Delivering Personal Health Budgets – Lambeth - NDTi · Delivering Personal Health Budgets –...

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

Click to edit Master title style

Types of Budgets offered

• One-off Personal Health Budgets

– Up to £500

– A way to support and enable isolated recovery needs

• Click to edit Master text styles

– 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


Achievements

• Co-production as the start point for everything.

• Integration of social care and health processes.

• Peer support.


– Second level

• Third level

– Fourth level

» Fifth level

13

• 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.


OutcomesRecovery Star Outcome Comparisons

30%

40%

50%

60%

70%80%

90%

100%

Reduction

Same

Improvement


– Second level

• Third level

– Fourth level

» Fifth level

14

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


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


– Second level

• Third level

– Fourth level

» Fifth level

15

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


Joe


– Second level

• Third level

– Fourth level

» Fifth level

16


• 4 hours of Personal Assistant (PA) support per week

- Budgeting/debt repayments

- Cleaning/laundry/shopping

Joe’s Integrated Personal Budget


– Second level

• Third level

– Fourth level

» Fifth level

17

- Cleaning/laundry/shopping

- Prompting for self care, medication monitoring

• Cooker/fridge/doorbell/showerhead

• Key safe

• Home and Dry redecoration

• Deep clean/rubbish removal


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


– Second level

• Third level

– Fourth level

» Fifth level

18

• 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


• 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


– Second level

• Third level

– Fourth level

» Fifth level

19

• 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


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


– Second level

• Third level

– Fourth level

» Fifth level

20

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


Build case for change

Articulatevision

Createsystemconditions

Developtechnology

strategy

Develop health workforce

strategy

Diagnosesystemprogress

Engagestakeholders

Applyinnovationmethods

Developdiffusionstrategy

Identifyinnovationpriorities

System transformation road map


– Second level

• Third level

– Fourth level

» Fifth level

21

strategystrategy

Lead &managechange

Identifymetrics

Mobilizeresources

Develop newrelationships

Develop new packages

DevelopNew outcomes

GENERIC INNOVATION HEALTH



– Second level

• Third level

– Fourth level

» Fifth level

22


Denis O’Rourke (NHS Lambeth CCG)

[email protected]

Rachel King (Personal Health Budget Co-rd)

[email protected]


– Second level

• Third level

– Fourth level

» Fifth level

23

Mark Young (Support Planner/Broker - COT)

[email protected]

The Collaborative

www.lambethcollaborative.org.uk

Delivering Personal Health Budgets – Lambeth - NDTi · Delivering Personal Health Budgets –...

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