Taking back control: Integrated Personal Commissioning

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It’s easy to dismiss those who say people ‘have had enough of experts’, particularly if you work for a think tank. But in health and care, we’ve long known that expertise is not the sole territory of the professional.

The Care Quality Commission now involves ‘experts by experience’ – people who have first-hand experience of health and/or social care services – in its inspections, in training inspectors and in the broader shaping of the organisation. Utilising the 'renewable energy' of patient expertise was one of the central pillars of the NHS five year forward view (Forward View), now more than two years old.

A lot has happened since the Forward View was published, including the development of the new care models programme, further devolution and most recently, the initial stages of developing sustainability and transformation plans (STPs). These initiatives have often focused on how different organisations can work better together in place-based systems of care. But as our recent research into STPs has shown, efforts to engage service users and the public in developing these system-level plans have often been lacking.

In contrast, the Integrated Personal Commissioning (IPC) programme – a partnership between the Local Government Association and NHS England – has been working to integrate health, care and education services around people rather than organisations. IPC focuses on individuals’ needs along with the community and peer support available to build their confidence and skills for self-managing long-term conditions. It enables health and care conversations around what is important to individuals, and seeks to offer choice and control through widening access to integrated personal budgets and developing more options to help people achieve their goals.

IPC is an important parallel to the population health systems developing through the new multispecialty care providers (MCPs) and primary and acute care systems (PACs). These new care models allow groups of providers to take the lead in planning health interventions across acute, primary and community-based care. And while this enables systems to make improved rational decisions across health and care, it is also important that people who have complex needs that cross organisational boundaries are empowered to opt out of traditional services if they aren’t working for them.

IPC sites across the country are working to try out different approaches to empowering people with complex mental, social and physical needs – particularly those who are at high risk of crises and admission to hospital (roughly 5 per cent of the population). The sites seek to connect people communities and maximise their personal expertise and relationships. Next year the programme will roll out to cover more sites, and it will operate across the whole of England by 2020.

The King’s Fund is bringing together leaders from across the IPC sites to discuss challenges in identifying and empowering people who would most benefit from this more personalised approach. In partnership with NHS England, we’ll provide a space for sites to share and learn from their mistakes and successes, and we will also monitor progression of the programme as it rolls out across the country. At the heart of this process will be listening to, and learning from, patients, service users and their carers.

IPC is not a panacea for the deepening challenges facing the NHS and social care systems as they weather the toughest financial climate in their history. But there are strong indications that when individuals take part in designing their care, they have a better experience with improved outcomes and more efficient use of limited resources. That has to be something to cheer in the new year.