Direct payments: More restrictions in health than social care

The Department of Health has launched a consultation on making direct payments in health care, promising tighter regulations on their use than in social care.

Direct payments are due to be introduced under the current Health Bill, with pilots expected to run from 2010-12, as part of a wider pilot programme on introducing personal budgets to the health service to increase choice and control for patients.

More restrictive regulations

The proposed regulations show there will be more restrictions in the use of direct payments than in social care.

PCTs would have to carry out a Criminal Records Bureau check on anyone employed by a patient to care for them who is not a friend or family member of the patient, or a member of their household, and tell the patient the results.

There is no such obligation on councils in relation to people hired by adult direct payment users so long as they possess capacity.

The consultation – Direct payments for health care – does not say directly that the recipient would be barred from hiring anyone whose CRB check indicates a problem.

Warning over workforce limitations

But Jeremy Cooper, director of public service consultancy iMPOWER, which has been involved in the personal health budgets pilot programme, warned: “Potentially it could really limit the people you are getting in the workforce.”

Patients would also face tougher requirements in relation to providing information to PCTs than face social care service users in relation to councils in areas including spending and changes in their health conditions, the consultation document said.

It said primary care trusts should set local policies on what direct payments could be spent on, but suggests a number of examples including: a course of physiotherapy or hydrotherapy for people suffering from long-term chronic pain; an air conditioner for someone suffering respiratory conditions, or complementary therapies, such as acupuncture.

Personal health budgets

Direct payments are one of three ways in which personal health budgets will be tested, as part of the pilot programme, the others being:-

  • a notional budget held by a commissioner, such as the patient’s doctor or primary care trust.
  • a budget managed on the individual’s behalf by a third party, like a charity.

Trusts are already able to offer the first two options, which do not involve giving money directly to individuals, but direct payments would only become legally allowable with the passage of the Health Bill.

The proposals come days before extensions to the range of social care users who are eligible for direct payments. From 9 November, councils must offer them to people who lack capacity and those subject to mental health legislation, apart from under certain conditions.

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