Feature Briefing

Personal health budgets: surplus of cash or deficit of ideas?

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e8329 (Published 10 December 2012) Cite this as: BMJ 2012;345:e8329

Re: Personal health budgets: surplus of cash or deficit of ideas?

I suffer from a terminal condition and also have a severe degenerative neurological condition which has left me with awful mobility and personal care issues, and but for the allocation Direct Payments, I would not be able to manage to live with my wife, independently at home as I rely on Carers and her daily assistance.

As former Chairman of the NW Lancs Physical Disability Partnership Board, I know friends and acquaintances who have either Direct Payments via the Local Authority or who elected for Personal Healthcare Budgets. I chose my source of funding very carefully, as did my friends, as we have individual different needs, and, while I would love to have a Season Ticket to watch football with a Carer, I know I will never be well enough to do that type of activity again. I do, however, want to be showered, dressed and given help to get to a safe place to sit, and I occasionally manage to get out in our Mobility Car.

I know how service users find both types of financial aid as ESSENTIAL and BENEFICIAL. I think most perhaps do know the mechanics and rules as there are fairly strict controls and checks made on Direct Payments and would hope the same systems are in place for Personal Budgets. It is not a surplus of cash at all, nor are Social or Healthcare Practitioners deficient on ideas, because these budgets give service users/individuals with substantial and chronic need of assistance the freedom to choose what they can purchase using their allocation, whether it be for Carers to help us shower and dress and a dozen other important tasks and basically to enjoy a standard of life able bodied people take for granted. It may help get a person out of the house to a social activity or to visit a relative or meet new acquaintances or by them purchasing an electronic aid like a laptop that helps support them to do things we can and do take for granted like communicating, as many cannot write or type but can operate laptops with speech recognition, and web cameras. This makes all of us feel we are not redundant and better off in a hospital or care home bed. Costs are put on just about everything but I tell you this free of charge: my dignity and self respect are paramount to me, as is my need to appear well turned out, even if it is just to sit in my own home to read online or speak to my father, who lives in Spain, maybe once a fortnight. No, not too much money or bereft of ideas, just giving people like me and my disabled and ill friends and others in similar positions the means to live life to a reasonable quality otherwise I would be reaching for my large morphine bottle within days.

Readers should look carefully into what we are really talking about here, and that is giving vulnerable individuals the wherewithal to choose the aids and services they need. Sadly due to many Government cutbacks and reductions in funding we are seeing more and more cash aid being stopped as we are assessed and re-assessed in the hope that a few hundred thousand of us will lose our funding - and that in turn has seen an increase in us seeking appointments with our Consultants, increase in GP time and accessing a range of services. I have also lost friends and acquaintances to Suicide this past 18 months as disabled people and others are terrified of losing what we have been assessed as needing. I know many of us share the view that we would rather take a magic bullet route than be institutionalised or left to sit in our own urine and bed clothes or when dressed in our own homes. We would be a gathering of housebound people feeling worthless and worse than useless and a burden on our families, and the Direct Payments and Personal Budgets make that vital difference between actually living a decent life with my condition and severe disability and becoming so depressed and dependant on an already over stretched wife and family to the point I would not want to continue to live. It really does make THAT MUCH OF A DIFFERENCE TO ME and many, many others.

Competing interests: No competing interests

16 December 2012
George H. Ronald
Former Director, Scottish Users' Network
Poulton-le-Fylde, Lancashire