STP aide-mémoire: Personalisation and Choice
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Reference: 05372
1. Introduction
Working alongside population based models of care, integrated personal commissioning (IPC),
personal health budgets (PHBs) and meaningful patient choice enable patients to personalise their
care to better meet their needs and preferences1. The NHS Choice Framework lays out the
choices that should be available to patients, but people’s awareness of their legal rights to choice
is low, and rollout of PHBs and IPC is at an early stage. A significant change is needed to truly
empower patients from all backgrounds and unlock the benefits of choice, PHBs and IPC.
STPs provide the opportunity to harness excellence where it exists within the footprint and
accelerate wider adoption (e.g. where there are existing IPC sites, localities with high performance
in PHBs, or where pioneer areas are preparing to test enhanced choice in maternity care).
2. Success in 2020
i. PHBs and integrated personal budgets, including NHS and social care funding, are
available to everyone who could benefit (in line with Mandate requirements)
• In each footprint at least 1-2 people per 1,000 of the population has a PHB or integrated
personal budget incorporating NHS funding. PHBs should be in place:
o to deliver NHS Continuing Healthcare and continuing care for children;
o for people with high cost packages of support e.g. people with a learning disability; and
o in specific areas where the model will deliver a positive impact e.g. in wheelchair
services and end of life care.
• People have the support they need to successfully manage their PHB, with choice over how
it is used.
ii. IPC is a mainstream model of care for people with highest health and care needs, planned
and delivered with partners in local government and the voluntary sector
• Core service components of the IPC model are in place for target cohorts in each locality,
underpinned by contracting and payment mechanisms that enable personalised care.
• Peer support and community capacity is harnessed and coordinated better with formal care
services, to support self-care for the IPC cohort.
• People with the highest needs have routine access to person-centred care and support
planning, including integrated personal budgets that blend funding from health and social
care.
iii. Patients make meaningful choices about whether, where and how they receive their
healthcare
• Patients are able to say:
o I have discussed with my GP/ healthcare professional different options and pros and
cons including, where appropriate, whether to have treatment.
o I was offered a choice of where to go for my care or tests, as appropriate.
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IPC is a whole-system model to enable integrated, personalised care and support across the totality of health and social care for
people with complex needs. PHBs focus on specific areas of care, for example NHS continuing healthcare, and are available to
anyone that could benefit, regardless of whether they are in the IPC cohort or not. There are specific mandated duties relating to
personal health budgets (The Care Act 2014: http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted; Children and Families
Act 2014: http://www.legislation.gov.uk/ukpga/2014/6/contents/enacted; NHS Responsibilities and Standing Rules (Amendment)
regulations 2013: http://www.legislation.gov.uk/uksi/2013/2891/pdfs/uksi_20132891_en.pdf). IPC is currently a demonstrator
programme and is expected to be rolled out across England by 2020-21.
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o I was given an opportunity to choose a suitable alternative provider when I was going
to wait longer than the maximum time specified in my legal rights.
o Information was available and I was able to find it in a format that was accessible,
helping me make a decision about my needs.
o I was given sufficient time to consider what was right for me.
3. How are we going to get there?
Planning
Implementation
i. PHBs and integrated personal budgets including NHS funding are available
• Assess PHB baseline data in CCG IAF and
benchmark across STP footprint, identifying
groups who could benefit from an expanded
PHB offer.
• Develop robust financial plans for PHB rollout
to reach at least 1-2 in 1,000 population per
year by 2020.
• Ensure alignment between PHB rollout and
other national programmes, such as learning
disabilities, special education needs disability
reforms, mental health, self-care, IPC and
vanguard sites.
• Assess what support is needed locally to
enable people to take up the offer of a PHB
including role of the voluntary sector in
providing this support.
• Sign up to PHB national delivery support
programme and expand PHB coverage in and
beyond NHS Continuing Healthcare and
continuing care for children.
• Identify contracts where funding can be freed
up, consider contract variations and signal in
commissioning intentions.
• Explore potential for PHBs in new service
areas such as wheelchairs, end of life, and
their potential impact on employment.
• Invest in evidence-based approaches to
improve people’s knowledge, skills and
confidence for self-management e.g. care
planning, education, health coaching, peer
support, group based activities, asset based
approaches and realising the value.
ii. IPC is a mainstream model of care for people with highest health and care needs
• Identify any IPC Demonstrator Sites in the
footprint, establishing local process for
keeping STP teams up-to-date with IPC
developments.
• Identify a locality that is well placed to join the
IPC early adopter programme.
• Assess multidisciplinary team capability to
deliver personalised care and support
planning and integrated personal budgets.
• Ensure local alignment with vanguards in the
footprint and teams leading PHB rollout.
• Build in consideration of IPC / PHB to
population based contracting to ensure
compatibility.
• Identify locally those with highest need who
could benefit from IPC and begin work on
linked datasets for health and social care for
these cohorts; adopt core IPC service
components emerging from the Demonstrator
Programme.
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iii. Patients make meaningful choices about whether, where and how they receive their
healthcare
• Complete self-assessment using the CCG
choice planning and improvement guide (to
be published shortly) to baseline local choice
and identify areas for improvement
• Embed choice in local commissioning policies
and plans, including expansion into services
which currently have no legal rights to choice
but where patients would benefit, for example,
end of life care.
• Initiate local patient awareness and
engagement campaigns to promote choices
available to patients, drawing on the national
awareness campaign and media materials for
local adaptation.
• Embed choice in protocols, referral and
clinical pathways, and increase utilisation of
the NHS e-Referral Service, to enable
efficient and effective choice.
• Commissioners and providers to ensure there
is a range of accessible information available
locally that supports patients to make
meaningful choices.
• Enable patients to choose about whether, and
if so, where to have treatment by
implementing shared decision making
principles consistent with RightCare.
• Inform and support patients to use their legal
right to choose an alternative provider if they
will not be seen and treated within maximum
legal waiting times.
• Implement processes, products and lessons
emerging from Maternity Pioneers.
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