Personal health budgets and their evil twin

Like every good comic book hero, personal health budgets have an evil twin. There are personal health budgets as they have been developed through the pilot programme. Then there are personal health budgets as described by people who are, lets say, less than convinced about them.

These ‘evil twin’ personal health budgets involve everyone being given a lump of cash to spend on whatever takes their fancy, and left to fend for themselves. What happens when the money runs out? Obviously that’s it, your money is spent on crystal healing and holidays to the Bahamas and the NHS will have no more to do with you.

The reality, as ever, is less exciting, and more complicated.

Personal health budgets have been trialled primarily with people with ongoing health conditions, with the evidence showing that they’re most effective for people with the highest levels of need. So they’re not for everyone. They are voluntary. People plan, with help if they need it, how the resource can help them meet health needs or outcomes that they’ve agreed with the NHS. They plan in the context of their whole life – which will of course include their family, friends and communities. They might choose services the NHS already provides, as well as things it doesn’t. The plan needs to include good consideration of any risks, and to contingency plan for the kind of occurrences that may happen (eg if someone has a relapsing condition, what happens during a relapse). This is all signed off by NHS staff, who need to agree that the proposals could achieve the outcomes they’re supposed to.

The money can be paid directly into someone’s bank account as a direct payment, but it can also be spent through the NHS, or by a third party. Where it’s a direct payment, generally this is paid in instalments, most usually monthly. Most areas have direct payment support services set up through their Local Authority, which help people to manage their money. There is very little evidence of fraud, either in the pilots, or in the wider use of direct payments in social care. People should be supported to review their care regularly anyway, and all direct payments are financially monitored. So the chances of someone blowing all the money`is not that high.

If someone’s needs change, their budget would be reassessed. If the plan is really not working out, they can go back to traditional services.  No-one would be denied the NHS care they need on the basis of having a personal health budget. So that’s that. Told you it wasn’t exciting.

So, lycra-clad superhero, or goatee bearded doppelganger? As with any caricature, the truth lies somewhere else. The final evaluation report from the pilot programme told us that personal health budgets could improve the lives of thousands of people, but implementing them successfully will be hard work. They are a massively counter cultural innovation that will require real leadership at all levels. They’ll need smart, responsive implementation strategies that don’t lose sight of the experience of the people they’re for, costs and outcomes, and the actual (as opposed to imagined) challenges that lie ahead.

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