At the end of January the Department of Health (DH) produced "Personal Health Budgets: First Steps" which describes how personal budgets might work in the NHS and describes the pilot programme which will demonstrate whether or not such budgets are effective.
For patients, the main benefit of having a personal budget is that it should increase the amount of control that you have over your care and improve your sense of well-being and confidence. However, the evidence from the use of individual budgets in social care is mixed. People to feel more in control but this doesn't always translate into a greater sense of well-being. Older people in particular see the management of a personal budget as an overly arduous task and would rather continue to receive care in the "traditional" way. The report notes that "further work is underway to understand why some people did not find that having an individual budget improved their satisfaction or quality of life". Regardless of this "mixed" evidence the DH does seem keen to press on with the whole personalisation agenda.
The document sets out the following "key" principles for personal health budgets:
- Upholding NHS values, this means supporting the NHS as a comprehensive service, free at the point of use and consistent with existing NHS policy. There should be clear accountability for the choices made. No one will ever be denied essential treatment as a result of having a personal budget. Having a personal health budget does not entitle someone to more expensive services, or to preferential access to NHS services.
- Quality, safety, effectiveness and experience should be central. the well being of the individual is paramount. Access to a personal health budget will be dependent on professionals and the individual agreeing a care plan that is safe and will meet agreed health and well being outcomes. There should be transparent arrangements for continued clinical oversight, proportionate to the needs of the individual and the risks associated with the care package.
- Tackling inequalities and protecting equality. Personal health budgets and the overall movement to personalise services could be a powerful tool to address inequalities in the health service. However, local organisations need to take care that their implementation does not exacerbate inequalities or endanger equality.
- Personal health budgets are purely voluntary. No one will ever be forced to take more control than they want, and a PCT does not have to offer an individual a particular of managing a budget if it does not feel that this is the best way of commissioning services for that individual.
- Making decisions as close to the individual as possible. Appropriate support should be available to help all those who might benefit from a more personal approach, particularly those least well served by existing services or access and who might benefit from managing a budget.
- Partnership. Personalisation of healthcare embodies co-production. It means individuals working in partnership with their family, carers and professionals to plan, develop and procure the services and support that are appropriate for them. It also means PCTs, local authorities and healthcare providers working together to use personal budgets so that health and social care work together as effectively as possible.
The document states that it would not be appropriate to specify which services or groups of people would benefit from a personal health budget but then goes on to list some "service areas" where people believe personal health budgets may be beneficial:
- NHS continuing healthcare;
- mental health services, especially for people with complex needs;
- maternity services;
- learning disability services;
- end-of-life care (but bearing in mind the particular sensitivities involved); and
- some long term conditions, especially where there are complex needs or opportunities to focus on preventive interventions
Emergency services are given as an example of an area that is unlikely to be appropriate for personal health budgets.
The document identifies three different approaches that may be used in delivering personal health budgets. Notional budgets whereby a patient would be involved in discussions about the options available within an agreed budget. The patient would then understand the amount of funding available and would be able to contribute to decisions about how this is to be spent. It is felt that notional budgets may be an option for those who want more choice and control over their care but don't want the hassle of actually managing a budget. The second option is to have real personal budgets held by a third party, with this approach patients are given a budget but this is held on their behalf by a third party.
This third party may help the patient to design their care plan and choose their services. The report cites Independent User Trusts as non-profit making organisations that can be used to hold funds on behalf of a patient. The third approach is healthcare direct payments whereby patients would be given cash payments to purchase and arrange the services they need. This option is not yet allowed by law, the Health Bill currently before parliament will enable these payments to be made and the Department hopes to start running pilot programmes from the middle of next year.
Whilst the aim of giving people more control over their care is laudable, this does depend on a thorough assessment and an effective care plan. Nationally the UK has a very poor track record in assessment that tends to be geared to the services available rather than the individual's needs and preferences. If the introduction of personal health budgets improves the assessment and planning process then these changes will reap real benefits. If, however, the new approaches are simply placed on top of questionable practices then the whole exercise will be a complete waste of time.
This article was taken from the BenefitsNow 12th newsletter 22/02/2009
Benefitsnow February 2009 Newsletter
Hello,
This is our twelfth newsletter which aims to bring news stories of interest to people with disabilities and their carers. We hope you find the information below to be useful. If you have any comments please e-mail john@benefitsnowshop.co.uk .
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