Politicians: please re-think the philosophy. Media: please force them to do so. Individual Health Budgets are wrong..

The latest banal and perverse outcome from the conservative “Individual Health Budget”  (IHB) policy (in some post-code areas and only in mental health) is plain to see. The original intention was as a “safety net” and “In Place of Fear A Free Health Service 1952 Chapter 5” but it has been slowly morphed into “Everything for everyone for ever“. The idea of a “mutual” where resources are distributed according to need is denied by these individual budgets. It is time to ration overtly. In a celestial world with unlimited funds and resources NHSreality would support IHBs. There are better ways to spend the money when a population approach is taken…. It’s a step in the wrong direction and continuation of covert rationing. Individual health budgets are wrong.. There will be still more perverse outcomes, if savings from one year are allowed to be accumulated by individuals.. In addition it confuses “needs” with “wants”….The Times leader 2nd September (Patient Power) misses the point completely.. (read complete leader: Patient Power) and subsequent letters are interesting)

Tom Whipple reports 1st September in The Times: NHS treats patients to holidays and video games following an article which first appeared in Metro.

Games consoles, holidays and pedalo boat hire are among treatments given to patients on the NHS under a £120 million scheme.

The policy, which allows people to decide how to spend “personal health budgets”, was criticised as wasteful yesterday after it emerged that patients were choosing therapies that had no proven benefit — and in some cases were not even treatments.

An investigation by Pulse, the GP magazine, found that patients had used the scheme to buy a sat-nav system, a tablet computer, shiatsu massage, summer houses and Wii games consoles.

Although much of the money went towards conventional costs, such as employing carers, one patient had also bought an appliance from iRobot, the company that makes the £300 Roomba robotic vacuum cleaners.

The NHS tells patients that personal health budgets, which have been phased in over the past year for people with long-term conditions, can be used “to pay for a wide range of items and services, including therapies, personal care and equipment. This will allow you more choice and control over the health services and care you receive.”

The scheme is based on the theory that conditions that demand significant out-of-hospital care, such as muscular dystrophy or multiple sclerosis, require healthcare better tailored to individual needs rather than a “one-size-fits-all” approach.

Patients are allocated a budget and then agree a “care plan” with their GP or NHS team that details how the money will be spent.

An analysis of a pilot scheme in 2012 concluded that patients received better outcomes than those whose care was allocated more conventionally. However, Nick Watson, a professor of disability research at the University of Glasgow, has published research that disputes this analysis. He argued that the widening of the scheme had “potentially very serious consequences” and that the evidence of recent spending showed that patients did not necessarily know how best to use money on their own health.

In one part of Cornwall, £267,000 was spent on only five patients, with £2,080 going on aromatherapy, £248 on horseriding and £7.34 on hiring a pedalo. In Stoke, money was used to buy Wii Fit consoles and for music lessons.

A spokesman for the Stoke clinical commissioning group said that the expenditure was “judged to help the patients and represent excellent value for the NHS”.

Professor Watson said: “Part of the reason people go to medical school is to find out how best to treat patients. Pedaloes and shiatsu don’t strike me as an appropriate use of money. I’m not arguing that people should not be involved in what healthcare they take, but I do think there has to be an evidence base that it would work. That is a chief requirement for the public funding of healthcare interventions.”

He said he believed that there was a political element behind the decision to reorganise the budgets. “There is almost a desire to take away from socialised healthcare to producing more of a consumerist ideology.”

Richard Vautrey, deputy chairman of the British Medical Association’s general practitioners committee, said that transferring money to personal health budgets can have significant knock-on effects. “Quite often [health managers] are working within limited margins and so the loss of a small amount of their income can jeopardise a whole service. This can have serious implications for large numbers of people just based on the whims of a small number.

“While individuals may value a massage or summer house, others will understandably start to question why they can’t also have such things paid for by the state.”

About 15 per cent of England’s 209 clinical commissioning groups provided details to Pulse of their planned budgets. The magazine estimated that £123 million would be spent on 4,800 patients this year through personal health budgets — with the funds coming out of existing budgets.

A spokesman for NHS England said: “Personal health budgets are designed to meet identified health needs in ways that give patients more control over the care and support they receive. The spending must be agreed between the individual and the NHS, meet the patient’s individual health needs and achieve the desired outcomes.”

‘Right to ask’ for personal health budget now in place

The Independent: NHS health budgets being spent on ‘horse riding, holidays and clothes’ for patients

 

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This entry was posted in A Personal View, Commissioning, Perverse Incentives, Rationing, 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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