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James Sanderson, NHS England’s Director of Personalisation and Choice, makes the case for giving people more choice and control over their health and wellbeing – not only giving them better health outcomes but also addressing some of the critical issues facing the wider NHS system. He will be speaking about this topic on Wednesday at this week’s Health + Care Commissioning Show 2017.
It is well known that people are now living longer and with more complex health needs. Seventy per cent of the health service budget is now spent on people with long-term conditions and it has been shown that population-based approaches do not always address individual needs: one size most definitely does not fit all. People have also long been calling for more choice and control over their care and support.
Empowering people to make choices and tailor their healthcare is fundamental to the changes the NHS is seeking to make over the next few years, as outlined in the recently published Next Steps on the NHS Five Year Forward View.
Integrated Personal Commissioning and personal health budgets can provide this more personalised approach and deliver empowerment. They enable the NHS to better respond to people for whom traditional healthcare services do not work well – particularly for people with high, ongoing care and support needs. They also can help commissioners and providers unlock more creative and effective care solutions that deliver better health outcomes, as well as more sustainable health services which effectively join up to other supporting services.
Ultimately, embedding these approaches at scale will encourage a shift in the relationship between the NHS and the people it supports. It is about moving towards a more equal relationship between services and people in all of our local communities.
We are serious about this and have mandated a commitment to ensure 300,000 people benefit from personalised health and care by 2018/19, including 40,000 people with a personal health budget and for 50-100,000 people to have one by 2021. The initial up-take figures are promising with nearly 16,000 people now with personal health budgets, which is more than double the figures from the previous year.
The Personalised Health and Care Framework helps local healthcare professionals to deliver this more personalised approach within their communities.
Building on the previous Emerging Framework published in May 2016 and working closely with the Local Government Association and others, this framework is an update for commissioners and providers about how they can use Integrated Personal Commissioning and personal health budgets locally. It is a ‘go-to’ resource which will include details about the Integrated Personal Commissioning Operating Model and a Finance and Commissioning Handbook. It also offers practical ways and case studies in which the NHS, local government, providers and the voluntary and community sector can now all work together, as well as emphasising the importance of co-production.
So what changes should clinical commissioning groups (CCGs) expect to see once Integrated Personal Commissioning and personal health budgets are implemented on a larger scale?
Integrated Personal Commissioning is a practical delivery model that enables the whole NHS system to join up and personalise its approach. Recent results from a local programme in Stockton-on-Tees demonstrate just how successful this operating model can be. The impact of this programme resulted in a significant reduction in unplanned hospital admissions for frail, older people; as well as a 35% reduction in delayed transfers of care from hospital and a 41% reduction in A&E attendances in the final quarter.
Personal health budgets, which are one mechanism for delivering Integrated Personal Commissioning, have already demonstrated that they can also play an important part in addressing the financial challenges facing the NHS, yet without sacrificing individual health outcomes and in most cases exceeding them.
In Warrington, some people experiencing End of Life care are now using personal health budgets to support their choice of the place that they would prefer to die in, with 83% of people able to die in a place of their choosing, against the average of 26% being able to do this. This also resulted in some significant cost savings, as one week’s worth of traditional service funding could now provide six weeks’ worth of services now commissioned through a personal health budget.
Finally in Nottinghamshire where a brother and sister who have very complex health conditions and were in receipt of a commissioned transport package for their day centre and respite journeys. They now use their personal health budget to lease an adapted vehicle which has resulted in approximately £19,000 saving in transport costs – a staggering result – and importantly the siblings now have more choice and control as they now have flexibility to use the vehicle any time they need and also have their highly trained carers with them at all times.
And these examples are just the beginning.
They highlight the potential opportunity for real changes that can be implemented on a much wider scale throughout the country which address the critical pressures facing our health service whilst improving individual health outcomes by offering people more real choice and control.