NHS Manchester. Helen Hemming PHB Project Manager

Transcription

1 NHS Manchester Helen Hemming PHB Project Manager

2 Personal health budgets (PHBs) A personal health budget is an amount of money that is allocated upfront to an individual to allow them to plan to meet their health and wellbeing needs in a way that best suits them. Personal health budgets are not about new money; rather they use money which would have been spent on an individual s care in different ways. personal health budgets aim to deliver better health and wellbeing outcomes through choice and control. They should facilitate integration across services At the heart of a personal health budget is a care/support plan which is developed in partnership, the person (and their family) taking the lead in discussion with the professional and others who can help them.

3 Government have stated : Future of PHB that by April 2014, all Clinical Commissioning Groups will need to have the capacity and capability to deliver personal health budgets, after April 2014 everyone who is eligible for NHS CHC will be able to ask for one, NHS CHC teams will need to understand personal health budgets and how they sit within the NHS Continuing Healthcare pathway and be able deliver them Following the Evaluation findings due October 2012 PHB may be extend to wider clinical areas

4 Manchester Progress. April Bid and was successful to be an In-depth Pilot site April 2010 Project team put into place 3 June Full pilot status December Direct payment status August 2011 RTC roll out options

5 47 Taken up PHB» 12 Since Died 11 Virtual / Notional Manchester Activity» Residential and Domically 36 Direct Payments 13 Transfer from Local Authority 4 Fast Tracks Mix of Personal assistants /agency

6 Myth s A PHB sits outside the CHC process and Framework A PHB is about Cost Saving A PHB is just a Direct Payment PHB get patients more money Patients misuse their budget Patients are given the budget to go away and do what they want with it Patients at an Increase risk of especially around safe guarding Patients are put at increased clinical Risk Its increases current heavy work loads

7 7 Step Process

8 Step 1:Contact Information The Application of the DST and eligibility Process. Patients eligible for CHC are offered a PHB budget The case manager discusses with the patient and family the PHB offer and if necessary a member of the project team will visit What we did : Patient Information Leaflets, staff training, guidance document which will be used to inform future policy Myth Busted : It is embedded in the CHC process

9 Step 2 : Identifying health needs/assessment As part of the CHC process the professionals in conjunction with the patient will agree where a patients care needs are best placed to be provided either a residential or domiciliary setting. The Case manager will complete a professional recommendations form identifying the clinical needs and risks which will feed into the Support Plan Myth Busted: Clinical needs and risks are a key part of the support Plan

10 Step 3 : Budget Setting As part of the CHC process the professionals in conjunction with the patient will agree where a patients care needs are best placed to be provided either Residential or Domiciliary setting. Budget setting Manchester is developing a Indicative Budget tool that is based on the DST domains.the tool is currently being tested within a few sites via the DoH and we are looking at rolling it out in the next few months Currently we also calculate a budget on a tool that links assessed hours to a set agency rate to ensure we don t provide a budget over PCT levels of cost All budgets are approved and signed off by the CHC budget holder. Myth Busted : The budget set is within the PCT costing the agency rate is set at a target rate which is lower than current rates giving a general 10% saving

11 Step 4:Support Planning The support Plan is at the heart of the PHB. It must contain information about clinical diagnosis and options for treatment or care but is balanced with contextual information from an individual about lifestyle and the impact of their health condition on that lifestyle. 7 Key areas What is important to me and for my health What do I want to change and achieve How will my support be organised,arrange and managed How will I use my budget How will I deal with any changes/risks How I will stay in control How the plan is going to be put into action

12 Support Planning Who helps with support Planning? It can be any one in Manchester we use Trained brokers

13 Myth s Busted The support plan must be checked and agreed by the Case manager it will identify any risk and how these are being managed. What skills /training required to carry out a task and how that will be achieved The budget breakdown of what is to being request to be purchased ( any unusual or controversial decisions are taken to a Risk panel )

14 Myth s Busted. All support plans must be approved and signed off by the PCT only what is agreed on the support plan can be purchased Myth Busted The PCT control and approve all expenditure

15 Step 5 Final Budget set The support plan must be approved and signed off by the commissioners.

16 Step 6: Personal Health Budget Commences The broker provide the support for sourcing the package be it agency or PA s Recruitment support Tax, NI, employment rights CRB checks for all staff including family members Accessing training for staff Insurance cover taken out

17 Step 7 : Review Patients are still subject to CHC review process In addition to the clinical review the PHB team complete 3 month audits This allows the team to check that the funds are being spent as identified in the support plan to look at reason for any under or over spend Myth Busted We are seeing monies being returned people managing budgets directly only paying for services received Only buying what they require

18 Myths Busted Myth Reality PHBs are more expensive PHB Budgets are usually slightly lower (approximate 10% lower for patients with direct payments) Patients misuse their budget, they can do what they want with it Patients are at an increased risk, especially around safeguarding Patients get more money than traditionally purchased care Budgets can only be used to purchase what has been agreed by the NHS. If a patient is found to be misusing their direct payment we can stop it at any time. Accounts are regularly audited Sign a contract with PCT Patients have choice who comes into their home. Many of the patients referred at the beginning of the pilot where presented due to safeguarding or issues with agencies, these have been resolved through employing a team of PAs directly with a PHB. Staff are CRB checked Clinical risk identified and managed overseen by Case manager Budgets are set within the pricing structure for the local PCT and are within the choice policy if this is in place. Increased work load for staff Case managers reporting reduced time in contract compliance issues Patients getting a service that suits their needs so reduced contact as more stable

19 Challenges Doing it isn t hard Getting your head around the cultural changes is HUGE