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Are you ready for Personal Health Budgets?
4 June 2014
On Tuesday 27 May 2014 a special one day conference was held at the Royal Society of Medicine, London to discuss one of the most progressive patient care concepts to emerge from within the NHS and one that which will become a patient right to have from October 2014.
Providing patients with a personal budget to determine health and wellbeing goals is nothing new, but the Personal Health Budget (PHB) is a very specific means to help those with chronic and long term health conditions. At its most basic, a personal PHB is an amount of money to support the identified healthcare and wellbeing needs of a patient which is planned and agreed between the patient, or their representative, and their local NHS team.
The conference started with Vidhya Alakeson (Deputy Chief Executive, Resolution Foundation and Mental Health Lead, personal Health Budgets Delivery Programme, NHS England) who spoke more about what these budgets exactly stand for: specifically to help patients re-engage with society after experiencing a long term health condition such as, for example, a stroke.
A PHB is designed to be collaborative between the patient and the local NHS team so that individuals can identify what matters to them and what direct payments can do for them in day to day life. Examples of such help might be to engage the services of a personal assistant for a few days of the week to help with opening the post, using a computer, handling telephone calls or it might involve facilitating trips to a local club or trip to see friends or even massage therapies to help a patient to regain better sleeping patterns and alleviate pain.
A good PHB will essentially put together a fund-payable directly to the patient-that reflects their needs to help them reintegrate into society and to help them with their daily lives.
As NHS England defines it then, a person with a PHB
1. Is able to choose the health and wellbeing outcomes they want to achieve
2. Knows how much money they have for their health care and support
3. Is enabled to create their own care plan
4. Is able to choose how their budget is held and managed
5. Is able to spend the money in ways and at times that makes sense to them
Of course the best way to show how helpful a PHB can be is to use a case study and the conference then moved to showcase a gentleman who had suffered from a serious stroke in 2009. As part of the PHB pilot scheme, he explained that as a former soldier and equestrian he had become greatly depressed at his sudden lack in mobility since the stroke confined him to a wheelchair. A PHB catered for the fact that the budget could use a sat nav to help driving (due to short term memory loss), a speech to text software programme (as his typing ability on computers had been impaired), a counsellor (to deal with issues of depression and anxiety) and a PA to speak on the telephone and arrange for medication.
We then heard from Professor Peter Beresford (Professor of Social Policy at Brunel University) who spoke about the need for the PHB to improve upon social care models which are currently ineffective and do not provide as much accessibility to older and disabled persons as much as they should. At the same time he warned that for the PHB model to succeed, groups required accessibility to the direct payments and that recipients of actual funds should be narrow.
One important comment that Professor Beresford made is that when creating the best package for a patient and discussing their needs a good question to ask is “What is the worst than can happen?” and to use that as a central point in analysing all the options available to help the patient.
The next speaker was Philippa Russell, Chair of the Standing Commission on Carers who explained that those who have long term conditions will live longer over time and so their needs do need to be catered for; some of the interesting statistics she raised through research included:
-33% of older people have at last one long-term condition, with the numbers with three or more conditions likely to double by 2018
-“New survivors”-numbers of adults 18-64 with learning disabilities is expected to rise by 32% over the next 15 years
-Numbers of young people with physical or sensory disabilities with similarly rise by 7.5% by 2030
-33% of people with long-term conditions also have or will develop mental health problems. Numbers of people with dementia expected to reach 900,000 by 2030.
She suggested that this reinforced the need for PHB and specific ongoing care after listening to the patient, Statistics from the 2nd Annual National personal Budget Surgery in May 2013 found that 70% [of 3,000 people] felt that personal budgets “worked for them” with users/carers (of all ages) reported positive outcomes:
-60% reported a better quality of life, with more choice and control in their support
-69% reported that they relieved the support necessary to get on with their lives and remain feeling well
-52% felt that their financial position was better
-53% felt that their physical and mental well-being had improved
The pilots therefore illustrated PHB’s had strong potential with a discussion paper quoting “Overall the personal health budget process did appear to have a positive impact on users’ and carers’ aspirations. 80% expressed satisfaction with the support planning process and the ability to “think outside the box”. Users chose a range of options to manage and to use their budgets.”
Philippa highlighted that the needs of patients had to reflect the objectives of a PHB, reflecting the NHS mandate requirement to personalise and self-direct care and support with a shift of care from hospital to home and community settings.
She rounded up her talk by detailing exactly what the future of the PHB model will look like:
April 2014: The “right to ask” [Personal Health Budgets currently only available to people with NHS Continuing Healthcare]
October 2014: The “right to have”
2015-Plans to extend the availability of Personal Health Budgets to a wider range of people living with long term conditions
2015?- Possibility of integrated Personal Health and Social Care Budgets (or at least synergy between Care Act duties on local authorities to offer Personal Budgets to users and carers and the NHS)
Dr Alison Austin, Personalisation Lead at NHS England was the next speaker and reflected on the increasing need for PHB’s as there are increasing numbers of people living with more than one long term condition, so placing an increasing demand on NHS care services. Dr Austin explained the PHB model was a holistic detailed care planning model that was outcome focused and not relying on episodic periods of care.
The key features of the PHB model were seen to be:
-They help people live with their long term conditions and stay out of hospital
-Are regularly reviewed to ensure needs are being met and money is spent as agreed
-They work best for those with higher levels of need
-They are not right for all NHS services (e.g. diabetes)
From a legal standpoint Dr Austin made clear that from April 2014 everyone receiving NHS Continuing Healthcare will have the ‘right to ask’ for a PHB. From October 2014 this will be a ‘right to have’.
Importantly Dr Austin made clear what the PHB is NOT suitable for and so services which are excluded are:
-GP services (GP contract)
-Acute unplanned care (including A&E)
-NHS charges (eg prescription charges)
While PHB financial payments could naturally not be used for services like alcohol and gambling, for instance, they were part of an agreed care plan that would meet health and wellbeing objectives, such as
-Supportive technology (eg computers, iPad, kindles)
The patient focused part of the day closed on observation that there is a lot of enthusiasm for personal health budgets and personalisation more generally. The NHS has shown that it has proof of concept and that a PHB can be cost effective and improves quality of life.