True integration must bridge the divide between services and the people they serve

As Integrated Personal Commissioning is launched, Luke O’Shea, NHS England’s Head of Patient Participation, explains how it can help start lives:

Today marks the start of a radical integration programme, the first of its kind in the world, called Integrated Personal Commissioning (IPC).

The most radical part of IPC isn’t the integration of health and social care, or the entirely new financial incentives, or the central role of the voluntary sector. These elements of the programme are vital, but are being tried at scale in programmes around the world. The really radical part, the controversial part, the uncomfortable part, is to hand real power over to people and, if they choose to take it, to allow them spend their own budgets according to their needs and priorities – ‘what matters most’.

The publication of the Five Year Forward View signalled a resounding consensus on the need for greater integration of services. Vanguard sites implementing new models of care are being announced this week which will attempt to bridge three great divides: between mental and physical health services, between social care and health services, and between hospitals and primary care.

The IPC programme, as an integrated care model, will look to address these divides. But it is also attempting to bridge a fourth great divide. This is the often invisible divide between services and the people they were created to serve.

Many policy debates focus on service structures and manage to overlook the people who have the biggest interest in getting things right; the people and communities they serve. We fail to harness their energy, expertise and motivation at our peril.

Growing evidence shows that a failure to involve people in their care and treatment leads to far poorer outcomes and higher cost. Services themselves have a bias towards the status quo, even when the needs of the population change beyond recognition. And the population is changing – with dramatically rising numbers of people with multiple long-term conditions – so a very different health and care system is needed.

If we want to create a safe, sustainable and relevant 21st century health and care system, we will need to involve patients in their care and share power with them as equal partners.

So today we are announcing the names of the areas that will go forward as IPC demonstrators. They have a very hard task for the many thousands of people they serve, but a vital one. They are working to transform the lives of some of the most disadvantaged and intensive users of NHS and local authority services.

Different demonstrators are focusing on different groups, which include children with complex needs, mental health service users, people with complex learning disabilities and people with multiple long term conditions.

People in these groups will be supported to take a far greater role in their care, with increased peer and community support, and with the option of taking their annual budget for care and support as an integrated personal budget. Fortunately, there is strong evidence to say that, with the right support, people are surprisingly good at shaping their care. They are typically prudent and thoughtful commissioners, listening to professionals, and with a huge personal interest in getting things right.

But for me this is about much more than arguments about service quality and value for money. It’s also about a basic right to self-determination.

For many intensive health and care users, routine health and care services severely constrain how they live their lives.

I spoke to the mum of a young woman with complex disabilities about the care she was getting before she took up a personal health budget. She said that she was not prepared to accept an ingrained poverty of aspiration for her daughter just because she had very complex health needs, so she decided to write her daughter’s care plan and a detailed budget alongside.

She deliberately wrote the plan in her daughter’s voice, and, to give them credit, the health professionals were supportive and signed it off. The opening sentence in her daughter’s plan said “I am waiting for you to start my life”, because she says that up until now previously her daughter had not been able to live her life to the full. That has all changed now. Her daughter is confounding professionals and doing things they said could never be done.

As the IPC programme begins, we face some big challenges and we will certainly make mistakes. But we have a duty to raise our aspirations and try to make this work. After all, there are many thousands of people waiting for us to start their lives.

Luke O'Shea

Luke O’Shea is Head of Integrated Personal Commissioning and Person Centred Care for NHS England.

He has previously worked in national policy and strategy roles at the Department of Health and as a commissioner in a local authority and the NHS.

Prior to that he worked in a range of government departments including leading work on early year services at the Prime Minister’s strategy unit, as a private secretary to a children’s minister and leading cross government working on ageing.

He describes as his proudest achievements his “modest role at the inception of Family Nurse Partnership in the UK and of my work on ageing”.

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  1. don jones says:

    hi kuke
    music to my ears i have managed a care package for the last 12 years from health and social care it is a 7/24 package for an adult with server learning difficulty assessed critical on all levels of care it has turned her life around as you have highlighted in your response above this person is doing things that most can only dream about
    please keep me updated on progress

  2. David Buck says:

    Luke, an excellent and interesting blog and i agree for those that want it personalised commissioning could be really powerful. But one question that perenially comes up with personal budgets is what happens “if it is busted” – both for the individual and, in aggregate, for the system. How is this squared, given the NHS’ principles of care according to need and the need to keep within budget (is that CCGs in this case, or a centralised pot)? Some could also (mis)interpret this as a step down the road to things like individual medical savings accounts, are you clear where this stops? Finally, are you monitoring the anxiety – and potential perverse effects – of coming close to budget caps, be they indicative or real? On the latter i’m reading the excellent book, Scarcity, on the neuro-science and psychology of the impact of poverty on decision-making and “bandwidth”, it’s worth looking at this in relation to monitoring the impacts of these freedoms, particularly on the poorest.

    • Luke O'Shea says:

      Hi Dave. Important question. There has never been a situation where a personal health budget has been “busted” and I will try to explain why. And there is never any question of necessary treatment being withheld. A more typical situation is people not spending all of the their budget, with the underspend returned to the CCG. First, the personalised care plan is carefully planned with the care team, regularly reviewed, and money is transferred in sensible chunks to appropriately manage risk of overspend. Secondly, the care team carefully consider what is included in the personal budget, and at present CCGs exclude acute, drugs or primary care expenditure. IPC sites are looking at ‘risk pooling’ arrangements, to maximise the amount that goes into a personal budget, and I can talk to you about this if interested. And on the medical savings point, this is not how it works. There is a care plan and the care team sign off the expenditure. There is not a budget that people spend freely. There has to be agreement that it meets a health need and it is monitored to check it is working well. Hope that helps. Luke

  3. doug Sheperdigian says:

    You may be interested in attending an event at the end of this month sponsored by the Digital Catapult. Please contact me if it seems of interest!

    The topic is Health and Social Care integration with the idea of putting “problem owners” and innovators together.

    Doug Sheperdigian (