A Business Perspective

On this page, we share our thoughts and comments on current issues in the health, care and social business market place, including any general learning from our work, when we think that might be useful. We also include links to any articles or blogs we have been involved with.

September 2020
Personal Health Budgets

The NHS Long Term Plan confirmed that the NHS needs a more fundamental shift in how it works alongside patients and individuals to deliver more person-centred care, recognising, as National Voices has championed, the importance of “what matters to someone” is not just “what’s the matter with someone”. Since individuals’ values and preferences differ, ensuring choice and sharing control can meaningfully improve care outcomes. The NHS Long Term Plan also reflected that creating genuine partnerships requires professionals to work differently, as well as a systematic approach to engaging patients in decisions about their health and wellbeing. The Plan said that the NHS will support and train staff to have the conversations which help patients make the decisions that are right for them. 

These are all fine words but a key question for patients and carers is how quickly can some of the professionals really change the way they have been working to date? How quickly, for example, can they find new ways of co-operating with patients and carers through personal health budgets (PHBs)? It is perhaps worth acknowledging, however, that not everybody seems to believe that patient views really matter when care decisions are being taken. Many people have considered this issue formally, trying to show practically and scientifically that listening to patients makes good sense. The very debate indicates that listening to patients and trusting them to be their own commissioners is not an automatic step for everybody and some hearts and minds are still to be won. This is so despite DHSC and NHS England consultations revealing strong support for PHBs and Matt Hancock’s words that “Everyone deserves the right to make decisions about their care, and health and care should be centred around each and every one of us, not a one-size-fits-all approach”.

he NHS Long Term Plan noted that the Comprehensive Model of Personalised Care is already being implemented. By September 2018 over 200,000 people had already joined the personalised care programme and over 32,000 people had received PHBs, nearly a quarter of which were jointly funded with social care. In fact, figures released from October 2019 show that the 32,000 PHBs figure had moved up to 70,000. 

The Long Term Plan states that the NHS will accelerate the roll out of PHBs to give people greater choice and control over how care is planned and delivered and up to 200,000 people will benefit from a PHB by 2023/24. This will include provision of bespoke wheelchairs and community-based packages of personal and domestic support and there will be an expanded offer in mental health services, for people with a learning disability, people receiving social care support and those receiving specialist end of life care. Indeed from the 2nd December 2019, everyone eligible for an NHS wheelchair and people who require aftercare services under section 117 of the Mental Health Act have had access to a PHB. Of course adults who are eligible for NHS Continuing Healthcare funding have had a legal right to have a PHB since October 2014. For the latest NHS England and NHS Improvement guidance on PHBs please see their document “Guidance on the legal rights to have personal health budgets and personal wheelchair budgets” dated December 2019. (https://www.england.nhs.uk/wp-content/uploads/2014/09/guidance-on-the-legal-rights-to-personal-health-budgets.pdf)

Again fine words in relation to target numbers in the NHS Plan for PHBs, 200,000, but if they are to be achieved then NHS England, CCGs and councils really need to focus even more seriously and more quickly on this whole area including how they all cooperate and coordinate their actions and decisions. The legal and regulatory mechanisms are substantially in place to effect and enable the required change in pace and scale for PHB uptake. But more debate about what the most difficult barriers to the pace of change in PHBs is needed, and how those might be countered and overcome and also what we all need to do to give PHBs the best possible chance of actually improving care, including the patient experience of living and dying.

Please note that the Government has acknowledged the importance of everybody receiving the care and support they need throughout the Covid-19 pandemic and further guidance has been issued and updated on the 11th September 2020 and is called “Using Direct Payments during the coronavirus outbreak: Full Guidance for People Receiving Direct Payments and Personal Assistants.” (https://www.gov.uk/government/publications/coronavirus-covid-19-guidance-for-people-receiving-direct-payments/people-receiving-direct-payments-and-those-they-employ-quick-read)

April 2020

Metamorphosis has been said to be a dynamic principle of creation, vital to the natural process of generation and evolution, growth and decay! We often think structures that we put up will last for ever but quite often this is not correct. We see buildings change and adapt before becoming obsolete, demolished and a new building going back up when needs change. The same is true of companies or other corporate structures that organisations use to deliver their services. These business structures can change, they can adapt, they can be dissolved and new organisations created.  These metamorphoses are going on all the time in the community as organisations adapt  to changing finances or to community needs, or the desire amongst organisations to work more closely together or dealing with the consequences of winning or losing contracts. 

Over the last few months, we have supported a client begin the process of dissolving a charitable company that was no longer able to access the necessary funding to continue its good works. But, in another case, we have supported and drafted the application to the Charity Commission for a new Charitable Incorporated Organisation as a client looks to support capacity building for its local community to improve health in its area.  We have helped redraft a Community Interest Company's Articles of Association to enable it to be owned and managed in a different way, to support better voluntary organisations in its locality to improve the local care and health agenda. Finally, we have been supporting a Community Interest Company that has won a new contract to provide community health care and needed to enter into business transfer agreements with those companies whose staff and assets were transferring to it to start performing the services from April 1st, 2020. 

Despite the impact of the Corona virus and the difficult financial pressures, healthcare organisations, social businesses and charities are continuing to adapt and flex and re-engineer themselves so that they are in best position to support their clients, residents and patients over the coming year. 

December 2019

Chris is a member of the "Communities of Integration Network" or "COIN". This is a  network of health and care practitioners and academics supported by the three Royal College of GP Faculties in London. The purpose of COIN is to advance the understanding and implementation of community-orientated integration care. COIN works with the online publication "Health Matters" to publish blogs that stimulate good community orientated integration care practice nationally and internationally. 
Please see a recent blog by Chris on the role of Community Interest Companies under the NHS Long Term Plan by clicking on the link below: