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Gold, incentives and meh

Revealed: NHS funding splashed on holidays, games consoles and summer houses

Exclusive Millions of pounds of NHS funding have been spent on luxury goods such as summer houses, holidays and pedalo boats, under a scheme to give patients ‘personal health budgets’.

A Pulse investigation found that the scheme to give ‘patients more control over their care’ has been used to buy many unevidenced treatments at the expense of long-established services, which have been defunded.

Information obtained under a Freedom of Information Act shows that CCGs in England predict spend of over £120m this year for 4,800 patients on the personal health budgets scheme.

CCGs reported the following services were bought by patients on the scheme:

  • NHS Nene CCG and NHS Corby CCG gave patient funds to have a holiday to rest and reconnect with family, an iRobot, and the construction of a summer house;
  • NHS Kernow CCG spent £2,080 on a patient’s aromatherapy, £248 on horse riding lessons and even spent money for a patient to hire a pedalo;
  • NHS Stoke CCG spent money on a Wii Fit games console for a patient, and £1,000 on a patient’s weekly music lessons.

Since October last year, all eligible patients have had the right to hold a personal health budget, which allows them to spend NHS cash as they wish. NHS England’s Five Year Forward View has called for a ‘major expansion’ of the scheme.

But experts have been scathing, as NHS England estimates it needs at least £20bn in efficiency savings to stand still by 2020. 

Pulse has learnt that personal health budgets are beginning to destabilise existing services, with one mental health service having to close its doors due to its funding being ploughed into the scheme.

Dr Richard Vautrey, deputy chair of the GPC, says personal health budgets can have a ‘very big impact on existing services’.

He said: ‘Quite often they are working within  limited margins and so loss of even a small amount of their income can jeopardise a whole service – so this can have serious implications for large numbers of people just based on the whims of a small number.’

Professor Nick Watson, professor of health and wellbeing at the University of Glasgow, said the scheme was ‘consumerist’.

He said: ‘I think that we are going forward on poor evidence and there is a clear ideological drive behind it.’

But an NHS England spokesperson said: ‘Personal health budgets are designed to meet identified health needs in ways that give patients more control over the care and support they receive. The spending must be agreed between the individual and the NHS, meet the patients individual health needs and achieve the desired outcomes.’

The policy has been plagued with controversy from its inception. Initial pilots for the scheme, launched in 2009, gave patients an upfront pot of money – either as a direct payment or a ‘notional’ budget held by the CCG or other independent party – for them to spend on services as they chose.

An independent evaluation of the personal budget pilots – led by the Personal Social Services Research Unit at the University of Kent – found there was a significant improvement in the quality of life and psychological wellbeing of the patients and a reduction in hospital costs.

However, it also found patients used significantly more non-NHS services as result of using the personal budgets, and that money was spent on theatre tickets and ready meals.

Readers' comments (41)

  • Umm...again...why the shock horror headline. It was never going to be used for anything to with the patients health. If there is a bottomless pit of funding of health care (i.e the NHS), anything given will NOT be spent on something that is freely available. no surprises folks for this disastrously thought out "bright" idea. now will someone pull the plug on this..no...great. And one wonders why there is no real money to employ nurse/pharmacists/real doctors (not noctors) to do the proper job.

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  • Of course what do you expect??
    This is EXACTLY what socialism promotes? Why? Because it's other people's money that's why!! Things won't change and it shows it's not just out politicians! Look at how the "benefit street" chavs spend YOUR money on nice TVs and track suits!! And these same people think YOU as medical professionals belong to them as well...... Socialism in its virulent British form means ska very and indentured servitude forever.
    Get used to it doctors.............unless you've got the guys to walk away you can't complain...

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  • Absolutely ridiculous.Health service should wake up

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  • this is what happens when you pursue 'patient-centredness'

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  • This is utterly bonkers of course, but NHS E and HMG seen totally wedded to the idea. One has to consider why.

    I think this is another trojan horse for privatisation.

    Today, it's theatre tickets and laptops. In a couple of years it will be for specialist outpatient appointments. And then everything...

    BTW I'm not against privatisation, I think doctors will do relatively well out of it, but let's be honest...

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  • Someone did once say "its very easy to spend OTHER Peoples money". Watch it in motion.

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  • This will not stop unless someone asks politician to justify it on high profile media. It's an easy vote winning act and equivalent of offering cash for votes.

    Sadly some "doctors" also believe in this - we had an ex-psych consultant, now working for private sector posting here stating this is an excellent idea.

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  • Spent 9 years in USSR but the level of Communism in this country surpasses imagination. If somebody doesn't get benefits, all he/she has to do is go up Rochester bridge and threaten to commit suicicde. The next day you give them a mobile phone so they can be in touch, arrange urgent housing, carers, schools for their children and everything else any other mortal would have to work for.
    Numbers of such incidents have g4rossly risen with tightening of the benefit system.
    I could wager that Marx and Engels are probably discussing that they had to have a revolution to impose communism in USSR but in UK they didn't have to lift a finger - it's unfolding spontaneoulsy due the follies of our policy makers.

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  • BTW, till HMG mature to the idea of liquidating NHSE which takes up £2 billion of the NHS budget every year, there is not going to be any improvement.
    Unfortunately,NHSE was created to do the 'dirty work' for the government so it has the mandate to do things which to us may seem stupid and grotesque'. And if the savings are not made, they'll just screw the NHS a bit harder:)

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  • @Sanjeev Juneja GP Partner | 01 September 2015 10:22am

    Absolutely spot on.Have you ever wondered why this country is so fixated with the past?Because it has nothing to look forward to.It sank along time ago and now everyone is a bum

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  • This policy means that the majority suffers for individual gain.
    Who will actually say no to a patient 'reasonably' asking for an Xbox to improve their quality of life? But where has the funds for this come from?- perhaps a drop in centre that many use and now has to close or reduce hours/ staff.
    What happens when the patients budget runs out? Will someone say "well you've spent all your money so no more services for you"? What if they then threaten to sue the authorities for letting them make a ridiculous decision? Or they threaten suicide?
    There has been no thought given to the unintended consequences of this.
    Of course this is a step towards privatisation. Privatisation will ALWAYS cost more because of the bureaucracy involved and shareholders to pay. End of.

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  • This right-wing publication and dog-whistle-style journalism are getting roasted at the Guardian. Seriously - can you not provide some context when reporting these sensationalist stories?

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  • for some it pays to be ill in nhs. there may be lots of cheats pretending to suffering from deprssion and benefit system does not allow them to say "i am feeling better"
    personal budget should be given if they agree to go back to work. there should be maximum amount of £500 for most needy.

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  • There was that bloke Lansley, he blew £2 billion on an ego trip. It worked well.

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  • Has anyone done the basic arithmatic - each person (on average) was given £25,000 - that is more than many people earn. (from the figures above)
    I still want to know what happens when the money runs out - break down - reassessemnt and another £25k??

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  • PS this reminds me of the patient who went to the food bank regualalry so he could save for a new 48" HD TV

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  • "each person (on average) was given £25,000 - that is more than many people earn."

    A lot of the money will be spent on providing carers for people who need full time care - but Pulse won't tell you that as it doesn't fit with its agenda.

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  • Another ploy to destabalise services and lead to privatisation!

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  • A free for all approach, we'll give you the money as long as you don't bother us!

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  • The NHS has never really adopted the WHO definition of health

    Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

    Perhaps if it did some of these so-called luxuries might not seem so outlandish.

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  • "Examples of ‘alternative’ PHB use in context are:

    people suffering from depression paid for leisure activities to reduce social isolation

    some patients with diabetes improved wellbeing by using the money for a Wii fit or personal trainer

    a patient with cancer bought a wig of their choice

    an iRobot vacuum cleaner was bought by a disabled person

    archery lessons for muscle training for an MS Sufferer

    air-conditioning or de-humidifying equipment – to help with breathing difficulties

    singing lessons, as an alternative to respiratory therapy – for a COPD patient

    However the statistics show that the vast majority of funds (80-90%) are spent on carers, PAs and nurses."

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  • Una Coales. Retired NHS GP.

    Thank you Pulse for exposing another daft scheme concocted by government and delivered ineptly by CCGs. Perhaps some accountability is in order to the individuals who approved an iRobot, whatever that is?

    Mainstream news has picked up this abuse of NHS funds and run with it. Dr Monah and I will be expressing our views on this topic tonight on C5 news at 6:30 pm. Needless to say I shall be EXTREMELY VOCAL against this socialist hairbrained scheme of spending other people's hardearned taxes and NI contributions on a lucky 4,800 who have received not basic but LUXURY items to improve their wellbeing. Oh if we could all afford an iRobot or wii fit console so we could sit on the sofa and play games all day...

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  • Go on Una, at least we have a spokesperson in you !

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  • Or another way to look at this would be to count our lucky stars that we're not in a position where we can't clean our own houses (and therefore need assistance either from a care provider (expensive, conventionally funded provision) or from an irobot (cheap alternative).

    I'm not sure why anyone would expect disabled and sick patients live in dirty homes - is poor hygiene good for their health and wellbeing?

    Is a Wii fit at £200 more LUXURY than hours of expensive physiotherapy and associated costs?

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  • Una Coales. Retired NHS GP.

    If a disabled person cannot clean their home, feed or clothe themselves, then the state provides social services and care homes. Game consoles have no place in the delivery of healthcare. Common sense must prevail else there will be nothing left of the NHS to care for the elderly and disabled.

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  • I think some of the less informed and narrow visioned thinks NHS runs for free.

    Well I've got news for you - it doesn't! NHSE wants "efficiency" saving in the region of 20 billion by 2020. Why? Because the country does not have enough money to support it's health care!

    So those who thinks Wii and theater tickets as part of "holistic care" ask yourselves this - would you be happy if I turned around and told you we can't treat your cancer with the latest drug because we spent it on holistic care. Do you think I'm exaggerating? Think again, this has been the case for many years in the NHS.

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  • @6:30 -

    As described, the money isn't coming out of your drugs budget - there are other budgets for occupational therapy, mental health services and physiotherapy.

    And (if you read the article) the scheme has SAVED hospital costs compared to the costs of what would have been given as the conventional treatment and has seen an improvement in QOL and wellbeing.

    A Wii Fit might be a cheaper therapeutic tool for someone than lots of sessions with an expensive physiotherapist and it also might be more accessible to someone with disabilities.

    Theatre tickets might be more emotionally uplifting for someone with mental health issues, than a group therapy session. It's about what works for the patient and what saves the NHS money.

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  • If you keep up to date with the latest research, you'll find that the Wii fit is in fact being used as a tool to deliver healthcare...

    http://www.ncbi.nlm.nih.gov/pubmed/?term=wii+fit

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  • @OHP 9.11pm
    Keeping 'up-to-date' with the latest research is akin to scratching a bears' bottom - whilst fun to begin with, it all turns out to be crud in the long run, and most likely to be dangerous for your health.

    As for wii fit being a 'tool to deliver healthcare', I can't help but think that if you are physically capable of working out on a wii fit, you are probably capable of following a keep fit instructor/physio/exercise sheet- all more cost effective ways of rehab/physical training.

    IMHO, PHB is definitely a waste of resources in resourced starved NHS.

    DGPP (3yrs)

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  • Phb is lunacy
    In a grossly underfunded nhs to waste resources on any non evidence based intervention is a disgrace as it reduces the effectiveness of the overall spend
    Available evidence for this is patchy and controversial
    It is a recipe for waste chaos and red tape on the grand scale
    A totally deranged idea from cloud cuckoo land or worse another secretive duplicitous Trojan horse for the privatisation agenda which is strongly opposed by the vast majority of the electorate
    The very idea that this madness is to be extended while cancer drugs are being withheld is another national disgrace due to doh and nhse

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  • Anonymous | Other healthcare professional | 01 September 2015 9:08pm

    I hope you realize "estimated" cost saving is just that - an estimate. We know too often a scheme, such as 7 day GP opening claims to have saved local AED attendance and saved X million pounds. Yet we do not see CCGs and hospitals in millions of underspend. Why?

    Because people re-adjusts their behaviour and hence their use of health system changes. This is not just for patients but for health care workers also.

    So I'm afraid your talk is just a pie in the sky. I wish the world was as simple as yours. "keep up to date" mate ;)

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  • @OHP 9:11pm
    You actually tried to present yourself as intelligent by posting a link of studies on PubMed as latest research about Nintendo Wii.
    Have you actually gone through those studies? Most of them have some technical issues that will limit their external applicability or justify the use of NHS (taxpayers' money and at the risk of cutting off other services)money. Most of those studies have really small sample size.
    Secondly, the money used for this lunacy is not new money. It is part of NHS budget. There is no reason to spend NHS money on stupid health programs with questionable health and economic benefits.

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  • 8:56am

    Yes I did read the studies and many of them found that Wii Fit had comparable outcomes to conventional physiotherapy. So in individual cases (where a patient may not be able to get to NHS physiotherapy services due to debility, disabilities, mental health issues or transport issues) then it may be more useful for the patient to have some motivating exercise tool at home.

    As far as the NHS budget goes, it doesn't just provide pills and chemo - it offers all kinds of other services provided by occupational therapists, physiotherapists, mental health services and psychological services.

    Therefore if there are ways to provide services to patients that are individualised to the patient's needs (eg. perhaps they are too ill, disabled etc. to attend group events) and if these have good outcomes for patients (i.e. improved wellbeing) and good outcomes for the NHS (ie. lower usage of more expensive hospital services) than I really don't see what the issue is.

    Apart from that as usual on pulse we see many doctor-centred posts that assume the only thing that matters is what doctors can provide (pills, chemo and radiotherapy).

    There are other ways to promote and maintain good health for patients - it's time to consider them.

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  • Is the real problem of Personal Health Budgets the threat to doctor's clinical monopoly to determine what treatment is, and is not available to patients?

    http://safe-medicine.blogspot.co.uk/2015/09/personal-health-budgets.html

    Personal Health Budgets facilitate Patient Choice, and Health Freedom, which means that patients might want to access non-pharmaceutical treatment.

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  • Gosh, is it hard to understand the simple economics?

    All of above will only work if patients cannot access any health care once their budget runs out. Currently they can use their budget how they like, and when it runs out they'll start accessing health care system as rest of the population does. This erodes the funds for everything else. GPs are opposng this not because we want monopoly (quite the opposite given we are NOT paid per activity but rather a block contract)

    Come on guys, try and look a bit beyond your agenda and try and understand how things work a little before making comments like "Is the real problem of Personal Health Budgets the threat to doctor's clinical monopoly"

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  • @ Steve Scrutton, 12:05
    You are not really a health care professional are you?

    If patients want to waste their own money on homeopathy and other woo that is fine. Just don't ask the NHS to foot the bill via PHP while denying others the option of proven treatments for cancer on cost grounds.

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  • As commented elsewhere PHB saves money - interesting how may people give this a political rather than practical spin! Most packages of care are for people with complex life long healthcare needs I hope to never experience. Being able to manage their needs and services directly is often more cost effective improves the situation. BUT it does threaten the professions control over anything with the word 'health' in it. Perhaps that's actually what is behind the outrage.... the coverage is silly season at its best.

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  • Some extreme right wing views on display here.Some health professionals appear to have lost their sense of perspective and need to refer to their professional codes of conduct!

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  • some quite surreal comments in this string.
    There is a clear divide between science and belief here.
    In a social healthcare system there is no limit to what each individual can consume, whereas in a capped social care system each individual can only consume more than the minimum if they have personal funds.
    Thus personal health payments are a ridiculous crossover between two separate systems.
    Hopefully they will disappear soon

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  • This is a front for privatisation. Evidence from the Netherlands showed the scheme was open to abuse, patients were conned by private firms into using them to 'manage ' their budguets, no improvement in health, most needs y patients ere not able to use the scheme and so it was stopped after 12 years of waste

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