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A year in the life: Being a national
pilot site for personal health
budgets in the end of life pathway
24TH January 2017, AHSN End of Life Care Road Show
Nick Seecharan, Programme Manager Long Term Conditions
Outline
Who we are and why did we apply to be a pilot site? A summary
of our population based approach, personalisation agenda and the
opportunity provided by NHSE.
What we are doing and what have we achieved so far? Outline of
the experience and results to date, sharing the pitfalls and the
successes.
What’s next? How we will apply learning to meet our trajectories
Who we are
130,600 population
236,600 population
Who we are
130,600 population
236,600 population
A vision for integrated, person centred care …
A vision for integrated, person centred care …
A vision for integrated, person centred care …
A vision for integrated, person centred care …
I know my care is well planned and joined up,
whoever’s help I might need. INTEGRATION
I feel better knowing that hospital is not the only
option. CLOSER TO HOME
I feel more in control because I helped tailor my
treatment to me. PERSONALISED
I am more confident about my ability to cope with
scary symptoms. SELF MANAGEMENT
I am getting the care and support I need, when, how
and where is best for me. PATIENT EXPERIENCE
Success in transforming LTC care
What we’re doing
• NHS England national pilot site for earlier identification
and EOL planning via PHB process.
• A unique ‘upstream’ approach among the 5 pilot sites,
beyond the ‘ring fence’.
• Proactive identification of cohorts in ‘last 12 mths of life’.
Why:
The PHB personalised care and support planning process
can create a high quality and cost effective, person
centred continuum of care between complex long term
condition teams and end of life care.
The Opportunity – Innovating around End
of Life could:
Create a process to
help people identify
and share their
preferred place of
death
➢ help individuals and
families plan better &
according to their
unique
circumstances and
preferences.
Improve access, by
reducing system
pressure around
current end of life
services.
➢ supporting reviews,
improving capacity.
➢ organic development
of choice and
alternatives.
➢ a culture of proactive
preparation, rather
than last minute
reaction.
Mean a more effective
And personalised use
of resources:
➢ A potential saving of
£1.3M if all HMS
patients are cared for
outside of hospital
during the final 3
months (£23k per
patient over the final
3 months of life),
could be reinvested
to extend choice.
Average EOL utility per patient last 12 months of life
FUNDING OPTIONS
Average distribution of costs in last 12 months of life
FUNDING OPTIONS
86%
FUNDING OPTIONS
Project Partners
Stakeholders
Achievements so far
12 PCSP trained
EOL planners
6 EOL PHBs
Integrated nurse
link worker to
support cross
organisational
learning &
collaboration.
Directory of
Service
development work
for emergent
planner network.
➢ NHS provider
commitment to
collaborate on unit
cost financial
activity analysis.
➢ Close collaboration
with existing CHC
team to develop
new ways of
working.
➢ a culture of
proactive
preparation, rather
than last minute
reaction.
➢ Local EOL cost
analysis data to
inform case for
change for
innovation and
releasing
personalisation
(PHB) funds from
efficiencies
through choice.
➢ An opportunity to
develop EPaCCS
on existing
practice.
What’s next
INNOVATE
➢ The ‘pay back’ personal health budget (retrospective)
➢ The proactive, earlier identification PHB.
➢Develop the marketplace > the PCSP framework
COLLABORATE
➢Greater participation in the project.
➢ Secure a model for non ring-fenced funding.
➢Hospices, LA, LTC charities > Joint planning for 2017-19
MEET TRAJECTORIES
➢HF/ COPD cohort(s) extended beyond targeted EOL.
➢ STP PHB Trajectory planning for 2018/19 submitted.
Further ambition and trajectories
To achieve NHS England’s mandate to offer PHBs to
anyone with a long term condition who could benefit, our
proposed strategy is a S.M.A.R.T approach that:
• tests structures and principles for expansion within
‘control’ cohorts.
• evaluates and applies this learning incrementally across
larger and different cohorts.
Our STP PHB trajectory planning reflects this, with first
drafts that project the following numbers of PHBs by Q4,
2018/19:
Further ambition and trajectories
Using Horsham & Mid Sussex CCG data – of the 225
projected by Q4, 2018/19, almost two thirds are expected to
evolve from structures, principles and funding earned from
the learning and outcomes of this pilot, as follows:
• 87 of these (39%) will be EOL PHBs, based on
sustainability plans described above.
• 44 of these (20%) will be PHBs extended to new cohorts
(LTCs & mental health), based on the learning and
outcomes of the current pilot.
THANK YOU. QUESTIONS?
Contact Us
EOL PHB Pilot:
Nick Seecharan
Programme Manager, LTCs
Jamie Barallon
Project Manager, LTCs
