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Evaluation of the Personal Health Budgets Pilots

Evaluation of the Personal Health Budgets Pilots. Julien Forder 1 , Karen Jones 1 , James Caiels 1 , Paul Dolan 2 , Caroline Glendinning 3 , Dominic King 4 and Karen Windle 1 Personal Social Services Research Unit 1 (Kent) Department of Social Policy 2 (LSE, London)

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Evaluation of the Personal Health Budgets Pilots

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  1. Evaluation of the Personal Health Budgets Pilots Julien Forder1, Karen Jones1, James Caiels1, Paul Dolan2, Caroline Glendinning3, Dominic King4 and Karen Windle1 Personal Social Services Research Unit1 (Kent) Department of Social Policy2 (LSE, London) Social Policy Research Unit3 (York) Imperial College, London4

  2. Central to the government’s ambition to ‘modernise’health care … … at the heart of the ‘personalisation’agenda … … to promote choice Build on experiences from social care and Individual Budgets In 2009 – DH invited PCTs to become pilots Personal Health Budgets (PHBs)

  3. Promoting choice Diversity Information Empowerment Control

  4. Wider choice of options for spending to give flexibility … … and more control over resources so people can access them Greater personal freedom and independence Self-esteem and sense of identity would be greater Quality of life would be improved … … cost-effectively Hypothesised benefits of PHBs …

  5. Aims of the evaluation CORE QUESTION Do PHBs ensure better health and social care outcomes when compared to conventional service delivery If they do work, how best can PHBs be implemented Evaluation dimensions User experience Carer impact Workforce Commissioning/Provider impact Outcomes Costs Cost effectiveness

  6. Design • Controlled trial without randomisation across 20 PCTs • Overall sample – 2000 across different deployment options and health conditions • NHS Continuing Healthcare • Diabetes • Chronic Obstructive Pulmonary Disease • Stroke • Mental health • Long-term neurological conditions • 1,000 patients will be recruited to the PHB group • 1,000 patients will be recruited to the comparison group • Two specialist services: end of life and maternity

  7. Recruitment Process • Different groups of HPs to decide and recruit • A group of HPs offer PHBs and recruit to the PHB group • In same site, a different group of HPs decide who is approached to be in the Comparison Group • Min of 75 to be recruited to the PHB and Comparison Group • Same group of HPs to decide and recruit to both groups • Selection bias more of a problem • Randomisation before the offer of PHB • Min of 75 to be recruited to the PHB and Comparison Group

  8. Robust evaluation key to understanding the impact of PHBs whether they work for whom they work whether they are the most effective way of providing services how to make them work best Importance of the recruitment process

  9. Individual Level Data Collection Baseline 6 months 12 months 9 months 3 months 1. Outcome data 2. Medical records 3. HES data 4. Care plans (PHB holders) 1. Outcome data 2. Medical records 3. HES data Outcome data Qualitative interviews about user experiences (55 PHB holders & carers) Qualitative interviews about user experiences (55 PHB holders & carers)

  10. Specialist Services • 10 in-depth interviews with budget holders using maternity services – after the birth • 10 in-depth interviews with carers of PHB holders - end of life services • 6 months after the death of the budget holder

  11. Organisation Level Data Collection 3 months 12 months 24 months 15 months 3 months 1. Face to face interviews – perceived success 2. Face to face interviews - Impact on organisations 3. Web-based questionnaire – impact on the workforce Face to face interviews – project leads Face to face interviews - Implementation Web-based questionnaire – front-line operational staff Telephone interview – progress of implementation

  12. Broad range of policy aims to be evaluated Variety of patient groups Need to collect data from busy people Diversity in local information systems The world is not standing still …control group Research design …… a few challenges

  13. Evaluation progress to date • Research and Development approvals • Implementation interviews • Impact on workforce – operational staff: to begin • www.phbe.org.uk

  14. Recruitment begins April 2010; ends April 2011 Fieldwork to end by April 2012 Interim reports: 1st - Early implementation issues: June 2010 2nd – All implementation issues: November 2010 3rd – Cost of implementing PHBs: May 2011 4th – Early experiences of PHB holders and carers: July 2011 5th – Satisfaction of PHB holders and carers: May 2012 Final report due in October 2012 Some key dates…

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