Integrated Personal Commissioning: Transforming care for people with complex needs

James Sanderson, Director of Personalisation & ChoiceMel Smeeton, Peer Leader, LincolnshireJo Akinyele, IPC lead, Cheshire West & Chester

Driving forward with personalisation and choice

James SandersonDirector of Personalisation and ChoiceNHS England

Personalisation and Choice

The Personalisation and Choice group is working with partners to enable patients to personalise their care, in order to better meet their needs and preferences and enhance their choice and control. The group is responsible for the delivery of three distinct, but interdependent programmes:

• Personal health budgets (PHB) • Integrated Personal Commissioning

(IPC)• Patient Choice

Forms part of the ‘Transforming commissioning’ priority of NHS England’s business plan for 2016/17Plays a key role in taking forward the vision of the Five Year Forward View

Making the vision a reality

Integrated Personal Commissioning and personal health budgetsIntegrated Personal Commissioning (IPC) is redesigning the ways the system will work for people with complex needs in England. It includes an integrated approach to personal budgets for people with health and social care needs.

A personal health budget is an amount of money to support a person’s identified health and wellbeing needs, planned and agreed between them, or their representative, and their local clinical commissioning group.

• The Integrated Personal Commissioning Programme is a partnership between NHS England and the Local Government Association (LGA)

• The programme is working to redesign the mainstream model of community -based care for people with complex needs

• The new model will empower people and communities to take an active role in the care they need, with greater choice and control through personal budgets.

• The programme is currently working with nine demonstrator sites across the country and in 2016/17 the programme will be welcoming new areas as early adopters for the start of national roll-out of IPC

Ramping up delivery

Making IPC happen in Chester & Cheshire WestJo AkinyeleIPC Project Lead

‘It’s my life –I decide!’

Cheshire site is one of the nine national demonstrator sites for IPC.The key partners in Cheshire are Cheshire West and Chester Council, West Cheshire CCG and Vale Royal CCG.  IPC is expected to be a mainstream model of care from 2020 and in Cheshire we are already introducing it as a default offer for people with highest health and care needs.

To ensure this happens we are planning and delivering IPC in partnership with the people using the services,our workforce and the VCSE sector .

Cheshire IPC projections by April 2018Site: Chester and West Cheshire Definition Number of

peopleProportion of

population

Total population 332,000

People in the IPC cohortPeople within your IPC cohort and who

are in the linked dataset – data to include health, social care and education activity

and spend6640 2%

People with a care plan/EHC plan

People within your IPC cohort who have a completed care plan/EHC plan 3320 1%

People with a personal budget (includes NHS-

funding)

People within your IPC cohort who have a completed care plan/EHC plan and

personal budget in place. Must include NHS funding.

664 2 in 1,000

Who will this benefit?

Cheshire is currently focusing on the children and adults with a learning disability and/or autism with the aim to roll out to the following group from April 2017:• Adults with multiple long-term

conditions,• Adults with significant mental health

needs.

Five key shifts in Cheshire

Personalised Care and Support Planning- The Right Skills

• Coaching• Power hours for staff• Live care planning sessions• Provider skills development

sessions• Carers skills and peer

support

Keys to Citizenship © Simon Duffy 2006

Choice and control: Personal and Integrated Budgets

• Single assessment for health and social care (and education)

• Integrated RAS pooling personal budgets between health, social care (and education)

• Brokerage service• Individual Service Funds• Market development so people can

exercise their choice

Lisa’s story

LISA’ S CARE COORDINATOR

It took a year to develop a person centred plan with Lisa. We had to work backwards from where we started and where we’d like to be in a year – 1 month plan, 3 month

plan and year, very slowly getting her to build up her strength, making tiny steps which have allowed Lisa to jog! We’re jogging alongside her, she does dip sometimes but

not as often, have been times at the beginning when we as a provider were jogging in front and not achieving

anything, and struggling how we were going to move forward, so we had to structure it around how Lisa would want it, now it’s done around her as best as we can, try and be as flexible as we possibly can which is not easy. We are now side by side, and if we are ahead, we pull

back, that might be when she’s had a dip and we have to come back again..

IPC has enabled me to take on a positive approach to risk taking. As Lisa has

autism, so too much change can be hard for her to cope with but changes are being introduced slowly and we are working in

co-production with mental health services and with our psychological service to

anticipate that these needs are likely to come up. When they do, we will work through them and move forward - we

shouldn’t not try to do things differently on the premise that she might not cope

because of her difficulties around change, it’s about her telling us when she needs that help rather than us imposing that help on her - that’s the difference!

LISA’S CARE PROVIDER

Information sharing Block contracts-

understanding current activity and costs

Scaling up PHBs beyond CHC

Culture change

Next steps

• Grow the Co-production network with service users and carers to identify gaps and future demand

• Market development to ensure that we have providers locally that can meet our residents needs

• Workforce development and integrated ways of working through introduction of integrated assessment and single resource allocation system

• Mainstreaming the IPC offer to enable scaling up

Mel SmeetonLincolnshire Peer leader

The importance of lived experience

Personalisation mattersPat’s Journey• What’s important to us as a family….• My journey• Why choose a personalised approach…...?

Pat’s journey• Diagnosed with vascular

dementia in 2011• Family determined to keep

Mum at home• Part time care initially

(September 2014)• Full time (live in) care May 2015

What’s important to us?

• Wanted Mum to remain at the heart of the family

• Care package to meet Mum’s changing needs

• Familiar surroundings, familiar people, continuity of care

• No hospital admissions, regular GP checks

My journey

• Joined local peer network, attended IPC residential in January

• Now member of Strategic Coproduction Group (April 2016)

• Link between local peer support, LG, CDGs and Board, strengthening the voice of people with lived experience, an “opportunity to influence choice”

• Coproduction is integral in shaping future decisions by “keeping it real”

Why choose IPC?

• Recognises the importance of the person’s individuality and their right to exercise choice in their daily lives

• Places the individual at the centre of their care

• Promotes dignity and independence in a setting that will meet their needs and wellbeing

In summary• Mum’s evolving care needs• Mum’s quality of life and the

benefits • Maintaining control• Changed relationship between

people and services• Empowerment playing an active

role in managing their health care