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Health and social care commentators have given a cautious welcome to government proposals to pilot personal budgets for healthcare and closer working between social care and NHS bodies.

The plans were included in two reports this week from health minister Ara Darzi to conclude his review of the NHS, the second of which - The NHS Next Stage Review into primary and community care - was published yesterday.

The personal budget pilots, which will start next year, will apply to 5,000 people with complex long-term conditions.

Challenges posed by individual budgets for health

Niall Dickson, chief executive of healthcare think-tank The King’s Fund, welcomed the potential of personal budgets to make treatment more responsive to individual needs, but added: "While individual budgets and direct payments are used in social care their effective use in health care poses some challenges."

Concerns have been raised that personal budgets could compromise the founding principles of the NHS - that care should be free at the point of delivery. But Darzi has sought to allay these fears by stipulating that no one should be deined care as a result of having a personal budget.
 
Dickson also called for the pilots to be carefully evaluated, saying they should not "follow the government’s usual pattern of using pilots as a prelude to national roll out".

Darzi also promised to pilot new models of integrated care, commissioned by primary care trusts, and including social care representatives. These would include "integrated care organisations" - multi-professional groups based around groups of GP practices - which would be responsible for managing healthcare resources for their populations, with a remit to promote more personalised services and healthier lifestyles.

Social care makes the difference for poorest

Turning Point chief executive Victor Adebowale said: “I strongly welcome the commitment to provide integrated care. Social care is often what makes the most practical difference to people from our poorest communities."

But he added: “The key will be in supporting new and innovative ways of engaging with excluded groups, who find it difficult to use primary care services and may not be registered with GPs."

In yesterday's report, Darzi said the Department of Health was consulting with the British Medical Association on bringing in annual health checks for all people with learning disabilities on GP registers, backed up by health action plans.

Valuing People

The 2001 Valuing People white paper promised that all people with learning disabilities in England should have health action plans by June 2005, but this has not been implemented, despite ongoing concerns about health inequalities faced by the group.

David Congdon, head of campaigns and policy at Mencap, said: "Whilst what is laid out in the report looks good on paper, it is imperative that it is properly implemented and delivered and the views of people with a learning disability are fully taken into account.

"Effective monitoring is also essential to make sure that inequalities can be identified at every level and acted on.”

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