Personal Health Budgets – an idea too far without overt rationing

Personal health budgets: surplus of cash or deficit of ideas? Krishna Chinthapalli, clinical fellow in the BMJ2012;345doi: 10 December 2012)

Doctors are unaware of “fantastic opportunities” offered by personal health budgets, says health department. Caroline White reports in BMJ2013;346doi: 28 January 2013)

Expect to hear a lot more about Personal Health Budgets, until it dies a natural death.  The idea flies in the face of mutualistic risk in a large group… It’s patching up and not addressing the ideology.

Personal health budgets are good for the few but not for the many, conference hears – Matthew Limb reports in BMJ2014;348doi: 27 January 2014)

Update 18th September: Times Letters “Should we give patients their own budgets?”

Allowing patients to spend NHS money on their own healthcare has divided public opinion

Sir, As your leader (Sept 2) says, it is important to focus on the health benefits gained rather than on what is being bought, but there is some doubt over whether this kind of disruptive change will improve care. Indeed, an independent evaluation of the pilot schemes by the University of Glasgow and King’s College London indicated that personal budgets cost £4,000 more per patient compared with usual care, and could have a negative effect on patient outcomes.

Your headline (report, Sept 2) concentrated on holidays and video games bought with NHS funds, but there is a much more fundamental issue at stake. We all pay into the NHS and expect our money to be spent wisely on services that are there when we need them. But this scheme is already destabilising existing services, and has the potential to drastically reduce the choice available to patients. We know of one charity-run mental health day centre that was recently forced to close due to its funding being cut in order to fund personal health budgets. It will not be the last.

If the primary concern is the wellbeing of patients and enabling them to take greater control over their care, a far fairer solution would be to fund NHS services adequately and enable them to give patients a greater choice of treatments. As you say, the best decisions are not made by a “distant bureaucracy” but by patients in partnership with experienced healthcare professionals.

Nigel Praities
Editor of Pulse

Sir, Those living with long-term health conditions face daily challenges that the NHS often cannot solve. Morevoer, the NHS is still oriented towards providing treatments for medical problems in the form of pills or operations; it is predominantly a biomedical service.

What if the NHS helped people with long-term conditions or disabilities to focus on outcomes that matter to them — for instance, spending time playing with grandchildren — as well as on the narrow clinical outcomes that health professionals focus on? What if it then provided a range of not just treatments but also support to help independent living and feeling in control of health and healthcare?

This is the kind of NHS that people who have their own budget experience; an NHS that works with them to help them to manage their daily problems as effectively as possible.

The Five Year Forward View as set out by the chief executive of NHS England makes the case that promoting wellbeing and independence need to be the key outcomes of care, with personal health budgets being part of this. Contrary to the views of the BMA and Pulse magazine, the evidence would seem to support him.

Professor Alf Collins
Clinical associate, Health Foundation

Sir, News that patients are spending public money on items such as game consoles and music lessons may sound profligate but it may actually represent a sound investment of NHS money by preventing far more costly hospital stays. The cost of a games console, exercise board for someone with respiratory rehabilitation needs, or music lessons for a patient with a mental health condition, is a mere drop in the ocean compared with the alternative hospital treatments.

Rather than demonising patients and clinical leaders for searching for brave alternatives to the status quo, we should encourage this kind of innovative thinking to help the NHS to meet its £22 billion funding gap.

Sam Burrows & Kate Woolland
PA Consulting Group, London SW1

Sir, Where is the money coming from to fund personal budgets? It can only be from other services when the NHS has to “save” £20 billion by 2020. This scheme only adds to the healthcare lottery. Some patients will enjoy riding lessons at taxpayers’ expense while others are deprived of the medications or operations they need.

Roger Goss
Co-director, Patient Concern


This entry was posted in A Personal View, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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