Personal budgets could help transform the health service but need to be used carefully, say NHS leaders

A survey of senior NHS managers has found widespread support for the idea of giving patients their own healthcare budgets, but raised concerns about how they might work in practice.

The NHS Confederation carried out 40 in depth interviews with health and social care leaders, and found that many remain unconvinced that policy thinking around personal budgets is mature enough to make the idea work. The NHS Confederation represents more than 95% of the organisations that make up the NHS. Its members include the majority of NHS acute trusts, ambulance trusts, foundation trusts, mental health trusts, primary care trusts, independent providers of NHS services, special health authorities and strategic health authorities in England; trusts and local health boards in Wales; and health and social service trusts and boards in Northern Ireland.

 

Shaping personal health budgets, a report published following research by the Confederation and the National Mental Health Development Unit, reveals that while there is  widespread acceptance that personal health budgets have considerable potential there are still concerns about their cost, scope and impact on other services.

 

Personal budgets are currently being trialled in a number of Primary Care Trusts in the areas of continuing care, long-term conditions and mental health and this year’s Health Bill has enabled NHS organisations to set up direct payment schemes for patients.

 

The Confederation’s report argues that while the pilots are an important step in developing the policy without other forms of choice and control running alongside personal budgets, the approach is unlikely to be the only answer.

 

It calls for more work to be done to establish how personal health budgets would work and what areas they should cover and says that if NHS leaders are to be convinced further, more work to identify the potential hazards of implementing personal health budgets needs to be done.

 

“There is no doubt that the NHS has been moving away from a top down model of provision, where you are told what treatment or care you will receive to a more patient led experience,” said Jo Webber the NHS Confederation’s deputy policy director.

 

“This is undoubtedly what patients expect and want but this research clearly demonstrated that while managers understand the benefits that personalisation of healthcare can bring, they are also concerned about some of the consequences.

 

“The costs involved in double running of services  are one concern leaders have raised and at a time when the NHS is facing difficult financial challenges it is important to be able to make the case that personal budgets do not need to form a drain on resources.

 

“Our members are also worried that if the take up of personalised budgets is not as great as hoped for then they might find themselves faced with having to make difficult decisions about what services it can carry on funding – there is a danger of over-stretch.

 

“This work highlights the considerable potential of personal budgets and the way they can help to empower patients and improve the care they receive but it should serve as a warning that the policy around them needs to be level headed, pragmatic and fully costed.”