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We’re at a crucial time for personal health budgets
Amid a continuing drive at for wholescale redesign of health services, another more subtle shift is taking place, to ensure that for a subset of people for whom traditional healthcare services don’t work, more personalised approaches become the norm.
Personal health budgets, or PHBs, have been described as a “breath of fresh air”.
I’ve heard people talk about personal health budgets as an attempt at privatisation, but that’s certainly not how I see it. For me this is a very real and exciting opportunity for individuals and their families to design healthcare approaches that genuinely take into account their needs and desired outcomes, in a holistic sense.
Personal health budgets are not about new money, but using existing money differently to meet people’s needs. At the centre of the budget is the care and support plan. This plan and the budget are then signed off by the individual’s NHS team, and regularly reviewed.
Take Thomas’ story as an example. Thomas has profound and multiple learning disabilities, and thanks to a personal health budget he has been able to move back home from a residential placement which was 100 miles away, where his care was not managed effectively. He and his family can now choose who looks after him and how he lives his life, in partnership with the local NHS team. This enables Thomas’s needs to be better met, and has reduced costs for the NHS as a result of a reduction in the number of unplanned hospital admissions.
In Leicestershire, our journey towards rolling out personal health budgets got into full swing in 2014, as the legal imperative to provide personal health budgets for people with Continuing Healthcare and continuing care for children drew closer. As the project manager, it was my responsibility to ensure that we could live up to this new ‘right to have’ in England from October 2014.
From the outset, I knew that buy-in from our senior leaders was essential in order to move this forward, and given the number of enquiries we had already received, my concerns were not about demand from patients. So one of the first steps I took was to hold an integration workshop for CCG colleagues, along with colleagues from the local authority. Personal budgets have been around for a number of years in social care, and unlike most of our chief officers in the CCG, colleagues from the local authority were comfortable with the common principles that underpin both personal budgets and personal health budgets.
Given the nervousness I had seen around personal health budgets at our CCG, in the first integration workshop I asked chief officers to make a model giraffe. This might sound like an odd activity, but it had a purpose. Some groups’ giraffes had longer necks than others, and all were different shades of yellow. I used this as an analogy for personal health budgets, to help my colleagues understand that patients need individualised solutions, just like the diverse range of ‘model giraffes’ we had created.
This was a real lightbulb moment, and so began a shift in attitude, which was solidified further by a second integration workshop where representatives from PeopleHub shared stories like Thomas’, which helped enormously to ground our ideas in what this means for patients.
Alongside this cultural shift, central to my role was significant work to put in place updated policy documentation and establish new procedures and processes. We knew that our approach needed to be sustainable and robust, as it was clear early on that the personal health budgets would expand beyond Continuing Healthcare and continuing care.
This work comprised the introduction of a new risk panel, and formalising the process for calculating people’s indicative budgets. Critical too was involving our finance specialist right from the start, and we spent considerable time using the NHS England template to determine what the local picture will look like, if one to two people per 1000 are potentially going to be eligible for personal health budgets, an estimate reflected in the recent Shared Planning Guidance for the NHS.
A few quick wins helped us along our journey. A great example was putting in place an extensive care package using a personal health budget for someone who was an active voice in the local community. Their care now costs us £100,000 less than it had previously, and they continue to share their experience with others.
We also focussed on people whose fluctuating health conditions resulted in their care packages breaking down, adopting the attitude that perhaps patients would be better designing their own treatment packages. One of the first people who fell into this category had, prior to having a personal health budget, been on the phone to us every day with a variety of issues and complaints. Now we hear from them extremely rarely (in a good way!).
Now, as we approach April 2016, a date when all CCGs should be in a place to roll out personal health budgets beyond Continuing Healthcare, we in Leicester, Leicestershire and Rutland feel quietly confident. We are in the final stages of confirming our local offer, we have a clear timeline in place, and we are taking it one step at a time. We are setting up a website with information about our local offer, and we’re in the process of creating leaflets for patients. We’ll also be letting people know through our regular newsletters.
The developing a local offer support programme, which is currently being run by NHS England, has been a fantastic opportunity for our CCG to meet with others and has helped to build our confidence as a local team. It’s also been an opportunity for me to reflect on how far we’ve come in a very short space of time, and what learning I might be able to share with others.
If I was to give any advice to other CCGs, it would be to get a team together, to write a robust project plan, and be realistic about what is being expected, both from others and of yourself. Don’t be afraid to learn from experience, and try things out as you go.
Personal health budgets are still relatively new, and we can only learn by doing.
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There are some exceptions to how a personal health budget can be spent, and these are outlined in the Direct Payments for Healthcare regulations. This includes, for example, spend on alcohol, debt repayment, surgical procedures, urgent care and anything illegal. There is no problem, in principle, with spending a personal health budget on the services of a sole trader, but this would need to be agreed with the CCG, as does anything outlined in the care & support plan that has been co-produced with the person and/or their representative. Local decisions about payment exclusions would need to be discussed with the CCG
Hi, I was very interested to hear of your positive experience. I lead the learning disability team at the DH and we are really interested in PHB for people with learning disabilities. We have recently become aware of Community Catalysts which is a social enterprise start up. They help people (some with learning disabilities) set up their own social enterprise and also put people in touch with social enterprises that can support individuals. One of their difficulties seems to be that people can use personal budgets to purchase services from a social enterprise run by a sole person but cannot use personal health budgets to do the same. Does anyone have any experience of this or able to shed any light on the matter?