Evidence and initiatives for integrating personal budgets for people with mental health problems

Because integrating personal budgets is a relatively new initiative, evidence is still emerging about the impact they might have on people’s health and wellbeing.

However, evidence suggests that people with mental health problems can benefit significantly from having increased choice and control over their care, because their needs tend to cross boundaries between health and social care. [14]

This section discusses some of the evidence from a recent evaluation of personal health budgets. [15] It also describes some recent initiatives by government to promote the integration of services around an individual’s needs.

Personal health budgets pilots, 2009-12

Personal health budgets were launched by the Department of Health in 2009 following the publication of the 2008 ‘Next stage review’. [16] They were piloted and evaluated until 2012 with the following key findings. For an example of a pilot in one area of the UK, see Practice example 7: The Northamptonshire personal health budget pilot.

Results

Health and wellbeing

• The evaluation suggests that personal health budgets are associated with improvements in quality of life and psychological wellbeing for budget-holders, and greater independence.
• A survey of budget-holders found that the budget had a positive impact on people’s independence and physical health. [17]
• It helps if people with mental health problems are supported to produce their own health and wellbeing outcomes and plan how to achieve them. [18]
• Personal health budgets have been found to have a more positive effect for NHS Continuing Healthcare and mental health than for other long-term conditions.

Cost-effectiveness

• The evaluation found that the personal health budgets were cost-effective in mental health compared with traditional service delivery.
• A recent evidence review of mechanisms for integrating health and social care funds found that improved integration could identify hidden unmet need, which could raise costs in the short to medium term. [19]
• As soon as personal health budgets were introduced, it became clear that integration between these new health-related budgets and their equivalent in social care was crucial if people were to be able to make sense of their care.

Integration

• The evaluation recommended that ‘personal health budgets should be considered as a vehicle to promote greater service integration’.

Initiatives to promote integration at the level of the individual

Integrated care and support are now high on the government’s agenda. In the June 2013 spending round it announced the £3.8 billion Better Care Fund (formerly the Integration Transformation Fund) to ensure a transformation in integrated health and social care. The Fund is a single pooled budget to support health and social care services to work more closely together in local areas. [20] Many areas are considering the use of integrated personal budgets as a central part of their plans.

In 2013 the government announced 14 ‘Integration Pioneer’ sites, which would be supported to develop innovative ways of creating change in the health service, which the government and national partners want to see spread across the country. Many of the sites are experimenting with integrating personal budgets as a way to reduce pressure on acute services.

Building on the evaluation of the personal health budgets pilots, the Care Act 2014 gives people eligible for NHS Continuing Healthcare funding a ‘right to ask’ for a personal health budget. They may also request a direct payment for health care. The ‘right to ask’ became a ‘right to have’ in October 2014.

NHS England recently set out plans for a new Integrated Personal Commissioning (IPC) programme, which will promote the integration of personal budgets for various groups of patients, including people with severe and enduring mental health problems. This programme builds on the ongoing work on personal budgets for patients eligible for ‘Continuing Healthcare ’ funding, the ‘Year of Care’ pilots and the work of the Integrated Pioneer sites.