Personal health budgets will be rolled out to over 50 000 peopleBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8233 (Published 03 December 2012) Cite this as: BMJ 2012;345:e8233
Personal health budgets will become available to 56 000 people in England with long term healthcare needs over the next 18 months, the Department of Health announced on Friday 30 November.
Norman Lamb, the care and support minister, declared the rollout after a final evaluation report of the scheme by independent researchers. He said, “Independent analysis has now shown that personal health budgets can put people back in control of their care and make a significant different to their quality of life. It’s inspiring to hear the human stories of success that these budgets have brought to people.”
One such story was that of Nikki, a young woman with Still’s disease. In an interview with the health department she recounted how she had previously been forced to go to hospital for any flare-ups. Now she spends her budget on flexible daily carers to help with the immediate management of a potential flare-up. “For me, having the personal health budget has given me a life, and I have one that I can take control of and actually enjoy,” she said.
Her GP, Andrew Ward, added, “I have to say that looking at the results it’s been the perfect solution. We’ve broken a pattern of frequent long admissions to Nikki enjoying a long spell of very good health.”
Personal health budgets have been piloted in 64 primary care trusts since 2009. They allow people to choose between receiving standard community care by the NHS or a budget to spend on services and goods of their choice.
During the past three years a £6m study of 20 pilot sites was conducted by the Personal Social Services Research Unit. An interim report by the unit found that the goods and services chosen by patients in the scheme ranged from paid carers and specialised physiotherapy sessions to acupuncture and a laptop computer to aid speech and language.
The final unit’s report, released on Friday 30 November, concluded that personal health budgets were cost effective, and the report supported a wider rollout, initially targeted at people with the greatest need.1 The report found a significant positive effect on care related quality of life among 2235 people with personal health budgets in comparison with those having conventional care (ASCOT wellbeing score 0.057 v 0.018 (P<0.001)). The difference was especially marked among people with larger budgets, who were also usually those who had previously had a care package called NHS continuing healthcare.
However, there was no difference in measures of clinical outcomes or in total cost. “The evaluation shows that those with the greatest needs benefit most from personal health budgets. That’s why we are giving people on NHS continuing healthcare the chance to get one first. And I hope more people who could benefit will be given the option of one,” said Lamb.
Charities have cautiously welcomed the rollout. Mark Goldring, chief executive of the learning disability charity Mencap, said, “We welcome the introduction of personal health budgets, which will give people with a learning disability the power to choose the healthcare that they need and which will hopefully act as a positive step towards ensuring they receive the best health treatment possible.”
Michelle Mitchell, director general of Age UK, said, “So long as personal health budgets are well organised and easy to use, they will help a significant number of older people to plan and be in control of their healthcare.”
But Mitchell added, “Personal health budgets will not suit everyone and may present confusing choices for some vulnerable older people struggling with illness or dementia. It is therefore essential that everyone who wants a personal health budget is well supported with the right advice and information, and those people for whom a personal health budget would not be appropriate should not feel pressured into taking one up.”
The Personal Social Services Research Unit’s report also stated, “The use of personal health budgets is likely to result in greater use of ‘non-conventional’ providers,” with implications for NHS services.
Another criticism by the Royal College of General Practitioners was that the budget could be “spent in ways that do not turn out to be effective in improving [people’s] health outcomes” and that “there are real risks that the introduction of personal health budgets could generate additional costs.”2
The health department will now set aside £1.5m to fund the expansion of personal health budgets into nine new primary care trust clusters. A department spokesman said that this would be earmarked for raising awareness among GPs and patients. The aim would then be to offer personal health budgets to anyone receiving NHS continuing healthcare by April 2014.
Cite this as: BMJ 2012;345:e8233