The personal health budget impact on end of life care

Winners of an HSJ Award for Compassionate Patient Care, Warrington Clinical Commissioning Group’s Personal Health Budget Implementation Manager reflects on the positive impact that personalising end of life care is having on people’s experience, and its potential to reduce demand on other, more costly services:

Since coming away from the HSJ Awards there has been lots of publicity about the impact that our work is having on people during their last days and weeks of life.

Personal health budgets have enabled us to provide truly person centred care and resulted in much more integrated working between our hospice and district nurses and the Continuing Healthcare Team at the CCG.

Whilst personal health budgets are fairly well established for people in receipt of continuing healthcare funding, there was scepticism from health professionals as to whether it could be extended to those receiving fast track funding for end of life care- people whose conditions are deteriorating rapidly and are able to get a support package put in place quickly, usually within 48 hours.

There were fears that it would take too long, or that people’s choice would be restricted in order to make things happen in time. We’ve now shown this is not the case.

In Warrington, our work initially focused on partnership working with our local hospice and streamlining processes to ensure that establishing personal health budgets would be robust without being onerous.

One of the biggest surprises has been that I assumed everyone would want to manage their pain and focus on symptom control with their personal health budget; however these were not the most frequent health outcomes that people identified.

Just as we can make assumptions about what constitutes best care for patients, I had made an assumption about people’s health and wellbeing outcomes. But 100% of patients we’ve worked with wanted support to manage anxiety, which is not an area that had previously been commissioned for with fast track funding. Through personal health budgets, people have now been able to meet this need – usually at zero cost, through accessing befriending services from a range of voluntary sector providers.

Through our work to establish personal health budgets, it quickly became obvious that not only did our process work, but that people were accessing much more cost effective support. By the end of the first year, 0 per cent of people had designed their care like our traditional offer in end of life care, all personal health budgets were either cost neutral or at a lower cost than the traditional care package, and 83 per cent of those people died in their preferred place of care – a huge increase compared with the 64 per cent of patients receiving a traditional care package on the same funding stream and the 26 per cent of the wider population who die in their preferred place.

I was pleased to see James Sanderson, Director of Personalised Care, celebrate our success in his recent blog, Giving control over end of life care.

Our work has now expanded and we are working with district nurses as well as hospice staff to provide choice and control to people receiving end of life care in the community. This has been well received by the nurses, who have seen the benefits of personal health budgets as a way to better meet people’s individual needs.

This way of commissioning care has put patients and their loved ones at the heart of the decisions being made and given them an equal voice. Rather than care happening to people, they have the ability to design a package of care that works for them and their lifestyle.

To date we have provided personal health budgets for more than 110 people receiving fast track funding, giving them the opportunity to receive care in the way that they want, by who they want and when they want. Our next step is to work with our hospital discharge planning team so that every person eligible for end of life funding has a personal health budget.

Whilst it can be difficult to prove that this work is preventing the need for other, more costly interventions, the huge increase in people achieving their preferred place of death is a strong indicator to suggest that personal health budgets have prevented hospital admissions.

Feedback from patients and families has also shown the benefit of personalised care and support, with patients being able to access support when they need it, rather than when clinicians and nurses think they might need it.

Or, as one of our Community Outreach Coordinators put it: “Personal heath budgets have just been a real benefit… it’s allowing people to take independence and to make their own choices about what they want.”

For further information:

Sarah Leach

Sarah Leach is the Personal Health Budget Implementation Manager for Warrington Clinical Commissioning Group.

She is responsible for ensuring the personalisation agenda is delivered as one of the key ambitions of the Five Year Forward View – transforming the way in which the NHS empowers patients. This includes leading the expansion of personal health budgets, the delivery of the individualised commissioning, and developing and implementing new models of delivering patient choice and control including in end of life care, mental health and wheelchair services.