Demise of primary care trusts stalls personal health budgets

The implementation of personal health budgets has been stymied by the government’s plans to scrap primary care trusts and its focus on reducing the deficit, an evaluation report said today.

The Department of Health-commissioned study found that pilot sites had been struggling to maintain the momentum of personal health budgets following the publication of the government’s health White Paper in July, which announced the abolition of PCTs and the transfer of their commissioning responsibilities to GP consortia by 2013.

It said this, along with the government’s focus on generating significant savings in the NHS, had led to delays in the implementation of budgets given the level of cultural change and resources required to effectively implement personal health budgets.

Like personal budgets in social care, personal health budgets enable people with health conditions to exercise choice and control over their support through a budget that is managed by the NHS, a third party such as a charity, or, in some cases, by the individual themselves.

The pilots began last year and are operating in 70 areas, 20 of which are being evaluated. Based on interviews in September and October 2010 with 43 key staff in these 20 sites, including commissioners and frontline professionals, the report identified strong support for the potential of personal health budgets to increase choice and improve outcomes for patients, while promoting more flexible services.

However, staff interviews also highlighted issues that had delayed implementation, including a lack of training, the time and support needed to work with people with complex needs on care planning, the lack of choice in the market for services, and the need to effect culture change in the pilot sites.

The report linked these issues to the wider context facing the NHS.

“While the priority of the government has to be focused on reducing the deficit, the reorganisation of the NHS has come when primary care trusts require resources to be able to effectively implement personal health budgets within the local pilots. With such significant changes, such as the abolition of strategic health authorities by 2012 and PCTs by 2013, there has been an impact on the implementation of personal health budgets.”

The personal health budgets pilots are due to continue until 2012. The government’s adult social care vision, published last week, restated its ambition to roll out personal health budgets and enable individuals to combine NHS and social care funds in a single pot.

However, Jeremy Cooper, director at consultancy iMPOWER, said personal health budgets needed a much stronger push from central government, as simply piloting them in the current context would not be sufficient.

“Now is just not the time for pilots because people have other things to worry about. It’s either going to be a slow death [ for personal health budgets] or someone needs to really push it.”

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