Personalised care for Armed Forces personnel in transition
Armed Forces personnel in transition, Integrated Personal Commissioning for Veterans Framework
The Armed Forces personnel in transition, Integrated Personal Commissioning for Veterans Framework (IPC4V) is a new personalised care approach for the small number of Armed Forces personnel who have complex and enduring physical, neurological and mental health conditions that are attributable to injury whilst in Service.
Developed with the Ministry of Defence (MOD), as well as with patients and their families, IPC4V provides a framework for effectively planning and delivering personalised care in line with the health commitments of the Armed Forces Covenant. Central to this is an improved discharge planning process, starting approximately nine months before these individuals are due to leave the military. As part of this, the MOD, health and social care, Armed Forces charities and other organisations work together with the individual to develop a personalised care and support plan that meets their needs in ways that work for them. Where appropriate, this also includes the involvement of the individual’s family/carer.
When implemented effectively, IPC4V gives individuals more choice and control over how their care is planned and delivered. It is based on what matters to them, meaning that they can choose how best to live their life and get the right support to make this happen. This is facilitated by the NHS Comprehensive Model for Personalised Care, which brings together the following six different components:
- Shared decision making
- Personalised care and support planning
- Enabling choice, including legal rights to choice
- Social prescribing and community-based support
- Supported self-management
- Personal health budgets and integrated personal budgets.
Individuals who are eligible for IPC4V are proactively identified by medical staff whilst they are on the Defence Recovery Pathway.
With the individual’s agreement and where appropriate, that of their family, they will then be referred for an assessment. As part of this, a multi-disciplinary and multi-agency steering group is set up to oversee the case and ensure the right people, including the individual, are involved.
Following an initial holistic assessment around the individual and their health and well-being needs, a personalised care and support plan is developed with them (and also their family where appropriate). These arrangements are put into place whilst the individual is still serving, ensuring that Armed Forces aware care and support are provided as they transition to civilian life and beyond.
When implemented effectively, IPC4V gives individuals more choice and control over how their care is planned and delivered. It is based on what matters to them, meaning that they can choose how best to live their life and get the right support to make this happen. In particular, individuals will benefit from the following:
- Personalised care and support planning starting before they have been discharged from the Armed Forces, drawing together the appropriate health and social care specialists, the MOD, local commissioners and military charities.
- A single integrated personalised care and support plan for all their health and wellbeing needs, including the option of a personal budget, personal health budget or integrated personal budget for all or part of their care.
- Ongoing support to help ensure that they are an active participant in the planning and management of their own health and well-being, with outcomes and solutions having meaning and context within their life.
- A dedicated Veterans Welfare Manager, who will be a central point of contact for the individual and all involved organisations. The Veterans Welfare Manager will provide a range of support, including ‘guided conversations’ to help the individual identify goals and actions and explore the management of their health and well-being within the context of their whole life and family situation. They will also make connections to community based resources, including veteran specific organisations, facilitate appropriate referrals back into health or social care and arrange an annual review of the individual’s care with them and each involved organisation.
- Armed Forces personnel in transition, integrated personal commissioning for veterans framework
- Armed Forces personnel in transition, integrated personal commissioning for veterans – information for patients
- Armed Forces personnel in transition, integrated personal commissioning for veterans – information for healthcare providers
- Personalised care for veterans in England, a guide for clinical commissioning groups and local authorities