The NHS Long Term Plan contains a commitment to deliver 200, 000 Personal Health Budgets by 2023/24. It was an ambitious target before Covid-19 struck and sounds even more challenging now. With so many competing priorities, we ask could Personal Health Budgets be part of the solution rather than part of a problem?
According to the Office for National Statistics, the government will spend £280bn on measures to fight Covid-19 and its impact on the economy, in the current year alone.
The public purse is stretched, and the conversations are starting about how we can all save money and attempt to balance the books. The evidence base on PHBs continues to evolve, and includes:
Nhs England » Personal Health Budget (phb) Quality Framework
We have drawn on the above findings and our work with both local authorities and CCGs to develop a savings calculator for our Virtual Wallet PHB solution, which enables CCGs to identify and model their potential local savings. Saving estimates range from 5% to 25%, depending on the cohort and budget deployment model, but we would expect a CCG to be able to prudently forecast a net saving of at least 10% of the budget spend. In summary, PHBs are a proven way to make substantial cashable efficiencies, but it does take some time and effort and hence the need for CCGs to act now.
Sets out how the NHS will systematically implement the Comprehensive Model for Personalised Care to reach 2.5 million people by 2023/24, of which a total of 200, 000 people will be supported by PHBs by 2023/24.
One of the ways to achieve the 200, 000 PHBs aspiration was making them the default position for Continuing Healthcare (CHC) packages, an expectation that was paused in March 2020 due to Covid-19.
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The NHS has signalled that CCGs are expected to resume default position from September 2020, albeit subject to local capacity and readiness to support the delivery of PHBs.
The aspiration and the reinstatement of the default expectation are one perspective. Another way to approach this is from a demand viewpoint. It may not feel like it right now, but the focus on Covid-19 will pass and the public have become more attuned to - and interested in – personalised care than ever before, hence the need to get ahead of it, regardless of the targets themselves.
Identifies personalised care and digital as two of the five major, practical changes that will create the new NHS service model fit for the 21st century. Both of these represent seismic and challenging shifts in relation to people, processes and technology.
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“Covid-19 … delivered an unprecedented shock to both demand for and supply of digital health services. The results have been substantial. In its recent history, the NHS has never seen such a rapid and widespread channel shift. The achievements of recent weeks stand in stark contrast to the relatively poor record the NHS has of adopting digital technologies at scale”.
One of the biggest challenges with an initiative like PHBs (and a concept like Virtual Wallet, our digital PHB solution) is that of culture change and transformation. Covid-19 has had horrific human costs, but is has acted as a catalyst for change in the NHS and in digital engagement. There is now an opportunity to embrace those changes for PHBs.
“The Covid-19 emergency has brought an upsurge in community solidarity and activism, underlining the vital role of local communities in supporting health and wellbeing”.
What Are Personal Health Budgets?
This is supported anecdotally by the 8pm clap, children leaving notes for elderly neighbours they barely know, people setting up social media groups to help with shopping for those shielding, the public signing up en masse for the NHS volunteering app and people generally helping their family, friends and neighbours more. Some of these movements have continued, some have waned.
One possibility for making some of them sustainable is to monetise them via PHBs – people could actually be paying their friends or neighbours to support them, if we open their eyes to it (promoting PHBs) and make it easy (like our Virtual Wallet PHB solution). It could solve some care and support needs whilst also addressing some of the unemployment issues affecting other sectors.
Secondly, we know that people are currently very wary of traditional care and support options (care homes and even domiciliary care) right now. The concept of employing a PA or finding non-traditional supports has never looked more enticing.
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Found that admissions to care homes fell by more than a quarter among publicly funded clients and by two-thirds among self-funders, alongside a drop in the use of home care. People are voting with their feet, so there is a duty (opportunity?) to provide alternative options to people.
Thirdly, at a practical level, many places and services are closed right now, there are backlogs of referrals, labour shortages across the traditional health and social care sector and increased demand for services linked to mental health and long-covid. Some of the authorities we work with are responding to these challenges by offering fast-track personal budgets to people affected, and those people are embracing the chance to take control of what matters to them, and find more creative / rapid / effective ways of meeting their immediate care and support needs.
As well as being morally the right thing to do, a growing body of evidence shows that better outcomes and experiences, as well as reduced health inequalities, are possible when people have the opportunity to actively shape their care and support”.
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From tracking over 9, 000 people with long-term conditions across a health and care system, evidence has shown that people who are more confident and able to manage their health conditions (i.e. have higher levels of activation) have 18% fewer GP contacts and 38% fewer emergency admissions than people with the least confidence.
This shift represents a new relationship between people, professionals and the health and care system. It provides a positive change in power and decision making that enables people to feel informed, have a voice, be heard and be connected to each other and their communities”.
This concept of empowerment sits at the heart of an emerging fundamental shift in the relationship between the citizen and the state. It is a global phenomenon, with personalised care models (and the equivalent of PHBs) becoming the norm in Australia, Canada and the USA, where our sister company is the market-leader in personalised care. Personalised care is the right thing to do, so we should do it now!
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The NHS Long Term Plan recognises personalised care as one of five major practical changes to the NHS to ensure we have a service that is fit for the future. This means people will get more control over their health, and more personalised care when they need it – including access to personal health budgets (PHBs).
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This PHB Quality Framework will support collaboration across integrated care systems (ICSs) to build on best practice and realise the improved outcomes and experience of NHS care and support that PHBs can offer for people. Integrated care boards (ICBs) will play a vital role in supporting partners to deliver high quality PHBs, offering strategic support to ensure PHBs are part of the solution to improve outcomes, tackle inequalities and make best use of resources.
When we really focus on what matters to people rather than what is the matter with them, we see a shift – PHBs support people to build on their strengths and develop their existing support networks, and empower staff to offer care and support that is flexible and innovative.
We continue our national commitment to deliver on the mandate expectation for 200, 000 people to have a PHB by 2023/24 and hope that this framework supports ICBs and partner organisations to make this a reality.
Pdf] Personal Budgets And Health: A Review Of The Evidence
The PHB Quality Framework supports ICBs to create the conditions to meet PHB performance expectations, with a focus on improving operational delivery to:
Both the ICS Design Framework and Thriving places: Guidance on the development of place-based partnerships as part of statutory integrated care systems outline the expectation for ICSs to work at place level, integrating and co-ordinating the delivery of health, social care and public health services around the needs of the population – including the use of PHBs.
The PHB Quality Framework focuses on PHBs, however, the principles and requirements can be applied to integration of health, social care and education needs around the individual through the provision of integrated personal budgets (IPBs). The potential to offer IPBs should be considered in all PHB offers – the key requirements for health within these remain as detailed in this document.
Joining Up Health And Social Care Personal Budgets Final For Website 13 Jan 1
The PHB Quality Framework is intended to support integrated care partnerships meet the requirements for quality improvement and
