Putting patients in control of their care

The Workstream Lead at Hartlepool & Stockton on Tees CCG, one of nine sites putting the Integrated Personal Commissioning Emerging Framework into action, shares how the programme is beginning to transform services for older people with complex health needs:

As an area that had been part of the original pilot, commissioners in Teesside were already convinced how effective Personal Health Budgets could be.

They believed in how they could support people to manage long term health conditions, so, for them, committing to the Integrated Personal Commissioning programme was a natural development.

When looking at the needs of people with complex needs, it clearly makes sense to work together across health, social care and the voluntary and community sectors, so IPC offered a real opportunity to commit to making integration real – both at an organisational level, but importantly so that the experience for people was simpler and supported them to take a more active role in managing their health.

Within Stockton-on-Tees, the joint IPC bid was agreed by Hartlepool and Stockton on Tees Clinical Commissioning Group (CCG), North Tees Hospital Foundation Trust (NTHFT), Stockton on Tees Borough Council (SBC) and Catalyst. A key feature of IPC is better partnership across statutory and voluntary services, and we’ve taken that seriously by asking Catalyst to employ our local project lead which ensures voluntary sector colleagues are central to the programme.

Our primary aim is to improve care for people over 65 with multiple long term conditions, with an early focus specifically on those living with respiratory problems such as chronic obstructive pulmonary disease (COPD).

This was a group of people for whom existing services were not working well. There were difficulties accessing pulmonary rehabilitation with increasing numbers of people ending up in A&E or with unplanned hospital stays due to respiratory problems, and this had been identified as a key reason for rising acute care costs. There was also little else on offer, as we didn’t have local support groups for people to access peer support and help to proactively manage their condition.

During this first year of the IPC programme, we have worked hard to define what we want to achieve.

At the heart of IPC is the premise that with the right support, individuals with significant health and care needs are often better placed than statutory bodies to design and integrate their own care. In line with the five key IPC shifts we are introducing a care model which includes personalised care and support planning, independent advocacy, peer support and brokerage with a strong emphasis on co-production.

People will be able to take as much control as they want including a clear offer of integrated personal budgets for those who will benefit.

IPC is well aligned locally with work initiated under the Better Care Fund (BCF) which is targeting the same cohort of over 65s with long term conditions, referrals into the programme coming from multiple sources as well as the BCF funded Multi-Disciplinary Service.

The different conversations that health professionals are having with patients are already having a real impact, with a 50% increase in the number of people who have attended pulmonary rehab’. A peer support group is now established that allows individuals to come together and help each other in finding ways to stay well.

The additional flexibility of a personal health budget has meant people can access community resources such as swimming lessons and other physical activities to help with their managing their condition. People have acknowledged that through the care planning they feel listened to and have control of their care and they have enjoyed the experience.

It’s been really encouraging to see some of the more concrete differences the programme is already making. For example, one of our physiotherapists reported that our new approach to care planning has completely changed the way he carries out assessments. By trying to get a better overall understanding of an individual, their personal situation and the wellbeing outcomes they’ve identified, rather than simply looking at ‘physio outcomes’, he feels able to support people to creatively develop plans that really work for them. He’s now part of a team that’s working together to enable people to stay well, and thinking beyond his role as a physiotherapist.

While the numbers of people we’re actively working with at the moment remains low, the ambition is clear. We are working towards IPC being the mainstream model of care for people with highest health and care needs, planned and delivered in partnership with social care and the voluntary and community sector.

At the moment we are one of only nine areas putting IPC into action, but as other early adopters join us – momentum for change is growing.

  • Integrated Personal Commissioning (IPC) is one of the pillars of the Five Year Forward View. It empowers people and communities to take an active role in their health and wellbeing with greater choice and control over the care they need.The IPC Programme will expand in 2016-17 through the early adoption of the model in new areas, representing the first stage of national roll-out. This will enable further testing and refinement and ensure compatibility with the New Care Models Programme, prior to national implementation by 2020-21.
Andrew Carter

Andrew Carter is the Stockton-on-Tees Integrated Personal Commissioning Communications Workstream Lead.

He is an experienced public sector governance and communications officer who has worked in local government, central government and the NHS.

Andrew has worked in the NHS for five years in varying roles including for acute providers, primary care trusts and currently for Hartlepool and Stockton-on-Tees Clinical Commissioning Group.


  1. Clifford G Tams says:

    My care was arranged before I left hospital 74 yrs old bed bound heart working at 30% .My wife 71 yrs old has to care 24-7 for our severely autistic son she cares for me 24-7 because of this my care time was set at 9-00 am to 9-30 am to give my wife time to herself go the doctors do housework go shopping for food.The care company have changed my care time to 10-30 my wife now has no time to do zero.

  2. Gary Gray says:

    Patients managing their own care : really? So where does the very real fact that a great many patients with chronic conditions – who would very much like to be given even the slightest chance to manage their care: cannot do so as a result of being pretty much ignored; where do they fit into this “in theory” rationale?? It’s all “pie in the sky” That as usual will amount to nothing.

  3. Kassander says:

    That you have the audacity to write that this marketization and pre-privatization of the NHS is :
    ” … so that the experience for people was simpler and supported them to take a more active role in managing their health.”
    is breathtaking.
    It’s a blatant attempt to define a cash limit to someone’s wellbeing expectation from NHS. That limit can then be used to cut back on what is provided as tightened Government faux austerity measures eat even further into NHS expenditure.
    The coup de grace comes on privatization of NHS when tariffs will be set for all treatments, and patient self financing top-ups will apply to any ”excess” necessary for medical and care package completion.

    • NHS England says:

      Hi Kassander

      Thank you for you comment

      Personal health budgets are an option for some disabled people or those managing complex long term conditions, and the budget needs to cover the costs of an individual’s assessed health needs. The NHS Constitution is clear that NHS services are free at the point of delivery, and personal health budgets do not change this fundamental principle. People would not be expected to ‘top up’ their budget to meet assessed care needs, and budgets can’t be used for all NHS services. For example, you can not use a PHB to pay for primary care, emergency services, or prescription charges. Full details can be found in the Direct Payments for Healthcare Guidance.

      Nobody would be denied access to necessary treatment as a result of having a personal health budget.

      Many thanks
      NHS England

      • Kassander says:

        ”The coup de grace comes on privatization of NHS when tariffs will be set for all treatments, and patient self financing top-ups will apply to any ”excess” necessary for medical and care package completion.”
        Thank you for publishing my hard hitting 1st comments !

  4. Teena Lucas says:

    my mum is in the late stages of Atlzheimers/ Dementia – she’s 80yrs old,and with very complex needs- she is still living in her own home – this has been achieved mainly due to the fact that my brother lives with her and has been prepared to care for her – in recent years we have had 2 different care companies providing various care packages – this has allowed my brother to go to work and some social life.I don’t live very locally, I’m married, I have children and work part-time- I also have regularly visited and shared some of the care. We have been paying privately for the care companies because my mum had been left with some savings when my dad died.We have basically run out of money now, having spent thousands of pounds on the care packages – it has been successful though and my mum is being well cared for and is very settled and happy.Obviously we are keen to continue with a successful care regime but can’t do that without money!Recently we applied, through our social worker, for continous care funding fron the NHS – very very difficult and upsetting experience this week – we had our meeting with NHS representatives to complete the form – I don’t properly know who they were or what their jobs are as they didn’t fully explain, but what I do know is that neither of them had visited before, neither knew my mum, and both demonstrated a lack of understanding for her condition – over a period of 2 hours we attempted to work through a collection of ‘domains’ and to effectively choose the appropriate description of her condition from a ‘list’ of given answers to questions – probably easy to fit people into the appropriate box if they have a physical illness that follows a set pattern with recognisable symtoms and generally accepted treatment plans /needs – virtually impossible to fit someone like my mum into some of the boxes – they were simply just not appropriate and trying to fit her into the NHS list of answers impossible – the outcome of this is that the NHS professionals were unable to give a true representation of my mum just filling out your form – for most of the ‘domains’ they wanted to ‘mark’ my mum down as low or moderate needs. We don’t know the outcome of our application at this moment in time – the NHS representatives were unable to give us a timescale for decision – simply saying it could take several weeks – obviously we have to continue providing care in the meanwhile.It’s very difficult to make future plans now as we simply don’t know what we are planning for!!!The whole thing ridiculous and very very stressful – I was so upset/confused after our meeting that I was unable to eat my evening meal and didn’t sleep that night – I had assumed that the NHS were there to help / offer support as would be the case if my mum was in hospital or receiving treatment for cancer etc – I couldn’t have been more wrong – the meeting felt like a battle – one where I was armed with a bowl of fruit but the opposition armed with nucleor weapons! The NHS will never be able to allow people in our position to ‘manage’their care / plan integrated personal care programmes etc – to do this will require massive changes in the view towards altzhemers/ dementia in absolutely everthing you do! honestly can you really achieve that – my experience this week tells me that you have a massive mountain to climb!

    • Mr K Watson says:

      Please contact the Alzheimers Society for help I am sure they will be of help.