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Independents' Day

Personal health budgets scheme forces mental health centre closure

A centre for people with serious mental illness run by charity MIND has been forced to close because of ‘drastic’ funding cuts resulting from the expansion of personal health budgets.

The Recovery and Wellbeing Centre, a day care centre in Basildon, closed in May after NHS Basildon and Brentwood CCG diverted funding to develop personal health budgets for patients with mental illness.

The CCG said that personal health budgets give patients more ‘choice’, and they can be spent on services such as gym membership.

But GP leaders said that this ‘highlighted the consequences’ of allowing personal health budgets ‘to proliferate in an unplanned manner’.

The Government offered personal health budgets - which provide patients with their own budget to spend on care they feel would benefit them - to any patient on NHS Continuing Healthcare nationally last year, and it was rolled out to any patient with a long-term condition in April this year.

But this was despite pilots of the scheme drawing criticism after patients spent their budgets on items such as theatre tickets and frozen ready meals, and warnings from a leading think-tank that they would inevitably lead to NHS services being decommissioned.

NHS Basildon and Brentwood CCG has since April introduced personal health budgets for people being cared for by secondary care mental health services, and in the six months after they are discharged.

However, managers at Basildon MIND said this has forced them to close the day centre, known as Valerie Lodge.

A post on the Basildon MIND Facebook page announced: ‘Unfortunately, since the implementation of Personal Health Budgets our funding has been drastically reduced, which has led to us being unable to continue this service.

‘We would like to thank everyone that has supported us over the years and we hope that you will continue to support the remaining services of Basildon MIND.’

According to local news reports, the charity lost up to £160,000 a year because of the new funding arrangements.

NHS Basildon and Brentwood CCG said: ‘This is not and has never been about cutting services but rather making them work for local people.’

The CCG added that the ‘decision to close the Valerie Lodge Day Centre was taken by Basildon Mind’ and that other local mental health day service providers, including other Mind branches, had ‘taken a different approach’ to the changes, by ‘developing their services and identifying new funding streams’. 

It also said that offering the patients with mental health problems personal health budgets will mean they ‘have more choice and control over how the money allocated to their care and recovery is spent than ever before’.

The budgets ‘could include a gym membership to help someone with their depression, or a course to help get a person back into work’, it added.

However, local mental health campaigners warned the closure of Valerie Lodge would ‘undoubtedly’ lead to people ending up back in hospital.

One petition launched in a bid to stop the closure stated ‘the loss of support from Valerie Lodge resulting from these same changes will undoubtedly lead to more hospital admissions’.

Dr Chaand Nagpaul, chair of the GPC said the case ‘highlights the unintended consequences of personal health budgets in the way they can destabilise funding arrangements for other services and have an impact on patients at large’.

He added: ‘We have warned against the proliferation of personal health budgets on the grounds they are fragmenting services. It is vital that if the Government wants [them] they should not be destabilising existing services. By allowing personal health budgets to proliferate in an unplanned manner this is precisely the consequence that is likely to follow.’

Readers' comments (21)

  • Is anyone surprised by this? There is a limited pot of money, and diverting this to social things that we would normally all expect to pay for ourselves is obviously going to remove money from the health economy.

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  • these closures to inefficient budget handling by NHs.
    starting and closing practices costs millions of pounds,starting and relinquishing experimental AltGP cost millions of pounds;unnecessary torturing of GPs by referring them to GMC cost £500,ooo each time with destruction and demoralisation of skilled man power.Until GPs have even fled to bankrupt Greece to save themselves,when they could
    After GMC FTPP after 3 years reinstating Gps fully ,not accepting it and wanting to test them by PCTs and other bodies also wasted funds apart from being illogical.

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  • enforcing non cost effective medication on GPs against evidence based medicine as in Suphonyureas as second line diabetic treatment,with costs to secondary care hypo treatment and costly secondary care treatment of Diabetic complications cost millions.
    Not considering Julien Given's cost saving paper in all aspects of General Practice care,presented at Primed Conference was dangerous to economy and health of public.
    What is the point of crying after spilling the beans.Sack the perpetrators without benefits for treason to the Health services

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  • I know some people have issues, but could you at least try and keep to relevant moans to the topic? Some of us here sound less than coherent.

    Is anyone surprised this is happening? CPNs used to provide good support for patients but psychiatrists are forced to discharge them from their case load from management (who are pushed by CCG's contract, who in turn are forced to make efficiency saving by NHSE).

    Mind you, public of UK had a choice to say "Oi, p!ss off, stop wasting public funds on popularist scheme and use it to make a real change" but didn't. Instead some people bought theatre ticket, trip to Paris, latop etc etc. I don't think people can complain about this either.

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  • Survival of the fittest. In fact if this was introduced in a way that would allow primary care to compete with secondary care GP practices would flourish. Most patients prefer to have care delivered in the community and once we are paid on a cost per consultation basis our lower costs would attract patients in their droves. Primary-care would grow as we would be receiving extra funds to pay for extra care. It would be hospitals been decommissioned

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  • Well, well. Why should one put all eggs in one basket? Surely the independence of charity has been compromised by its funding.
    Patients have complained many times that day centres are a waste of time and money because they want more than to come to a place where they can have a cup of tea on their own.
    I once had a patient in a Day Hospital for mentally ill who attended for 18 years every day after he exposed himself once in public. He had a learning disability.
    Careful review of other patients showed many had wrong diagnosis and wrong treatment. So, one could argue that attendance there was eventually useful to some who after many years got some help. Eventually, Day Hospital closed. In fact, if all patients were cured/helped sufficiently to be more independent all hospitals would close as they would not need admissions.
    Patients do experience varied problems in attending Day Centres too. Some complain that staff are too religious and have problems with boundaries. It is shocking what one hears and how patients struggle to get out of the system that ruthlessly disregards them at times. At Doctors4Justice we get requests for information on secular treatment centres but we do not know of any in UK.
    Do you?

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  • As an ex NHS Consultant Psychiatrist I think spending money on laptop and theatre tickets is a good idea as it can improve mood greatly as well as finances. Many mentally ill look for jobs on the Internet, take on free courses, look at free therapy articles and learn about their condition and medication.
    A very good investment, I say.

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  • And, please, do not forget how MIND campaigned that NHS mental hospitals should be closed. Maybe, I am too old because I remember all that.

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  • So according to Helen Bright, ex consultant psychiatrist, NHS should spend money on theater tickets and laptops if you are mentally ill.

    Why not on someone with physical illness then? After an appendisectomy, having an laptop I'm sure will greatly help to brighten their mind. In fact, I have a patient with terminal cancer diagnosis who always wanted to travel the world. Should we not pay for her to go on a world cruise with dedicated medical tam backing her? I'm sure it will be much more helpful then the SSRI she is taking. Perhaps we should then tell many other patinets the local hospice has close to fund one person on a world cruise to keep her happy?

    The point is, at which point does NHS stop being bearer of all responsibility? And where is the evidence such personal materialistic gifts from tax payers are cost effective treatment? I'm sorry but I disagree with the the ex-NHS doctor above. I suggest looking at broader picture, not just what you fancy doing for the person in front of you.

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  • I'm a Consultant Psychiatrist and completely disagree with Dr Bright. Sadly most people cannot be trusted with 'free' money. It is not free money- as we see if you give it to individual patients you are taking it away from something that might benefit the collective. It just all feeds into the me me me culture with no personal responsibility. Theatre trip over and then what??

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  • Personal health budgets have been up and running in social services for a long time and there is a financial limit. They also need to be agreed by social workers. So a terminal patient could not use their PHB for a world cruise as it would be too expensive and/or seen as inappropriate. Remember social care is only part subsidised. The worrying thing is that when applied to the NHS, which is currently free, no one is sure what will happen when a patient that has chosen to have a PHB spends it and still needs more care for the same clinical area.

    My guess is that our Government plans to bring in PHBs for all of the NHS. Once a patient reaches their PHB limit they will have to pay. Patients will eventually be forced to pay health insurance companies to cover this as they do in the USA under the affordable care act (Obama care).

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  • Currently, we know from PHB pilots when they "run out" of money they access the NHS as they usually do, just like the rest of us. i.e. no responsibility for the money they had and spent. The pilot reported patients spending money on theatre tickets, laptop etc (hence my comment)

    This is why they spend it on luxury goods. It's different from social care PHB as there are minimal restriction on approval of these funds (as evidence shows).

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  • PHBs for continuing health care (NHS) allows patients to choose where to spend their money. This is up and running in most areas of the NHS. However this still has to be agreement of where the money is spent. This of course depends on health care clinicians and management. Decisions are made in different ways in different places. It is quite likely that in some geographical areas the criteria of where the PHBs is spent is more liberal allowing money to be spent on such things as theatre tickets.

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  • Steve Martin's comment ... the lunatics are running the asylum in Basildon and Brentwood ....
    That is my area and I have had severe mental health problems my entire life but am a long way off of being a 'lunatic'!

    Sometimes it just happens to be that MH patients know more about their needs and what works for them than a psychiatrists who depend on the ICD10 and BNF to find an answer to what they see as a problem. They treat symptoms but are blind to the cause of our distress.

    Time psychiatrists came our of their cosy offices and faced patients, they should be available to patients in the same way as GP's are.
    We are not lunatics, just folk with very troubled lives, and if you lived through so me of our experiences, you may adopt a very different view.

    As for being a 'lunatic' I have worked my entire life, now past 70 still working, I am a double trained nurse. I teach student nurses at University and never been unemployed, which is more than a lot of folk without mental health issues can say.

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  • Gym sessions and theatre tickets !? - give me strength. I am a retired GP and get bored sometimes - can I have free sessions/theatre tickets please - Oh some Test Match and Cup Final tickets would also be nice. What about some wine and a Fortnum and Mason hamper

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  • Colin Leys, April 2013: "Aside from whether patients welcome the cash payments there are wider issues that need addressing, namely whether the scheme strips cash from the NHS and so weakens the service for others; will it be a subsidy for private care; and who steps in if the money is spent before the year is up?"
    Open Democracy article
    Wake up and smell the coffee

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  • Victoias attitude is one of the reasons people avoid the stigmatising that goes on behind closed doors by psychiatrists against those who have no choice who they end up seeing on the day.pity the likes of Helen B are not more common..MIND has had a monopoly for too long well done Basildon

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  • The trend here is clear.

    Patients - great, it will be better for ME NOW
    GPs - what about OTHERS and what heppens when the money runs out LATER

    If you want to call GPs short sighted and insular, go a head. I'm sticking to my guns and oppose this unproven money wasting exercise

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  • Personal health budgets are a recipe for chaos fragmentation and waste on a grand scale.
    An idea of unlimited stupidity
    I cannot comprehend the complete morons who could produce such a deranged debacle.

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  • Too much emphasis is put on what folk cannot do, rather than their better qualities of what they can do.
    There are special discounts fro folk with all sorts of issues, the unemployed, over 60 etc so why not make theses services free fro folk with mental health problems?
    Giving someone a lap[top to sit at home all day doesn't help no matter what they do with it. MH patients need to be encouraged to get our and socialise, attend the local library where computer access is free. Clubs for the mentally ill, have you aver attended one, all they talk about is their illness ... not healthy at all!
    I work with patients who volunteer in our local university, what a change I have seen in them, make them feel valued, stop concentrating of their weaknesses, you will be very surprised indeed of what they are capable of ... and you would be so proud of their achievements.
    As great are clubs like MIND are they concentrate too much on mental health and not enough of the the 'person', but then that is what keeps them in business!

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