Using Personal Health Budgets to support patients at the end of life

Background

Birmingham Hospice is situated in one of the most deprived areas in Britain. In 2019, it also had the highest number of people dying in hospital in the UK [1].

There were lots of reasons for this. Some people were not receiving the right support, at the right time, to help them cope at home. Family members were not necessarily able to take time off work to look after them.

Other patients were unable to maintain a suitable home environment because they were in financial crisis. For example they couldn’t afford to pay heating or water bills.

All of this can lead to a patient reaching a crisis points - either being admitted to Accident and Emergency (A&E) or being assessed with a safeguarding need due to neglect.

Project overview

Birmingham Hospice has worked with Birmingham and Solihull Integrated Care Board (ICB) to provide more support to people living across Birmingham and Solihull at the end of their lives. Using Personal Health Budgets (PHBs) the hospice has been able to  arrange for people to receive the goods and services they need.

In the four years since the project started, the hospice supported over 1,280 patients. At least 50 patients are supported on the case load at any one time.

Any health care professional can refer a patient to the service if they need extra social care support and are in the end stage of life (if death is expected within 12 weeks). 

The team manages the PHB budget on behalf of the patient, providing services that are most benefit for each individual.

The service supports patients of all ages, but the average age of people referred is around 70.

Examples of items and services provided to support patients include:

• towels for the care agency to use
• nightwear
• bedding for a hospital bed 
• cleaning services 
• haircuts, in the patient’s home.

All third party services are vetted by the PHB Team to ensure they are regulated, have undergone safeguarding checks and have relevant insurance.

The service allows people more dignity and choices at the end of life. It has proven successful at reducing hospital admissions by supporting patients to stay at home for as long as they want to.

The PHB service also supports patients to be discharged from hospital more quickly by making sure their home environment is suitable. This might include deep cleaning; moving furniture to allow hospital beds to be in situ; or arranging care services to complement a faster discharge.

By supporting the whole family, the service reduces carers’ stress-related absence from work and helps prevent crisis situations.

A clinical assessment of the PHB service in 2022 showed that patients with PHB support had fewer:

• primary care contacts
• urgent care contacts
• emergency care contacts
• hospice admissions.

Key facilitators

The hospice piloted the service in 2018, with support from the local Clinical Commissioning Group (CCG). They supported 25 patients at the end of their lives. Since then it has been extended and has evolved into the service it is today.

The hospice’s Personal Health Budget (PHB) team has grown. It now includes social workers and a befriending service to help support socially isolated people. The team can now help patients with wider problems such as:

• filling in forms
• accessing benefits
• sorting out power of attorney
• writing wills.

Patients on the PHB caseload can access all the hospice’s services, including wellbeing and counselling. 

The PHB team works closely with MacMillan Cancer Support, whose advisors come to the hospice once a week to help people access benefits and discuss financial concerns. They also have a good relationship with Citizen’s Advice, and other professional services, regularly referring patients to the appropriate organisation.

Challenges

Ideally, patients would be referred into the service at an earlier stage of their condition. However, the demand would be too high for the team to cope with, and there is not enough funding available to maintain this level of support.

To ensure the service is sustainable and meets the requirements of the ICB funding, support has been limited to those who are in the last 12 weeks of life.

The PHB team have seen an increase in referrals and requests for urgent help and support.

They are looking at how they can support local professional teams and services, including the acute sector, during a time of economic uncertainty.

1.    Birmingham City Council. Birmingham health profile 2019. [Internet] Birmingham City Council; 2019 [cited 2024 Aug 27].