Integrated Personal Commissioning

Ian Dodge, National Director, Commissioning Strategy, NHS England

Ray James, President, ADASS

Zoe Porter, Head of Delivery, IPC & Personal Health Budgets

Graeme Niven, Chief Finance Officer, NHS Hartlepool & Stockton CCG

Jo Fitzgerald, Director, peoplehub

Jeremy Taylor, Chief Executive, National Voices

IPC: an overview

Zoe Porter, Head of Delivery

IPC & personal health budgets

Integration and empowerment is a fundamental response to future health & social care challenges

“There is broad consensus on what the future needs to be. It is a future that

empowers patients to take much more control over their own care and

treatment. It is a future that dissolves the classic divide, set almost in stone

since 1948, between family doctors and hospitals, between physical and

mental health, between health and social care, between prevention and

treatment.”

Five Year Forward View, 2014

Who for? • Children and young people with complex needs, including

those eligible for education, health and care plans.

• People with multiple long-term conditions, particularly older people with frailty.

• People with learning disabilities with high support needs, including those who are in institutional settings or at risk of being placed in these settings.

• People with significant mental health needs, such as those eligible for the Care Programme Approach or those who use high levels of unplanned care.

To achieve what? • People with complex needs and their carers have better quality

of life and can achieve the outcomes that are important to them and their families through greater involvement in their care, and being able to design support around their needs and circumstances.

• Prevention of crises in people’s lives that lead to unplanned hospital and institutional care by keeping them well and supporting self-management as measured by tools such as ‘patient activation’ – so ensuring better value for money.

• Better integration and quality of care, including better user and family experience of care.

The core elements of IPC

The IPC sites • Barnsley • Cheshire W & Chester • Luton • Hampshire • Portsmouth • South West • Stockton-on-Tees • Tower Hamlets • Lincolnshire

IPC demonstrator sites

Key programme enablers:

critical questions and components of delivery support

National outputs of the IPC delivery support

programme • Standard replicable models on key components of Integrated Personal

Commissioning

• Broader expertise on the active ingredients necessary for local and national success

• Evidence of impact through a robust national evaluation

• A cohort of leaders from across the system who can share and influence

• Stories that clearly show the benefits and what can be achieved told by people and the professionals that support them

• Clearly identified policy and legislative issues being addressed

• A delivery programme to support roll out

‘We stand on the cusp of a revolution in the role that patients – and also communities – will play in their own health and care.

Harnessing…this renewable energy is potentially the make it or

break-it difference between the NHS being sustainable or not.’

Simon Stevens

Mitchell’s story

2008-2015

Jo Fitzgerald, peoplehub Director

Personal health budget milestones

Mitchell’s personal health budget started in

September 2008 What changed?

• Designed support around Mitchell; no longer ‘one size fits all’

• Recruited and trained our own staff team (band3/4)

• Designed a comprehensive training plan

• Greater choice, control and flexibility

• Changed relationship with health professionals

Mitchell transitioned to NHS Continuing Healthcare

in May 2010

• Mitchell now funded via NHS CHC

• No disruption to Mitchell’s support

• Able to retain existing arrangements and staff team

Mitchell’s health deteriorated in 2013

resulting in frequent ICU admissions

• Staff worked in partnership with ICU staff; learnt new skills

• Increased confidence and resilience

• Early discharge from ICU; discharge directly from ICU to home

• Built excellent relationships with ICU staff

End of life planning - 2015

• Built on relationships with ICU staff: good conversations, shared decision-making

• Excellent/efficient communication – e-mail link with lead ICU/respiratory consultant

• Developed a robust emergency management plan and end of life plan

• Mitchell had a good death on 18th March, 2015

Integrated Personal Commissioning in

Stockton-on-Tees

Graeme Niven, Chief Finance Officer

Importance of co-production Joint bid between:

• Catalyst

• Hartlepool and Stockton-on- Tees CCG

• North Tees and Hartlepool Foundation Trust

• Stockton-on-Tees Borough Council

Reinforcing existing local partnership work

Our cohort • Financial model based on people over 65 years of age with a Long Term

Condition

• Initially focus on respiratory pathways

• AGE UK Teesside coordinating community engagement

• Referrals to include ‘seldom heard’ groups, ensure we’re representative of

the whole community

• Cohort to influence a bottom up approach to developing IPC in Stockton

Our approach

IPC Stockton explaining their work to engage with participants to build the programme from the bottom up at the IPC Leadership event 9th June 2015.

Here’s where it fits in • Momentum Pathways

• Personal health budgets

• Personalisation

• Better Care Fund

• Peer Support Groups

• Foundation Trust’s year of care modelling

Making it happen • Strong local Voluntary, Community & Social Enterprise Sector (VCSE)

• Development of peer support networks

• One care plan

• Non-traditional route of administering personal budgets being explored

Patient story AGE UK:

• Mrs D referred into Better Health, Better Wealth

• Socially isolated

• A number of Long Term Conditions

• Finds it difficult to contact different clinicians

• Prefers direct contact with Age UK

• Unhappy with ‘prescribed’ care plan

• Now in receipt of a PHB

• Combining health and social care budgets would overcome her current concerns, giving her choice and control over her care package and one point of contact.

Next steps • Information Governance-explicit consent

• Linked data sets

• Financial model will aid conversations

• Utilise evaluation tools, e.g. Outcome Star and POET

• Market Development Session

• Inform commissioning process

Questions for the panel