The Staffordshire Way Personal Health Budgets The Gnosall
The Staffordshire Way Personal Health Budgets The Gnosall Pilot The Staffordshire Personal Health Budgets (PHBs) pilot began in April 2010 and became one of approximately 60 pilot sites across the country. Dr Ian Greaves agreed to be the clinical lead for a PHB pilot project within Gnosall Surgery focused on patients who have one or more Long Term Condition with a high dependency on their GP or secondary care. The PHB Project Manager also worked with the Continuing Health Care Team and Continuing Health Care patients. March 2011 Direct Payment Status Achieved! Direct payment status was secured on behalf of NHS North Staffordshire and South Staffs PCT the first in the West Midlands!. Achieving this meant that Staffordshire had reached the maximum level of requirements set out by the DH in order to provide real personal health budgets. Findings from Gnosall There is no common source of information on what support is available in social care or health, especially community provision, including who does
what, how much it costs and what the added value is. Calculating the individual financial envelope is easier for social care since the care plan is costed for individual needs and this is not currently the case in the NHS Personalisation training is required for health staff. Health staff tend to look at care planning in a service focussed way rather than being person centred. What is difference between a care plan and a care plan with a PHB? Dr Greaves stated that what he has learnt is that a personal care plan is key to everything. This is mirrored in the NATIONAL PHB pilot evaluation. It clearly defines medical and social care needs and the patient and family owns the care plan. It states; who will need do what by when who will pay for it how it will all come together what needs commissioned by health care and social care professionals
It is tailored to the persons lifestyle which is WHAT PERSONALISATION IS ALL ABOUT! Collaborating across Staffordshire event A countywide networking event was held in April 2011 attended by 75 people including over 40 GPs Speakers; National Clinical Director of Public Health for England Dr David Colin-Thom OBE Local GPs Dr David Hughes from Leek and Dr David Palmer from Stafford. Included a market place of 18 information stalls featuring local public and voluntary sector services to promote the wider wellbeing agenda beyond health and social care. Key milestones in the county January 2011 A showcase event to bring Cabinet Members
and Department of Health officials together to promote the Personal Health Budget Project. June 2011 Staffordshire has the first child PHB in the country Come to Staffordshire! Professor Stephen Field, Chair of the Governments NHS Future Forum visited Gnosall Surgery on 12th August 2011 More recent visitors during 2012; John Wilderspin, National Director for Health & Wellbeing Board Implementation Baroness Jolly, Co-Chair of the Parliamentary Party Committee on Health and Social Care Other initiatives 1 of 7 prestigious national Early Implementer sites for The Year of Care Funding Model The aim is to have a national funding model that facilitates the
delivery of integrated health and social care for people with a LTC based on need rather than disease. Developing the use of Direct Payments in Residential Care pilot status from the Department of Health and SCIE (Social Care Institute for Excellence) We will explore how direct payments for people in residential care will give them and their families control over the resources available to pay for their care. Where are we now with PHBs? Project Manager Matthew Oakley DoH Learning Hub status awarded in November 2012: Roll out of various training events 3 x 2-day Person Centred Thinking and Support Planning from Helen Sanderson Associates. 2 people are doing the Train the Trainer programme so training can be delivered locally in the future. How many people have PHBs? Nationally;
Three-year pilot programme tested out personal health budgets in the NHS, involving 70 PCTs in England Over 2,700 people in the pilot: including people with a range of long term conditions i.e. COPD, stroke, diabetes, neurological, mental health needs People in receipt of NHS Continuing Healthcare, many of whom previously received personal budgets in social care, were a key group In Staffordshire; 26 people have been or are still going through the process 10 have had a PHB, 5 are still ongoing Some people did decline to have a PHB The future. next steps Nationally: All people eligible for NHS continuing health care will have a right to ask for a personal health budget by April 2014 Discussions that from April 2015 there will be a wider right to ask for people with a long term condition and who would benefit from a personal health budget. In Staffordshire Project Manager funding approved by CCGs up to 31st March 2014
Establishing a Stoke & Staffordshire PHB Learning Network and continue to raise awareness of personal health budgets with key stakeholders The future . next steps Launch a Staffordshire PHB website and toolkit. Development of a personal health budget pathway with Continuing Health Care that runs from the decision to ask for a personal health budget through to the review stage, with clearly defined roles and responsibilities for staff that will support people at each stage of the process, and will deliver PHBs for patients who ask for them from April 2014 Budget setting and Financial governance, and improving direct payment
delivery through the development of a process and governance procedures for continuing healthcare and associated resources required. The future . next steps Establish a transparent method that will mean up-front budget allocations (indicative budgets) can be given to people before support planning begins; in line with best practice findings from the national pilot evaluation. Clinical governance and training Establish resources needed for clear clinical governance and training guidelines for personal assistants so personal health budget holders can employ their own staff. This will include the clinical oversight and sign-off of health tasks that personal assistants would undertake. This would look to achieve the balance between the right of the individual to control his or her care package and ensuring adequate protections are in place to safeguard well-being
. Using the Personal Budgets for Continuing Healthcare - The 10 features of an effective Process by Vidhya Alakeson Personal Health Budgets Seven Step Process - for Continuing Healthcare Step Stage What this means What will happen Choosing a personal health budget Engage the individual with the concept of the personal health budget
Information to help them make an informed decision as to whether or not they would like a PHB, once deemed eligible Calculate and share an indicative budget Identify the cash value of the PHB Person provided an indicative budget based on needs - support planning begins Support planning Develop a support plan which identifies the goals for health and well being and how those goals could be met
Support plan developed, directed by the individual stating how the budget will be spent. Assistance provided to develop the plan, where necessary. Approval the plan Support plan is approved on the basis that it will help meet the objective's set out in the support plan and does not put the individual at an unacceptable level of clinical risk Approval of the support plan by CHC Nurse - based on whether the plan will meet needs and achieve outcomes; considering risk, clinical
and financial governance. Managing the budget Individuals can exercise as much or as little direct control over the money and receive as a direct payment, via a third party or as a notional budget Get the financial arrangements in place to allow the PHB to commence Set up the support Individuals and families should have as much choice and control as they wish as to how the services and support are put in place
Identify the support provisions, as identified in the support plan. This may involve periods of recruitment. Reviewing the support plan The effectiveness of the support plan should be judged on the basis of whether the goals identified in the plan are being met CHC to review in line with current procedures, involving other professionals, family etc as necessary 1 2
3 4 5 6 7 Why are personal health budgets important? On 7 January the Government issued its Mid-Term Review, taking stock of progress made in implementing the Coalition agreement signed in May 2010. The review says: "We will continue to improve the standard of care, particularly the treatment and care of people with dementia and other long-term conditions, by: gradually increasing the availability of personal health budgets to increase
patient choice and control." The Mid Staffordshire NHS Foundation Trust Public Inquiry Chaired by Robert Francis QC Patient focussed culture Putting the Patient first What can you buy with a Personal Health Budget?
Purchase of personal exercise equipment, including treadmill, exercise bike, bicycle Personal Health Trainer Massage to improve circulation and pain relief Alternative therapies such as aromatherapy for pain relief and relaxation (reduce anxiety) Alternative approaches to smoking cessation Ways of promoting healthy eating and/or weight loss, for example kitchen equipment, bathroom scales, cost of joining a slimming club Ways of reducing social isolation, especially for those who are depressed. This could include funding leisure activities/hobbies that keep people occupied/stimulated and involve accessing the local community (providing opportunities to socialise) Equipment required to undertake leisure activities/hobbies (see above) for example art materials or sporting equipment. Travel expenses to access universal services or to pursue leisure activities (see above) To enable the service user to be accompanied on an activity, where this is necessary Purchase of air-conditioning or de-humidifying equipment (for people with breathing difficulties) Equipment to improve access around the home, for example modular ramps to improve access to different parts of the home or garden for wheelchair users
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