Agenda item

To receive a report from Maria Smith, Strategic Lead for Personal Health Budgets for Leicester City, West Leicestershire and East Leicestershire and Rutland Clinical Commissioning Groups.  The report sets out the CCG’s Local Offer and the plans currently in development to expand the offer in line with national guidance.

The Board received a report from Maria Smith, Strategic Lead for Personal Health Budgets for Leicester City, West Leicestershire and East Leicestershire and Rutland Clinical Commissioning Groups.  The report set out the CCG’s Local Offer and the plans currently in development to expand the offer in line with national guidance.

It was noted that:-

a)         There was requirement for Health and Wellbeing Board to be informed of the local personal health budget (PHB) offer.  

b)         Individuals eligible for continued health care (CHC) had been given the right to have a personal health budget since 2014. 

c)         The Integrated Implementation Group comprised representatives of all three local authority‘s children’s, adult social care and education services, LPT, the 3 Healthwatch groups in the LLR and procurement, finance and communications representatives.  The group were building the integrated personal budget process and the broad pathway for the future.

d)         Services for individuals requiring a mental health package would be the main focus for 2017/18 and the focus in 2018/19 would be those with long term health conditions.

e)         One challenge of offering personal budgets was that existing funds were predominately contained within large block contracts and disaggregating these elements to release the resources to offer services in a different way was a complex process.  Work was progressing with LPT and contracting and commissioning colleagues to resolve these issues. 

f)          The proposals for the PHBs Local Offer linked well with the work already being undertaken on the STP.  There were close links with the STP’s Integrated Locality Teams Programme Board to ensure the models they were creating also had an integrated personal budget offer as part of their delivery offer.

In response to Members’ questions the following responses were received:-

a)         At present there were 105 PHBs in place within LLR and the early evidence suggested that individuals had yet not chosen to have radically different health care support than they had received in previous packages.  Initial feedback from patients, their representative and carers on the group generally indicated that, whilst they were some frustrations with the process as it was being developed, there was, nonetheless, indications that recipients of PHBs were happier with their care compared to their previous continued health care packages.  A cultural change was needed within the NHS to move away from a service led approach, which may not always provide services to meet individual needs.  Equally, a corresponding cultural change was also required from individuals who were still generally asking for a specified number of hours for their care rather than opting for other forms of care.

b)         There was no evidence to suggest that PHBs for people with physical and mental health issues had been subjected to financial abuse.  Those administering the PHBs also had some experience of monitoring budgets for those who couldn’t look after themselves within the current CHC packages.   Whilst financial abuse could never be guaranteed, there were safeguards and guidelines in place intended to prevent this.  Third party organisations were also involved in helping to manage money in these circumstances, and, in some instances, court appointed representatives of the patients were involved.   In addition, there was a stringent monitoring programme in place that reviewed the budgets every three months.

c)         A recent review of equality and diversity responsibilities had indicated that data was not being collected to allow detailed monitoring of which parts of community had taken up PHBs; either in relation to ethnic diversity or in relation to taking up services which may be more culturally sensitive to their needs.   This data would be captured in the future for both PHBs and CHCs and would be integrated into one team.  This should make the process more efficient and responsive to patient’s needs. 

d)         It was not possible to confirm the total financial envelope for the 1-2,000 PHBs envisaged in next 3-5 years as this was currently being scoped at present; and there were no details, as yet, of the financial resources that could be released from the large block contracts.  This profiling could be shared with the Board members.  In essence, there was no new money within the health system for funding PHBs and existing resources would need to be spent in different ways than at present.  Staff were working with providers to examine ways in which the process could be taken forward and there was no intention to remove an existing service that worked well.  The key to the process would be monitoring the risks and how those risks would be managed, as it would not be possible to provide existing services and provide different care services as part of PHBs at the same time.  Resources would gradually need to be transferred from the big block contracts to the PHBs since the CCGs were not allowed to fund both. 

f)          It was estimated that the likely cost of CHC packages was approximately £3.9m per year per 1,000 people.

g)         Staff were working with LPT to see what the potential consequences upon existing services could be and also what future services could look like.  There was also a need to break through organisational barriers to enable different service delivery.   For example, PHBs may be able to provide care differently for patients with long term conditions that can’t be cured but, nevertheless, could improve a patient’s outcomes and prevent them going into crisis.  This would benefit the system overall by enabling people to be cared for at home (or in residential setting) for longer instead of being cared for in the acute sector.  Services would look very different in 5 and 10 years’ time and this transition would need to done in a planned and phased way with all stakeholders involved.

The Chair commented that the Board required a more details of the financial implications for the future service provision of the expanded PHB offer as it needed to understand the potential risks involved and could only endorse the proposals if it had all the relevant information available on which to make an informed decision.

AGREED

1)         That the Board support the principle and concept of Personal Health Budgets.

2)         That the Board does not have sufficient financial information in relation to future years in order to endorse the planned further expansion of personal health budget/integrated personal budget offer into 2017 and beyond.

3)         That the financial information be shared with the Chair to circulate to Board Members and subsequently a response to the planned future expansion.