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.
The scale of the task is significant, and there are complexities to overcome if we are to deliver the tailored, personal care envisaged. Many CCGs are at an early stage of formulating their solutions, but examples of best practice are beginning to emerge, which can give commissioners the tools they need to develop effective and sustainable PHB plans.
In tandem with CCGs, Commissioning Support Units have been on a rapid learning curve. Thanks to our involvement in the early adopter sites and our work with CCGs across the country, we have developed specialist expertise in this area and a clear operating model to effectively support CCGs. As a result, we are not only seeing positive impacts for patients but evidence of cost savings through different ways of working.
In our experience, one of the first and most important steps is to understand and plan for the challenges which lie ahead. As well as the obvious impact of administrating the service, there are significant cultural challenges to overcome which require a different way of thinking about control and risk. There are also implications for contracting, where traditional block contracts may not deliver the person-centred, flexible solutions which are central to PHBs. This is why training is a vital part of delivering successful PHBs, as even generously resourced operations may not have all of the experience and knowledge required to ensure an effective service. A thorough review of a CCG’s readiness to meet national targets, including addressing key challenges, is a good place to start. This provides valuable feedback and ensures there is a clear plan of action to deliver within the timescales.
When it comes to implementation, we have developed a clinically-led, seven-step model to create and manage PHBs, drawing on both national guidance and learning from early adopter sites. From obtaining consent and understanding the health and wellbeing needs of patients; to creating individual plans, organising support and monitoring progress - adopting a clear, effective process helps CCGs stay on track.
As well as giving patients more control over the management of their health, there are positive signs that PHBs can deliver efficiencies. By analysing data across four of our CCG areas and comparing the annual cost of PHBs with the estimated cost of equivalent ‘traditional’ care packages, we are seeing savings of between £120,000 and £460,000 per CCG, over £1 million in total – which is a 16% cost avoidance.
As we move towards Integrated Personal Commissioning, which will expand personalisation further, it’s important to look beyond current PHB requirements and explore innovative solutions. We are working with some CCGs to look beyond continuing healthcare to areas such as mental health and equipment. We are also developing 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.
While current targets are stretching, there is growing data, experience and innovation which will help CCGs to deliver PHBs and to explore the possible.
Toby Holder, Personalisation and PHB Manager, NHS Arden & GEM Commissioning Support Unit
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As personalisation and PHB manager, Toby’s role is to lead the development of personalisation services within the organisation, ensuring PHBs empower people to take control over their own care. Toby is a qualified learning disability nurse and experienced Continuing Healthcare (CHC) clinical manager with extensive expertise in designing creative support packages to meet the needs of individuals through person centred planning.