Personal Health Budgets – a denial of mutualisation and utilitarianism

Personal Health Budgets are not a good idea as a whole  – they are a denial of the mutualisation of risk needed in a universal health care system, and of the utilitarianism needed to run efficiently. Most of us professionals, with our hearts still in the old NHS, are very uneasy with this experiment… It may work, like FundHolding, for small select groups, but it represents a denial and rationing of services to others.

Caroline Price in Pulse magazine reports 17th November 2015: NHS chiefs spend £1.2m on publicity drive to expand use of personal health budgets

NHS managers are spending more than £1m on the drive to get CCGs to offer more people personal health budgets despite ongoing concerns about how they will affect the health service, Pulse has learned.

NHS England’s personal health budgets delivery plan for this year – obtained through a request under the Freedom of Information Act – detailed spends, totalling £1.18m, on various initiatives that included a round of workshops for CCGs and a pilot for developing business cases at 12 sites.

GP leaders questioned why managers were spending this figure on rolling out personal health budgets (PHBs) at a time when the NHS is running a huge deficit – and warned the Government’s long-term agenda was to use PHBs to cut services.

The delivery plan is part of NHS England’s drive to widen access to the budgets under its Five Year Forward View, which outlined that CCGs should ‘lead a major expansion’ of PHBs in 2015/16 and ‘include clear goals on expanding PHBs’ as part of their strategy.

CCGs have been expected to offer PHBs to patients receiving NHS Continuing Healthcare since last October, while NHS England also set out a commitment to extend the offer to anyone with a long-term condition who can benefit, from April this year.

In addition, this year more than 10,000 ‘high-need’ patients – including elderly people with long-term conditions, and people with serious mental illness – are being given a combined personal budget, covering both their health and social care services.

NHS England boss Simon Stevens has said more than five million people could be using such budgets for their NHS care by 2018.

Among the range of initiatives, the delivery plan included:

  • £235,000 to support CCGs to develop a local offer for PHBs beyond continuing care, including a series of five-day events across England.
  • £176,000 for 12 sites to develop business cases and commissioning models for PHBs.
  • £370,000 to develop a training programme for personal assistants.
  • £80,000 to train up the voluntary care sector to offer support and advice on PHBs.
  • £50,000 to publicise stories from people with PHBs to help learning.

This comes despite concerns about the drive to continue rolling out personal budgets, after Pulse revealed that they were being used in some cases to buy non-evidenced based care such as aromatherapy, holidays and pedalo boating while existing, long-established services are being cut in order to set them up.

The BMA has callled for a review of the budgets as a result, while the chief executive of NICE has also said they need further evaluation before being rolled out more widely across the NHS.

Dr Richard Vautrey, deputy chair of the GPC, said the delivery plan raised questions about ‘this agenda and the clear pressure to expand [personal health budgets]’.

Dr Vautrey said: ‘At a time when the NHS has a £30bn deficit people should ask whether the reason the Government and NHS England are so keen on this is fundamentally about cutting costs, rather than truly empowering and improving services to patients.’

He added that while the budgets ‘might be superficially attractive to patients and carers, ultimately it’s a way of containing social and other costs associated with care in a way that may be less easy for NHS England to do under the current arrangements’.

Dr Vautrey said: ’People need to be aware of what that hidden agenda is – ultimately it means they can cut services that patients normally expect, but all of a sudden when they ask for them find they are no longer there’.

NHS England refused to comment on the figures, but responded that patient Kevin Shergold said his budget was ’not a pot of money I’ve been given to spend however I see fit’ but ‘is agreed, accounted for and monitored by medical professionals’, while the budgets give patients ‘freedom to live our lives as we choose – in a way that’s sensible and cost effective’.

Personal health budgets delivery plan – where the money is going

  • Supporting CCGs to develop a local offer for PHBs beyond continuing care, including series of five-day events across England – £235,000
  • Finance and commissioning support for 12 sites to develop business cases and commissioning models for PHBS – £56,000 (and up to £120,000 direct funding to sites)
  • Support to ensure successful delivery of PHBS to adults and children on NHS continuing healthcare / continuing care – £120,000
  • Develop learning materials and information on good practice – £10,000
  • Develop training programme for Personal Assistants – £370,000
  • Train up voluntary care sector to offer support and advice on PHBs – £80,000
  • Publish stories and blogs from people with PHBs to help support local and national development of PHBs – £50,000
  • Support for CCGs to offer people with learning disabilities PHBs (or joint budget) – £100,000
  • Support CCGs to deliver PHBs in line with relevant national policy, regulations and best practice – £10,000
  • Measuring progress – £30,000

Total – £1,181,000

This entry was posted in A Personal View, NHS managers, Rationing, Stories in the Media, Trust Board Directors 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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