From April 2015, many patients in England (depending on where they live) who have complex needs (such as people with diabetes or serious mental health problems) may be offered an integrated personal budget, a single pot of money to cover both their health and social care needs. The voluntary sector is expected to play a strong role in this initiative through, for example, encouraging and supporting individuals with managing this budget. IPBs also offer new opportunities to the private sector.
Integrated personal budgets (IPBs) are part of a new approach called ‘Integrated Personal Commissioning’ (or IPC) concerned with joining up health, social care and other services (such as education for children and young people) at the level of each individual. According to NHS England, within or alongside new models of care, IPC and personal health budgets
IPC is one of the central pillars of the Five Year Forward View and its Self Care Programme that aims to reduce ‘demand’ on NHS services. This claims that it wants to help individuals develop the knowledge, skills and confidence they need to manage their own health and social care needs, to deal with setbacks and to know who to contact in times of need. By making the most of the community resources around them, including expanded services from the voluntary sector, it’s thought that IPC will prevent or reduce the need for unplanned care.
According to NHS England, IPC will
- enable individuals (or their carers and families) to control the resources available and to shape their own care, and
- encourage individuals to make the most of the community resources around them and to develop their knowledge, skills and confidence in managing their health needs.
Who is it for?
Its thought that, in future, IPC could be the main way of providing community-based care for around 5% of the population. This 5% includes people with multiple long term conditions, frailty, severe and long-term mental health problems and children, young people and adults with complex needs, including learning disabilities and autism.
These may be individuals who already have
- a personalised care and support plan or education, health and care plan (about 1% of the general population);
- a personal budget for social care or education; or
- a personal health budget.
How is it provided?
IPC will be managed by multi-disciplinary teams within new care coordination ‘hubs’, usually in primary care. These hubs will draw together general healthcare social care, mental health care and specialist care with the voluntary sector.
This means a completely different approach to planning and commissioning community, social care and other services, and developing ways of delivering personalised care on a large scale for certain populations.
A co-ordinated assessment leads to a single personalised plan for each individual, geared towards ‘maximising their personal potential for self-management’.
Through IPC, all adults, children and young people with a personalised care and support plan have the option of some kind of personal budget for all or part of their care.
At the moment, a number of organisations or ‘demonstrator sites’ are implementing a new integrated process that, in future, will become the single way of providing personal health budgets in the NHS, personal budgets in social care for people with complex needs, and personal budgets for some children and young people with special needs.
Is IPC a good thing?
In theory, integrating health, social and other services should help to improve patient care. However, although NHS England promotes IPC as a way of better integrating services while at the same time personalising care, IPC should also be seen in the context of what is happening to the NHS more generally.
According to NHS England, one of the main aims of IPC is to prevent or reduce the need for unplanned care. As we said earlier, the emphasis it places on self-management is central to NHS England’s Five Year Forward View which, among other things, aims to drastically restructure the NHS and its workforce. It raises concerns that
- the way that self-management is being presented masks the fact that patients will have reduced access to health care professionals,
- especially in the context of NHS underfunding, integrated personal budgets may be used to privately purchase care that is no longer available on the NHS, and
- the new structures or ‘new models of care’ proposed by the FYFV have not been developed for a universal, publicly funded service like the NHS, and may facilitate a move towards turning the NHS into a health care system based on private insurance. Personal health budgets and the more recently proposed integrated personal budgets have been seen as a key method of achieving this.
It’s proposed that, in future, people will be able to opt in to IPC where they could benefit from a bespoke package of care rather than remain with their existing provider. This could mean, for example, that a patient decides to have a package of care from a private company instead of a local NHS Trust. One major drawback for NHS users is that this would reduce the Trust’s income by several thousand pounds a year and if a number of patients were to do the same, this could seriously undermine the Trust’s ability to provide services to other patients.