Social workers unconvinced by NHS personalisation

Mental health social workers and other professionals are unconvinced that personal health budgets will deliver improvements for service users, NHS leaders and health, civil servants warned today.

Just 28% of professionals are “enthusiastic” about the implementation of personal health budgets, which are being piloted in 68 areas in England ahead of a national rollout starting next year.

More than half of social workers (58%) and three-quarters of community psychiatric nurses (CPNs) said they feared the bureaucracy involved in administering the budgets would outweigh any potential benefits, according to the report by the NHS Confederation and the government’s National Mental Health Development Unit (NMHDU).

Personal health budgets involve giving service users choice and control over their healthcare through the allocation of NHS funds, which they can take as a cash payment or leave to professionals to manage.

The study was based on 60 in-depth interviews with professionals and a survey of 645 frontline mental health practitionersincluding 104 social workers, outside the 68 pilot areas.

Though half of respondents thought personal budgets would enable a positive shift in power and control to service users, the research uncovered significant doubts about their implementation.

Bureaucracy was a leading barrier to implementation, cited by 54% of respondents overall and more particularly by those versed in personal budgets in social care, such as social workers and CPNs. They feared that the level of paperwork associated with assessment and managing health budgets would reduce face-to-face time with service users.

Just over half of all professionals thought there was a lack of evidence that health budgets would improve outcomes. Psychiatrists (71%) and psychologists (62%) felt particularly strongly on this, which the report attributed to their “allegiance to evidence-based medicine”.

Several professionals had an “intrinsic belief” that service users lacked the ability or knowledge to choose treatments wisely, and felt greater health literacy was needed if service users were to exercise choice in this way.

However, the study also uncovered widespread ignorance about personal health budgets, with 57% of respondents saying they knew little or nothing about them, and it said there was still scope for their opinions on the issue to be influenced by learning and debate.

“This study clearly represents a challenge to the government’s commitment to implementing personal health budgets,” said NMHDU director Ian McPherson. “However, it also presents a challenge to professions to demonstrate that their reservations about personal health budgets reflect a prime concern for the well-being of service users and not an unwillingness to give up some of their current authority or even an underlying anxiety that, given more control over how limited resources are used, people would not necessarily choose the services that professionals currently offer.”

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