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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)

  • 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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