ICSs and PHBs - In Control of Success

The move towards Integrated Care Systems (ICSs) and the associated consolidation of CCGs and integration with local authorities seems like a good thing overall.  The question that we have been asking ourselves at PPL is what does this mean for Personal Health Budgets? 

Although great progress has been made on PHBs in recent years, the pandemic has understandably delayed their rollout and when we speak to people in the health sector, it feels like move to ICSs may be causing a further delay.  We therefore offer our perspective on how the narrative for PHB Leads within ICSs can be switched from Indecision Causing Slowdown to a more positive one of being In Control of Success.   

1. Don’t wait –The NHS Long Term Plan contains a commitment of 200,000 PHBs by 2023/24, and so progress needs to be made now. Many ICSs are still being formed and developed, and ICSs currently have no statutory footing (although that should change next year), so waiting for an ICS-wide solution for PHBs is dangerous.

2. Each ICS is different – There is no blueprint for developing an ICS and there is wide variation in the arrangements being put in place and the maturity of partnership working across systems. So, whilst one ICS may be developing systems and processes that will tackle PHBs across the whole region, others won’t be getting in to that level of detail. 

3. Systems, Places & Neighbourhoods – The typical ICS covers a large area, with a population of between 1 and 3 million people. A key premise of ICSs is collaboration over smaller geographies within ICSs, which are referred to as ‘places’ and ‘neighbourhoods’.  What we are seeing is that whilst ICSs may steer overall policy for PHBs, the actual delivery is likely to be at a more local level, potentially led by the same people and/or on a similar footprint to existing CCGs that have laid the groundwork for PHBs. 

4. Social Care v Health – One of the aims of ICSs is to bring social care and health closer together. Given the maturity of the personalisation agenda within social care, many health organisations already work closely with their social care colleagues on PHBs.  Not reinventing the wheel makes sense, especially to get started.  However, as the number of PHBs scales up, health organisations should be developing and owning their own approaches, recognising that PHBs aren’t the same as social care direct payments, seeking to learn lessons from local authorities rather than just adopting what they do. 

5. Targets not delivery – A review of the plans of a sample of ICSs suggests that ICSs are likely to focus on policy, targets and measurement of PHBs rather than the actual delivery of them. It therefore seems as though the hard work done by PHB leads and specific CCGs will be continue to be valuable.

Lets figure it out together... 

We have a range of low-cost, low-commitment solutions that can help you be In Control of Success and stay on track with your local PHB targets despite the challenges all around.  More importantly, we are passionate about PHBs and the difference they can make.  If you are too, we’d love to talk to you about your thoughts on the above.