Personalisation

Improves people’s health and wellbeing, joins up care in local communities, reduces pressure on stretched NHS services and helps the health and care system to be more efficient.

Helps people with multiple physical and mental health conditions make decisions about managing their health, so they can live the life they want to live, based on what matters to them, as well as the evidence-based, good quality information from the health and care professionals who support them.

Recognises that, for many people, their needs arise from circumstances beyond the purely medical, and will support them to connect to the care and support options available in their communities.

Brings six different parts of the health system together based on a growing evidence base of what has worked in shared decision making, personalised care and support planning, enabling choice, social prescribing and community-based support and personal health budgets and integrated personal budgets

Personalised care and support planning is a systematic way of ensuring that individuals living with one or more long-term condition (LTC) and their health and care professionals have more productive and equal conversations, focused on what matters most to that individual. It is a collaborative process between equals, whereby people with health and care needs, along with their family and/or carer, work together with care practitioners to discuss:

• what is important to them, setting goals they want to work towards
• things they can do to live well and stay well (and for some people, dying well)
• what support they need for self-management; agreeing actions they can take for themselves
• what care and support they might need from others and how this can best fit in with the rest of their lives
• what good support looks like to them as an individual
• preparing for the future, including making choices and stating in advance
• preferences for care at the end of their life (where relevant and appropriate)

Personalised care means people have choice and control over the way their care is planned and received based on ‘what matters’ to them and their individual needs and preferences.

Maternity

Personalised care and support planning is a process to identify what matters to each person using maternity services and makes sure that their care reflects this. With their midwife or obstetrician, they will consider and discuss their life, family situation, health and wellbeing, and preferences, so that their care reflects their needs and wishes.

The result of these conversations is a personalised care and support plan. This will set out the decisions they have made about the care and support to be received throughout pregnancy and birth. The plan will cover antenatal care, labour, and birth as well as postnatal care. It should be reviewed by the midwife and/or obstetrician with women at every contact or appointment and updated if anything changes.

Cancer

Personalised Care and Support Planning (PCSP) helps people living with cancer to take an active and empowered role in the way their care is planned and delivered, with interventions and care tailored around the things that matter most to them.

It is achieved through a series of supportive conversations in which the patient, or someone who knows them well, actively participates to explore the management of their own health and well-being in the context of their life and family situation.

A Personalised Care and Support Plan ensures people’s physical, practical, emotional, and social needs are identified and addressed at the earliest opportunity.

A Personalised Care and Support Plan will help you to:

• keep a record of conversations, decisions and agreed outcomes.
• understand a patient’s care and support needs, their life and family situation.
• know what is required to make the plan achievable and effective.

A Holistic Needs Assessment (HNA) is a simple questionnaire for patients. An assessment can be carried out at any stage of the cancer pathway, on paper or electronically and will:

• identify a patient’s concerns.
• start a conversation about needs
• develop a Personalised Care and Support Plan
• share the right information, at the right times.
• signpost to relevant services.

HNAs are a key intervention of personalised care for people living with cancer.

Shared decision making puts the patient at the centre of decisions about their care and treatment. It is a collaborative process where a clinician, such as a GP or hospital consultant, supports a patient to reach a decision about their treatment.

A shared decision-making conversation brings together:

• The clinician’s expertise, such as treatment options, evidence, risks, and benefits.
• What the patient knows best, such as their preferences, personal circumstances, goals, values, and beliefs.

Before your appointment with a health and care professional, please consider the following questions:

What matters to me?

What is important to me?

What am I worried or concerned about?

You might also want to consider whether it would be helpful to have someone attend the appointment with you.

Thinking about what matters to you before your appointment will help to tailor your care and treatment around what matters to you.

During the appointment, consider asking three simple questions:

1. What are my options?
2. What are the benefits and risks of each option?
3. How can we decide together that is right for me?

These questions are important because, alongside your health professional, it will help you gather the information you need to make a decision that is right for you.

You will also be able to understand what options are available for you and what the benefits and risks of these options are.

The benefits of shared decision making:

• The patient receiving care and those delivering care can understand what’s important to the other person.
• People feel supported and empowered to make informed choices and reach a shared decision about care.
• Health and care professionals can tailor the care or treatment to the needs of the individual.

How we support shared decision making

• The care and support you receive should take into account your needs and preference.
• You have the right to be involved in discussions, and make decisions about your treatment and care, together with your health or care professional.
• Patient decision aids support conversations and help patients make informed choices. The National Institute for Health and Care Excellence (NICE) has developed several tools to support shared decision making for specific conditions. These tools are available on the NICE website.

Social prescribing allows GPs, nurses and other primary care professionals to refer patients to a range of local, non-clinical services, to support their health and wellbeing. A SPLW will talk to you about what matters to you and they can connect you to relevant community groups and services for practical and emotional support.

Social prescribing works for a wide range of people, including people:

• With one or more long-term health conditions
• Who need support with their mental health
• Who are lonely or isolated
• Who have complex social needs which affect their wellbeing.
• In LLR all GP practices have social prescribing link workers. If you are interested in working with a social prescribing link worker, please discuss this with staff at your GP practice.

Care coordinators identify and work with people, including the frail/elderly and those with long-term conditions, to provide coordination and navigation of care and support across health and care services.

Health and wellbeing coaches support people to increase their ability to self-manage, motivation levels and commitment to change their lifestyle. They are experts in behaviour change and focus on improving health related outcomes by working with people to set personalised goals and change their behaviours. They work with people with physical and/or mental health conditions and those at risk of developing them.

Health and wellbeing coaches can be an effective intervention for people experiencing a range of long-term conditions, including respiratory, cardiovascular (including type 2 diabetes and hypertension), and stress/low mood. They can also support people with weight management, diet and increasing activity levels.

A personal health budget is an amount of money to support the identified healthcare and wellbeing needs of an individual, which is planned and agreed between the individual, or their representative, and their Integrated Care Board (ICB) It isn’t new money, but a different way of spending health funding to meet the needs of an individual.

About personal health budgets: A personal health budget is money to pay for things that keep you healthy. It can make it easier for you to get the care and support that works for you. You have more choice over how your needs are met.

How personal health budgets work: Your local NHS team will support you to write your care and support plan. This will help you understand how you can spend the money. It could be a nurse, a care manager or someone who helps you make decisions about the support you pay for – this is called a support broker.

Personal health budgets can work in three different ways: 1. Notional budget – this means your local NHS team organises your care and support. You know how much money there is to spend and you say how you want to spend it. 2. Third party budget – this means the budget is held by an organisation that is not part of the NHS. 3. Direct payment – this means you have the money to buy and manage your own healthcare and support. You will be asked to show how you spent the money by your local NHS team.

You can get a personal health budget if you:  Are an adult who has NHS Continuing Healthcare. A child or young person who can get Continuing Care. Have ‘section 117 after care’ and have been in hospital because of your mental health. Have a NHS wheelchair. This is called a personal wheelchair budget and gives you choice over your wheelchair. Your local NHS team will be able to tell you if you are able to have a personal health budget.

What you can use a personal health budget for : You can use your personal health budget for things such as, Personal care, doing things that help keep you well such as swimming, having help to do gardening, attending art or pottery classes, getting equipment that meets your health needs such as exercise equipment, assistive technologies that can remind you to take your medication or help you communicate, Greater choice over your wheelchair if you get a personal wheelchair budget

You cannot use your personal health budget for: Emergency health services, services you usually get from your GP, things that are not legal, paying money back that you owe, gambling, alcohol, and smoking.

Your personal health budget should work well for you and keep you safe. Having a personal health budget should be a good experience. You have control over decisions. Organisations that give you health and social care should work with you to give you the best possible service.

Policy for Personal Health Budgets

NHS Continuing Healthcare (CHC) is a care package for people aged over 18 that is funded entirely by the NHS. To qualify for CHC, you’ll need to be assessed to see if you have a ‘primary health need’ that requires healthcare, rather than social care.

To be eligible for CHC, you don’t need to have a disability, specific health condition or illness, and it doesn’t depend on where the care will be provided.

Applying for CHC funding

There are a few steps in the process, which are laid out below:

Checklist

If a health care or social care worker thinks you might be in need of an NHS CHC package, they will do a Checklist to see if you meet the criteria for a full CHC assessment. A Checklist is a screening tool, it is used to help practitioners identify people who may need a full assessment of eligibility for NHS CHC. The Checklist does not indicate whether you are eligible for NHS CHC, only whether you require a full assessment of eligibility. It is important to be aware that the majority of people who “screen in” (have a positive Checklist) are found not to be eligible once the full assessment has been done. Completion of the Checklist will be done at a suitable time and place – it wouldn’t be appropriate to do this, for example, if you were in hospital.

If the Checklist shows you aren’t eligible for a full CHC assessment at that point, it will be held on record so we know it’s been completed. If your health changes at any time, the Checklist can be repeated.

Full Assessment

CHC assessments are undertaken by Midlands and Lancashire Commissioning Support Unity (MLCSU) on behalf of Leicester, Leicestershire & Rutland ICB.

If the Checklist shows you are eligible for a full assessment, a CHC co-ordinator from MLCSU will arrange a meeting with you, your representative(s), e.g. family, and a multi-disciplinary team (MDT) of health and social care professionals who are involved in your care.

After the meeting, which usually takes about two hours, the MDT will make a recommendation to the ICB. The MDT can recommend:

• CHC funding, in your home or in a nursing or residential home;
• NHS Funded Nursing Care in a nursing home;
• a joint funded package of care, with social care, in your home or in another location; or
• that you are not eligible for CHC funding or any of the above.

Some of these options may include means testing, or extra charges by a care home for ‘lifestyle choices’ that are outside normal health and social care costs.

Integrated Care Board (ICB) Decision

Only in exceptional circumstances, and for clear reasons, will the MDT’s recommendation not be followed by the ICB. However, the ICB can ask for more evidence if needed to verify the recommendation.

If you are unhappy with the ICB decision

If you are unhappy with either the process or a decision made regarding eligibility for NHS continuing healthcare, you can request a review of the decision by contacting MLCSU via the contact details included on the eligibility outcome letter. For further information regarding the review of an eligibility decision, please visit the MLCSU website by clicking here.

Funded Nursing Care (FNC)

If the MDT recommends that care is provided by a registered nurse in a nursing care home, you might be entitled to a contribution towards assisted nursing. This funding is known as NHS Funded Nursing Care.

Before a decision on NHS Funded Nursing Care is made, you’ll need to be assessed in the same way as we’ve explained in the ‘applying for CHC funding’ section above. If you aren’t eligible for CHC funding but are entitled to NHS Funded Nursing Care, the contribution will be made directly to the nursing care home.

The rest of the cost will be paid through the local authority, or if you are not eligible for social care support you might have to fund your care yourself.

Who to contact:

For any queries relating to the CHC assessment and appeals processes, please contact the MLCSU CHC Team on 0116 504 0112 or via email at mlcsu.spallr@nhs.net.

For any queries regarding ongoing appeals of CHC eligibility decisions, please contact the MLCSU Appeals Team on 0151 433 6987 and select option 2. Alternatively, they can be contacted via email at mlcsu.rrvanddisputes@nhs.net.

Further information on the CHC service can be found at MLCSU’s website

Personal Health Budgets

A personal health budget (PHB) is an amount of money planned and agreed between you (or your representative) and the ICB to support your health and social care needs.

It can be provided in three different ways, for more information please visit the Personalisation web page.