospital admissions

  3. Tracey Smith says:

    I`m unsure as to what sort of resources is thought to be avilable for service users to buy.With reduced budgets in local councils,many of the voluntary organisations are closing,have had their remit altered to secure funding and also have long waiting lists to access the service.
    What about service users who have mental illnesses such as anxiety/psychosis/depession whose health complaint can be variable?
    How will these budgets relate to PIP that is awarded both for service users and carers?
    Who will manage the budgets for service users/carers who do not wish to be managing budgets or employing people to provide care for their loved one and don1t you think that there is a potential for abuse of vulnerable people to go undetected-at the moment if a personal budget is reviewed there is the opportunity for a professional to check these issues.
    What about service users who have forms of physical/mental illness/learning disability or difficulty who don`t have major needs but do have some needs?

  4. This plan is a way forward.
    For 4 years Cool Recovery, independent mental health charity in S Devon, has been trying to find ways of working in partnership with mental health services & service users to access Personal Budgets & Personalisation agenda but there needs to be a clear & user-friendly pathway.
    Cool Recovery is a volunteer/members -led charity with a 15 year track record. The majority of families & individuals using our resources are affected by ‘severe & enduring’ mental health problems. There has always been a paid worker to ‘carry the can’- to be responsible, to be there, to keep the light on…. to pay bills, to listen, to counsel, implement policies & procedures etc.

    Up til now we have not received any statutory funding. We have relied on grants & donations This is now unsustainable due to the increased demands on our resources, time & the lack of other services.
    We need statutory funding to continue & to attract match funding.

    How much does the government value the voluntary sector?

  5. Pearl Baker says:

    An ‘integration of health and social care’ is a welcome idea, however we must look at some ‘test’ cases where there have been serious deficiencies in both and health and social care, and build on these mistakes.

    The MONITOR is responsible for monitoring an ‘Integrated’ health and social care system, would it not be sensible to include this agency in this process! to identify the current problems.

    I am particularly concerned with patients subject to a COP Order for ‘property and finance’ placed in accommodation by the LA providing care and support, but currently unregulated by the CQC, there is much talk about DOL patients but no thought is being given to the other group.

    There is documentary evidence that one patient has been seriously neglected by the LA. I am sure there are many others.

    Advocacy it to be welcome, however they should be well versed and trained in the subject matter of those they propose to support. Individuals suffering from a severe and enduring mental illness, will require an Advocate proficient in Mental Health Law, legislation including DWP Welfare Benefits.

    I would like to see a ‘friends and family’ leaflet being given to all carers and patients to enable a starting point of where the current problems are. A Poster campaign should promote what the NHS are proposing, including where the ‘friends and family’ leaflet could be found and onward transmission.

    Carer
    Independent Mental Health Advocatevand Advisor

  6. Kath Parson says:

    The good news is that advocacy is now on the radar of people like Simon Stevens. Better news would be some mention of an open dialogue with members of the advocacy community in planning this new IPC programme.

    As Chief Executive of the Older People’s Advocacy Alliance (UK), the only national infrastructure advocacy organisation supporting the provision of independent advocacy for older people I would welcome the opportunity to discuss with Simon how NHS England intends to engage with the advocacy sector. As OPAAL has over 150 member organisations, we could be a good place to start. Please see web site for access to our latest joint publication in partnership with Macmillan Cancer Support ‘Every Step of the Way’ 13 stories illustrating the difference independent advocacy support makes to older people affected by cancer’.

  7. John Kapp says:

    I welcome this news, believing that it could provide better outcomes for much less cost. I show in paper 9.76 of the second website how every £1 invested in meditation centres near each GP surgery to which GPs could refer patients for Mindfulness Based Cognitive Therapy courses could save £7 in hospital admissions, brushes with criminal justice systems, etc.

  8. Lavern Newell says:

    i am head of service services in coverntry for people with LD and MH needs i am particularly interested in any work to progress the integration of social and health budgets