Personal health budgets: helping to build a more responsive, more integrated, NHS

Nicola Watt, Personal Health Budgets Team, Department of Health

The story so far

In July 2008, High Quality Care for All announced that from 2009 there will be a pilot, building on experience with individual budgets in social care, to test personal health budgets as a way of giving people greater control over the services they use. Our aim is to support the cultural change needed to create a more personalised, responsive and innovative NHS.

This January, we published Personal health budgets: first steps.¹ This set out some basic principles about personal health budgets, for example, that they need to be equitable, voluntary, and part of an NHS that is comprehensive and free at the point of use. It also called for expressions of interest in the pilot programme – which elicited an incredibly strong response.

We awarded 70 sites, covering every strategic health authority region in England, ‘provisional’ pilot status subject to a further assessment of their capability later this year to become ‘full’ pilots. Many intend to focus on NHS continuing health care, long-term conditions, mental health services, or end-of-life care, but we have also seen more unusual proposals looking at obesity or substance misuse, for example.

There are different types of budget

Giving someone a personal health budget does not necessarily mean giving someone money. They could be notional budgets, real budgets held by a third party, or direct payments. In all cases, a personal health budget needs to be underpinned by a clear care and support plan, signed up to by both the individual and the relevant professionals.

PCTs can already offer notional and third party budgets. Direct payments, where people receive money to arrange and pay for their own health services, require new legislation, currently going through Parliament in the Health Bill. Subject to parliamentary approval, we hope direct payments could be available to approved pilot sites from summer 2010.

Evaluating the personal health budget pilot

The Department of Health is commissioning an independent research team to look comprehensively at the impact of the pilots. We aim to have the team in place this summer. They will report at intervals, with the final report likely to be published late in 2012 following the completion of the three-year pilot phase and independent peer review. The evaluation will focus on five broad areas: effects on individual outcomes (including carers); behavioral change (of individuals and NHS staff); finance and cost-effectiveness; system effects, including impact on staff and on existing services; and the implementation of personal health budgets.

Related initiatives

This programme is just one of a range of policies designed to make NHS services more responsive, including patient choice, care planning and support for self-care. More widely, the cross sector concordat, Putting People First, seeks to ensure that local strategic partners work together to achieve greater personalisation of services and support. Indeed, there are many other related initiatives underway not just in the Department of Health but across Whitehall.

Two Department of Health programmes that share some of the key aims of personal health budgets, particularly around supporting innovation, improving patient/user experience and high-quality care, are the Common Assessment Framework for Adults demonstrator sites and the Integrated Care Pilots.

The development of a Common Assessment Framework for Adults is currently supported by nine local authority-led partnerships.² The demonstrator sites have each committed to develop and test solutions to sharing people’s personal information securely and appropriately across health, social care and extending this to wider community support services. A person-centred and proportionate process of assessment and care/support planning is a central aspect of each site’s work, as they look to encourage supported and self-assessment for users, carers and their families to allow personalised support and outcomes. Two of the nine partnerships (Camden and Hampshire) are in the same areas as provisional pilot sites for personal health budgets.

The Integrated Care Pilots will test and evaluate new models of integrated care to explore different ways in which health and social care could be provided to help drive improvements in local health and well-being.³ Integration refers to partnerships, systems and models as well as organisations – crossing boundaries across primary, community, secondary and social care. Five of the 16 pilot sites are in the same areas as provisional pilots for personal health budgets (Cumbria, Norfolk, Torbay, Wakefield and Northamptonshire), although not necessarily looking at the same patient groups.

All of the programmes are committed to ensuring that good practice learning is shared as projects develop and seek to make and maximise appropriate links with other relevant programmes.

How to get involved

There is clearly an overlap between the aims of the whole systems demonstrators and the personal health budgets pilots, including promoting individuals’ well-being and independence and integration between and health and social care. Several personal health budget proposals specifically mention telecare and telehealth.

Through the Whole Systems Demonstrator work, you will have gained invaluable experience about how to overcome some of the technical and cultural challenges that our pilot sites will face over the coming months and years. We think that this could be a very exciting opportunity to build on that experience.

If you would like to know more, or get involved with the personal health budgets pilot programme please visit the following websites.

Personal health budgets, Department of Health website (www.dh.gov.uk/en/Healthcare/Highqualitycareforall/DH_090018)
Personal health budget learning network portal (http://www.personalhealthbudgets.org.uk)

Or write to us at:

References

[1] Department of Health (2009). Personal health budgets: first steps. London: Department of Health. Available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093842 (accessed on 28 July 2009).

[2] More information about CAF available at: http://www.dhcarenetworks.org.uk/CAF/ (accessed on 28 July 2009).

[3] More information about ICPs available at: http://www.dh.gov.uk/en/Healthcare/IntegratedCare/DH_091112 (accessed on 28 July 2009).