Scoping a Personal Health Budget Service for Nottinghamshire 1. Background The right to have a personal health budget (PHB) for adults eligible for NHS continuing healthcare and children in receipt of continuing care came into force in October 2014. To date, this service has been commissioned from Arden and GEM CSU (GEM) as part of the continuing care assessment and review service. The Forward View into Action: Planning for 2015/16 anticipates that CCGs will lead a major expansion in the offer and delivery of personal health budgets (PHBs) to people who, where evidence indicates, could benefit. As part of this, by April 2016, it is expected that PHBs or integrated personal budgets across health and social care should be an option for people with learning disabilities. The Care Act 2014 confirms personal budgets in law for people with eligible assessed social care needs, including the right to a direct payment. A Frequently Asked Questions publication issued by NHS England defines a major expansion as equating to between one and two in 1,000 people (0.1 0.2 percent of the population) over the next three to five years. CCGs are expected to engage with their local communities and include clear goals on expanding PHBs within their local Joint Health and Wellbeing Strategy. This paper has been developed with input from social care and all 5 Nottinghamshire CCGs, with a view to working closely together and developing cohesive plans. 2. What is a personal budget? A personal health budget is an amount of money to support a person s health and wellbeing needs, planned and agreed between the person and their local NHS team. At the centre of every budget is a care and support plan. This plan helps the person decide their health and wellbeing goals, together with their NHS team, and sets out how the budget will be spent. Once the plan is agreed, the money itself can be managed in different ways: a notional budget with no money changing hands a real budget held by a third party a direct payment to the person. It is also possible to join together personal health budgets with personal budgets for social care so that people can have a more seamless experience. Appendix 1 offers the personal story of a personal health budget. Appendix 2 outlines the experience of personal health budget holders. 1 July 2015
Why a personal health budget? Many people with long-term health or social care needs want more control and choice over the care they receive. They also want much more of a say in defining the outcomes from their health and social care that are important to them, and deciding how they will be achieved. There is also evidence that individuals who are supported to engage more effectively with their condition and with healthcare professionals have a positive experience of their care and experience better health outcomes. Personal health budgets are a way of enabling people with long-term conditions and disabilities to have greater choice, flexibility and control over the healthcare and support they receive, and to be more involved in discussions and decisions about their care. 3. Developing a Local Offer CCGs are required to identify within their local offer: - Who can get a PHB (including any eligibility criteria). - The organisations involved in delivering PHBs locally. - How to find out more information. - How to apply for a PHB. Support in expanding PHBs is available via NHS England s PHB delivery programme and CCGs were invited to renew their membership of the programme by 31 May 2015. The five Nottinghamshire CCGs have done this. 4. Current Situation Management of PHBs within continuing healthcare transferred from GEM to the new continuing care provider, CityCare, from 1 July 2015. GEM provided a generic model which was adopted across most of the East Midlands. The new provider and specification affords the opportunity to review this and to integrate PHBs with social care Personal Budgets and processes. This would streamline the process for the individual, who would be able to plan to meet both their health and social care outcomes from the total budget available to them. To date, PHB expertise has been limited to NHS continuing healthcare and what might be involved in the roll out of PHBs to the wider community requires clarification and financial modelling. 5. Going Forward It has been agreed that a project manager will be recruited to undertake a scoping exercise to understand what is required, how the CCGs can meet their responsibilities with respect to the roll out of PHBs and to work with the social care lead as to how the process and budget can be integrated around the individual. The aim is that, when a person may have eligible social care as well as health needs, that they have one budget to cover all their needs and do not have to undertake two separate processes and monitoring arrangements. The work will also consider which groups of people could most benefit from being targeted for joint PHBs/PBs based how this can support them to achieve better and more cost effective outcomes based on existing evidence. 2 July 2015
The project manager post will be for 6 months and work closely with the quality teams across all 5 CCGs and social care. This post will be aligned to the continuing healthcare programme of work for which the lead commissioner is currently Rushcliffe CCG. The post holder will however work as part of the shared Quality Team and will therefore be hosted by Nottingham North and East CCG. It is proposed that the end of the secondment would culminate in the production of a project plan identifying how PHBs will be rolled out and integrated with social care across Nottinghamshire. The Plan should: Access learning from local projects such as those in Bassetlaw, Nottingham City and Northamptonshire. Access national expertise via NHS England s PHB delivery programme. Utilise Direct Payments expertise from the Local Authority. Identify the potential impact of the roll out on existing contracts and financial plans. Propose the content and identify the resource requirements of a local integrated offer and a model of delivery. Determine how to engage with Nottinghamshire s Strategy for Health and Wellbeing, 2014-17 to ensure that the CCGs goals on expanding PHBs are reflected. Recommend appropriate staffing, training requirements, transaction processes for managing the PHBs and accountability / governance arrangements. Consider the role of the County CCG PHB Steering Group or whether a PHB project group should be established to oversee the development and a place to discuss/agree processes of work. 6. Reporting The project manager would provide regular progress reports to the relevant Quality Lead with a final project plan, following consultation with relevant parties, produced by the end of November 2014. The project manager would also complete joint quarterly progress reports with the Nottinghamshire County Council Lead, providing information to the County Council s Transformation Board, which includes the Transformation Programme Director s for the three units of planning; Mid Notts Better Together, South Notts and Bassetlaw. 7. Recommendations The Governing Body is recommended to note: The information contained within the report offering some background on personal health budgets Joint work across the 5 CCGs and local authority is advisable to ensure the best for our population. That a project will be established, with a project manager, to scope this over the next 6 months. 3 July 2015
Appendix 1 Personal Story Excerpt taken from April 2015, Issue 204 - Personal Budgets in Mental Health, Key Points on Implementation: 4 July 2015
Appendix 2 - The Experience of personal health budget holders 5 July 2015