The Health Bill tabled in Parliament on 15 January authorises the introduction of personal health budgets. It is accompanied by a wide ranging impact assessment which draws together findings from international experience.
The Bill provide a power to enable the use of direct payments – one
form of personal health budget - where an individual will receive money
to arrange and pay for their own health services within clear
guidelines. Direct payments have existed in social care since 1997,
but they will be a significant departure from the current funding
arrangements for health.
A number of pilot schemes are proposed to see if the benefits of direct payments in social care are replicated in health settings. The benefits have been improved service user wellbeing through greater self-direction, leading
to increased satisfaction and feeling of being in control, and lower costs
through more planned care and a greater focus on prevention. Pilots
will explore the potential to use personal health budgets to give more
autonomy and choice to more deprived patients, thus reducing health
inequalities.
The Department of Health has now invited applications from PCTs. The circular makes it clear that Personal health budgets are part of a broader picture of personalisation and empowerment, including self care and self-management, choice, care planning, and capturing and responding to patient voice.
While mental health is specified as an area for pilots there are one or two warning signs that old-style paternalism may be around. For example “Approval for treatments that the NHS would not normally fund because they are not shown to be cost-effective must be obtained in the normal way from the PCT’s exceptions committee” . The whole point of individual budgets is that they are flexible and personal. What benefits the individual is not a NICE approved treatment but being in control and the dead hand of a PCT committee is clearly the wrong way to go!
While there are numerous references in the circular to the need for a culture shift, it is not always evident. The care plan has to be agreed by the PCt. Providers have to be regulated. Indemnities have to be given. Effectiveness of treatments has to be assured.
Now is the time for SPN members to be asking their PCT to participate in the pilots and seeking to get involved in the steering groups for pilots so that the dead hand of NHS bureaucracy does not stifle this exciting new development
Download Personal Health Budgets: First Steps
Terry Bamford
January 2009
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