Individual budgets and healthcare presentation by Jon
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Transcript Individual budgets and healthcare presentation by Jon
Partnerships and
personalisation: the
implications of direct
payments and personal
budgets
Prof. Jon Glasby
Co-Director, Health Services Management Centre
Outline
Background
Advantages/barriers
Personal budgets
Implications for social care
(Tentative) implications for health care
1. Background
“The potential for the most fundamental
reorganisation of welfare for half a century”
Cash payments to service users aged 18-65
in lieu of direct service provision
Extended to include older people, younger
people aged 16 and 17, carers and the
parents of disabled children
Now mandatory rather than discretionary
1. Background
Illegal under 1948 legislation
Indirect payments (pioneered by disabled
people)
ILF
1990 NHS and Community Care Act
Lobbying and research by disabled people
Disabled people involved in
implementing direct payments
1. Direct Payments are very simple
– it’s not hard
Direct Payments = a means to an end
(of independent living)
Choice and control are central
2. Advantages
More responsive services and increased
choice and control
Improved morale and mental/psychological
wellbeing
A more creative use of resources which may
sometimes reduce costs, but which certainly
ensures better value for money
A blurring of the boundary between
health and social care
2. Barriers
Perceived focus on physical impairment
‘Willing and able’
Complexity of monitoring arrangements
Staff attitudes and knowledge
Political concerns in some authorities:
‘privatisation by the backdoor’?
Boundaries with NHS and housing
3. Personal budgets
Rights-based approach (more like social
security than traditional social care)
Links to PCP and circles of support
Sees DPs/PBs as a means to an end
Can use same resources much more
effectively
Emphasised in the White Paper and being
rolled out
3. Seven steps to Self-directed Support
Set
PB (using in Control’s RAS)
Plan support – with support as needed
Agree plan
Manage PB (currently 6 distinct degrees
of control)
Organise support – complete flexibility
Live life - people use their PBs to
achieve outcomes important to them
Review and learn
4. Implications for social care
“In the future, all individuals eligible for publiclyfunded adult social care will have a personal
budget (other than in circumstances where
people require emergency access to
provision): a clear, upfront allocation of
funding to enable them to make informed
choices about how best to meet their needs.”
(Transforming social care 2008 circular)
4. Implications for social care
Not a matter of ‘whether’ but of ‘how’ and ‘how
quickly’
Significant cultural challenges for whole of social care
Key test will be not regulating/scrutinising the new
system to death
Focus shifts from assessment and from services to
planning/review/outcomes
Holds out the potential for reforming the system as a
whole – not just bolting on to the existing system
5. (Tentative) implications for health
People do use DP/PB for health care
Separating health and social care rarely
makes sense to the individual (or workers)
DP/PB for social care and not health flies in
the face of the partnership agenda
DP/PB could help the NHS deliver key
priorities
Growing sense of momentum
5. What could the world be like? –
HSMC’s expert seminar, 2004
How can we make direct payments work
better in integrated health and social care
settings?
Could/should direct payments be extended to
health care and in which areas of health
care? What implications might this have?
Could we learn from the choice and control of
direct payments to improve health care?
5. What could the world be like? –
HSMC’s expert seminar, 2004
Would fit well with long-term conditions
agenda
Scope to extend to specific groups
Wide concerns about a broader roll out
(equity, supply, cost etc)
Scope to learn DP lessons in health care
Need to repeat the 1990s battle for ‘hearts
and minds’
5. Key questions for health care?
When might it improve outcomes if people
know upfront how much is available to meet
their needs?
When could the person/those close to them/a
worker achieve better outcomes by having
the flexibility to be creative?
Where is it really important that support is
truly personalised?
5. Possible areas for an integrated PB?
LTC (admission avoidance)?
Mental health (recovery budget)?
Continuing care?
Maternity services?
Expensive out-of-area placements?
Learning difficulty services?
Disabled children?
End of life care?
Etc etc
5. How could this work for LTCs?
Scope for an admission avoidance scheme
(with IB set at a % of the tariff)?
Scope to compare community matron v
budget-holding professional v CIL/peer
support model?
Scope to work with LA to make money
available (similar to Pointon case)?
Scope to encourage Independent Living
Trusts?
Further information
Alakeson, V. (2008) Let patients control the purse
strings, BMJ, 12 April, 807-809
Glasby, J. and Duffy, S. (2007) – policy paper on
direct payments and health (www.bham.ac.uk/hsmc)
Glasby and Littlechild (2009) Direct payments and
personal budgets. Policy Press
In Control (www.in-control.org.uk)
National Centre for Independent Living
(www.ncil.org.uk)
See also, the partnerships and personalisation section
of the HSMC website