Transcript Citizens Commissioning for health : practical possibilities

Citizens Commissioning
for health : practical
possibilities
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What’s this workshop all about?
This workshop is an invitation to think
through some of the issues relating to
holding and managing a personal health
budget.
There’s a lot to think about together!
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We think…
that the success of personal health budgets
will depend on citizens co-designing and
co-producing the developing market
because…..
citizens are the people who know best what
their needs are and what will meet them
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This will mean…
Citizens working in partnership with:
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Primary Care Trusts
Local Authority commissioners
User-led organisations
Providers
So, we need to be clear about what’s important
and why.
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So, what are we talking about?
The ways of holding and managing a personal
health budget and their potential impact on
the experience.
1. Notional budget (no money changes
hands)
2. Real budget held by a third party.
3. Direct payment. (Being piloted this year).
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True or false ?
Does having a personal health
budget give you choice and
control ?
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Yes?
The answer should be a resounding yes!
But…..
We think that being given a personal
health budget is only the beginning.
Having more choice and control isn’t just
about having a budget to plan with; it’s
also about day-to-day decision-making.
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So, let’s think about it
Sally is 22 years old and has complex
health needs. She has a personal health
budget. Her mum, Margaret, is recruiting
staff for Sally’s team.
The manager of the agency which is
holding Sally’s budget suggests she helps
with the recruitment process. She also
suggests that the area manager gets
involved too.
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The shortlisted interviewees
Hayley
Mary
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Who decides ?
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Margaret is keen to employ Hayley
because she is Sally’s choice.
Since the agency is holding Sally’s
budget, they are the legal employer’s
of Sally’s staff.
Who should have the final say?
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What’s the deal?
Notional budget – No money changes
hands but an individual understands their
budget and has a say in how it’s spent.
Direct payment – gives an individual
maximum choice and control but also
brings responsibilities (although there is
help and support available.)
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What are the third party
options?
Whilst every option should enable the same
amount of choice and control, the locus of
control will be different depending on the
arrangement.
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Practical Possibilities
Vs
Potential Pitfalls
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An Independent User Trust
(also known as Independent Living Trusts)
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Practical Possibilities:
Puts the individual at the heart of the decisionmaking process.
Friends, family members, advocates or others can
be trustees.
The trust follows the rules set out in the trust deed
and can employ staff.
Potential Pitfalls:
Not everyone has an established circle of support.
Trustees may see the responsibility as too onerous.
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A community interest company
(a type of social enterprise)
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Practical Possibilities:
They are quite easy to arrange and are not-for-profit.
Families could join together to set up their own CIC.
The DH is encouraging the use of CIC’s so there
should be help available.
Potential Pitfalls:
 A CIC for more than one person would need to be
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CQC registered and the individual focus would be
lost.
You will probably need funding for start-up costs
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User-led Organisation
Practical Possibilities:
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All Local Authorities are now required to support the
development of a user-led organisation in their area.
The locus of control lies with citizens
Potential Pitfalls:
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May have a wide remit and lots of clients
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Voluntary Organisation
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Practical Possibilities:
Good source of advice, information and support
Good networks and more community-based
CQC registration
Not-for-profit
Potential Pitfalls:
Budget holder’s voice weakened
Organisation may have a wide remit and many
clients.
Likely to be bureaucratic.
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Private Sector
Practical Possibilities:
 Commercial drive
 Service development
 CQC registration
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Potential Pitfalls:
Budget holder’s voice weakened
Organisation may have a wide remit and many
clients.
Likely to be bureaucratic.
Profit motive
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What are the ingredients of a good
third party arrangement?
Guiding Principles
Self-determination
Transparency
Choice and Control
Three guiding principles in
“Managing the Money:
Resource Development Options for
Personal Budgets”(CSIP)
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Self-determination:
Decision-making should be as close to
the individual as possible remembering
that involving them is not the same as
sharing power.
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Transparency
The individual should:
 know the sum of money available to them to
meet their outcomes.
 be central to decision-making on financial
matters
 Have easy access to detailed income and
expenditure
The budget:
has to be separately accounted for within the
third party banking arrangement.
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Choice and Control
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Promotes citizenship
Puts the emphasis on flexibility
Focuses on outcomes.
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What are other people doing?
Malcolm’s Story
(an example of a not-for-profit registered
charity holding and co-managing a personal
health budget)
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For You To Take-away
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We need to make sure that decision-making
is as close to the person as possible.
Citizens need to be involved as
commissioners in third-party arrangements.
We need to make sure the shift in power is
real.
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What else do we need to
consider?
1.
2.
3.
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5.
How can we begin to shape the
developing market?
How do we know who to trust?
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Our To-Do List
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5.
Find out who is interested in shaping
developing the market.
Find out which social enterprises, user-led
organisations and providers are already
working on issues relating to personal
health budgets.
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