Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event. Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development. This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being. More information is available online: www.expo.nhs.uk

1. Moving forward with personal health
budgets
Dr Alison Austin & Colin Royle
@A_Austin4 @colinroyle

2. Contents
• What are personal health budgets?
• What do they mean for people?
• Evidence & policy context
• Coproduction
• Support for CCGs

3. The challenges
• Increasing numbers of people living with more
than one LTC – increasingdemand on services
• Safety: Francis, Berwick & Winterbourne
• Facing a decade without an increase in
spending: unprecedented in NHS history, set
against rising demand (4% pressure pa)Safety
– Francis, Berwick & Winterbourne

4. Personalhealth budget are part of the
solution, they:
• Radically changes the relationshipbetweenthe health
professional andpatient to a muchmore equal one.
• Centre arounda care plan andfocus on outcomes
• Delivers integration at individual level andhigher quality care.
• Works well for people withthe highest support needs.
• Enables a wider range of possible solutions thantraditionally
commissionedservices. Not newmoney
• Promotes self-management andreduces reliance onNHS
services.

5. Malcolm’s story
Colin Royle

7. About Malcolm
• Celebrated 70th birthday in January 2015
• Married for over 43 years
• Father to two children
• Spent most of his career in sales
• Retired in 2005 to spend more time with Anne
(Malcolm’s wife/my mother)

8. Early symptoms
• Withdrawal from activities
• Became more self-involved
• Some memory loss
• Confused and disinhibited

9. Complex needs
• Became doubly incontinent
• At high risk of choking (dysphagia)
• No longer able to understand what was being said
• Unpredictable behaviours and aggression

10. Diagnosis
• Started becoming ill immediately after retiring
• Was sectioned (3) in February 2008
• Diagnosed with right frontal lobe dementia in June 2008.
• Only one in every one million people suffer with this form of
dementia

11. Care package
• Discharged from hospital in 2008 under section 117 of Mental Health Act
• Fully funded through health
• I became Malcolm’s full time carer
• Initially attended day centre: Mon – Thurs. 8am – 5pm
• Started receiving personal health budget in 2009

12. What helps dementia sufferers?
• Consistency
• Routine
• Familiarity
• Living at home
• Clear and simple language
• Appropriate levels of medication

13. How was PHB used?
• Employed five members of staff to care for Malcolm
• We chose rates of pay for carers
• Gave choice over attending which daycentre suits him
• More flexibility in hours of support
• Used for all of Malcolm’s life needs, including health
• Purchased sky + box, rented a flat, bought a fence
amongst others

14. Real risk – Money well spent?
Daycentre - £28,500
• Didn’t understand his needs
• Generic activities
• Lack of choice
• Lots of anxiety
• Highly medicated
Sky + box - £35
• Provides choice
• Stimulates him
• Keeps him calm
• Keeps him engaged
• Keeps him safe

15. And finally…
• Malcolm passed away in April this year
• Had consistency in his care until the end
• Staff understood his needs and communicated effectively
• Staff still visit the family regularly
• Had more choice in activities
• Spent all of his life living at home with his family, some six and
a half years after being discharged from hospital

16. 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).

17. POET survey:
302 PHB holders and 247 carers took part in
2015 POET survey
• Over 85% of PHB holders and 75% of carers
said their views were included in developing
their support plan
• Over 80% of PHB holders and 75% of carers
said the budget had a positive impact on
quality of life, independence and arranging
support
• Best results when views included and the
process of getting a budget was easy
But ….
Around
15% said
aspects of
getting a
PHB was
difficult

18. Five Year Forward View
• sets out how the health service needs to change,
arguing for a new relationship with patients and
communities.
• makes a specific commitment to do more to support
people with long term conditions to manage their own
health and care.
• sets the expectation that people will be given more
choice and control, including personal budgets and
Integrated Personal Commissioning (IPC).

19. Personal health budgets are part of mainstream
NHS
•Continuing Health Care: fromApril 2014 people receiving NHS Continuing
Healthcare have had the right to ask for a personal health budget, this was
strengthened to a “right to have” in October 2014.
•Children and Families2014: children who have special educational needs
should have a single assessment, an Educational, Health and Care Plan and
the option of a personal budget.
•The NHS Mandate: fromApril 2015 people with long term conditions who
could benefit should have the option of a personal health budget.
•The 2015/16 Planning Guidance: “CCGsto lead a major expansion in
2015/16…… CCGs should engage widely ….. include clear goals on
expanding personal health budgets within their published local Joint Health
and Wellbeing Strategy.”

20. Forward View into action: Planning for 2015/16
“ CCGs should engage widely and fully with their local communities and patients, including with
their local Healthwatch,and include clear goals on expanding personal health budgets within
their published local Joint Health and Wellbeing Strategy.”
• CCGs have the flexibility to set out their own plans, informed by local demographic, current
understandingof groups who may benefit and by knowledge of where they may have the
most benefit locally.
• All offers should include:
– those eligible for adults NHS Continuing Healthcare & children’s continuing care
– children with special educational needs and disabilities
– Adults and children with learning disabilities
• Numbers will vary depending on local demographics

21. Who could benefit?
Benefit is linked to the level of need rather than on a particular diagnosis or having a
particular condition. This could equate to around 1 - 2 in 1,000 people (0.1 - 0.2% of the
population).
Groups who may benefit include:
– people receiving NHS Continuing Healthcare
– people who do not qualify for NHS CHC, but who have health needs which would be
suitable;
– children with education, health and care plans, who could benefit from a joint budget
including money from the NHS;
– people with learning disabilities and high support needs
– people who make ongoing use of mental health services;
– people for whom current services don’t work, so end up accessing acute services more; and
– people who need high cost, longer term rehabilitation e.g. people with an acquired brain
injury, spinal injury or mental health recovery

22. Importance of involving people with lived
experience
Colin Royle,
Co-founder of peoplehub

23. The importance of working together
• Bringing policy and practice together. This ‘early testing’ is incredibly
efficient.
• Spotting pitfalls - “that just wouldn’t work!”
• Offeredthoughtful challenge to policy and papers.
• Sense-checking– people with lived experience will sometimes ‘hear’
things in a different way
• Developing trust

24. Our model

25. National PHB peer network
The peer network has:
• Constructively commented on and helped to shape
emerging policy and contributed to emerging policy
and practice including the direct payments
regulations and guidance.
• Contributed to all the good practice guides.
• Identified important workforce and training issues.
• Shared their experiences at national events.
• Developed key messages on personal health
budgets.

26. All CCGs should be developing their local PHB
offer
Local offers should set out:
• Who can get a personal health budgetlocally?
• Which organisations are involved ?
• How can professionals and the public can find out more information?
• How can someone apply for a personal health budget?
Local offers should be:
• Developed togetherwith people with direct experience and providers
• Agreed by the health and wellbeing board and published
• Linked into the commissioning and contracting cycle
• Backed up by an implementation plan

27. Support
for CCGs

28. Developing the local
offer programme
Running across country starting:
London 23 Sept
Birmingham 1 October
Leeds 13 October
Newcastle 3 November
Manchester 10 November
Bristol TBC
Book at events.england.nhs.uk

29. Where to get more information
Personal Health Budget NHS Learning Network
www.personalhealthbudgets.england.nhs.ukor www.england.nhs.uk/healthbudgets
peoplehub www.peoplehub.org.uk
POET - www.thinklocalactpersonal.org.uk
Integrated Personal Commissioning
http://www.england.nhs.uk/wp-content/uploads/2014/09/ipc-prospectus-updated.pdf
Any Questions about PHBs, the support offer or POET contact:
england.personalhealthbudgets@nhs.net