James Sanderson, Director Personalised Care, NHS England
@JamesCSanderson @Pers_Care @ExpoNHS
#PersonalisedCare #Expo18NHS
Personalised Care Next steps for extending the legal rights to personal health budgets.
Thursday 6 September 2018
Personal Health Budgets and Integrated Personal
BudgetsAn amount of money to support a
person’s identified health and
wellbeing needs, planned and
agreed between them and their local
CCG. May lead to integrated
personal budgets for those with both
health and social care needs
(Initially Specialist)
Supported SelfManagement
Support people to develop theknowledge, skills and confidence
(patient activation) to manage their health and wellbeing
through interventions such as health coaching, peer support
and self-management education (Targeted and Specialist)
Social Prescribing and Community-Based
Support
Enables professionals torefer people to a ‘link worker’
to connect them intocommunity-based support,
building on what matters to theperson and making the most of
community and informalsupport (All tiers)
OptimalMedicalPathway
Personalised Care Operating ModelWHOLE POPULATION
when someone’s health status changes30% OF POPULATION
People with long term physical & mental health conditions
Cohorts proactively identified on basis of local priorities and needs
Shared Decision Making
People are supported to a) understand the care, treatmentand support options available and the risks, benefits and
consequences of those options, and b) make a decision about a preferred course of action, based on their personal preferences
and, where relevant, utilising legal rights to choice (All tiers)
Personalised Care and Support Planning
People have a proactive, personalised conversation which focuses on what matters to them, delivered through a six-stage process and paying attention to their clinical needs as
well as their wider health and wellbeing.
ReviewA key aspect of the personalised care and support planning cycle.
Check what is working and not working and adjust the plan (and budget where applicable)
LEADERSHIP, CO-PRODUCTION
AND CHANGE ENABLER
WORKFORCE ENABLER
FINANCE ENABLER
COMMISSIONINGAND PAYMENT
ENABLER
Scale of Impact
28,040PHBs by March 2018
Including at least
4,106Integrated
budgets
13,829 PHBs
delivered by IPC sites
More than
15,000 adults
have PHBs, a high proportion are CHC
recipients
57,000 PAM Assessments delivered by
December 2017
60% + CCGs are
invested in Social Prescribing
19,241 PMCBs at the end of
March 2018
75,914people in IPC siteshad a personalised care plan by March
2018
This is a 266%
increase in 2
years
16,000people have been able to access health
coaching
83% CCGs completed Choice
Planning and Improvement self-
assessment
173,143people
joined IPC by December
2017
Personal health budget areas
5
Continuing Health Care
moving towards PHBs as the default for delivery
Mental Healthincluding S117
Choice in End of Life Care
Looked After Children
Wheelchairs and other specialist
equipment
Substance Misuse Neurological disability
People with a learning disability
Integrated Budgets Veterans
PHBs progress towards 2021 ambition
Emerging Evidence
WARRINGTON FYLDE COAST STOCKTON-ON-TEES
85% improved or maintained level of patient
activation (average shift of 9.7 points), with attendant
decrease in likelihood of hospital admission
10% reduction inA&E attendances due to IPC
15% reduction in delayed transfers of care due to IPC
12% reduction in emergency admissions for
older people with frailty
Across Continuing Health Care, direct savings of up to 17%; indirect savings of £4k per person
Personal health budgets in end of life care - 83% were
able to die in a place of their choosing, against an average
of 26%
One week’s worth of traditional services funds six
weeks of services commissioned through a personal health budget
NOTTINGHAMSHIRE
£19,000 saving in transport costs for siblings with very complex health conditions
Lease their own adapted vehicle through a personal
health budget for journeys to day centre and respite,
instead of a commissioned transport package
Malcolm’s Story
Colin Royle
September 2018
9
About Malcolm
• Turned 70 years of age in January 2015
• Married for over 43 years
• Father to two children
• Spent most of his career in sales
• Retired in 2005 to spend more time with Ann (Malcolm’s wife/my mother)
10
Becoming unwell – initial signs & symptoms
• Withdrawal from activities
• Became more self-involved
• Some memory loss
• Confused and disinhibited
11
Complex needs
• Became doubly incontinent
• At high risk of choking (dysphagia)
• No longer able to understand what was being said
• Unpredictable behaviours and aggression
12
Diagnosis
• Started becoming ill immediately after retiring
• Was sectioned (3) in February 2008
• Diagnosed with right frontal lobe dementia in June 2008.
• Only one in every one million people suffer with this form of dementia
13
Lack of care packages
• Discharged from hospital in 2008 under section 117 of mental health act
• Initially fully funded through health
• I became Malcolm’s full time carer
• No domiciliary agencies willing to work with Malcolm due to complexity of behaviours
• Initially attended daycentre Mon – Thurs 8am – 5pm
14
What if Personalised Care had been introduced earlier?
• Earlier conversation at the start of/before diagnosis
• Would have looked at what mattered to Malcolm rather than what was the matter with him
• Looked at his whole life rather than services available
• Asset based approach rather than deficit model
• Became one of the first PHB holders in 2009
15
What helps somebody living with dementia?
• Consistency
• Routine
• Familiarity
• Living at home
• Clear and simple language
• Appropriate levels of medication
16
How his personal health budget was used
• Employed five members of staff at any one time to care for Malcolm through 3rd party (Vol sector organisation)
• We chose rates of pay for carers
• More flexibility in hours of support
• Malcolm and family involved in all of the decisions around his care
• Used for all of Malcolm’s life needs, including health
• Purchased sky + box, rented a flat, bought a fence amongst others
17
Real Risk –Money well spent?
Daycentre - £28.500
• Didn’t understand his needs
• Generic activities
• Lack of choice
• Lots of anxiety
• Highly medicated
Sky + box - £35/month
• Provides choice
• Stimulates him
• Keeps him calm
• Keeps him engaged
• Keeps him safe
Win/Win
• Malcolm passed away in April 2015
• Had consistency in his care and more choice in activities until the end
• Estimated cost of care package over £100k per annum cheaper during last two years of his life
• Medication reduced by two/three within first two years of receiving his PHB
• Spent all of his life living at home with his family, some six and a half years after being discharged from hospital
19
Extending the Right to Have
Implications for the future
of dementia care in
England
Ian McCreath
Personal Choice Programme
Manager
dementia
“We have the right to be recognised as who we are, to make choices about our lives including taking risks, and to contribute to society. Our diagnosis should not define us, nor should we be ashamed of it.” DAA Dementia Statements 2017.
Extending the right to have
22• Alzheimer’s Society
23
24
25• Personal Choice Programme
Personalised Care creates a unique opportunity to
rethink dementia for the 21st century
“We now have the opportunity for a profound transformation. At its heart it is about building an NHS around the needs of the patient.”
Theresa May, 18th June 2018
Extending the right to have
26• Alzheimer’s Society
“By having new person centred conversations, professionals in dementia care can collectively make better interventions and deliver more meaningful outcomes with people, based upon choice, control and community.”Jeremy Hughes, April 2017
Extending the right to have
27• Alzheimer’s Society
Extending the right to have
28
Where next?
29
People with dementia need to be…
31
Extending the right to have
Aware Informed
EnabledEmpowered
Financially
backedListened to
People working & volunteering in health, social care and VCSE, need to be…..
32
Extending the right to have
Aware Informed
EnabledEmpowered
Financially
backedListened to
People affected by dementia
CC
G &
Local A
uth
orityC
om
mu
nit
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sets
Navigators
Personalised Care & Support
AWARE • INFORMED • ENABLED • EMPOWERED
DEM
ENTIA
-FRIEN
DLY
•P
ERSO
NA
LISED •
FAIR
INC
LUSI
VE
•C
REA
TIV
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SUST
AIN
AB
LE
BOLD • CREDIBLE • OPTIMISTIC
Making it work
Extending the right to have
6 reasons for optimism
34
Extending the right to have
Converging
prioritiesBroadening
definition of health
New post-diagnosis
pathways
Co & multiple
morbidities
A united movement Today
Extending the right to have
Extending the right to have
Ian McCreath
Personal Choice ProgrammeAlzheimer’s Society
@IanMcCreath
We Get it We Are United We Will Do It
Any questions?
