Personal Health Budgets: Time to let systems take care of the paperwork, not front-line staff

Wednesday, 27 November 2019

I've been working within the Personal Budgets and Personal Health Budgets sector for ten years now and throughout this time, I've seen some incredible moves forward in the efforts to personalise care and support services.

The mainstreaming of Personal Budgets in adult social care has played a significant role in providing better choice and control with every adult, living independently with social care support, now accessing a Personal Budget.

Because of the move towards Personal Budgets, I’ve spent a large chunk of my time supporting Local Authorities digitise and standardise their processes, with the goal of improving efficiencies in how personal budgets are assessed, estimated, reviewed and reported.

The current PHB landscape

With the introduction of Personal Health Budgets (PHBs), we’ve had a large number of CCGs and Trusts approach us to help them solve similar problems to what Local Authorities faced a decade ago. However, there are some striking differences between what happened then, and what’s happening now.

Firstly, the take-up of PHBs nationally is still patchy in many areas. NHS England has set some lofty PHB targets for 2021, with many CCGs and Trusts now scratching their heads trying to figure out how they’re going to meet them.

They’re also faced with unprecedented financial pressures, meaning local processes that staff have adopted remain paper-based, poorly-defined and generally not helpful. I’ve even seen simple quarterly PHB reporting take far longer than it should because of staff having to count through paper records manually. Something that could so easily be automated.

The problem with the current approach

For true personalised choice, everyone’s person-centred planning needs to start with an accurate and reliable indicative sum of money based on assessed need, and not a traditional care package.

Commonly, I see the ‘ready reckoner’ approach, which goes something like ‘think up a suitable traditional care package, cost it up and hey presto, there is your PHB figure to work with’.

This methodology is simply a traditional care allocation dressed-up (badly) as personalisation, and it does nothing towards apportioning resources equitably and sustainably. It also lacks any degree of fairness or consistency, providing no evidence base when met with a challenge that it’s too much or not enough, making it difficult to resolve disputes.

Offering PHBs consistently and fairly

What is needed is an evidence-based, statistically-sound and defensible approach to resource allocation that is sufficiently accurate to be relied on over time to provide a strong basis for personalised planning, whilst helping to manage a strained public purse. When modelled statistically, there is a high correlation between assessed need and care costs.

Notional PHBs, alongside Direct Payments, do have the potential to allow CCGs and Trusts to move entirely away from the old ways of planning support and towards PHBs becoming ‘business as usual’. To achieve this, and meet NHS England targets for both PHB numbers and PHB outcomes reporting, processes and reporting functions must be digitised, streamlined and standardised.

Digitising and standardising processes

Attempting this rapid growth using ill-defined and unwieldy processes will magnify existing problems. It won’t be sustainable and there is a clear danger of processes, paperwork and reporting becoming more and more convoluted and inefficient.

Designing different workflows, templates and budget-setting tools in every area will also lead to a huge waste of public resources and will be an awful experience for PHB recipients moving between areas.

A single, digital system at a regional level will enable teams to work efficiently when setting-up and administering PHBs. Doing so will create major efficiencies and provide continuity for PHB recipients who move between localities in the region.

Once templates and workflows have been designed and proven to work well in an area, they can easily be ‘lifted and shifted’ into another area, removing the need to re-invent the wheel.

As a consequence, outcomes reporting can be standardised and automated, saving staff time spent manually putting together the figures, and enabling realistic and genuine benchmarking between areas.

So the good news is that if these processes can be fully standardised and digitised over a reasonable period of time, I’m confident we can create a positive shift in productivity and help front-line staff spend more time on the things that matter most!