www.england.nhs.uk
Realising the
Potential of People
Dr Alison Austin
Personalisation Lead,
NHS England
@
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
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The Challenges
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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
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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”
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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
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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
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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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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
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What the Mandate means: Who benefits?
If you’re going to do it… do it right
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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
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• 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