PERSONAL HEALTH BUDGETS

Most patients with long-term conditions 'unprepared for personal health budgets' (Pulse: 31 March 2015)

More than half of patients with long-term conditions feel they would be unable to make decisions about how to spend a personal health budget, a report from a health information pressure group has claimed.

The Patient Information Forum surveyed over 1,500 people with long-term conditions and found only 43% of people felt they would ‘have enough information to make decisions on how money was spent in managing their condition, if they had more direct control over how a limited amount of money is spent’.

The survey findings come as the Government launches a further drive to introduce personal budgets into health care, with the launch of eight ‘integrated personalised commissioning’ pilots.

The pilots will see over 10,000 ‘high-need’ patients, such as elderly people with long-term conditions and children with disabilities and their families, given one budget to and choose what services they want to cover both their health and social care needs.

The Government is also making CCGs guarantee people on continuing health care are offered a personal health budget for their health care needs, following widespread adoption of such personal budgets for social care, although some CCG leaders have expressed reservations about whether the approach is cost-effective.

 

Concerns as ‘personal health budgets’ imposed on 10,000 patients (13 March 2015: Our NHS)

Thousands of patients across England will from 1 April be expected to individually manage the funds allocated for their healthcare, which have been merged into their social care ‘entitlements’, the NHS announced this week..

In Barnsley, Cheshire, Tower Hamlets, Hampshire, Portsmouth, Stockton and the South West of England, 10,000 patients with complex needs will be a single ‘pot’ of money from which they will be expected to purchase both their health and their social care needs.

The details vary by area but the main groups affected are older people with multiple health needs, children with disabilities, and people with diabetes, dementia, learning disabilities, or serious mental health problems.

The move was hailed by new Chief Executive of the NHS Simon Stevens as a ‘radical initiative’ which would ‘make a reality of person-level health and social care integration’.

But the announcement comes as new research reveals widespread fearsamongst health professionals, that ‘Personal Health Budgets’ (PHBs) represent the privatisation of the National Health Service - and considerable doubt amongst patient groups that they will be effective, safe or appropriate.

 

"Handing patients NHS cash" is just rebranding cuts (10 July 2014, Open Democracy)

Personal health budgets are to be rolled out to many more patients and combined with social care personal budgets, Simon Stevens, NHS England’s new Chief Executive announced yesterday.

The announcement has been framed as handing money over to patients and giving them more direct control over their lives. Unsurprisingly, this has so far largely been welcomed. Stevens talks of ‘north of five million patients’ having a combined personal health and social care budget by 2018.

But as spending on both social care and the NHS contracts, what is the evidence underpinning this massive shift in resources?

It is helpful to look at what has happened in social care, where personal budgets have been operating for some years. There, advocates promised that they would make support better and cheaper and reduce bureaucracy.

Instead, new layers of bureaucracy were created by the so-called ‘resource allocation system’ (RAS), according to the independent evidence to date. The RAS was intended to let people know the size of their budget upfront to make sensible decisions about how to spend it – but has conspicuously failed to do that.

Unfortunately, it looks as though this is the same model that it is planned to run-out in personal health budgets.

                

Frail need joint health and care budget, says NHS boss (BBC News: 9 July 2014)

Vulnerable patients should be offered their own personal health and care budgets, the NHS England boss says.

Simon Stevens wants to see the frail elderly, people with disabilities and those with serious mental health problems given joint pots from the NHS and council-run social care services.

The hope is that five million people will be offered them by 2018.

The plans represent an extension of a policy - known as personal budgets - that has started being rolled out.

The idea is to give patients a nominal budget - probably at least £1,000 - which they can then decide to spend on whatever care and services they want, as part of a drive to give patients more power.

GP and emergency care is not included, and they can use these the same as anyone else.

These budgets have been used in social care for a number of years - nearly 650,000 people have them currently.

But they have just started to be used in the NHS, with less than 2,500 patients thought to be getting them.

 

GPs could take control of the administration of personal health budgets, says think-tank (Pulse: 9 July 2013)

The Government should consider putting GP practices in charge of the administration of patients’ individual personal health budgets, a leading think-tank has said in a report launched by the care minister overseeing the initiative. Under proposals suggested by 2020health, GPs would be subcontracted by CCGs in certain cases to make ‘small discretionary payments’ to patients as part of the personal health budget scheme, with the practices taking responsibility for the administration of the budgets. In the pilot, the GP role was limited to making referrals and recommendations.

The authors, who looked at the DH’s analysis of the pilot results published last year as well as at data stemming directly from the pilot areas, came out strongly in support of personal budgets for mental health patients and those requiring continuing care. They also said it should in future be rolled out for arthritic patients, for haemodialysis transport and falls prevention.

But GP leaders said that taking on the administration of the scheme - which is due to be rolled out by April 2014 to 56,000 patients receiving continuing care - would add ‘budgetary bureacracy’ to practices at a time when CCGs are allowed to personalise commissioning arrangements without the need of a new initiative.

 

Hospitals accused of creating 'two tier' NHS by charging for some treatments (The Daily Mail: 8 July 2012)

Hospitals are offering patients who aren’t eligible for certain types of care or who don’t want to wait the option of paying for their treatment, according to this article. The hospitals describe the treatment as ‘self-funded’ rather than private and say the payments are significantly lower than those of private clinics. Several hospitals, including Epsom & St Helier Hospital Trust in Surrey and Homerton University Hospital NHS Foundation Trust in London, offer IVF patients the option of NHS, private or ‘self-funded’ treatment.  The practice has raised fears that wealthy patients will be able to jump the queue, while the less well-off suffer. Joyce Robins, of campaign group Patient Concern, said the practice could create a two-tier NHS and she questioned whether ‘normal’ patients would be pushed down the queue in favour of those willing to pay. And critics say it contradicts the founding principle of the health service – that healthcare is free to all at point of delivery.

 

 

SEE ALSO:

NHS chief warns of potential for user fees (PharmaTimes: 16 April 2013) 

NHS chief warns of prospect of charges (Financial Times: 14 April 2013) 

NHS boss warns charges will have to be considered (The Telegraph: 15 April 2013)

Public in favour of charging for 'some' NHS services (Health Insurance Magazine: 17 April 2013)

 

PERSONAL HEALTH BUDGETS

 

Personal health Care budgets as a transition state to profit‐driven care (paper by Lucy Reynolds) 

Lucy Reynolds examines the evidence about the impact of PHBs so far and compares this to international experience.

"Dutch PHBs have diverted public funds to ineffective therapies, consumer spending and unscrupulous brokers. Substantial fraud and abuse emerged in the now discontinued Dutch PHB experiment. Early evaluations of English pilots reported that budgets failed to cover the previous level of service for some patients, and NHS teams no longer resolved problems with suppliers

 

RCN Comments on Personal Health Budgets announcement (Royal College of Nursing Press Release: 30 November 2012)

The Royal College of Nursing issued a statement highlighting its concerns with the implementation of PHBs, noting that “there may be unintended consequences caused by the extension of the use of Personal Health Budgets.” Its concerns have not been allayed by the recent pilots and assessment.  The RCN notes - “We want all patients to feel empowered, and we want patients who have struggled to find the care that suits them to have another option, however a system which we believe may put pressure on patients to ‘top-up’ their care needs careful consideration before it is heralded as a real solution.” Furthermore, a major concern for the RCN is that “these budgets may exacerbate inequalities by giving the best care to those able to argue for it, and it may place vulnerable people at risk.” The RCN’s statement concludes “the priority for the NHS should be to provide the care that is needed to all its patients, and the move to Personal Health Budgets could prove a costly distraction from that important aim.”

 

Concern at hasty PHB launch (BMA News, Views & Analysis: 04 December 2012)

Doctors’ leaders are disappointed that some of the shortcomings identified in the BMA’s survey of doctors earlier in 2012 have not been addressed by the report from the Department of Health on the pilot personal health budget (PHB) programme. The report -  Evaluation of the Personal Health Budgets Pilot Programmes  - notes that although there was an improvement in psychological well-being and quality of life, the PHBs do not appear to have a substantial impact on clinical outcomes. The BMA highlights that according to the evaluation “no significant effects were found with regard to two clinical measures … and there was no significant difference in mortality rates.” This finding reinforces concerns expressed by doctors in the BMA survey in 2012 that suggests that doctors would be uncomfortable with initiatives introduced without clear evidence of improved outcomes.

 

Do personal health budgets improve quality of life for patients? (The Kings Fund blog: 12 December 2012)

Commenting on the Department of Health’s report -  Evaluation of the Personal Health Budgets Pilot Programmes - The King's Fund noted that the use of PHBs is associated with significant improvements in quality of life and psychological well-being, but not in health. The pilot programme was launched in 2009 over 64 sites and included people with chronic obstructive pulmonary disease, diabetes and long‐term neurological conditions, mental health, stroke, and those eligible for NHS Continuing Healthcare. Benefits were found to be more marked where people had higher levels of need. The best results were seen in pilot sites that provided clear information to patients on the amount they could spend, offered greater flexibility in what they could spend it on, and gave more choice in how the budget was managed. Those sites offering less information, flexibility and control did not achieve significant improvements. According to the King’s Fund, an analysis of direct and indirect costs suggested that the scheme as a whole was cost-effective, meaning that the quality-of-life benefits were achieved at no greater overall cost to the NHS.

 

Mind welcomes greater choice and flexibility that personal health budgets could bring (MIND News: 4 December 2012)

 

Personal health budgets risk spiralling costs and fraud, warn experts (GP Online: March 2012)

(more on PHBs)

 

 

 

 

 

 

 

 

 

 

 

 

more on charges: 

TOP-UP PAYMENTS

MORE CHARGES FOR CARE?

Key facts:

14% increase in self pay in the last 3 years

70% of GPs blame restrictions in NHS treatments

NHS rationing is rising

Hospitals encouraged to offer more private care

 

Key trends:

Stricter rules for GPs on rationing (gp examples)

Hospitals offering more private care

More people forced to pay for care

 

More patients are already being forced to pay?

Related content:

More articles on rationing

Background on rationing

Background on personal health budgets

Background on top-up payments

Ways people could be forced to fund their own health care

 

  

Policy controversy:

The current market-led NHS changes are restricting care and driving hospitals, GPs and patients towards private care.

Few politcians openly support fees for care, but policy and funding pressure could mean patients have to pay to top up their care beyond basic levels, and a two-tier NHS could result.

Colin Leys explains "Shrinking of NHS hospitals means free provision will be reduced to being good enough for the poor, and a safety net for the rest"

The costs of healthcare are rising worldwideTax rises could be needed and cost savings are being made. What's next, more of the market, more personal responsibilty and new user charges?

The NHS confederation has proposed increasing NHS user charges for GP and hospital visits, which according to Allyson Pollock quite ignores "decades of research evidence about the catastrophic effect that this would have on access and the poor."

 

 

Who thinks there should be more charges?

MPs committee says "we are concerned that other savings are being achieved by rationing patients’ access to certain treatments. These include cataract surgery and hip and knee replacements.

The NHS managers organisation says "we identify four tough choices: do nothing; spend more; do more for less; ordo things differently", which could include more user charges.

The government say NHS care will remain free at the point of use, Jeremy Hunt, health secretary, said he would “oppose” the introduction of new user charges into the NHS.

 

Recent reports:
 
A report by the NHS Confederation March 2013

Forder, J., Jones, K.,  Glendinning, C., et al. PSSRU Discussion Paper. November 2012.

A report by the King’s Fund and Ipsos MORI based on two deliberative events in London and Leeds in April 2013 

This report for the Nuffield Institute predicts the NHS will be charging for treatment within ten years. It suggested a “review” of the range of services that the NHS should offer free at point of use.
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