i

Enclosure: Gi Agenda item: 9

GOVERNING BODY PAPER

Title of paper: Personal Health Budgets: Background and update briefing

Date of meeting: Wednesday 27th November 2013

Presented by: Simon Shenton-Tan Title: Head of Integrated Commissioning

Prepared by: Simon Shenton-Tan Title: Head of Integrated Commissioning

Summary of Strategic Objectives Supported by this Report (X)

Improve health outcomes X To assure and drive improvements in quality X

Ensure access to high quality primary care services

X Meet statutory obligations X

Ensure access to high quality secondary care services

Take a long term approach to the health needs of the local population

X

Building a new Clinical Commissioning Group

Enhance communications with practices and patients

Enhance the use of information X Please provide brief executive summary:-

This presentation provides a briefing on what Personal Health Budgets are, the innovations that we have pursued as a pilot site, and the process that we have established

Summary of Impact Assessment and Risk Management Issues (x)

(please provide detail in the body of the report)

Impact on Risk Assurance Framework (x) Yes X No N/A

Impact on Environment (x) Yes No X N/A

Legal Implications (x) Yes X No N/A

Resource implications (x) Yes X No N/A

Equality impact assessment (x) Yes X No N/A

NHS Operating Framework areas of Quality, Reform and finance (x)

Yes X No N/A

Patient and Public Involvement (x) Yes X No N/A

Communications and Engagement (x) Yes X No N/A

Impact on CCG Constitution (x) Yes No X N/A

Brief Summary of Recommendations

The briefing outlines the legal requirements, basis the budgets may take, and the innovative arrangements that have been established

Page 2 of 2

1. Executive Summary

1.1

1. Personal health Budgets are a legal requirement and must be offered by the 1st April 2014

2. Greenwich was a pilot development site, and we have pursued an approach of integration with our RBG partners

3. We have incorporated several innovations in our approach 4. Our process has been tested and we have begun to offer PHBs

2. Impact Assessment and Risk Management Issues

2.1 There are resource and management implications, over time there may be less direct management of budgets if patients choose DPs, equally there will be more equity and efficiency because of resource allocation tools

2.2 Offering PHBs will require resourcing for support and assurance purposes

3. Recommendations

3.1

To note the details of the briefing on compliance with deadlines, and the innovation involved with the establishment of the process

Personal Health Budgets

Background and update briefing

Enclosure Gii

DH graphic giving personalisation overview

2

Current PHB requirements and timetable (set by NHSE)

• As of April 2014, adults eligible for NHS Continuing Healthcare (fast-track and non-fast-track) have the right to ask for a personal health budget (PHB), including a direct payment (DP) for health care

• From October 2014, the “right to ask” will become a “right to have”

• These rights also apply to the parents of children and young people eligible for support under the National Framework for Children and Young People’s Continuing Care

• From April 2015, CCGs expected to offer PHBs to other people with long term conditions likely to benefit from increased choice and control

3

Vision and values of Personalisation

• Greater choice and control over the health and wellbeing outcomes they want to achieve, and the support to achieve outcomes

• Personal budgets and personal health budgets to give people greater choice and control

• Demands a different type of conversation between patients and professionals: shared decision-making is the norm. Achieving this cultural shift can be challenging.

• Professionals have skills and knowledge, but patients are the experts in their own lives - we empower how they want to live, and how care and support is shaped with their lives

• Giving people freedoms and flexibilities within a system with appropriate checks and balances

4

Greenwich PHB progress update – detail and innovation

• PHB (CHC non-Fast-Track) integrated pathway

• Mirrors RBG adult personal budget pathway

• CHC team case-manage non-fast-track CHC cases

• Choice and Control Consortium - independent support planning services

• Greenwich Carers’ Centre supporting DPs

• RBG make and monitor direct payments for CCG

• Fast-Track and CYP processes under development

5

Greenwich PHB progress update – detail and innovation

• 3 types of PHB: notional budgets, DPs for health care and third party arrangements

• Our new resource allocation system (RAS) allocates ££ resources based on individual need and for carers’ respite

• The RAS is an integral part of our new CHC Health Needs Assessment

6

Greenwich PHB progress update – detail and innovation

• Our new integrated CHC HNA includes questions about carers’ needs

• RAS commissioned from FACE, also used by RBG adult social care

• PHB values calculated with anonymised assessment scores using web-based “Carecalc” for immediate calculation/indicative PHB value

7

Greenwich PHB progress update – detail and innovation • Commissioned “eformsapp” to automatically populate

the same data fields in all 5 patient-facing CHC forms, saving a huge amount of practitioner time in data entry

• Three patient information leaflets clarifying process and rules

• Commissioned a contract for DPs

• System safeguards to manage PHBs effectively, with or without support

• Evaluative tools (POET) developed by In Control and the University of Lancaster to evaluate the impact of the PHB process on patients, and the impact of PHBs on patients’ lives - compare Greenwich performance with other CCGs

8

Greenwich PHB progress update – commissioning challenges

• Broadening the scope of the Greenwich PHB offer over time – increasing scope of PHB spend to maximise patient choice & control

• Identifying opportunities to withdraw (some) monies from existing contracts (eg with community health services), so more funds can flow into PHBs

• Gathering intelligence/knowledge about what people are purchasing with their PHBs, to inform best commissioning decisions

• Adjusting patterns of commissioning over time, to achieve the optimum balance between pre-commissioned services and PHBs

• Giving providers time to adjust business models, avoiding market “meltdown”

• Stimulating the provider market, enabling the supply of supports and services that patients want to buy, with less emphasis on direct commissioning

• Identifying funding to cover the costs of integrated PHB functional delivery (by the CCG CHC team, third sector and RBG)

• Offering PHBs to people with other long term conditions (April 2015)

9

Extract from

NHS Greenwich CCG

patient information

leaflet

10

There are 7 steps to the personal health

budgets (PHB process), as follows:-

1. Identifying your health and wellbeing

needs, and setting your personal goals/

outcomes

2. Finding out how much money is in

your personal health budget

3. Planning your support, and deciding

how to spend your budget

5. Getting your support plan signed

off/approved by NHS Greenwich CCG

4. Deciding how you want to manage

your personal health budget

6. Buying/arranging services to provide

you with the support you need

7. Reviewing whether your personal

health and wellbeing outcomes are being

met