www.england.nhs.uk

Realising the

Potential of People

Dr Alison Austin

Personalisation Lead,

NHS England

Alison.austin4@sky.com

@

Structure of presentation

1. The Challenges facing the NHS

2. The Mandate for Change

3. Patient Activation

4. Person-centred care and support planning

5. Personal Health Budgets

6. Integrated Personal Commissioning

2

The Challenges

3

1. Increasing numbers of

living with more than one

LTC – increasing demand on

services

2. Safety – Francis, Berwick & Winterbourne

3. Face decade without any

increase in spending,

unprecedented in NHS

history, set against rising

demand (4% pressure pa)

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Traditional NHS models will need

to be radically rethought.

•Financial case. Efficiency will not be enough. We need new sources of value, increasing the outputs/outcomes, not just more efficient staff.

•Model of care must change. Acute focused, episodic single disease models will not work. We need active patients, self-managing multiple long term conditions and supporting each other. We will need proactive, personalised care planning to support & manage multiple morbidities.

•Recognition that People are greatest untapped source of expertise & value. They need to be ACTIVE PARTNERS in control of their care and health

4

Future Direction

The NHS Mandate Objective:

• “To ensure the NHS becomes dramatically better at involving patients… empowering them to manage and make decisions about their own care and treatment.”

• “by 2015… more people managing own health… everyone with LTCs including MH, offered a personalised care plan… patients who could benefit have the option to hold a personal health budget… information to make fully informed decisions.”

• Shared decision making, self-management, PHBs, information and personalised care planning all linked

The Five Year Forward View

• “Patients will gain far greater control of their health own care –through the option of a shared health and social care budget.”

• “We will also introduce integrated personal commissioning”

5

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6

Having more control being an active

partner means- Two experts in the

room.

Clinician

• Diagnosis

• Disease aetiology

• Prognosis

• Treatment options

• Outcome probabilities

Patient

• Experience of illness

• Social circumstances

• Attitude to risk

• Values

• Preferences

• Goals

Reference: adapted from Angela Coulter

What is Patient Activation?

Patient Activation – knowledge, skills and beliefs

Knowing something with help/harm health is not enough

Evidence strong that ‘Patient Activation’

leads to better outcomes & lower costs

Active and

empowered

patientEngage

with

clinician

more

Reduced

service

use Able to

work

more

Meds

use

improves

Lifestyle

improve

ments

e.g. diet

Info

seeking

Better

disease

manage

ment

Study of 25,047

patients showed

greater levels of

activation

experienced

better health.

Other studies

show improved

self-management

behaviours and

reduced service

utilisation.

Personal Health

Budget trial of

2000 people

showed improved

quality of life and

fewer admissions‘Patient Activation’ a term for confidence, skills & knowledge

Equal Partners through:

Shared Decision Making, including Patient Decision Aids

• Better experience of care, some reduction in use of

services, less surgery.

Personal Health Budgets & personalised care planning

• RCT: cost effective, improved Quality of Life, best for high

needs. Other studies show impact on carer well-being

Self-Management Support, such as Expert Patient

• Impact of behaviours, Quality of life, symptoms and better

use of resources.

• Not just technical information, but behaviour change

NHS | Presentation to [XXXX Company] | [Type Date]9

Personalised care planning, the

House of Care and system change

10

Left wall – engaged,

informed individuals &

carers

Right wall – health & care

professionals committed

to partnership working

Foundations –

commissioning, metrics,

incentives

Roof – organisational &

clinical processes

No single organisation can make the

change happen in isolation

1

1

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• help people live with their long

term conditions and stay out of

hospital,

• change the relationship,

• enable people to use NHS

funding in different ways, not new

monies,

• focus on outcomes,

• centre around a care plan which

is agreed by NHS,

• are regularly reviewed to ensure

needs are being met and money

is spent as agreed,

• are not suitable for all NHS Care

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2

Personal health budgets – new for the NHS

The independent evaluation of personal health

budgets has shown that they can lead to improved

quality of life whilst meeting health needs and

being cost effective (even saving money for some)

In addition…….

The national personal budget survey (POET) involving 195

PHB holders and 117 carers across 12 sites showed that:

• 73% reported a positive impact on independence

• 69% reported a positive impact on health

• 70% carers reported a positive impact on their own quality of

life

• Knowing the budget up front is important

A staged approach is being taken to rollout across England

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Personal Health Budgets: The Commitments

NHS Mandate Objective: “by 2015… more people managing own health… everyone with LTCs including MH, offered a personalised care plan… patients who could benefit have the option to hold a personal health budget… information to make fully informed decisions.”

Legal Duties: from October 2014 everyone receiving NHS Continuing Healthcare will have the “right to have” for a personal health budget.

5 Year Forward View: Integrated Personal Commissioning will include the option of a “budget that will be managed by people themselves”

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What we know:

• they work best for those with higher levels of need

• people with higher levels of need are more likely to need

both health and social care support

• They are applicable to mental and physical health

• They reduce unplanned care

• They are not right for all NHS Services

16

What the Mandate means: Who benefits?

If you’re going to do it… do it right

1

7

Evaluation - benefits of personal health budgets depend on how they were introduced.

Best results – people know budget up front; advice and support available; choice and flexibility over how to spend budget , choice on how it is managed.

Scale-up - challenge of maintaining the integrity of the values.

To work well, personal health budgets need

good support from all parts of the system

co-production with people with direct experience

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Meeting the Mandate commitment: Getting

ready in NHS Continuing Healthcare

• Every CCG (211) signed

up to support programme

• Over 170 CCGs have

attended the accelerated

development programme

• 188 have accessed small

amount of additional

funding

• Markers of Progress –

currently being used by

over 80%

Integrated Personal Commissioning (IPC)Builds on 2 Core elements:

• Care model: Person-centred care and

care planning, combined with an optional

personal health and social care budget

• Financial model: An integrated, “year of

care” capitated payment model

Aims to:

• Improves quality of life and increase

person-centered care

• Reduce crisis and unplanned care

• Increase integration

Aimed at:

• Children and young people with complex

needs

• People with LTCs and complex needs

• People with learning disabilities with high

support needs

• People with significant mental health

needs

Joint working

NHS England will work in partnership

with range partners including:

• LGA, ADASS, TLAP

• Monitor, PHE, NHS IQ

• Voluntary sector including Strategic

Partners, & National Voices

• People with lived experience

Programme Board and Governance is

being established

Core Implementation Group developing

plans, working with range partners

Timeline

• IPC announced on 9 July

• Prospectus published on 4 Sept

• Applications in by 7 Nov

• Selection process complete Dec

2014

• Models to be operational by April

2015

Evaluation through 2015-17

Where to get more information

2

0

• Personal Health Budget Learning Network

www.personalhealthbudgets.england.nhs.uk

• Wider individual and public participation

http://www.england.nhs.uk/2013/09/25/trans-part/

• The Coalition for Collaborative Care

http://coalitionforcollaborativecare.org.uk/

• Integrated Personal Commissioning

http://www.england.nhs.uk/wp-

content/uploads/2014/09/ipc-prospectus-updated.pdf

• NHS Improving Quality

www.nhsiq.uk