Implementing personal health budgets for children with continuing healthcare

Julie Stansfield, Sue Bottomley and Michael Chew17th January 2014

How to participate today

Presenters

• Julie Stansfield, Chief Executive of In Control and Health Programme Lead

• Sue Bottomley, In Control associate & lead for NHSE programme

• Michael Chew, Assistant Director Children’s Commissioning, Wigan Council/Wigan Borough CCG

Agenda

• National overview and context• NHSE programme & priorities• Implementation on a local level – The

Wigan experience• Wider support available to CCGs &

councils• Questions

Julie Stansfield:National update & context

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NHS White PaperSpending review

Carers’ strategy

SEND Green Paper

Right to Control

NHS Operating Framework.NHS Future Forum

and the Government’s response

October 2011 announcement that, subject to the evaluation, people receiving NHS

Continuing Healthcare will have a right to ask for a personal health budget by April

2014This was followed up by an

announcement of a “right to have” and from 2015 extension to other long term

health needs who would benefit.

5 distinctive features:

• The person knows how much money they have upfront .• The person chooses the outcomes to be achieved, in

agreement with their health professionals.• The person is enabled to create their own support plan,

with whatever support they may want.• The person freely chooses the way in which their budget

is held and managed. • Whichever option is chosen to hold and manage the

money, the person is able to spend it flexibly, to achieve their planned outcomes.

What is a personal health budget?

Personal health budgets are just one part

Personal health budgets are just one part of the drive to personalise public services in general, and health services in particular

Personalised care planning

Personal health

budgets

Right to Control pilots

Special Educational

Needs & Disabilities

(SEND) pilots

Choice, including choice of

provider, GP, treatment

and Choose & Book

Self-directed support

Personal budgets in social

care

Our overall approach

Who can have a personal budget?• Anyone who wants one. Needs should be such that a

budget can be reasonably set

What can a budget be spent on? • Not emergency care or core GP services• Agreed care plan with agreed health and wellbeing

objectives• Services should be appropriate for the state to

provide – not gambling, debt repayment, alcohol, tobacco

Mirror social care wherever possible

Different ways of delivering a personal health budget

• Notional

individual

budget

• Real budget held on

the individual’s

behalf

• Direct payme

nt – cash

held by patient

•M

ore d

irect co

ntro

l to

ind

ividu

als

• Personal care

• plans

• From Aug• 2013

NHSE Programme 2014

We are expecting to see;

• A planned approach to offering personal health budgets for continuing health care for children and young people. This activity to have already successfully supported a number of families to take up a personal health budget for their son or daughter’s health support

• Work underway to link approaches to assessment, decision making and the allocation of funding for personal health budgets for continuing health care -and the linked work needed to re-design a local approach to the commissioning and de-commissioning of existing services and provision to ensure that support is available to families if they take up the option of a personal health budget

• A strong, active and committed local partnership with a positive approach to continuing health care and willingness to make the changes needed, remove barriers and positively promote personal budgets for CHC. This may include amending eligibility criteria and consequent increases in the number of children and young people receiving CHC funded packages (this will depend upon the existing offer, the decision making process and the current number of children and young people with CHC support)

Sue Bottomley: NHSE Programme

Expressions from 10 sites – 4 selected.

Over next six months we will:• Identify local priorities and offer specialist site

support from In Control Children’s Team• 5 regional events focused on health and its

responsibility and requirements for implementation of C&F Bill

Priorities for Continuing Health Care PHBs

• Agreeing scope – what’s in – what’s out• Agreeing transparent systems and processes• Workforce development –paradigm shift• Developing meaningful metrics• Ensuring transferability and connection to

personalisation and individual budgets• High end support – ensure targeted

services are fit for purpose

SEN:D Pathfinder and Personalisation in Wigan

Michael ChewAssistant Director: Children’s

CommissioningWigan LA/Wigan Borough Clinical

Commissioning Group

SEN:D Green Paper (Sept 2011)

• Background and Context• Low aspirations • A flawed system (adversarial)• Limited choice and control• Segregated• Difficult to understand/navigate• Bureaucratic

Wigan Context

• Integrated commissioning model• Integrated care• Partnership• Care in the community (CHC)• Aiming High legacy (Direct Payments)• Special Schools review

Key areas of development

• Education, Health and Care Plans• Integrated pathway and infrastructure• Integrated Personal Budgets• Personalisation (Real Wealth)• Workforce design (modernising services)• Parent Engagement• Local Offer

Achievements in Wigan

• 44 EHC Plans with 11 personal budgets (including some with NHS funding)

• Positive outcomes for families • PHBs (Continence products and Wheelchairs)• Integrated keyworking offer• Personalisation of NHS services • Restructured parent engagement• Developed a Local Offer

Challenges and Opportunities

• Implementing whole system change• A vision for PHBs (what is possible?)• Resource Allocation System• Transparency (a local offer for healthcare)• Sustainability (outcomes and efficiency)• Market development• Engaging stakeholders (families and

providers)

Summary

• Improved the patient experience• Increased choice, control, empowerment• Personalisation not just PHB• Key contribution from NHS workforce• Requires whole system change

Wider support available

• Health and Children’s programmes:– Build on national support available– Practical, on-site support– Membership community– Bespoke support available

www.in-control.org.uk/health

www.in-control.org.uk/childrens

Any questions?

Further information and contact details

www.in-control.org.uk/health

www.in-control.org.uk/children

www.in-control.org.uk/news/e-newsletter

julie.stansfield@in-control.org.uk

sue.bottomley@in-control.org.uk

laura.bimpson@in-control.org.uk

m.chew@wigan.gov.uk