Nov 16

Positive relationships – by design - is current policy on personal health budgets and personal budgets missing a trick?

Posted: 7 November 2016

Jim ThomasIs current policy on personal health budgets and personal budgets missing a trick? Jim Thomas, Programme Head – Workforce Innovation at Skills for Care argues that ‘personal workforce budgets’ should be used to bring teams from social care, health and housing together in a sustainable, whole system approach to community-based care.

Over the last year, Skills for Care in partnership with the Department of Health, Health Education England and Skills for Health have developed and run a scheme of funding focused on providing personalised workforce funding to people with a learning disability and / or autism who may be about to be discharged from inpatient services, or be at risk of admission.

Personalised workforce funding enables people in someone’s circle of support (for example a nurse, parent, direct support workers) to develop skills and knowledge to meet the particular needs of that individual. It does not replace or provide a means to fund workforce development that would be considered as general requirements for workers to undertake their role. It offers the opportunity for the relevant people involved in supporting someone, regardless of whether they are family carers, volunteers or work for health, social care, or other sectors to learn together - or for their learning to be planned as complimentary activities as part of an integrated intervention. Personalised workforce funding can model and support integrated, cross sector, co-production and support.

A personal workforce budget is an agreed amount of funding, or learning and development resource, focused on making sure that people supporting a person with complex care and health needs have the specific confidence, competence, values, attitudes, skills and knowledge to ensure that person is able to make individual choices and maintain their independence, with dignity and the respect of their local community. It may be a one off workforce intervention (e.g. a specific course). It may be an ongoing workforce intervention (e.g. coaching or mentoring). But it is different to general workforce development support.

The personalised workforce programme tested the idea of personal workforce budgets in practice. Funding of between £1000 and £8000 per grant was provided to meet workforce development needs, each related to specific individuals around positive behavioural support (PBS), autism and associated topics, including skills to deliver further development. This resulted in 2,900 training interventions focused around the needs of 169 'focus people'. We know that many of the workers also used the skills they gained with a much wider number of individuals. The funding had to be spent on workforce development activity focused on meeting the needs of an identified individual. Applications were judged by an independent panel against stated criteria, which focused on outcomes for the individual, their team and the wider system.

The early findings from this work suggest that this resulted in 82% of the organisations involved reporting that as a result of the learning and development funded by a personal workforce budget, there had been a reduction or avoidance of a hospital admission for the person the workforce budget was linked to and / or to other people that those staff also support.

The impacts on the workforce included:

  • Professionals had become far more adept at putting themselves in the focus person’s world, thus helping them and others to understand what can be done to minimise anxiety and stress.
  • The training impacted on the culture of the service, with staff embracing the view that behaviours perceived as challenging are seen as a form of communication that a need is not being met.
  • Lower staff turnover, reduced stress and better reflection.
  • Staff report feeling more confident when dealing with challenges, reducing the incidents.

Personal stories emerging from the work included:

  • “The person is more settled, he does not seem to be as anxious and is more relaxed in his home environment”
  • “Improved physical health due to improved care”
  • “Intensive interaction has been really useful in building relationships. The focus person has begun calling people by their names, where previously she was shouting man or woman ... she is able to do more adventurous trips out…and largely it is the staff team understanding and skills that have contributed to this”
  • “Much improved quality of life, developing positive relationships with staff team, decrease in challenging behaviours”
  • “Immediate improvement in self-esteem, quality of life, access to activities and positive relationships”
  • Reduction in the amount of antipsychotic medication prescribed in the local area
  • One person needing 2:1 staff support instead of 5:1 that was needed previously.
  • "The funding helped to bring together several agencies and family carers for a common purpose, which is something we would normally find very difficult or impossible."

While this programme of work is only one model of personalised workforce funding, it is evident from the work to date that such an approach can have a significant impact on people's lives and relieve pressure on public services.

The questions now are:

  • Could the approach be adapted or adopted on a broader scale?
  • What would the opportunities and challenges be?
  • What does the existing evidence base tell us about where this kind of approach has been used before?
  • Is personalised learning and development, specifically directed at the workforce and support people in the community the missing link?

Jim Thomas