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Control of the purse strings will combat stigma.
- Roger N Chitty (16 April 2008)
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Purse strings and care pathways
- Andrew Craig (29 April 2008)
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Roger N Chitty, Consultant Psychitrist Cherrybank Resource Centre, 85, Wellington Road, Ellesmere Port, Cheshire, CH65 0BY.
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I was heartened to learn, from Alakeson's article, that the evidence gained, so far, indicates that schemes which allow for seriously mentally ill patients to have contol of their own care budgets, are for the good (1). Such self directed patients feel more satisfied and have greater mental stability. Unfortunately, services for mentally ill patients in the UK make little, if any, allowance for the exercise of choice by patients, in the provision of their care. Therefore, it is vitally important for mentally ill patients that such schemes should become common place in the UK. Decision making and the exercise of choice are fundamental to the concept of autonomy, and respect for autonomy lies at the heart of medical ethics. The autonomy of mentally ill patients is, of course, often threatened by nature of their mental illnesses, and when it is overwhelmed they will need to be cared for paternalistically. However, when this is not the case, their ability to manage their own care budgets will surely enhance their own sense of self worth and well being, and will raise their standing in the eyes of others. Thus, such schemes will help to de- stigmatise those with mental illnesses. Let's have more of them. (1)Alakeson V. Let patients control the purse strings. BMJ 2008;336:807-9. Competing interests: None declared |
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Andrew Craig, Partner The Moore Adamson Craig Partnership LLP, London SW12 8LG
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Vidhya Alakeson’s article on personalised budgets (“Let patients control the purse strings” BMJ 12-4-08 ) is timely, given the statement by Secretary of State for Health Alan Johnson at the end of March in the Sunday Telegraph effectively moving the personalisation and choice agendas closer together and identifying patients with complex conditions such as motor neurone disease (MND) and multiple sclerosis as being likely to benefit from having more control over how resources are used to provide their care. Mr Johnson’s statement was followed in The Times on 1st April by a view from Lord Darzi that one way of furthering the choice agenda for people with long term conditions such as MND would be for individuals to control their own budgets as this could benefit both patients and the NHS. In that context it was particularly encouraging to see the example in Vidhya Alakeson’s article of how personalised budgets might work in the NHS on a “year of care” basis. A year of care pathway commissioning tool for MND developed over the past two years will be launched to coincide with the 60th anniversary of the NHS. This will create a real opportunity for more choice and increased user and carer control for people with this deteriorating neurological condition.
The MND Year of Care pathway tool will inform commissioners and providers about what should be affordable and deliverable to help them locally to meet the standards in the National Service Framework for Long Term Neurological Conditions (April 2005). It will also raise the expectations of patients and carers about what should be acceptable in terms of quality care inputs and shared decision making so that they can make more informed choices, including end of life decisions. The extension of “choice” and the move towards personalised budgets should provide real momentum for this. We would like to see piloting and early implementer work around personalised budgets involving MND and other long term neurological conditions in particular. These developments also create opportunities for Third Sector organisations such as the MND Association to increase its advice and information services to its client group, possibly through a brokerage function, so that they may make more informed choices. Choice in this sense could mean choosing to have a personal health and social care plan reflecting the MND Year of Care pathway, choosing to use the multidisciplinary assessment and treatment expertise available through one of the MND Care Centres which have been established by the Association at 17 NHS Trusts around the UK and, ultimately, choosing to control health and social care resources. Letting informed patients and carers “control the purse strings” has the potential to change everything for the better. Using care pathways in conjunction with this maps out an effective and acceptable route for everyone to travel. Competing interests: The Moore Adamson Craig Partnership LLP are consultants to the Motor Neurone Disease Association |
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