Webinar slides: Personal health budgets and mental health: Getting ready and getting it right

Personal Health Budgets for Mental Health:Getting ready and getting it right

Vidhya Alakeson and Alex Mycawka7th May 2014

How to participate today

Contents

1. What is a personal health budget – a quick recap

2. Experience and evidence from the national pilot programme

3. Roll out and the mental health demonstrator programme

4. Opportunities in mental health5. Challenges in moving forward

WHAT IS A PERSONAL HEALTH BUDGET?

What is a personal health budget?

An allocation of NHS resources to meet identified health and well being needs

A route to increase individual choice and control in decision-making about healthcare

A means to create greater shared decision-making in the NHS

A tool to support individual recovery

5 features of a PHB as defined by NHS England The person with a PHB:

1. Is able to choose the health and wellbeing outcomes they want to achieve

2. Knows how much money they have for their health care and support

3. Is enabled to create their own care plan4. Is able to choose how their budget is held and

managed5. Is able to spend the money in ways and at times that

make sense to them

THE NATIONAL PILOT PROGRAMME

Examples from national pilot programme

Recovery budgets in Merseyside PHBs for dementia in continuing healthcare IAPT pilot in Eastern and Coastal Kent Substance misuse treatment and recovery pilot

in Croydon Community mental health team pilot in

Northamptonshire

Positive findings from the national PHB evaluation Significant improvements in care-related quality of life and

psychological well being No impact on health status or on clinical measures No significant differences by age, sex or socio-economic

status Lower costs of inpatient care compared to the control group -

£1400 per person per year. Overall more cost effective than conventional service delivery Particularly positive effects for CHC, mental health, for larger

PHBs over £1000 and for PHBs that were implemented flexibly.

Implementation matters: Do it right or not at all• The national evaluation is clear: how personal health

budgets are implemented has a real impact on outcomes• Most positive outcomes depend on flexibility over:

– how PHBs can be used – individual creativity not menus

– how the money can be held – full range of options needs to be available

• Restrictive implementation can result in negative impact on budget holders

ROLL OUT AND THE DEMONSTRATOR SITES

NHS mandate commits to roll out

Option for people with long term physical and mental health conditions who could benefit from April 2015

“I’m pleased to see the work that NHS England is doing with clinical commissioning groups on the use of personal health budgets within mental health services. I hope that the experience drawn from this work will enable the roll out of their use in mental health services across the country” (Norman Lamb MP, Dec 2013)

Mental health demonstrator programme Launched by Norman Lamb MP in December 2013 – 18

month programme 13 sites – mix of former pilot sites and new local

partnerships High cost populations: out of area placements, high cost

residential placements, frequent users of inpatient or A&E services, primary care mental health services.

Focus is on how to implement personal health budgets sustainably within the mainstream NHS – no longer a pilot

THE OPPORTUNITIES

Supporting individual recovery journeys

Providing alternative crisis care

Preventing hospitalisation and crisis

Participant Total costs of care 2010-11 (excluding meds)

Total costs of care 2011-12 (excluding meds)

Difference in costs

A £19,464.75 £14,207.36 - 5,257.39

B £56,291.89 £16,903.11 - 39,388.78

C £6,263.24 £11, 068.84 + 4805.60

D £40,934.71 £4,259.08 - 36,675.63

E £15,527.88 £3,056.16 - 12,471.72

Total £138,482.47 £49,494.55 - 88,987.92

Costs for individuals before and after receiving a personal health budget, Northamptonshire

Providing integrated whole person care

THE CHALLENGES

Allocating resources to individual

Use costs of previous year’s community mental health service costs?

Include some of the costs of inpatient and crisis services?

Base personal health budgets on mental health cluster costs?

Invest in an off-the-shelf resource allocation package?

Unlocking money from existing contracts

Agreeing the scope of personal health budgets

Only a few sites in the pilot programme included all outpatient clinical services in a personal health budget e.g. Northamptonshire, Croydon

Most sites offered limited choice, restricted to support services

Range of reasons for limiting clinical services, including getting buy-in from trust

What do you think should be in and out of a personal health budget?

Achieving the necessary culture change ‘I’m a highly trained, highly expert specialist in a field

which has involved many, many years of training, many years of clinical experience, and my job is to know the best evidence and best practice for the kind of presentations that I’m expected to see within my field. It would be completely against my code of practice to say to a young person, yes, go ahead and spend money on something that has no evidence base’ (Psychiatrist)

Alex Mycawka

Any questions?

Further information

www.in-control.org.uk/health www.in-control.org.uk/webinarschedule2014www.in-control.org.uk/stayconnected

[email protected]@yahoo.co.uk