Written by Jo Harvey
I’ve been following with interest the conversations from @NHSPHB this week where people have been sharing their experiences of personal health budgets (PHB). Some questions have been raised too, such as, how do you leave room for people to take risk in support planning, what does good health planning look like and how can it work in practice.
As a healthcare professional and person-centred thinking practitioner I have been blogging about personal budgets in social care and in health for some time from personalisinghealth.com and this site. I have also been involved in the personal health budget work that has been taking place around the country and so have direct contact with the decision makers (the people who decide on the allocation of funds), the brokers (the people helping people to develop their plans) and the person for whom the budget is for. As such I’ve found that I’ve been gathering information along the way, which might well be of assistance to people applying for PHBs and writing personal health plans. As this is all very topical this week, I thought I should share! Here are my top 5 PHB lessons learnt:
1: Don’t get confused by the language. Like most things in this field, the language around health planning can seem a little daunting to begin with. Not least because some areas around the country call it ‘personalised care planning’ whilst others refer to it as ‘support planning’. They mean the same thing; the plan that is written to show how a personal health budget (PHB) will be spent in order to support someone to live life the way they choose.
2: Keep it simple. We are in danger of seriously overcomplicating the health care planning process and I’d like to think we could take what we learnt from personal budgets in Social Care and apply it to health so that we can avoid this. We are all guilty of course. I myself, in my eagerness to be thorough and to pass on my full knowledge have been involved in producing lengthy documents that detail every possible way in which good support can be achieved and why. The truth is often, the more you write, the less someone will read, and in the case of a support plan it is absolutely essential that you get the decision maker to read the key elements. So for example, instead of 6 pages of information about a person, their gifts and talents and the things that are important to them, how about using a one-page profile that communicates who they are, what is important to them and how best to support them on a single sheet? The decision maker is far more likely to read this and therefore make a funding decision based on a deeper understanding of the person it is for. ‘Risk’ is another area of planning that can be refined. All too often we take a blanket approach to risk cumulating in a 19-page risk assessment when what we can do is ask; what risks are there involved in the way you want to achieve your outcomes? Is this risk important to help you live your life the way you want? If it is – how do we mitigate the risk? For those big risks I use the person-centred risk process to keep it simple.
3: Getting good information to include in support plans involves having a different kind of conversation. As health professionals we have a lot of processes aimed at getting set information from people about their health conditions and medication. Assessing people in this way is how we were trained, so gathering information in the context of how someone wants to live their life whilst still recording this information for an official purpose requires a very different approach. There are different ways you can do this, personally I use person-centred thinking tools. They enable me to have good conversations with people, keeping them at the centre of any decision making. As well as doing this, they provide templates to formally capture this rich information so that funding decision makers can follow it easily – ideal for applying for PHBs.
4. Have a good structure. In my experience if people enforce planning templates that are too prescribed it can stifle creativity but if you give someone a blank sheet of paper, they often don’t know where to start. I think having an easy to follow structure when embarking on writing a health plan is really helpful. Papers like “Implementing Effective Care Planning” written by Rita Brewis, which can be found as part of the Person Health Budget Toolkit, are helpful in providing this structure and this is something that I have referred to when creating the headings that I’ve found work best. These are; One-page profile, More Information about Supporting Me, Working/Not Working, Outcome Grid, Risk and Contingency, Budget Sheet, Decision Making Record and Action Plan. Regardless as to which headings you use in your plan there is one theme that needs to weave throughout and that is the demonstration of how the person-centred outcomes link to the person’s eligible need and how the spend of the budget will help achieve these outcomes. This is what the decision maker needs to reference.
5: Use the best person for the job. All too often health plans are written on behalf of people as a default without considering their capacity to be more involved. It is true that sometimes a person’s health condition can be so severe that they are unable to contribute heavily but we should not start with this assumption and wherever possible the person or the close family should be supported to produce their plan. This is referred to as the ‘empower and enable’ approach in Social Care and certainly has its place in health.
I hope this has been useful. If you want to join is on the PHB conversation follow us on @HSAUK and search for @NHSPHB