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Will personal health budgets really give people greater choice and control of personalised health care?

Author: MS Trust

Angela Coulter of the King's Fund questions whether personal budgets are the best way to give people control of their own health care.

The Health Secretary, Andrew Lansley, plans to roll out personal health budgets to all those receiving NHS continuing care in England by April 2014.

NHS continuing care (also known as fully funded NHS care) is care provided outside hospital that is arranged and funded solely by the NHS. It is only available for people who need ongoing health care and meet certain eligibility criteria, for example a complex medical condition that requires a lot of care and support.

People with personal health budgets will be able to make their own decisions about how to spend the NHS funds allocated for their care in line with an agreed care plan. The scheme will enable people to access services not available through the NHS and have greater choice and control over the provision of care. The budget for this plan can be held by a health professional; by an independent third party on behalf of the individual or by the individual.

However Angela Coulter, visiting Fellow at the King's Fund and former Chair of the Picker Institute, questions in her blog whether these shared budgets are the best way to achieve greater responsiveness to individual needs, believing the scheme may be too complex and may hamper the choice of the people rather than enhancing it. Concern has been raised that the scheme may start to shift resources into complementary therapies or non-health care items; if the clinical benefits are complex, those involved in underwriting the personal health budgets may lose enthusiasm; and the scheme may enable choices only for those people who have the confidence and capacity to take on individual budgets at the expense of those who do not.

A pilot scheme for personal health budgets is currently underway and the fourth interim review was recently published. This found that many of those who were offered personal health budgets responded positively to the offer of greater choice and more control, but the prospect of budget-holding caused confusion and anxiety for others. This was made worse by the lack of information both before and during planning.

An alternative scheme, the Year of Care Programme, is investigating the potential of personalisation of care for people with long-term conditions without the use of personal budgets. By incorporating shared decision-making and self-management support, the programme aims to enhance annual health checks and ensure that people are offered a choice of local NHS and community services through responsive commissioning. Overall, people involved are clear about the benefits: producing a better experience for people involved and real changes in self-care behaviour; improved knowledge and skills for professionals; greater job satisfaction, better organisation and team work, and improved productivity.

Direct payment scheme for social care - A to Z of MS
MS Trust news item Personal health budget pilot
MS and me - self-management guide to living with MS
King's fund blog
Picker Institute
Year of Care Programme (RCGP)
Personal health budget pilot - Department of Health website
Everything you need to know about personal health budgets
Information on NHS continuing care