PERSONAL HEALTH BUDGETS GUIDE Developing a local peer …...The national peer network was launched in spring 2011. Since then, local peer networks have begun to meet in some of the

PERSONAL HEALTH BUDGETS GUIDE

Developing a local peer network

Author: Jo Fitzgerald, peoplehub with thanks to Andrew Tyson, Rita Brewis, Trudy Reynolds and the national personal health budgets peer network.


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1 Why are personal health budgets important? 3

2 Peer networks – a new relationship 4

3 Why develop a peer network? 6

4 Working with people – the importance of co-production 11

5 Developing a core group of people with experience 14

6 Practical issues 19

7 Conclusion 22

8 References 23

Contents


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A personal health budget is an amount of money to support a person’s identifiedhealth and wellbeing needs, planned and agreed between the person and their local NHS team. Our vision for personal health budgets is to enable people with long term conditions and disabilities to have greater choice, flexibility and controlover the health care and support they receive.

What are the essential parts of a personal health budget?

The person with the personal health budget (or their representative) will:

n be able to choose the health and wellbeing outcomes they want to achieve, in agreement with a health care professional

n know how much money they have for their health care and support

n be enabled to create their own care plan, with support if they want it

n be able to choose how their budget is held and managed, including the right to ask for a direct payment

n be able to spend the money in ways and at times that make sense to them, as agreed in their plan.

How can a personal health budget be managed?

Personal health budgets can be managed in three ways, or a combination of them:

n notional budget: the money is held by the NHS

n third party budget: the money is paid to an organisation that holds the money on the person's behalf

n direct payment for health care: the money is paid to the person or their representative.

The NHS already has the necessary powers to offer personal health budgets, although onlyapproved pilot sites can currently make direct payments for health care.

What are the stages of the personal health budgets process?

n Making contact and getting clear information.

n Understanding the person's health and wellbeing needs.

n Working out the amount of money available.

n Making a care plan.

n Organising care and support.

n Monitoring and review.

Personal health budgets

Spreading the word … the network is a chance to share positive approaches to getting a life.

Support – the peer network will providesupport for the people who are taking ideasforward from the ground level up.

- National personal health budgets peernetwork members, in response to beingasked “what’s the most exciting thingabout the network?”

Personal health budgets have been piloted inover 70 locations in England. An in-depthevaluation of 20 sites, published in November2012,1 supports the planned national roll out.

For people using health services in England,the introduction of personal health budgetsrepresents a major step towards being able tomake genuine choices, with as much directcontrol over the process as they choose, andas is appropriate. Taking this step is no smallmatter, either for the clinicians and otherprofessionals responsible for commissioningand delivering health services, or for healthservice users and their families.

This change involves a fundamental shift inthinking and practice, away from an approachthat sees patients as passive recipients of

professional care and support, and towards aperspective where they are equal partners inmaintaining their own health and wellbeing.This is a shift to a 21st century approach tohealth care informed by our developingunderstanding of the importance of diet,exercise, friendship, social contact and,perhaps most important of all, contribution.This new approach asks for action by allconcerned, not least people themselves, whilerecognising that contributions must bevoluntary, and made at a time when peoplefeel confident and ready to do so.

This guide aims to support commissioners andlocal organisations (NHS organisations and theirpartners) to assist people to play their part inthis process through peer networks – peoplewith lived experience of personal healthbudgets, or who are working towards them. It reflects on the development and learningfrom the national personal health budgets peernetwork2 and some early local peer networks.

The guide draws on the words of people involvedin the networks, many of whom remain verycommitted to the process. It attempts tomake sense of learning from the earlymeetings of the peer networks, and to drawtogether lessons that will be useful to others.


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1 Why are personal health budgets important?

Some early users of personal healthbudgets feel strongly that a new working relationship betweenprofessionals and people must be at the heart of personal health budgets – a view supported by the Department ofHealth. The peer network is one model of how this new relationship can work: a network links people who are engagedin co-developing personal health budgets with the Department of Healthand with the pilot sites. The groupprovides a unique space where issues can be raised and debated alongside the main decision makers.

The personal health budgets peer networkplays a central role in helping us get thepolicy and delivery of personal health budgetsright. Their targeted involvement in our workensures that what we develop is grounded inreal experience. As a group, the network hasa wealth of knowledge and experience andthey offer real challenge when we need it.

They are also essential allies in helping toexplain to NHS professionals and others whatpersonal health budgets mean in practice andhelping to get people on board.

- Alison Austin, personal health budgetspolicy lead, Department of Health

The national peer network was launched inspring 2011. Since then, local peer networkshave begun to meet in some of the pilot sites.This guide sets out the learning to date,which should encourage the introduction ofmore local networks.

Local networks are both ends in themselves –in that they support the people concerned;and means to a broader result – throughsupporting effective local implementation ofpersonal health budgets (see the Personalhealth budgets toolkit3 and the peoplehubnetwork).2 In particular, the guide on effectivecare planning4 highlights the role of local peernetworks in shaping local systems as peoplebegin to think about the implications ofpersonal health budgets in their life.


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2 Peer networks – a new relationship


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What we have learned: advice from the national peer network and pilot site leads


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The NHS perspective

With clear guidance and terms ofengagement, peer networks have thepotential to be enormously helpful for commissioners and others in the NHS in helping to produce the profound organisational changes needed to make the delivery of personal health budgets effective.

n Personal health budgets involve seeingpatients from a fresh perspective andvaluing them as people, not simply aspatients. Peer networks will include peoplewith a rich variety of life experiences,professional backgrounds, skills and abilities,bringing new perspectives on old problems.

n Personal health budgets involve a changedrelationship between patients and the NHS in which the views of the patient and the views of health care professionalsare brought together in a comprehensiveplan to inform decision making. One of the most powerful ways to develop theconditions for this changed relationship is through successful modelling to showwhat the changed relationship means inpractice. A good way to do this is forpatients, NHS managers and staff to work together to agree policies and plansfor delivering personal health budgets. A peer network is one means of achievingthis. Such networks have the potential to change relationships on both a one-to-one and a collective level.

3 Why develop a peer network?


n Real life stories have the power to changeattitudes. Gathering a group of people who are confident to tell their story andwho understand the wider context ofpersonal health budgets is one of the best ways to inspire professionals.

n People’s contribution can go far beyondtheir stories. As the national peer networkhas shown, the more people are able tolocate their own experiences and learningin the overall context of personal healthbudget policy and practice, the moreconfident they become in offering criticalanalysis of each suggested development.

n A peer network creates an opportunity tohear directly from people about how thingsare going and to discuss with them howthings might change or be improved. A peernetwork can create many practical ideas. Itbrings policy and practice together. This earlytesting is very efficient. People can helpspot pitfalls and approaches that will failbefore they are implemented more widely.

n A peer network shares the responsibility forgetting things right. NHS professionals andthose using services often begin theirengagement with a degree of wariness andeven suspicion. Working alongside people withlived experience is a very effective way formanagers to develop a shared understandingand strong working relationships, and tochallenge assumptions. They are able todevelop robust policies and procedures,celebrate successes together, and implementpolicies and practice based on real, livedexperience. This enables all concerned tostart believing that being transparent canbe a helpful and positive experience.

The person’s perspective

For many people with complex and long termhealth conditions or disabilities, life is astruggle which can be complicated further by bureaucratic NHS systems and lack oftransparency. Peer networks offer people thechance not just for personal support, but alsoto have real influence. They assist people tobuild or rebuild their confidence, skills and self worth through taking on a role other thanthat of patient; they help people to stepoutside their own world and their owndifficulties and see things from the perspectiveof others; and they provide the opportunity to give back, to make a contribution tosomething that is of manifest significance for the life chances of others. Through a peernetwork, people find they have the opportunityto relate to others in a similar situation, shareexperiences, and join together in mapping outpractical ways to improve the process.

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n People who have a personal health budgetare usually very clear about the purpose ofpersonal health budgets and know theyhave the potential to change their lives.Being involved in a peer network enablesthem to bring to life some of the centralconcepts in a practical way. They are able toinfluence development and delivery andensure that personal health budgets staytrue to purpose.

n Transparency is an important principle inpersonal health budgets – transparencyaround money, processes, and what thedeal is. Peer networks require transparencyand willingness to be open about localpolicies and practices so that people canfind collective solutions. The benefit is thatlocal people understand the real challengesin implementing personal health budgets,and appreciate the barriers and the degreeof culture change necessary. Greatertransparency about implementing personalhealth budgets and how decisions are madeis a way of building trust. Similarly, clarityabout decision making at a personal levelbuilds trust between people and health careprofessionals. In this way, people come to

understand why things are the way theyare, and gain a better appreciation of theconstraints facing organisations.

n A peer network enables people to shape and influence policy and processesthat have a direct impact not only on their own lives, but also on the lives of others in their local community. People have a vested interest in beinginvolved because they want the rules tomake sense for themselves, and to be fair for everyone.

n Working with others on an issue that is socentral to people’s life and circumstancesquickly creates a sense of shared ownershipof personal health budgets, which buildstheir legitimacy and wider acceptance. Thishelps to establish personal health budgetson an equal footing to more traditionalmeans of delivering health care.

n Giving people information empowers them. With information, people cansupport professionals to deliver personalhealth budgets more effectively. They canalso support each other in practical andconstructive ways.


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n Being involved from the beginning, whenthere is a real opportunity to influence, ismore satisfying, more interesting and allowspeople to be more creative.

n A peer group that has a clear strategic aimand a job to do may be attractive to peoplewho wouldn’t normally join a support group,and they often find that being in a group of

like-minded people with a shared vision canbe tremendously supportive. It enablespeople to share ideas, test out their thinking,learn from each other and ask for advice. Italso meets a need that many people express– the need to be useful. It gives people asense of purpose that they may have lost iftheir life has changed dramatically as a resultof a long term condition or disability.


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Why is a peer network important to me?

n To give something back and to help those who need the assistance that I did, and still do sometimes.

n Learning from others’ experiences.

n Shared values and a determination to make it happen.

n More power in numbers.

n Breaking the sense of isolation.

n Enables us to have a real influence.

n Meeting like-minded people.

n Sharing information – being kept up to date with what’s going on.

n Being seen as the experts we are.

n Honest and open conversations.

n Opportunities to speak at national events.

n Challenges the views of people and makes them rethink.

n Test out ideas in a safe space.

n Feeling valued.

n No-one needs to worry about what they’re saying – it’s non-threatening and non-competitive.

n When you meet people with a wide variety of experiences, you’re in a better position tohelp others – a greater body of knowledge.


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There are many definitions of the termco-production, including this one fromthe world of social care:

It is active input by the people who useservices, as well as – or instead of – thosewho have traditionally provided them … Co-production is a potentially transformativeway of thinking about power, resources,partnerships, risks and outcomes. To act aspartners, both users and providers must beempowered. Co-production means involvingcitizens in collaborative relationships with …staff who are able and confident to sharepower and accept user expertise.5

The national personal health budgets peernetwork is based on this thinking. The aims ofthe network were to co-develop personalhealth budgets with the Department ofHealth, by enabling people to contribute on alevel playing field through empowering themwith information and knowledge in anenvironment that provided some rules andstructure. The national peer network seesitself as a community of people with a sharedvision, a learning network, a peer supportgroup and a training programme.

These elements are complementary. If peernetworks are to succeed, we need to workand communicate with them in ways that areradically different from those we are used to.People must be seen as active partners, with aperspective that will sometimes be at variancewith that of the NHS, but who havesomething substantial and valuable to offer.

Person centred

When meeting with networks, managers needto leave behind the safe ground of agendas,minutes and formal chairing arrangements,and engage with people in ways that arecomfortable to them, while providing thestructure needed for clear communication.Both the national peer network and localnetworks make use of person-centred thinkingtools6 to structure meetings, set priorities andprovide a sense of connection with people’slived experience. Managers should familiarisethemselves with these tools.

Reciprocal

The national network developed a modelaiming at a reciprocal relationship betweengroup members and the Department of

4 Working with people – theimportance of co-production


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Health – to balance the needs of theorganisation with the needs of the group,while remembering that a group is also madeup of people. The ‘contract’ was a sharedcommitment to the development of personalhealth budgets in all their complexity.

Responsive

The national network meets bimonthly: itdeliberately does not work to a structuredprogramme, but develops organically inresponse to the evolving national programmeand issues that arise for members. It makes

use of person-centred thinking tools to co-produce outcomes that are helpful to thegroup and that also support the personalhealth budgets pilot programme. Thisapproach is readily replicable in local networksprovided there is leadership and commitmentfrom both NHS leaders and local people.

Impact

The national peer network makes its impactas clear as possible by recording outputs thatare explicit and visible. It aims to be supportive,to be fun, and to celebrate its successes.

Main principles underpinning peer networks

n Respect – everyone’s contribution is valid.

n Equality – no-one’s contribution is more important than anyone else’s.

n Inclusion – people are members of families, friendship groups and communities.

n Diversity – involve people of different ages, ethnicities and backgrounds, and withdifferent health conditions.

n Independence and interdependence – people work together towards a good life for all.

n Strength – by growing in confidence and numbers, we can have more impact on whatneeds changing.

n Celebration – always celebrate success and move on to the next challenge.

n Trust – all the above is best achieved in an atmosphere where people trust one another,are comfortable and feel safe.


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Values and principles into action

How do peer networks put these values andprinciples into action? How do they strike abalance between what matters most to theperson, and what matters to the widernetwork and its purpose? How do peopleretain a sense of controlling their own destiny,while also working in partnership with theNHS and others?

Person-centred thinking tools6 can help us to find out what matters and how people can be supported to participate in this way. One example is the use of one-page profiles to find out:

n my gifts and talents: what people say about me

n personal health budgets: what’s importantto me about this work

n how people can support me to do this workand how I can support others.

Connecting with what matters most to peopleis especially important when they aren’t well.There needs to be a commitment todeveloping a trusting relationship, awillingness to be honest and to forgivemistakes on both sides.

The model of peer networks that we havetested strongly suggests that one criticalsuccess factor in reconciling these difficultthings, and keeping focused on what mattersmost to people, is to create a strong coregroup of people with lived experience of apersonal health budget.


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The model used to develop the nationalpeer network involves establishing a strongcore group made up almost exclusively ofthose in receipt of a personal health budget,their family members, or those preparingto receive one. This model is also a soundbasis for developing local peer networks.There are a number of reasons for this.

n This approach goes some way to correctingthe power imbalance between people andprofessionals. It can be intimidating to joina group of people who are confident in

their knowledge about local policies andpractices. Bringing people with livedexperience together, in a space where theycan test out their thinking and understandingwith others in a similar situation, is a helpfulmeans of developing their knowledge andconfidence. This is very much a personaldevelopment process, a journey of discovery for people who have foundthemselves in a dark place and have (often)lost faith in public services. This approachdoesn’t exclude project leads or otherclinicians or managers from all meetings.

5 Developing a core group of people with experience

INVESTING ANDEMPOWERING

n Department of Health

n Personal healthbudgets sites

n Lead for peer network

PEER NETWORK

n Core group of peoplewith lived experienceof personal healthbudgets

INFLUENCING ANDDEVELOPING SOLUTIONS

n Input into all personalhealth budget workstreams

n Presenting alongside theDepartment of Healthat national events

n Helping inform policyn Developing the toolkit

for roll outn Developing key

messages


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It just means that on balance the coregroup is made up of people with a personalhealth budget and their family members.This gives the core group a degree ofautonomy and independence needed toensure it develops as a safe space forpeople to test out their thinking and learnfrom each other.

n At the beginning of a network’s development,it’s important that the views and ideas ofthose with lived experience aren’t drownedout by professionals who have had moreopportunity to think about the issues beingraised. People with lived experience don’thave formal professional groupings ornetworks from which to learn in the sameway as professionals, nor do they have aprofessional body where they can safelydiscuss issues with like-minded people.

n A peer group can give people the sameopportunities as health care commissioners,project leads and others, who often havetheir own learning communities andnetworks. It can also provide a safe spacewhere people do not need to ask questionsof each other (people with lived experiencehave a ready understanding of oneanother’s situation), or to exposethemselves or test their understanding with the people who have the power toinfluence their life. It feels risky to saysomething isn’t working in front of thepeople who provide or commission it.

n A central aim of this approach is toempower those using personal healthbudgets by providing them with high-

quality information, which they are allowedto assimilate in their own way and at theirown pace. Experience with the nationalpeer network suggests that building up agroup of people who are confident tospeak out about complex issues in relationto health care, choice, control and thesubtleties of implementation in a difficult,changing environment requires a high levelof investment and a sharp focus on theneeds and strengths of people, as well asthe wider network.

n A group of personal health budget holdersand family members offers the opportunityto rehearse. Rehearsing answers to complexquestions and testing out ourunderstanding of complex issues gives usconfidence to speak out when it comes tothe real, challenging situation. The nationalpeer network took the opportunity torehearse sharing personal stories to givethem confidence to speak publicly and athigh-profile events. Rehearsing is a greatway to empower people.


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The national peer network had a clear intent to amplify people’s voices. It alsorecognised that there is strength in numbers.Those involved knew the group needed to be large and strong enough so that peoplecould dip in and out. They also wanted adegree of flexibility and to ensure multipleperspectives. So the group worked hard toensure there was representation from peoplewith different health conditions and indifferent situations. The group includes peoplewith their own personal health budgets, aswell as family members who have experienceof a range of health conditions includingmental health issues, multiple sclerosis,learning disabilities, spinal injuries, epilepsyand dementia. The group spans a wide agerange and includes people of differentethnicities and cultural backgrounds.

Investment

Developing a strong core group of peoplewith lived experience of personal healthbudgets is critical to the overall process ofempowering people to play an active role inthe development of personal health budgets.The model (page 12) shows that developing apeer network is a dynamic process whereknowledge, information, resources, creativityand thoughtful challenge flow into and out ofthe group. While the core group has largelyremained constant, there has been activeinvestment in the group in relation to time,energy, knowledge and resources. Financialinvestment has made it possible for people to

attend meetings, but there has also been theinvestment of time and energy by Departmentof Health staff and the lead for the peernetwork. The Department of Health ensuredthat peer network members had enoughknowledge about the context, purpose andimportant elements of a personal healthbudget to be able to co-produce solutionswithin the different work streams, contributeto policy making, develop core messages, andmake inputs into the toolkit.3 The ideas andcontributions that have flowed from thegroup have been insightful and robust. Thelead for the peer network has also investedtime and energy in developing relationshipswithin the group.

Leadership and facilitation

Strong leadership and skilled facilitation arecritical to the development of a peer network.To find the right person to fulfil these roles,it’s helpful to develop a clear picture of whatis needed and the sort of person who coulddo the job. It is then important to plan aprocess that has regard to equal opportunitiesand that includes members or prospectivemembers of the network. The leader may ormay not be the same person as the facilitator,depending on people’s skills and confidence andthe support available to undertake the roles.

Facilitating the meetings involves developingan outline for the session. A facilitator willopen and close the meeting, set the tone forthe discussions, focus and often record the


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content of the discussions, and facilitateinteraction within the group. In terms offacilitation, it’s helpful to think about thewhole person and their skills and abilities.Lived experience of a personal health budgetis important when facilitating a group – itcreates an affinity with the group and bringsits own legitimacy. It will also influence thevalues and priorities within the group.

Leading a group requires energy, so it’simportant that the leader has a strongpersonal desire to fulfil the role. Whoeverleads the group will need support at thebeginning, but this should be empoweringand enable the leader to take on moreresponsibility over time. Our experiencesuggests that support can take differentforms, but essentially it comes from peers –other people using personal health budgetswho share the sense of purpose and mission.Ideally, leadership of a peer network shouldbe invested in a person with lived experiencewho has the right qualities and skills. Theleader will also need a sound knowledge ofpersonal health budgets in order to planmeetings and answer questions from thegroup. A good leadership style will befacilitating, involving and valuing. It’s reallyimportant that leaders are good at saying“thank you” for people’s contributions and

transparent about how their contributionshave been shared. The group’s success willdepend on strong relationships, both withinthe group and with the main NHS partners,which need a sustained investment of timeand personal contact – leaders need topossess a degree of relentlessness anddoggedness.

Leadership roles should be paid, and involvesome formal accountability to the widernetwork. Accountability needs to be botheffective and light touch: one of the principlesof the personalisation agenda is to moveaway from complex and burdensomeprocedures, and this also applies toaccountability arrangements.


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Successful meetings

ENSURE

The peer network is resourced properly

Roles and responsibilities for leadership andfacilitation are clear

Members know what they are joining

The leader is knowledgeable about personalhealth budgets

Members’ contributions have a clear impact– people need to know they are beinglistened to

Meetings are dynamic and responsive

People are brought into the group at the earliest opportunity and at a stagewhen everyone can learn and find solutions together

Policy and processes are co-produced asmuch as possible

Investment in the peer network meanspeople can contribute to decision makingon a level playing field

The conditions make it easy for people to contribute

The group’s processes remain constructive,interested, supportive and focused

The peer network is both a collective voiceand a group of individual views

AVOID

Underestimating the importance ofinvesting time and resources in the group

Poor leadership and facilitation

Expectations that are too many/too diverse

The leader having a poor understanding of the purpose and processes of personalhealth budgets

A tokenistic approach – people will quickly notice

Rigid bureaucratic structures and processes

Developing a peer network after themajority of policies and processes have been agreed and put in place

Only bringing simple decisions to the group (nothing to get their teeth into)

People lacking comprehensive informationand sufficient time to read and digest things for their comment and contribution

Incomprehensible jargon and acronyms

The group lacking enough useful work (so the network becomes complainingrather than constructive)

Inadequate understanding of and response to group process and dynamics


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Commissioning a peer network

Always bear in mind your role, and how you are perceived. If you are a part of aclinical commissioning group that holds the purse strings and has to make difficultfunding decisions, people on the receivingend will regard you with some reserve. If you are a clinician or health care provider,you may also be seen as occupying a position of power and possibly as havingvested interests. One way to mitigate theseperceptions is to set clear ground rules for the peer network, using the reflections above, but then commission an independentperson or organisation to set up the network.Place trust in people using personal healthbudgets and their families – they are expertsthrough experience.

A peer network needs to be resourcedproperly. Leadership roles need to be paid, asdo people’s expenses. Childcare and othercaring responsibilities should also be paid for.

The process to get the network going will require careful thought and a degree of patience. Strong peer networks take time to develop.

On average, a network takes up to sixmeetings over 12 months to form a strongcore group. Almost certainly it will succeed orfail on the back of the personal commitmentof one or more local personal health budgetusers. One of the most important things NHScommissioners can do is provide good supportto people who emerge as potential leaders.Other resources may also be available to getthings moving – eg a patient involvementmanager who has good local contacts, a thirdsector organisation involved in health issues, ora broker with local knowledge. Every locality isdifferent and there is no simple prescription.

Setting up and running a peer network

However the network is commissioned, andwhoever takes the first steps, the followingpractical considerations need to be borne in mind.

n It’s helpful to think about the practicalitiesof meetings in some detail. Considertimings: do you hold meetings in thedaytime or the evenings; do you meet inthe week or at the weekend? You may notbe able to accommodate the needs of thewhole group in this regard, but try andmake it as convenient as possible for mostpeople. Raise this as an issue if necessary.

6 Practical issues


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n Make sure meetings are held in the rightkind of venue, preferably in a comfortableenvironment in the community rather thana boardroom. Think about public transportlinks and car parking. Create the rightconditions for people to engage: thinkabout physical access, lighting, temperatureand ventilation, acoustics and refreshments.Lay out the room cabaret style (with peopleround tables) and make sure the facilitatorcan be seen and heard by all.

n Be very clear about the ground rules formeeting. Make sure the group iscomfortable with these and they areaccessible, perhaps displayed on a flipchart.Rules about confidentiality, and how to pickup difficult issues if a person is distressed,are especially important.

n Try and ensure you know who is coming;make sure they are welcomed and youknow their names. Make special efforts

with new members. Be aware when peopledon’t show up, and follow up with themlater. Is there a problem? Record apologiesand note if a person is sick or unable toattend for some other reason.

n If you need people to make complexdecisions, or you are worried there will betoo much information for them toassimilate, or strongly held contrary views, itcould be appropriate to send something toread in advance to set out the issues – butdon’t make a habit of this. Don’t fall intothe trap of traditional committee meetingswith long agendas and a lot of supportingpapers.

n All concerned need to be clear about therole, remit and functions of the group. Thenational personal health budgets peernetwork meeting was set up to support thepilot programme, so members were veryclear that the purpose of the group was toco-produce ideas and solutions, tocontribute to culture change, to support thevarious work streams, and to work with thecommunications lead. Local networks needsimilar clarity.

n People need to know how the group ispositioned and perceived by the NHS andothers: how much influence it has, andhow they might realistically expect things toevolve in future. These things can beuncertain, but if so, say this. It’s importantto strike a balance between frighteningpeople off with too much responsibility, andsuggesting that they will not be listened to.


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These things can change over time – groupscan gain or lose influence – so part of theskill is getting across that the network’sdestiny rests in the members’ own hands, at least in part.

n What is expected of the group needs to becommensurate with the input of time andresources. People need enough informationand confidence to make well informedcontributions, and that requires investment,but not too much to overwhelm them.

n Establish practical rules. People need to beclear about what they are committing towhen joining – how long meetings run for,how frequently they meet; but also aboutreimbursement for their time, whatexpenses can be claimed, whether childcareand other caring responsibilities can beclaimed for, and so on.

n Do your best to help people to feel relaxedand to join in. You can’t go back to thebeginning of the developmental processevery time a new person joins, but it’simportant to revisit central concepts overtime and recognise the challenges of joininga group further down the line.

n Give people time to settle in to the network and get to know one another. It takes time and effort to make contactwith people and nurture relationships.

It will take at least four meetings before thegroup starts to form and then performproperly – group dynamics are complex andneed careful facilitation. There also needs tobe an investment of time in sharing thelocal context. People assimilate informationover time and at their own pace, so as thegroup grows it can begin to wrestle withthe more difficult questions.

n Be open and encouraging. Don’t assumethat because a person has a complex healthcondition, they’ve got too much on theirplate. Participation in the national peernetwork showed that even people in receiptof NHS Continuing Healthcare want to havea chance to contribute, and theircontribution can have real value. Givepeople the opportunity, whoever they areand whatever their circumstances.

n Keep the basics of person-centred thinkingin mind at all times.6 If things get difficult orstuck, ask people what is working and notworking regarding the point at issue.

n Consider the best ways to record themeetings. Person-centred thinking toolsprovide several options (and resources)here.6 The record needs to be clear, easilyunderstood and useful to the group.


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Peer networks can be extremely helpful, rewarding – and fun. If donewell, they can build local enthusiasm and momentum for personal healthbudgets in ways that are both positiveand realistic.

Such networks do require the investment of time and effort to get going and to get right. Experience suggests that suchinvestment is fully justified.

We have worked with Jo Fitzgerald and Colin Royle from peoplehub to help us set up and facilitate a local personal healthbudgets peer network. The peer network has brought together an enthusiastic andenergetic group of people who have helpedthe team in Oxfordshire develop and test outnew ideas around personal health budgets.

They have challenged us to think about things differently at times, but are our biggestadvocates and supporters. Within a fewmonths the people in the group have grownin confidence , so much so that they are nowwriting articles about their experience ofhaving a personal health budget, have beeninvolved in making a local DVD about whathaving a personal health budget means andhave spoken at several local and regionalevents. It has taken a few meetings, but now the group has real focus and purposeand we are looking forward to the peernetwork helping us shape personal healthbudgets in Oxfordshire as we offer them tomore people.

- Trudy Reynolds, personal health budgetslead, Oxfordshire

7 Conclusion

1 Forder, J. et al. Evaluation of the personalhealth budget pilot programme.Personal Social Services Research Unit,University of Kent for the Department ofHealth. 2012. www.phbe.org.uk

2 Personal health budgets network:peoplehub. www.peoplehub.org.uk

3 Department of Health. Personal health budgets toolkit.www.personalhealthbudgets.dh.gov.uk

4 Department of Health. Implementingeffective care planning. 2012.www.personalhealthbudgets.dh.gov.uk

5 Needham, C. and Carr, S. Co-production:an emerging evidence base for adultsocial care transformation. SCIEResearch Briefing 31. Social Care Institutefor Excellence. 2009. www.scie.org.uk

6 Helen Sanderson Associates. Reading Room: Personal budgets.www.helensandersonassociates.co.uk

8 References


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https://www.phbe.org.uk/

http://www.peoplehub.org.uk

http://www.personalhealthbudgets.dh.gov.uk/Topics/Toolkit/

http://www.personalhealthbudgets.dh.gov.uk/Topics/Toolkit/HowPHBswork/Care/

http://www.scie.org.uk/publications/briefings/briefing31/

http://www.helensandersonassociates.co.uk/reading-room/how/personal-budgets.aspx

Gateway Ref No. 18685

Personal health budgets team

Websites: www.personalhealthbudgets.dh.gov.uk/toolkitwww.nhs.uk/personalhealthbudgets

Email: [email protected]

Department of Health customer service centre: 020 7210 4850

http://www.personalhealthbudgets.dh.gov.uk/toolkit

http://www.nhs.uk/personalhealthbudgets

mailto:[email protected]

Documents

PERSONAL HEALTH BUDGETS GUIDE Developing a local peer …...The national peer network was launched in spring 2011. Since then, local peer networks have begun to meet in some of the