NHS Arden & GEM Commissioning Support Unit (CSU) is leading the way in delivering a fundamental shift in the way people receive health care and support.
As one of only three UK-based organisations selected to deliver a wave 2 pilot, we are working with Clinical Commissioning Groups, local authorities and providers to ensure they have the knowledge and infrastructure to deliver effective Personal Health Budgets (PHB). We are ensuring all stakeholders make good use of the opportunity to improve health and social care integration.
With the roll out of Personal Health Budgets in Continuing Healthcare this April, and more widely from October, there is a significant challenge in ensuring PHB not only give people more control over their health but that they are a cost effective and sustainable long term solution.
The new landscape of PHB presents providers and commissioners with numerous challenges such as: monitoring appropriate use of money, developing the market, ensuring consistent quality of care and understanding the impact on health outcomes. In addition, the government’s ambition for health and social care integration by 2018 puts significant emphasis on CCGs and local authorities, working in partnership with other organisations, to deliver a seamless experience for patients.
In partnership with CCGs across Warwickshire and Coventry we took part in a national pilot programme to test the feasibility of PHB. As one of only three UK-based organisations selected to take part, we gained valuable insight into the development of PHB and extensive practical skills to deliver effective solutions.
Using this experience, we developed a bespoke Personal Health Budgets scheme, on behalf of CCGs in Warwickshire, Coventry and Rugby and Worcestershire. Working with providers, local authorities and other partners, our scheme provides the infrastructure to deliver effective PHB across continuing healthcare, learning disabilities and mental health care, including procuring brokerage services, negotiating jointly-funded packages, supporting communications and defining and monitoring health outcomes.
Within the scheme, we have ensured that our partners have strict governance procedures in place to deliver cost effective solutions and that they have robust risk management and safeguarding practices in place.
Recognising the importance of increased health and social care integration, we worked closely with local authorities to ensure processes and procedures were streamlined and that learning could be shared effectively.
Rather than making complex structural change behind the scenes between organisations and government departments, we trialled a ‘dual carriageway’ approach which brought together the referral, assessment, budget setting, planning and monitoring of different budgets. This meant that even though separate organisational structures remained in place, PHB users would experience the benefits of a single, streamlined system.
To ensure stakeholders were fully aware of the PHB agenda, a communication strategy was developed. As well as engaging with a range of audiences, including holding community-based activities, a number of CHC staff undertook the National PHB training and have become PHB Champions to actively promote personalisation. In addition, we have prepared a range of detailed planning, policy and support materials to ensure that all staff were aware of the potential of PHB and we have developed a suite of documents for CCGs, including a PHB Commissioning policy.
Our integrated approach and strong project management skills ensured that an effective and proven operational model could be rolled out from 1 April 2014.
The PHB scheme has shown that individual patients can have more choice in the design of services and that resources can be allocated efficiently so that
PHB do not need to cost commissioners more than traditional approaches.
We are ensuring individuals remain at the heart of the decision-making process through the development of outcomes-based support plans. Plans are regularly reviewed and a process has been put in place to capture people’s experiences of receiving a PHB. We are also exploring the use of quality of life indicators, similar to the national pilot.
Our PHB team has gained significant experience through the delivery of successful PHB and with our commitment to ongoing learning, we continue to offer high quality and up-to-date advice to our CCGs.
"It was great to hear directly from your colleagues that they get what PHBs are all about and you were able to share the success you have already had in Coventry and Warwickshire in delivering the significant benefits PHB bring. The enthusiasm in the room was great and infectious and the number and quality of the questions showed that the team is well placed to deliver PHBs in the right way… I was also very impressed with the turnout and the presence of key members of your leadership team, it demonstrates real commitment to deliver PHB."
David Johnson, PHB national carers lead, following an internal Arden PHB launch, May 2014
By using the HARMs audit as part of the prescribing incentive scheme, the CCG has raised awareness of the role of safer prescribing and polypharmacy in reducing hospital admissions.