Delivering Personal Health Budgets – Lambeth Denis O’Rourke NHS Lambeth CCG NHS Lambeth CCG Rachel King Personal Health Budget Coordinator (Lambeth) Mark Young Support Planner/Broker (COT)
Delivering Personal Health Budgets – LambethDenis O’Rourke
NHS Lambeth CCGNHS Lambeth CCG
Rachel King
Personal Health Budget Coordinator (Lambeth)
Mark Young
Support Planner/Broker (COT)
Background to Personal Health
Budgets• Lambeth PHB Pilot established in 2009
• Co-produced by service users, carers, PCT, SLaM, VCS and LA
• Key driver – lack of progress on • Key driver – lack of progress on recovery/personalisation
• Focus on working with people using primary and secondary mental health services
• Offering ‘one-off’ and ‘integrated’ PHBs
• Now part of the (DoH) Going Further Faster programme
The wider context in which PHB has developed in
Lambeth
3
Lambeth
Create a platform for people to come together
Voluntary Sector Providers CliniciansPrimary Care
Public Health
People who
use services Commissioners
THE
COLLABORATIVE
THE
COLLABORATIVE
Carers
Public Health
Mental Health
Trust
The Lambeth Living Well Collaborative
Social Care
We trying to applying the principles of Co-production in our commissioning and service delivery
1. Recognising people as assets
10/04/12
2. Building on people’s existing capabilities3. Peers support networks4. Blurring distinctions5. Facilitating rather than delivering6. Mutuality and reciprocity
Nef&Nesta
People Powered Health Programme -applying the principles of Co-production at a system level(see PPH….Commissioning People Powered health 2013)
Running an ongoing
process involving over
1,600 people actively
contributing to the
design and delivery of
improved services
Key elements of our service model
• People as citizens and partners in delivery of their care
• Integrated care and support – one caseload?
• Improved access• Improved access
• Better guidance and support in the community
• Building primary care capacity
• Peer support in all settings
• Increased user control and choice
• Getting connected and supporting reciprocity
Our big 3 outcomes
1. To recover &
stay well
2. To make their own
choices3. And to participate
on an equal footing
in daily life
Our road map – trying to take whole
system approach
Programme Management
LLWC Thursday monthly meetings
MHIP Commissioning / QIPP Board meetings
Lambeth CCG meetings
Borough Wide Co-production Events
Locality meetings (e.g. PC)
Quarterly SLaM quality contract review meetings
PAG/Commissioner monthly meeting
Outcomes Impact Targets
Integrated services to make a better offer
Revise Collaborative vision and principles
Reduction in Residential Care via SWOT
Living Well Network implementation
Rehabiltation Service Review
Prototype Crisis Retreat
Vocational and Employment services
Redesign acute bed based services
CMHT redesign
Integrated Talking Therapies
Improving info and choice optionsSupport min 20 people move on from residential care
(baseline 140)
250 people access service offer by March 2014
Big 3 outcomes progress
Service offer evaluation (12 ppl)
Service offer large evaluation (c250 ppl)
Follow up of COT clients that have been discharged
PHB/GFF 125 people to access PHB - by March 14
R&S uptake (monitor quarterly)
Working with People Differently
Timebanking
Peer Support
My Health Locker
Mobilising people and changing our culture
Workforce and Culture Change Strategy
Communications Strategy
Co-Production Platform/Academy
Personal Budgets
Improving info and choice options
Connecting Communities / asset based framework
Community Medication service - prototype
Changing the way services are commissioned
Modelling to support LWN and CMHT redesign
Voluntary and Community Services
GSTT Charity Bid development
Collaborative Alliance Contracting/Commissioning Framework
Development of Big 3/Health of the system Metrics
Refresh system investment map
Collaborative Leadership
Build the case for change
Engage and support the development of the cooperative council
Engage with regional and national organisations and networks to
promote and share co-production
Continued development of the Collaborative platform and
development of metrics to assess the 'health' of the collaborative
• Over 400 people supported by the Community Options Team/ Primary Care Support Service with c300 moved on from CMHT during 2012
• Information and Resource Hub (managed joint with peers) opened June 2013
• 3 locality Timebanking partnerships growing
Impact to date
• 3 locality Timebanking partnerships growing
• Peer Support initiatives expanding (e.g. Missing Link, Solidarity in Crisis, Mind)
• Agreement on system change – new front end “Living Well Network” and redesign of secondary care services
• Provider Alliance Group established – full time project manager –moving toward a single alliance contract
• So far over 80 people have a Personal Health Budget to support recovery
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Types of Budgets offered
• One-off Personal Health Budgets
– Up to £500
– A way to support and enable isolated recovery needs
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– Second level
• Third level
– Fourth level
» Fifth level
12
• Integrated Personal Budgets
– Merging and streamlining the Adult Health and Social Care
processes
– FACS eligible needs
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Achievements
• Co-production as the start point for everything.
• Integration of social care and health processes.
• Peer support.
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• Third level
– Fourth level
» Fifth level
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• Borough wide Recovery and Support Plan.
• Currently developing an integrated assessment.
• Voluntary sector’s role: support planning and brokerage.
• Personalisation and personal budgets as the cornerstone to all service development/s.
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OutcomesRecovery Star Outcome Comparisons
30%
40%
50%
60%
70%80%
90%
100%
Reduction
Same
Improvement
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• Third level
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0%
10%
20%30%
Managin
g Menta
l Hea
lth
Phys
ical
Health
and S
elf C
areLivi
ng Skil
lsSocia
l Net
works
Work
Rel
ationsh
ips
Addict
ive B
ehaviour
sR
esponsi
bilitie
s
Identit
y & S
elf Est
eemTru
st &
Hop
e
Recovery Star Outcome Area
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How budgets were spentArea Example of spends
Furniture/Household Washing machines, curtains, carpet, removals, fridges, cookers,
redecoration, doorbell, showerhead, cupboard conversion
Electronics Laptops, SAD lights, camera
Fitness/Gym Gym membership, trainers, treadmills, bicycles and associated
accessories, rowing machine, fitness DVD
Travel Train ticket to visit family, respite breaks, travel to access support
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• Third level
– Fourth level
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Travel Train ticket to visit family, respite breaks, travel to access support
services
Vocational/Leisure Driving lessons, gym instructor courses, writing courses, singing
courses, Sky TV, ESOL 1:1 tutoring, art materials, tattoo convention
ticket, media course, internet connection
Assistive
Technology
Pivotal, door alarms, gas shut offs, personal alarms
Assistance/Re-
skilling
Personal assistant/s
Spiritual Religious retreats, headstone
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Joe
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• 4 hours of Personal Assistant (PA) support per week
- Budgeting/debt repayments
- Cleaning/laundry/shopping
Joe’s Integrated Personal Budget
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• Third level
– Fourth level
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- Cleaning/laundry/shopping
- Prompting for self care, medication monitoring
• Cooker/fridge/doorbell/showerhead
• Key safe
• Home and Dry redecoration
• Deep clean/rubbish removal
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Benefits of Integrated Personal Budgets• A personalised approach to support
• Greater involvement in planning of support
• Indications that this reduces frequency of contact with secondary services, and reduces length of hospital
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• Indications that this reduces frequency of contact with secondary services, and reduces length of hospital stay
• More flexibility around how funds can be spent
• Health and social care needs met with the one package of support
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• Mainstreaming personal health budgets; developing the PA market and RAS.
• Mainstreaming the integrated assessment and single recovery plan across 4 boroughs
• A risk aware approach to supporting people
Challenges going forward
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• A risk aware approach to supporting people
• Ongoing reduction in public sector expenditure – 25% cuts in LGovt
• Integrated provision through Alliance Contracting c£70M
• Aligning PbyResults with outcomes?
• Workforce culture change to support co-production at all levels
• System commitment to transformation through co-production
• Lambeth Big Health Debate
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Current
Multiple
2012/13
Contract
values
Current
Multiple
2012/13
service,
Future
Single
2015/16
Alliance
Future
Single
2015/16
Big 3
Integrated Provision - Alliance contract
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values
49 Primary care
practices
20 Third sector
providers
MH Trusts (SLaM,
SWLSTG)
service,
activity and
productivity
profiles
Alliance
Contract /
Joint
Venture
framework
Big 3
outcome and
productivity
profiles
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Build case for change
Articulatevision
Createsystemconditions
Developtechnology
strategy
Develop health workforce
strategy
Diagnosesystemprogress
Engagestakeholders
Applyinnovationmethods
Developdiffusionstrategy
Identifyinnovationpriorities
System transformation road map
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strategystrategy
Lead &managechange
Identifymetrics
Mobilizeresources
Develop newrelationships
Develop new packages
DevelopNew outcomes
GENERIC INNOVATION HEALTH
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Denis O’Rourke (NHS Lambeth CCG)
Rachel King (Personal Health Budget Co-rd)
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Mark Young (Support Planner/Broker - COT)
The Collaborative
www.lambethcollaborative.org.uk