Personal health budgets bring benefits and bureaucracy

Service users are benefiting from personal health budgets (PHBs) but these improved outcomes are being put at risk by barriers and delays to accessing them, finds an evaluation of the government’s pilots published today.

Most recipients surveyed for the report said PHBs had improved their health and well-being across a range of areas, while the majority also reported feeling enhanced choice and control over their healthcare. For instance, those receiving continuing healthcare said they appreciated being able to choose who their carers were and the timings of their appointments.

Like personal budgets in social care, PHBs involve people being allocated a sum of money to meet agreed needs, whether in cash,, a payment managed by the primary care trust or a third party, or a combination of these arrangements. Health budgets were most commonly used to fund personal assistants or support in the home, physical exercise or alternative or complementary therapies, the report found.

Lack of information

However, despite the benefits, researchers found a “general lack of information” among those surveyed about what they were allowed to spend their personal health budget on.

Others reported having requests to use their PHB turned down by PCT panels or officials, including for items such as vitamins, alternative therapies, wheelchair servicing and costs associated with employing carers, such as additional heating bills. In some cases, people reported not receiving a full explanation for why items were turned down.

Respondents also experienced delays in gaining approval for purchases, leading to “major distress” for some service users, instances where the item was no longer needed by the time approval was granted and people paying for items out of their own pockets. PHB holders also felt that personal health budget teams did not keep them well enough informed about progress in using their budget and purchasing items, with some unable to get hold of PCT officials when they phoned up for information.

Need to cut bureaucracy

“Overall, budget holders wanted to see a reduction in bureaucracy and quicker approval and implementation processes to stop people becoming demoralised,” said the report.

Researchers from Kent and York Universities, Imperial College and the London School of Economics interviewed 52 people with long-term health conditions who had been offered a PHB, 41 of whom had a budget in place, and 13 carers of PHB holders, across 17 primary care trust areas.

They concluded that some of the issues highlighted could reflect teething problems given that the interviewees were among the first to access PHBs in the pilot sites. However, the report identified clear areas for improvement including the need for clear information on eligibility for budgets and on how they can be used, speedier processes for approving expenditure and closer contact between service users and personal health budget staff.

PHBs are being piloted in 66 areas and a final evaluation is due this autumn, which will inform a roll-out of the system. The government has already committed to giving everyone receiving continuing healthcare the right to request a personal health budget by 2014.

Mithran Samuel is Community Care’s adults’ editor.

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