The Five Year Forward View sets an ambitious target of achieving 50,000-100,000 Personal Health Budgets (PHBs) by 2020, with clinical commissioning groups (CCGs) expected to deliver PHBs for between 0.1% and 0.2% of their population.
Since being involved in PHB early adopter sites, NHS Arden & GEM CSU has been working with NHS England, CCGs and other partners to drive forward PHBs. Combining national best practice and local knowledge, we have developed PHB services which ensure CCGs are compliant with the NHS England mandate and enable them to offer PHB services at scale.
As a result of successfully delivering PHB services across a wide area, we are not only seeing positive impacts for patients but evidence of cost savings through different ways of working. We are also driving improvements through innovative uses of technology, collaborative working and further development of PHBs at a national level.
The challenge
There are many challenges to overcome if CCGs are to deliver the person-centred, flexible solutions which are central to PHBs.
Many CCGs are at an early stage of formulating their solutions and even those involved in the initial pilot sites have a way to go to make PHBs available to a larger cohort of budget holders within NHS England timescales.
Changing the way services are delivered requires a complete shift in mindset and culture, and a different way of thinking about control and risk. There are wide implications across CCGs, from workforce training and resourcing, to the administration of the service and impact on contracting. Plus, there will be a need for greater integration with social care with the new Integrated Personal Commissioning (IPC) programme, to ensure people have a seamless experience of managing their health and care needs.
Developing a solution
Since our involvement in the early pilot programme for PHBs, we have developed the resources, systems and processes to enable effective delivery of PHB services.
Working with CCGs across the country, it became clear that there would be a need for visible, embedded PHB resources within CCG teams. In response, we created a ‘hub and spoke’ model for delivering PHB support, which offers national expertise, flexibility and economies of scale alongside specific knowledge and resources to deliver services at a local level.
We designed and tested an operating model, with optional levels of support - from full end-to-end support to modular provision which dovetails with existing in-house resources. This includes access to fully ratified PHB processes, templates, toolkit and training which has allowed customers to embed services quickly and efficiently.
Recognising the need to accommodate local variation within PHBs, our service has been designed around three key areas:
- PHB Diagnostics: To test the readiness of CCGs by reviewing current PHB systems and processes against national requirements, including producing a thorough gap analysis, recommendations and action plans.
- PHB service delivery: Offering support at every stage of PHB service development - throughout strategy, delivery and review. This includes on our clinically-led, seven-step model for creating and managing PHBs, working collaboratively with patients to create effective care plans, source providers and ensure all PHBs are fully ratified by the CCG.
- Specialist PHB training: To ensure CCGs are fully prepared and resourced to take PHBs forward, including covering planning, cultural change and specific skills training.
Outcomes
We are currently delivering PHB services spanning seven counties and 18 CCGs. We have established processes and systems in place to enable CCGs to expand their PHB services, ensuring they are compliant with the NHS England mandate and that they incorporate robust governance and decision making.
Across four of our CCG areas we are seeing savings of between £120,000 and £460,000 per CCG, when compared to traditional care packages – showing up to a 16% cost avoidance.
Most importantly, there have been significant improvements to the wellbeing of patients who have greater control and choice over their care and support.
As we continue to drive improvements with PHBs, we are working collaboratively with partners to explore services beyond continuing healthcare and are supporting the move towards Integrated Personal Commissioning (IPC).
“The budget has definitely helped us be creative, to look at her as a whole person, to look at her physical, social and psychological needs… It has given us a lot of flexibility in terms of her needs on all levels.”
Mother of a PHB holder
We are expanding the use of technology, including developing an e-marketplace to assist in the selection of services. We are also about to launch a cloud-based IT system which will transform the management of PHBs for commissioners, with a central recording system and the ability to easily analyse data and produce reports from anywhere. Patients will also be able to access their care plans and see progress on delivering their PHB.
Our experience in delivering PHB services means that we are actively contributing to NHS England policy and guidance and are involved in ongoing projects and training around the development of PHBs nationally.
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