Integrating equality within personal health budgets


20 / 09 / 2011

  • The organisation
  •  What we did and why
  •  How we did it
  •  Results and next steps
  •  Further information and contact details


    The organisation

    NHS Doncaster is a primary care trust which commissions healthcare services on behalf of the population of Doncaster. Doncaster Metropolitan Borough Council (DMBC).  The trust has a resident population of around 291,600 people and employs around 400 staff in its commissining arm and 1700 staff in it provider arm.

    What we did and why

    Nationally, more and more people are living longer with complex needs and long-term health conditions, this is creating an increasing demand on health and social care services. Though the Government has made clear its intention to focus on reducing the budget deficit, the spending review has pledged an extra £2 billion for social care budgets by 2014-15.

    NHS Doncaster and Doncaster Metropolitan Borough Council (DMBC) signed up to take part in a national pilot scheme to trial Personal Health Budgets. Both the Equality Act (2010) and the White Paper Equity and Excellence: Liberating the NHS strengthen the requirement for NHS organisations to involve patients in decisions on spending and service delivery particularly where disadvantaged groups may be affected.

    Participation in this pilot was used as an opportunity to improve the health and social care outcomes of patients living with long-term conditions and those with complex needs. The pilot also aimed to explore ways of embedding equality and diversity within the commissioning process. With Patient choice listed as a right under the NHS Constitution, Personal Health Budgets put patients in the ‘driving seat’ of commissioning their own care.

    How we did it

    Two personal health budgets pathways were developed – one for fully NHS funded cases, and another integrated pathway for joint funded cases with DMBC. Actions to deliver this included:

    • development of a resource allocation system (RAS) for fully funded cases
    • develoment of a joint RAS for joint funded cases with DMBC, taking into account statutory responsibilities of both organisations including duties around equality and diversity
    • revising documentation to join health and social care processes,  including a joint Self-Assessment Questionnaire (SAQ). This reflected the need to provide a good quality service for all and that equality must be at the heart of the SAQ. A high quality, safe service is not good to someone who needs it but cannot access it, or who does not want to use it because it is insensitive to their needs.

    A resource allocation tool for clients with mental health needs based on the Recovery Star Tool (developed by the Mental Health Providers Forum) was developed. Potential barriers to the Recovery Star Tool's effectiveness were identified with Black and Minority Ethnic (BME) users, including issues of language, religion and spirituality, concepts of family and their roles in recovery, and cultural understandings of aspects of mental health.*  A total of 31 clients were recruited onto the mental health pilot group and 21 on the control group.

    Partnerships were developed with third party voluntary sector organisations to help manage personal health budgets on NHS Doncaster’s behalf. These included:

    • Rethink, the largest national voluntary sector provider of mental health services with almost 300 services and 147 support groups
    • Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust, which has a strong record of providing high quality mental health and learning disability services to local people.

    The results and next steps 

    The Recovery Star Tool means that service users now have a tool which can help them access services addressing barriers which have historically been shown to hinder equality of access. Equality data and other sources of evidence are now being used so outcomes are measurable and the impact of care plans can be evaluated.

    Working with partners has allowed commissioners to explicitly take account of and represent the views of patients, groups and communities in the mental health field, particularly where there have been concerns about inequalities and service provision. This means that public health outcomes are measurable, substantive and are developed through evidence-based strategies with the involvement of service users, patients and local communities.

    Prevention and personalisation, the pilot has empowered people to maintain independence as this quote illustrates

    " My mum was diagnosed with vascular dementia December 1999 and lived in a care home.  I decided I would take her home and provide 24 hour care for her for as long as I possible could. I completed a self assessment questionnaire, and from that I was allocated a weekly budget to spend on meeting the care needs of my mum. Overall, my mum’s quality of life has greatly improved whilst remaining in her own home. I think the familiarity of her own environment has helped reduce the anxiety she felt when she was in a care home. With the flexibility of a personal health budget I am now hopeful my mum will continue to remain in her own home where she feels safe."

    In terms of next steps:

    • plans are in place to roll out the pilot within the two existing service areas and to start mainstreaming it into long term conditions and Children’s continuing care.
    • independent evaluation is being undertaken, which takes into consideration issues of language, religion and spirituality, concepts of family and their roles in recovery, and cultural understandings of aspects of mental health
    • the findings of the report of the Recovery Star BME Pilot Study REF(June 2009)* will be embedded across all commissioning processes

    Further information and contact details, Commissioning and Planning Manager, NHS Doncaster, 01302 566137

    The Recovery Star Model Cultural Competency, Report of the Recovery Star BME Pilot Study Mental Health Providers Forum, June 2009


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