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Don't spend it all at once

Sure, give patients pocket money for healthcare - just don't be surprised when it gets blown on sweeties and comic books, says Copperfield

Sure, give patients pocket money for healthcare - just don't be surprised when it gets blown on sweeties and comic books, says Copperfield

Here's another item to add to my ever-growing list of Jobs I Don't Want - care manager.

PCTs across England are to roll out pilot schemes in which patients with long-term conditions such as left-handedness, hay fever and Gilbert's syndrome are issued with pocket money - sorry, that should have read, 'a personal health budget' - to play pick 'n' mix with the contents of the BNF, the health and wellness section of the Yellow Pages and the Naughty Night Nurse adverts in the classifieds of the local free paper.

A similar scheme has been a huge success in the social care sector. Experts have concluded that their service users have been empowered to use their fiscal allocation 'imaginatively'. I assume that is some sort of euphemism - as in the imaginative and creative ways that MPs have been making use of their expenses claim forms.

Lord Darzi himself was on hand to reassure nervous frequent attenders that trips to the GP and A&E would not eat into their allowance. Free-at-the-point-of-demand access to expert advice on trivia is one of the cornerstones of the NHS.

Anyway, balls to it. If Mr Sweet Pee wants to spend all of his annual health budget on two trips to Paris to get some kinesiological treatment for his diabetes, it's no skin off my nose - even if it might result in toes off his feet. It's not going to change my life.

Except. And this is a big except... there's a catch.

Whatever the patient intends to spend their money on has to be agreed and signed off by a care manager. Even before the Good Lord broke the news, I just knew what was coming... 'and of course, this will usually be the patient's GP'. Shaft me ragged.

Real-world example

Here's a real-world example of how the system will work. A bloke with a long-term condition comes into the surgery. We must accept he's an expert in its treatment despite extensive correspondence in the medical record proving the opposite beyond doubt. Based on a lifetime's study of syndicated medical columns, he decides the treatments I offer are not suitable for him. He wants to spend his pocket money on some toys, some sweeties and a comic. Or a Airnergy machine, some pulsatilla and a textbook on Buteyko therapy.

This presents me with no ethical dilemma. He's a grown-up. He's an asshole. I can change neither. He can spend the money on jelly babies for all I care. Some of you, the warm fluffy ones with the ink still wet on your Certificates of Compassion or the bearded loons who still think that people can change, might feel differently. Good luck in your efforts to persuade your patients that blowing all their dosh on a Nintendo Wii plus Sports Pack may not be an optimal allocation of resources. I'm just going to sign the form.

The problem is, there's no downside. What I really want is for the halfwits who opt for iridology over insulin to go shopping for their own NovaRapid when the truth hits home.

No such luck. If the money runs out the patient will be welcomed back into the NHS like the prodigal son. Looks like we'd better start fattening some calves.


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