Personal Health Budgets for Mental Health: Getting ready and getting it right Vidhya Alakeson and Alex Mycawka 7th May 2014

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Personal Health Budgets for Mental Health: Getting ready and getting it right Vidhya Alakeson and Alex Mycawka 7th May 2014

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How to participate today

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Contents What is a personal health budget – a quick recap Experience and evidence from the national pilot programme Roll out and the mental health demonstrator programme Opportunities in mental health Challenges in moving forward

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What is a personal health budget?

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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

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5 features of a PHB as defined by NHS England The person with a PHB: Is able to choose the health and wellbeing outcomes they want to achieve Knows how much money they have for their health care and support Is enabled to create their own care plan Is able to choose how their budget is held and managed Is able to spend the money in ways and at times that make sense to them

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The national pilot programme

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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

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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.

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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

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Roll out and the Demonstrator Sites

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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)

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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

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The Opportunities

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Supporting individual recovery journeys

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Providing alternative crisis care

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

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Providing integrated whole person care

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The CHallenges

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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?

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Unlocking money from existing contracts

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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?

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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)

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Alex Mycawka

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Any questions?

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Further information www.in-control.org.uk/health www.in-control.org.uk/webinarschedule2014 www.in-control.org.uk/stayconnected health@in-control.org.uk alakesonvidhya@yahoo.co.uk