This case study shows how commissioners are working with mental health service providers to help them change what they offer and to make the market more flexible and responsive to what people want through the use of personal health budgets.
In Merseyside, people with mental health problems have been offered personal health budgets as part of the pilot programme in an areas where services are provided by Mersey Care NHS Trust.
As part of the pilot, personal health budgets have been tested in two ways in mental health services:
- Over 150 people have been offered one-off budgets of up to £400 (also known as individual recovery budgets).
- Six people have been offered a personal health budget for larger packages of support and all six of these are joint packages with social care
A voluntary organisation, Imagine, has provided support planning and brokerage to people offered personal health budgets. An advisor from Imagine spends time with each person and their family, to help them to think through what they want to achieve and how they might go about doing it. The support plan is then discussed and agreed with a health professional, for example the person’s community psychiatric nurse, social worker or occupational therapist.
The commissioner pays the personal health budget directly to Imagine, who then helps the person to arrange the support. The money is held by Imagine, and then can be used to buy items directly using a company credit card, BACS or by requesting an invoice. This makes it possible to buy items that the NHS would not normally be able to arrange. It also means that people do not need to have a bank account that can be used for a direct payment.
For recovery budgets, people define their own health and social care outcomes, (what in their view will contribute to their recovery and keep them well), and the intended outcomes are recorded in the care programme approach care plan. As long as the money is used in ways that are legal and safe, it can be used in any way that make sense to the service user.
For joint packages the Imagine ‘broker’ arranged direct payments for healthcare and third party fund management support through the local authority direct payments team.
One-off recovery budgets have been used to help people to get back to work, for education and training, for holidays, and for other leisure activities. The money has been used in ways that are very different to conventional NHS services, but which have enabled people to achieve goals that are directly linked to better mental health and enabling them to rebuild their confidence. The items bought include: bus passes, singing lessons, art classes, equipment to start a business, fishing tackle, garden tools, laptops, computers, gym membership, short breaks, relaxation sessions and bikes. Six service users pooled their money to set up an allotment using vouchers for a local gardening centre.