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Making sense of what’s going on with personal health budgets

Bureaucracy Monkey Business Images Rex Features




This post is, more than anything, to help me make sense of what’s going on with personal health budgets (PHBs) at the moment, hence the photo. Not only is it an area that I’m pretty ignorant about but there has been a torrent of publications on the topic in recent days so I thought it would be worth trying to piece together what’s going on.


What are they?


Personal health budgets, like personal social care budgets, provide people with a defined resource with which to purchase support to meet identified needs. They can be taken as a direct payment, or managed by a third party or by a commissioner. 


Are they any good?


Well, the evaluation of the government’s personal health budgets pilot programme (published last November) found that they were associated with significant increases in patients’ quality of life and psychological well-being, though not in their health. There was no statistically significant difference in the cost of personal health budgets and conventionally commissioned services overall (though there were savings for some groups).


It also concluded that outcomes were better the more people were told about the value of their personal health budget, the more freedom they were given over its use and the higher the budget. This mirrors findings about social care personal budgets from the 2011 National Personal Budgets Survey.


So for the first in that recent torrent of publications: Zoe Porter, the Department of Health’s personal health budget lead, has written a post on her it’s not all about the money blog emphasising this point – done right, PHBs work, done wrong, they don’t:


“You know the best thing about the personal health budgets evaluation… It’s that it identified the components for success that if you implemented them in one way you get the benefits, and introduced in another way, they are not worth doing…This is gold dust.”
 
What’s happening now?


Well, all NHS commissioners can offer personal health budgets managed by a third-party or by the commissioner themselves already. However, direct payments are only available in the PHB pilot sites.


So, the government last week published draft regulations for consultation to enable the roll-out of personal health budgets by enabling all commissioners to provide direct payments. 


So who is going to get them and for what?


The regulations make clear that personal health budgets will not be provided for a significant number of health services: seeing your GP, paying for prescriptions, vaccinations, operations or emergency care. I won’t go into details, but reading the consultation document on the regulations, this all seems to make sense.


However, that still leaves a significant proportion of health services and it’s here that things get interesting.


You must provide social care personal budgets; you can provide personal health budgets


While the current draft Care and Support Bill would place a duty on councils to provide all eligible service users with a personal budget (other than in exceptional circumstances), a different approach is being taken in the NHS.


It will be up to NHS commissioners to decide whether to offer personal health budgets and to whom. The exception is for people in receipt of NHS continuing healthcare, who will have the right to request a PHB by 2014, though not a right to receive one. (The evaluation found cost savings of £3,100 per person from personal health budgets for people on CHC).


It appears that the DH is proposing that such a request should be granted when the benefits of the person having a PHB outweighs the costs (p13-14 of consultation). But the DH is assuming that about half of the 56,000-odd people on continuing care would receive a personal health budget (so half would either not request one or be refused on request).


For other groups – including people with mental health problems, learning disabilities or other long-term conditions – it will be up to NHS commissioners to decide whether to offer PHBs.


This is justified on the basis that there are uncertainties about the positive impact of personal health budgets beyond people in receipt of continuing healthcare, and this will require further testing. In order to to this, nine of the pilot areas are doing further work and policy decisions about further roll-out will be made in the light of this and other evidence.


What does this mean for the integration of health and social care budgets?


For people working in and receiving social care, it seems likely that the benefits of PHBs will be greatest where they can be integrated with personal social care budgets.


Back to our torrent of publications, sector personalisation coalition Think Local Act Personal last week launched a project to look at how PHBs and personal social care budgets can be integrated


Some of the nine pilot areas mentioned above are looking at this too. And particular attention is being paid to how integrated budgets could work in mental health, with the Association of Directors of Adult Social Services and Royal College of Psychiatrists publishing a joint statement on this topic last week.


The two organisations committed to working to widen access to integrated budgets for people with mental health budgets who wanted them, including by tackling “unnecessary bureaucracy and a lack of information sharing between clinical staff”.


The DH consultation on regulations makes clear that, with integrated personal budgets, accountability for the social care side will remain with the council and accountability for the health side with the NHS. How far this presents a barrier to access will be something to explore. 


An ongoing postcode lottery?


But the biggest barrier could be that, while all councils will be having to provide personal social care budgets to all their eligible clients, it will be up to NHS commissioners to do the same with PHBs.


Though this may change in the light of further evidence, the Department of Health’s impact assessment on its new regulations makes clear that some NHS commissioners may hold back on providing PHBs for reasons of culture, not evidence.


“This could, for example, be where staff in one areas are very willing to transfer a lot of control to the individual, whereas in other areas this is not the case. Here, in spite of evidence pointing towards a certain method of implementation, it may take a long time to change the culture within individual organisations and localities.” (p30)


What do professionals think?


That’s just a very brief overview of PHBs and, as I said at the start, this is an area I’m pretty ignorant about. So do get in touch with any feedback on your experience of personal health budgets, good or bad. The email is mithran.samuel@rbi.co.uk 


Picture credit: Monkey Business Images/Rex Features

Mithran Samuel

About Mithran Samuel

Mithran Samuel is adults' editor at Community Care.

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