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GPs go forth

Personal health budgets to drive decommissioning of NHS services, says think-tank

CCGs will need to decommission unpopular services to make personal health budgets work when they are rolled out to all patients with long-term conditions in 2015, a leading think-tank has warned.

The Nuffield Trust says services that are not chosen by budget-holders will have to be decommissioned, but done at a pace that prevents the market from shrinking.

The think-tank’s new report, entitled personal health budgets: challenges for commissioners and policy-makers, also says there will need to be new infrastructure around budget setting and care planning, but this will need to be found in existing budgets.

The personal health budgets scheme is due to be rolled out by April 2014 to 56,000 patients on continuing care and be offered to anyone with a long-term condition who could benefit by 2015.

But it has proved controversial, with pilots of the scheme drawing criticism after a DH report revealed that patients were using their budget to buy theatre tickets, ready meals and complementary therapies.

The Nuffield Trust report said that pilots have ‘barely exceeded 100 people’ using the scheme and that using them at scale will present new challenges for CCGs.

It added: ‘Their extension to people in receipt of continuing care, and after that to those with long-term conditions, presents a much larger challenge for commissioners, who will need to reassure themselves that a wider range of providers demonstrate sufficient quality to merit inclusion.’

It added: ‘CCGs will also need to be ready to decommission services not chosen by budget holders; but at a pace that allows providers the chance to adapt and minimises the risk of market shrinkage (leaving individuals with fewer choices than before).

‘Likewise, efforts aimed at diversifying the market of providers need to be carried out with care to avoid destabilising existing providers.’

Commissioners will need to implement new systems, but using existing budgets, the report added.

It said: ‘For the system to work, new infrastructure around budget setting, care planning and system monitoring is required; funding for which would need to be found in existing budgets.

‘There is some evidence to suggest that some efficiency can be achieved by “piggy-backing” on the systems that already exist to support personal budgets in social care.’

This follows a report by another think-tank, 2020 Health, that called on the Government to consider putting GP practices in charge of the administration of patients’ individual personal health budgets.

Readers' comments (33)

  • Personal health budgets are definitely the way forward for long-term conditions like mental health, diabetes - patients need to retain their autonomy and right to exercise personal choice to escape the disempowering mantle of GPs, psychiatrists, nurses, behaviour is often a slippery slope to abuse. Unpopular services like abusive psycho-therapy should be De-Commissioned - permanently.

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  • Good old trade blog( with added extras)

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  • Is it possible to and what happens if a personal health budget is overspent?

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  • Unless I misundersttod it, personal health budgets can be used for pretty much anything patients fancy as long as it is approved by whoever that's in charge. I'm sure pulse had an article which showed kind of things patient bough and from memory many had no direct link to health (e.g. laptop). And there is no penalty for it - if you've spent it all, you can still turn up and ask for same service from NHS as always.

    It's crazy. People can spend all of it on psychic healing then come back and say "it didn't work, can I have a counselling please."

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  • The first posting illustrates perfectly whilst this is madness. A lunatic fringe of patients will waste money on nonsense treatments (laptops / theatre tickets have already been mentioned) and therapies with a proven track record of helping people will still have to be funded when it doesn't work.

    Why, as a taxpayer, should I be funding theatre tickets for people?

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  • More fragmentation of services by pushing spending and "choice" down to the individual and the introduction of additional bureaucracy to support it. Of course it will result in decommissioning of services and top-up payments by patients who can afford them.

    This is another step in the Tory/LibDem ongoing effort to destroy the NHS as a taxpayer-funded comprehensive health service free at the point of service.

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  • "Why, as a taxpayer, should I be funding theatre tickets for people?"

    If the theatre ticket proves to be more effective at getting someone with agoraphobia out of the house, or alleviating a patient's depressive symptoms than the options currently on offer, then why not?

    The point is patients can decide what works for them as individuals. Doctor's frequently don't "know best" and don't necessarily have many options to offer.

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  • Well done Anon 4.11pm finally a voice of common sense. Doctors do not always know what is best, though give some of the arrogance displayed on this site, this may never actually sink into their egotistical heads

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  • >alleviating a patient's depressive symptoms than the options currently on offer, then why not?

    Why not?

    Because if they want to purchase this kind of thing they should buy it using their own money, not mine. This isn't healthcare, and it shouldn't come out of the healthcare budget.

    Oh...I'm feeling depressed. Can you pay for my holiday please...? It would make me feel better....

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  • Dear God! The lunatics are not only taking over the asylum but this thread too! This is a stupid waste of taxpayer money and should be stopped at once.

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