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Three lessons for integrated personal commissioning

Alex Fox
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NHS England chief Simon Stevens’ first high profile announcement was for a programme for people power in the NHS based on personal health budgets, or ‘integrated personal commissioning’ (IPC).

What could the NHS learn from councils’ experience of implementing personal budgets in social care? How could this attempt to offer integrated personal budgets succeed where the original individual budget pilots failed to bridge the gaps between sectors some years ago?

As NHS England set out its plans for IPC, I thought now the perfect time to share three hard-won lessons.

First, reforming supply is as important as reforming demand. Personal budget control can help people make different demands, but it’s meaningless unless commissioners are deliberately reshaping supply in anticipation.

Areas such as Hertfordshire have created accessible local marketplaces for personal budget holders. Others have continued to develop familiar services, while people with personal budgets find they have the freedom to choose their care, but nothing new to choose.

In social care, this has meant that only a relatively limited number of direct payment holders have had both the resources and the genuine freedom to create genuinely new forms of care such as the new personal assistant workforce and hundreds of very diverse micro-enterprises. That has been life changing for some, while others have remained isolated individual consumers, with small or variable entitlements to resources, and a limited menu of choices.

Second, don’t expect the culture of collaboration and co-production to follow personal budget reforms. Instead, embed collaboration across the system, particularly in commissioning. Almost 20 years after direct payments legislation, user-led commissioning, mutually owned providers and genuine co-production are still in their infancy, meaning the insight and creativity of people who use services and their families remain largely untapped.

Third, remember that personal budgets and the services they typically purchase are only one part of achieving wellbeing for people with long-term support needs. The ultimate goal is to help people to live good lives in good places. That goal, effectively expressed in the wellbeing duty of the Care Act, needs embedding throughout the system; in the traditional services as well as the newly created ones.

If the whole system is aligned to supporting people to connect with each other and to take charge of their support and their lives, personal budgets will start to become the default option. Otherwise, they will remain peripheral and illusory.

Councils have an opportunity to help shape these reforms as they are rolled out across the NHS. They also have much at stake: direct payment holders have demonstrated that people can be better integrators of complex packages of support than professionals. IPC done well could unlock the integration challenge in ways that have previously eluded the cleverest professionals.

Alex Fox, chief executive, Shared Lives




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