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Time for a new ‘personal’ relationship between the NHS and the people it supports

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.

James Sanderson

James Sanderson is the Director of Personalised Care at NHS England, working within the Strategy and Innovation Directorate to oversee the strategy and delivery for a range of programmes that are helping to empower people to have greater choice and control over their care. This includes the Personal Health Budgets programme, Integrated Personal Commissioning (IPC), Shared Decision Making, Person-Centred Care, Maternity Pioneers and developing and implementing new models of delivering patient choice.

James joined NHS England in November 2015, and was formerly Chief Executive and Accounting Officer for the Independent Living Fund (ILF). The ILF was used to support disabled people across the whole of the UK to live independent lives through the provision of direct payments enabling the purchase of personal assistance support.

After graduating, James embarked on a career in the private sector before joining the ILF in 2002 to undertake a number of senior roles including Operations Director with responsibility for front line service delivery, and Business Development Director with responsibility for performance development, change management and information governance.

14 comments

  1. Anonymous says:

    Sent today to NHS England……

    Dear Jo Fitzgerald – ‘Personal Health Budgets & Integrated Personal Commissioning!!’

    Many thanks indeed for your demeaning and superficial response upon being informed of the intimidation that threatens the care of my micro-cephalic and totally vulnerable daughter and her palliative care. However could Richard Mills have possibly thought that NHS England (Personal Health Budgets & Integrated Personal Commissioning) might have an iota of interest in ‘individual’ Personal Health Budgets?

    Thank you in addition for your ‘close attention to your experience and your concerns’ and for carefully noting that I have failed to find any support at all whether locally or nationally, including Peoplehub who have twice failed to respond to me at all. Of course you have no need for me to remind you that their Advice, Advocacy and Brokerage page on their website is completely blank.

    In gratitude,

    Sent by an ex recipient of ILF Funding.

    PERSONALISATION????!!

  2. Jeffrey Silk says:

    Hi James,
    Any thoughts or comments on my response of 3 July?
    As local authorities tighten their eligibility criteria due to cuts or govt policy raises the threshold, even more people will be left to their own salvation without the advice and care planning support they need.
    What’s the plan then?

    • George McAvoy says:

      Whilst Jeffrey Silk makes an interesting point – it is important to acknowledge that public funds are not unlimited and that an amount of personal contribution may be necessary. In other words those who can should be prepared to contribute.

  3. Kath Parson says:

    Hi James
    Here at OPAAL (Older People’s Advocacy Alliance UK) we promote ‘Voice, Choice and Control’ through the provision of advocacy support to people, over 50.
    Our Flagship £3.5M cancer advocacy support programme works with over 30 partner organisations and has delivered support to over 2,000 older people in the last three years. If you need examples/stories of those we’ve helped we have 3 publications the latest of which tells stories of complex cases https://opaal.org.uk/resource/facing-cancer-together/ a successful blog (this years finalist in the health and care category of the UK Blog Awards with over 450 posts ://opaalcopa.org.uk/ and lastly several short 3 – 5 minutes films featuring older people telling their stories onhttps://www.youtube.com/c/opaalcopa
    Do get in touch with me, i.e. Kath Parson CEO kath@opaal.org.uk if you feel we can be of help with implementing new models of delivering patient choice.

  4. Jeffrey Silk says:

    Integrated Commissioning only benefits a proportion of the population. There are many people who, because they are above the funding threshold of local authorities, are left to their own devices and do not get the level of support they need and deserve in meeting their care needs. They are largely ignored by Council’s and CCGs who have no incentive to support the joint approach you suggest……even though they have exactly the same or similar health and social care needs.
    If integrated health and social care is to be the panacea for the future it must be capable of supporting the whole population and not just a few.

  5. Kassander says:

    “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 … ”

    “staggering” indeed. So much so that one would expect that a hyperlink to the data and analysis would have been provided. It isn’t!
    Practice in Our=NHS is EVIDENCE based or is claimed to be.
    Please supply the evidence to support your “staggering” assertion.

    • NHS England says:

      Many thanks Kassander for your response and raising the issue about methodology and evidence. Whilst the illustrative examples raised in the blog are not yet published (although we will be shortly publishing a review of the End of Life Care – Personal Health Budget programme), other extensive evaluation of personal health budgets has shown that when people take more control of their care, the total cost of care to public services often falls.
      Personal health budgets have been independently evaluated in a major controlled trial (2009-2012) involving 70 areas. Over 1,000 adults receiving a personal health budget participated in the trial. A comparable number of adults were in the control group. Therefore the findings can be robustly attributed to the effects of the personal health budget and demonstrated that personal health budgets are cost-effective, improve quality of life and reduce unplanned hospital admissions.
      For more details, please go to http://www.england.nhs.uk/personalised-health-and-care/national-expansion-plan/< http://www.england.nhs.uk/personalised-health-and-care/national-expansion-plan/>

      Kind regards,
      NHS England

      • Kassander says:

        1.0 Why is this reply from some un-named person of no fixed appointment instead of the supposed author: James Sanderson, Director of Personalisation and Choice at NHS England?
        This looks like a ‘Hit & Run” original.

        2.0 To claim that data, analysis and methodological detail which perhaps could verify these astonishing assertions might be published sometime in the future is far from standard practice in any Evidence-based system. More akin to ‘The dog ate my homework – but I’ll bring it in after it’s been stomach pumped.’

        3.0 What reply which has been posted is seemingly a crib from the two references attached.
        They, in turn, tell nothing about the actual near miraculous claims made in the article which the author seems un-ready to even attempt to substantiate.

        Poor show – Very poor show.

      • Kassander says:

        1.0 “Whilst the illustrative examples raised in the blog are not yet published (although we will be shortly publishing a review of the End of Life Care – Personal Health Budget programme)..”

        1.1 You have my eMail address, please ensure that you send me a copy of this “review” with clear directions to the section which hi-lights the (alleged) findings quoted in the article above.

        2.0 ” other extensive evaluation of personal health budgets has shown that when people take more control of their care, the total cost of care to public services often falls.”

        2.1 Please supply me with eCopies of this “extensive evaluation” with clear references to the sections which support that which you claim.

        3.0 “the total cost of care to public services often falls.”

        3.1 It is noted that the Total cost may not be reduced, it may just be sourced from elsewhere – e.g. from the recipient +/ their kith and kin?

        3.2 “often falls”
        Which side of 50% is that, please?

  6. Kassander says:

    ” 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.”

    This is a frankly ASTONISHING assertion from a Director at Our=NHS.
    As a matter of urgency, you should provide access via this thread to the totality of the methodology, data and peer-reviewed findings upon which you base this ground-breaking statement.
    One might also expect that such findings will have been, or soon will be, a matter of discussion at an NHS England Board meeting. Details will be appreciated, please.

  7. Ollie Hart says:

    Great ideas. Is it all about the money or better health and wellbeing outcomes- can probably do both but all the rhetoric seems to focus on cost reduction…

    • Kassander says:

      Spot on, Ollie Hart.

      I’m just waiting for the Cost-Benefit Analyses carried out by NICE to be screwed down tighter and tighter as Our=NHS is prepared for the final acts of Privatization to be wheeled out from their storage.

      An indicator of what’s in store:
      I’ve just come back from ‘my’ (NHS) dentist.

      £20+ just for an inspection.

      Amongst other items, I have a fallen out, front tooth crown – Replacement ~ £250

      I’m on a low fixed income – how on earth can I afford that?

    • NHS England says:

      Yes agree Ollie – whilst this blog was focused on the impact savings for the system, this new approach is very much about delivering both improved health and wellbeing outcomes for individuals and efficiency savings for the system.

      Kind regards,
      NHS England

      • Kassander says:

        Au contraire:
        The article was focused on completely unsubstantiated claims of astonishing financial savings achieved by shifting money from the NHS’ left-hand pocket to a purse, without the cash actually moving.
        To repeat those (in)famous words “I can do that. Gizza Job.”

        Whilst you, “Ms/Mr NHS England” claim that:

        “… this new approach is very much about delivering both improved health and wellbeing outcomes for individuals …”

        The ‘results’ which seek to prove that this “new approach” is meeting those criteria are speculative in the extreme and without peer reviewed evidence.

        Some might claim that they are, at the least, worthless. Others might use stronger words.

        Show us the data, and the analysis. Let’s apply Popper’s Falsification tests.

        And may we have a reply from the author, rather than some anonymous person masquerading as
        “NHS England”.