Personal Health Budgets for Mental Health:Getting ready and getting it rightVidhya Alakeson and Alex Mycawka7th May 2014 презентация

Alakeson and Alex Mycawka 7th May 2014

evidence from the national pilot programme
Roll out and the mental health demonstrator programme
Opportunities in mental health
Challenges in moving forward

meet identified health and well being needs
A route to increase individual choice and control in decision-making about healthcare
A means to create greater shared decision-making in the NHS
A tool to support individual recovery

with a PHB:
Is able to choose the health and wellbeing outcomes they want to achieve
Knows how much money they have for their health care and support
Is enabled to create their own care plan
Is able to choose how their budget is held and managed
Is able to spend the money in ways and at times that make sense to them

in continuing healthcare
IAPT pilot in Eastern and Coastal Kent
Substance misuse treatment and recovery pilot in Croydon
Community mental health team pilot in Northamptonshire

of life and psychological well being
No impact on health status or on clinical measures
No significant differences by age, sex or socio-economic status
Lower costs of inpatient care compared to the control group - £1400 per person per year.
Overall more cost effective than conventional service delivery
Particularly positive effects for CHC, mental health, for larger PHBs over £1000 and for PHBs that were implemented flexibly.

is clear: how personal health budgets are implemented has a real impact on outcomes
Most positive outcomes depend on flexibility over:
how PHBs can be used – individual creativity not menus
how the money can be held – full range of options needs to be available
Restrictive implementation can result in negative impact on budget holders

physical and mental health conditions who could benefit from April 2015

“I’m pleased to see the work that NHS England is doing with clinical commissioning groups on the use of personal health budgets within mental health services. I hope that the experience drawn from this work will enable the roll out of their use in mental health services across the country” (Norman Lamb MP, Dec 2013)

– 18 month programme
13 sites – mix of former pilot sites and new local partnerships
High cost populations: out of area placements, high cost residential placements, frequent users of inpatient or A&E services, primary care mental health services.
Focus is on how to implement personal health budgets sustainably within the mainstream NHS – no longer a pilot

personal health budget, Northamptonshire

service costs?
Include some of the costs of inpatient and crisis services?
Base personal health budgets on mental health cluster costs?
Invest in an off-the-shelf resource allocation package?

the pilot programme included all outpatient clinical services in a personal health budget e.g. Northamptonshire, Croydon
Most sites offered limited choice, restricted to support services
Range of reasons for limiting clinical services, including getting buy-in from trust

What do you think should be in and out of a personal health budget?

in a field which has involved many, many years of training, many years of clinical experience, and my job is to know the best evidence and best practice for the kind of presentations that I’m expected to see within my field. It would be completely against my code of practice to say to a young person, yes, go ahead and spend money on something that has no evidence base’
(Psychiatrist)