Integrated personal
commissioning
Mitchell’s personal health budget has transformed the quality of his care, and helped us to join up services. It has enabled us to build a skilled team around him, using
the years of expertise we have developed. It has also transformed the experience of having 24-hour care in the
home for the rest of the family.
The magic ingredient is trust. We now feel comfortable in our home, supported by people who know us well and can
make good decisions about Mitchell’s day-to-day care.
Simon Stevens calls for people
powered commissioning
In July Simon Stevens started the IPC programme to drive radical, people-powered commissioning of health and social care. The aims are:
• People and their carers have better quality of life and can achieve the outcomes that are important to them and their families
• Preventing crises in people’s lives that lead to unplanned hospital and institutional care.
• Better integration and quality of care,
• The programme brings together initiatives -personal health budgets, Long-Term Conditions Year of Care programme, the
Aimed at four groups of people
with health and social care needs
• Children and young people with complex needs.
• People with multiple long-term conditions, particularly older people with frailty.
• People with learning disabilities with high support
needs, including those in institutional settings or at risk of being placed there.
• People with significant mental health needs, such as those eligible for the Care Programme Approach or those who use high levels of unplanned care.
Person centred care principles
• Person-centred care and support planning: Access to support to enable people to develop a plan which covers all aspects of life, not just tightly defined health and care need.
• Personal health and social care budgets ambition: People can have control over their budget, including the option of a direct payment. Personal health and/or social care budgets will be offered to those who could benefit or who are eligible from within the population, including the option of a direct payment.
• CCG Planning guidance talks of capitated ‘Year of Care’ budget. This could come from 1% of CCG budget ring fenced to support new ways of working
• Information, support, advice and advocacy: Access to good information support, advice and advocacy from a range of sources. No one should be excluded from the opportunity to take part because of their background.
• CCG Planning guidance specifically extends personal health budgets to people with learning disability to enable them to live in community
Integrated Personal Commissioning
is based on two core elements
Care model: Person-centred care and care planning,
combined with an optional personal health and social care budget
• To include personalised care and support planning,
independent advocacy, peer support and brokerage AND a clear offer of integrated personal budgets for those who will benefit.
Financial model: An integrated, “year of care” capitated payment model
• To remove existing financial barriers to prevention and
integration, as well incentives for unnecessary activity that drive up costs. Sites will develop and test a blended funding model that brings together all the NHS and local authority funding for a defined target population.
Sites will need:
• Strong local partnership and community involvement: The local authority, the CCG and VCS, alongside people who use services and their families.
• Good fit with local strategies: Clear links to implementation of the Care Act, the Children and Families’ Act and the use of the Better Care Fund.
• An identified cohort: Develop targeting approaches within populations
• Integrated, capitated payments: Develop new ways to understand costs and pay for health and social care services.
• Information, support, advice and advocacy: In partnership with VCS.
• Person-centred planning: That covers all aspects of people’s lives.
• Peer support: Investing in the local voluntary sector and community groups.
• Personal budgets: Giving control over the budget; option of a direct payment.
• Metrics and evaluation: Tracking the difference this has made for people and the impact on the system, to allow robust evaluation.
Support offer to sites
Where sites are already part of a related programme such as personal health budgets Going Further Faster, Integration Pioneers or Year of Care the support they receive support designed to complement and be co-ordinated with any existing provision. It will include:
• Help on key issues: such as the financial model, information governance, risk stratification, care planning, personal budgets
• Leadership and organisational development: support to develop strong partnerships, to co-produce with people who use services, and to support staff to adopt new ways of working.
• Access to networks: eg via Think Local, Act and the Coalition for Collaborative Care.
Next Steps
Next steps:
• Selection process completed December 2014
• Models to be operational by April 2015
• Evaluation through 2015-17 SW Collaborative
• 30 January Thought leadership event Bridgwater
• July 2015 Cohort 2 – Dartington and then six monthly wave of Cohort
Five Year Forward View
• Partnership between NHS, LA and Voluntary sector
• Current pattern unsustainable
• Radical upgrade in prevention and public health – failed to act on Wanless warning.
• Where people need health care, to have more control
• Services for people with multiple conditions not single illness– break down traditional barriers/patterns
• Support carers and involve communities/vol sector
• Activated patients
