The thorny issue of how personal health budgets will work in practice is being tackled by an e-commerce platform that promises an easier way for the public to spend, as Daloni Carlisle explains
Amid all the excitement - and nervousness - about introducing personal health budgets for continuing care this April, one thing seems to be missing: how do patients actually buy their care?
Yes, there are plenty of case studies outlining the difference that personal health budgets have made to individuals and, yes, there is guidance on how people entitled to a budget should work out a care plan with their clinician. There is information, too, about how to manage budgets and keep financial control at commissioner level.
But when it comes to the practical means by which patients can buy what they want there is much less information.
How can the NHS help patients, if you like, “shop” for services? How can patients compare prices, for example, or be sure of the qualifications and track record of their chosen provider? Or, for that matter, provide feedback on quality?
It is a gap that Lyn Duncan, chief executive of cloudBuy, spotted early on as social care personal budgets were developing. She has developed a solution that is now being extended to the NHS.
Twenty years ago, Ms Duncan was a management consultant working in health, trying to find ways to bring primary and secondary care together. “What I saw was monolithic systems where people would fall into the spaces between services and die,” she says. “So for me this is not just business - this is actually something that matters.”
Her career evolved from health towards establishing cloudBuy, an international e-commerce platform for businesses that helps users to streamline and manage their procurement, often delivering large savings. Hampshire Hospitals Trust is one of a number of trusts to use the N3-accredited platform. The advent of personal budgets in social care created the perfect opportunity to turn this technology towards service users.
Working with Serco and Hertfordshire County Council, in 2011 cloudBuy developed an e-commerce website for people holding a budget where they can browse potential suppliers meeting different needs before making their choice and purchasing. The local authority can “kitemark” suppliers and allocate a budget for people to “spend” through the site.
“People can also top up their spending,” explains Ms Duncan. “For example, using a debit, credit or prepaid card they can purchase an extra visit from a carer for an elderly relative who may be feeling isolated and whose budget won’t cover this element.”
Called Care Marketplace, the platform not only provides the means for people to browse, choose, purchase services and provide feedback but also allows local authorities to manage the finances and provides transparency on what services are being bought - and whether they are meeting customers’ needs. It is funded through transactions.
“The feedback loop is really important,” says Ms Duncan. “Every day we open the newspapers and see stories about patients being abused. Here is an opportunity for vulnerable people and their family members to feed back not just to the supplier but also to the public and to the local authority, which can start to help understand where the money is being spent and the level of services being delivered.”
It also opens the care market to those who do not have a personal budget but who nevertheless need to buy care services for themselves or relatives. They can use the site to assess their needs and help them decide what kind of care they might want to look at. Now Care Marketplace is to be extended to cover social care in Northamptonshire, with a view to creating a national platform that any local authority can buy into and that can - in time - extend to health.
‘Whatever we develop, it needs to attract the private and voluntary sector and have the confidence of users’
At the same time, cloudBuy is collaborating with NHS Shared Business Services to develop a Care Marketplace for the continuing health of personal budget holders.
Ms Duncan explains what this national e-marketplace means for her. “My mother is in Aberdeen, has diabetes and last year she suddenly developed a back problem which meant she needed some help. I live in Berkshire and there was nothing I could do from here, so I had to go and get her and bring her back to my home,” she says.
“If there had been a national e-marketplace I could have remotely assessed her needs, created a care plan, gone shopping and bought what she needed, whether that was extra grip rails, visits from a nurse or help with shopping.”
Penny Osborne, assistant director for business intelligence and performance improvement at Northamptonshire County Council, explains why she feels this approach is the right way to go.
She says that when social care budgets were introduced a few years ago, local authorities struggled to put the policy into action. Some came up with portals to provide information about services to users; some developed payment cards.
But both were “static and inflexible”, she says. There was no incentive for portal developers to draw service providers to their sites and people did not like the payment cards. They also excluded those not holding budgets - which is most of us.
Dynamic marketplace
So last year, Northamptonshire County Council held a “salon” with the New Local Government Network, inviting private providers to come up with innovative solutions that would meet its need - to provide a dynamic, self funding marketplace attractive to service providers, users and frontline staff and open to all.
The council has now formed a partnership with cloudBuy and consumer loyalty experts Grass Roots to develop this.
It’s early days. Phase one will be local; phase two will be much more visionary and could see health advice being brought in as a service people can buy, or linkages made between health and social care budgets.
“Whatever we develop, it needs to be beautiful and easy to use,” says Ms Osborne. “It needs to attract the private and voluntary sector and have the confidence of users and frontline staff.”
Meanwhile, this month, NHS SBS and cloudBuy will launch a service for the NHS. Any clinical commissioning group or commissioning support unit will be able to buy into it and then work with cloudBuy and NHS SBS to populate the site with local providers and accredit budget holders to purchase through it. Greater Manchester CSU plans to pilot the scheme.
Dr Hannah Goodman, NHS SBS director of solutions, again stresses it is early days but adds: “Our great vision is that we will enable links to be made with local authorities to provide seamless integration with social care budgets.”
So for those CCGs struggling with the practicalities of personal health budgets, this could be just what they are looking for.
The power of individual budgets
We blithely trip along in life regarding ourselves as invulnerable until something happens to us or a loved one which completely changes our perspective. I have now reached a point in life where, with aged parents, there are serious issues looming about their health, mobility and how best to support them in the future.
I am far from being alone in this and indeed there are many like me who are juggling still- dependent children with increasingly dependent parents, many of whom have complex medical and social needs. Lack of mobility leads to social isolation, which in turn leads to additional health needs - the cycle quickly becomes very negative.
None of this is new. Twenty years ago I was a management consultant working in the area of inter-agency collaboration. Even then it was very apparent to me that there was a high risk that a vulnerable person could slip into the black holes between services.
What is different now is that there is even less money around to support these services and the number of people requiring help has continued to increase.
One of the reasons that we as a company enthusiastically embraced the move to individual budgets is that, in the current fiscal environment, it is probably the only way that more can be done with less.
More importantly, people can be empowered to take charge of their lives, family members can become an intrinsic part of the decision making process, and we can have real time feedback on the quality of service delivered and the outcome.
Our vision is a single point of access for an individual across all health and social care provision, where there are no black holes and vulnerable people have access to appropriate and quality checked services wherever and whenever they require them.
The work that we have done to date makes us confident that this is realistic and that we can deliver it now.
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