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Article
Publication date: 30 March 2022

Elizabeth Welch, Karen Jones, Diane Fox and James Caiels

Integrated care continues to be a central aim within health and social care policy in England. Personal budgets and personal health budgets aim to place service users at the…

Abstract

Purpose

Integrated care continues to be a central aim within health and social care policy in England. Personal budgets and personal health budgets aim to place service users at the centre of decision-making and are part of a wider long-term initiative working towards personalised and integrated care. Personal budgets began in social care with the national pilot programme of individual budgets, which aimed to incorporate several funding streams into one budget, but in practice local authorities limited these to social care expenditure. Personal budgets then moved into the health care sector with the introduction of a three-year personal health budgets pilot programme that started in 2009. The purpose of the paper is to explore the post-pilot implementation of personal health budgets and explore their role in facilitating service integration. We examine this through the RE-AIM framework.

Design/methodology/approach

During 2015 and 2016, eight organisational representatives, 23 personal health budget holders and three service providers were interviewed, 42 personal health budget support plans were collected and 14 service providers completed an online survey.

Findings

Overall, personal health budgets continued to be viewed positively but progress in implementation was slower than expected. Effective leadership, clear communication and longer-term implementation were seen as vital ingredients in ensuring personal health budgets are fully embedded and contribute to wider service integration.

Originality/value

The paper highlights the importance of policy implementation over the longer-term, while illustrating how the venture of personal health budgets in England could be a mechanism for implementing service integration. The findings can serve to guide future policy initiatives on person-centred care and service integration.

Details

Journal of Integrated Care, vol. 30 no. 3
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 2 August 2013

Vidhya Alakeson

The purpose of this paper is to illustrate the potential for service integration by focusing at the level of the individual rather than through structural integration or care…

972

Abstract

Purpose

The purpose of this paper is to illustrate the potential for service integration by focusing at the level of the individual rather than through structural integration or care coordination. The paper illustrates the potential for integration through the experience of the personal health budgets pilot programme.

Design/methodology/approach

This paper is based on a review of the experience of personal health budget pilot sites, drawing on the national evaluation of the pilot programme and the author's experience of working with pilot sites between 2010 and 2013. It also draws on the experience of similar programmes in the USA.

Findings

Personal health budgets support integration in two distinct ways. First, they can support the delivery of more holistic, whole‐person care in line with the principles of shared decision making. Second, by bringing personal budgets in social care and personal health budgets together, they can provide a vehicle for integration across health and social care systems. If integration starts from, and responds to, what matters most to individuals rather than with the development of joint structures and processes, the result is more likely to be integrated care.

Originality/value

This is one of only a small number of papers that discusses the scope for personal health budgets to improve the integration of care. Integration between the NHS and social care, in particular, has been identified as a central priority for the NHS.

Details

Journal of Integrated Care, vol. 21 no. 4
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 2 December 2014

Caroline Norrie, Jenny Weinstein, Ray Jones, Rick Hood and Sadiq Bhanbro

The purpose of this paper is to report on the introduction of individual personal budgets for older people and people with mental health problems in one local authority (LA) in…

Abstract

Purpose

The purpose of this paper is to report on the introduction of individual personal budgets for older people and people with mental health problems in one local authority (LA) in 2011.

Design/methodology/approach

Jenny Weinstein is a Hon Senior Lecturer at Kingston University, Professor Ray Jones and Rick Hood are based at the Joint Faculty of Health and Social Care, St George's, University of London and Kingston University, London, UK.A qualitative study is described in which structured interviews were carried out with participants belonging to each service user group. The study aimed to explore the following issues: first, service users’ experiences of the assessment process, second, whether service users wanted full control of their budgets and third, if personal budgets make a difference to quality of life.

Findings

xService users (n=7 older people and carers; n=7 people with mental health problems) found the personal budgets system and assessment process difficult to understand and its administration complex. Older people in particular were reluctant to assume full control and responsibility for managing their own personal budget in the form of a Direct Payment. Participants in both groups reported their continued reliance on traditional home care or day care services. These findings were reported back to the LA to help staff review the implementation of personal budgets for these two user groups.

Research limitations/implications

Study participant numbers are low due to difficulties recruiting. Several potential participants were not interviewed due to their frailty.

Practical implications

Studies of this type are important for constructing local knowledge about national policies such as the implementation of personal budgets in social care.

Originality/value

Studies of this type are important for constructing local knowledge about national policies such as the implementation of personal budgets in social care.

Details

Working with Older People, vol. 18 no. 4
Type: Research Article
ISSN: 1366-3666

Keywords

Article
Publication date: 14 October 2009

Sara Weech

This article describes the journey that West Sussex PCT and County Council have set out on to test and experiment how personalisation in health can improve patient outcomes and…

Abstract

This article describes the journey that West Sussex PCT and County Council have set out on to test and experiment how personalisation in health can improve patient outcomes and experience of health care. The journey is far from over, but the article describes the importance of top‐level commitment and leadership, the progress we have made, the lessons we have learned and some of the challenges we see ahead. It is about local action and learning, and does not presume to suggest it is the right or the best approach. The article is a case study to follow up the article about self‐directed support in health by Rita Brewis in the previous Issue of this journal. West Sussex is a provisional DH pilot area for the introduction of personal health budgets, and is a member of the Staying in Control programme. West Sussex County Council has been an individual budget pilot site, and has nearly 2,000 people receiving individual budgets and a target that all adults receiving social care will be offered self‐directed support by April 2010.

Details

Journal of Integrated Care, vol. 17 no. 5
Type: Research Article
ISSN: 1476-9018

Keywords

Open Access
Article
Publication date: 2 October 2018

James Sanderson and Nicola Hawdon

The purpose of this paper is to outline how personal health budgets and a universal, integrated model of support, can positively transform the way in which individuals with a…

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Abstract

Purpose

The purpose of this paper is to outline how personal health budgets and a universal, integrated model of support, can positively transform the way in which individuals with a learning disability experience their health and support needs.

Design/methodology/approach

The review recognises that Integrated Personal Commissioning, as a policy approach, provides the framework to offer personalised care, and enables people to live an independent, happy, healthy and meaningful life.

Findings

Evidence suggests that a personalised and integrated approach to both health and social care not only offers better outcomes on all levels for the individual, but also benefits the system as a whole.

Originality/value

The study reveals that a personalised care leads to people to have choices and control over decisions that affect in better health and wellbeing outcomes for people.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 13 no. 1
Type: Research Article
ISSN: 2044-1282

Keywords

Article
Publication date: 19 August 2009

Rita Brewis

This article outlines the work being taken forward by In Control, an independent social enterprise and charity, with a range of innovative PCTs and local authorities, to explore…

Abstract

This article outlines the work being taken forward by In Control, an independent social enterprise and charity, with a range of innovative PCTs and local authorities, to explore how the concept of personalisation may be applied in health. The programme has been called Staying in Control, to reflect the need for joining together health and social care so that a person does not lose control when their health deteriorates and different funding streams and services come into play.

Details

Journal of Integrated Care, vol. 17 no. 4
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 9 February 2015

Jill Manthorpe, Martin Stevens, Kritika Samsi, Fiona Aspinal, John Woolham, Shereen Hussein, Mohamed Ismail and Kate Baxter

The purpose of this paper is to report on a part of a study examining the interrelationships between personalisation and safeguarding practice. Specifically the authors aimed to…

Abstract

Purpose

The purpose of this paper is to report on a part of a study examining the interrelationships between personalisation and safeguarding practice. Specifically the authors aimed to examine how safeguarding practice is affected by the roll out of personalisation in adult social care, particularly when the adult at risk has a personal budget or is considering this.

Design/methodology/approach

A sample of annual reports from Adult Safeguarding Boards in England was accessed for content analysis covering the period 2009-2011. One part of this sample of local authorities was selected at random; the other authorities selected had been early adopters of personalisation. The reports were analysed using a pro forma to collect salient information on personalisation that was cross-referenced to identify common themes and differences.

Findings

The authors found variable mentions of personalisation as part of the macro policy context reported in the annual reviews, some examples of system or process changes at mezzo level where opportunities to discuss the interface were emerging, and some small reports of training and case accounts relevant to personalisation. Overall these two policy priorities seemed to be more closely related than had been found in earlier research on the interface between adult safeguarding and personalisation.

Research limitations/implications

There was wide variation in the annual reports in terms of detail, size and content, and reports for only one year were collected. Developments may have taken place but might not have been recorded in the annual reports so these should not be relied upon as complete accounts of organisational or practice developments.

Practical implications

Authors of Safeguarding Adults Board reports may benefit from learning that their reports may be read both immediately and potentially in the future. They may wish to ensure their comments on current matters will be intelligible to possible future readers and researchers.

Originality/value

There does not appear to have been any other previous study of Safeguarding Adult Boards’ annual reports. Documentary analysis at local level is under-developed in safeguarding studies.

Details

The Journal of Adult Protection, vol. 17 no. 1
Type: Research Article
ISSN: 1466-8203

Keywords

Article
Publication date: 24 February 2012

Jacky Hammond

This paper aims to provide a review of the Signposts programme which facilitates individuals in developing self‐directed support, and seeks to share learning from development of…

Abstract

Purpose

This paper aims to provide a review of the Signposts programme which facilitates individuals in developing self‐directed support, and seeks to share learning from development of this programme across the mental health sector.

Design/methodology/approach

Information for the review has been collected through anecdotal reports from individuals in receipt of Signpost services – this has included individuals who have used mental health services, their carers and professionals. The paper frames its work within the national context of government policy and research.

Findings

The complexities of self assessment and self navigation within existing mental health systems are difficult for many individuals to overcome. Based on principles of control and choice, the Signpost system allows individuals to take control of their lives and purchase the care and support they need. It has been important to develop a bespoke quality framework to enable protection of the public purse as well as the individual; Signpost UK has achieved this with its Quality Brokerage Framework.

Originality/value

This paper describes a highly innovative framework delivery of mental health self‐directed support within the personalisation agenda. Through partnership working, the framework not only provides a bespoke provision for mental health clients, but also an adaptable programme across all client groups which enhances principles of choice and control.

Details

Mental Health and Social Inclusion, vol. 16 no. 1
Type: Research Article
ISSN: 2042-8308

Keywords

Article
Publication date: 9 November 2015

Michael Clark, Tony Ryan and Nick Dixon

Commissioning has been a central plank of health and social care policy in England for many years now, yet there are still debates about how effective it is in delivering…

Abstract

Purpose

Commissioning has been a central plank of health and social care policy in England for many years now, yet there are still debates about how effective it is in delivering improvements in care and outcomes. Social inclusion of people with experience of mental health is one of the goals that commissioners would like to help services to improve but such a complex outcome for people can often be undermined by contractual arrangements that fragment service responses rather than deliver holistic support. The purpose of this paper is to discuss a form of commissioning, Alliance Contracting, and how it has been allied with a Social Inclusion Outcomes Framework (SIOF) in Stockport to begin to improve services and outcomes.

Design/methodology/approach

The paper is a conceptual discussion and case description of the use of Alliance Contracts to improve recovery services and social inclusion in mental health care in one locality.

Findings

The paper finds that the Alliance Contracting approach fits well with the SIOF and is beginning to deliver some promising results in terms of improving services.

Research limitations/implications

This is a case study of one area and, as such, it is hard to generalise beyond that.

Practical implications

The paper discusses a promising approach for commissioners to develop locally to guide service improvements and better social inclusion outcomes for people.

Social implications

Rather than developing good services but fractured pathways of care across providers and teams, the Alliance Contracting approach potentially delivers more holistic and flexible pathways that ought to better help individuals in their recovery journeys.

Originality/value

This is the first paper to set out the use of Alliance Contracting and social inclusion measures to help improve services and outcomes for people experiencing mental health problems.

Details

Mental Health and Social Inclusion, vol. 19 no. 4
Type: Research Article
ISSN: 2042-8308

Keywords

Article
Publication date: 17 June 2011

Sarah Carr

This paper aims to argue that the inflexible administration and funding silos which characterise a health and social care system focused on uniform provision is no longer working…

641

Abstract

Purpose

This paper aims to argue that the inflexible administration and funding silos which characterise a health and social care system focused on uniform provision is no longer working, particularly for those who require some support to live independent and fulfilled lives.

Design/methodology/approach

This paper details social care reform policy and the personalisation agenda, particularly self‐directed support and personal budgets. It considers the implications of these developments on personalisation, equity and integration and user‐determined standards and challenges service fragmentation and current commissioning practice.

Findings

Personalisation reforms in adult social care, which are being carried over to health services, are challenging traditional models of uniform or large‐scale care provision. Personalisation means putting people in control of their care and support and giving choices – which in turn means commissioning for local difference and personal preference, as well as bottom‐up pressure for services to integrate in a way that avoids funding or service boundary disputes and ensures individuals can choose and control their support.

Originality/value

It is argued that a focus on equality and fairness now needs to turn to equality of opportunity to exercise choice and control, and to the idea that everyone should expect locally appropriate, good‐quality services and support no matter where they are.

Details

Journal of Integrated Care, vol. 19 no. 3
Type: Research Article
ISSN: 1476-9018

Keywords

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