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CAMHS won't see you now

Personal budgets need to be called out for what they are

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‘The NHS provides a comprehensive service, available to all.’ That it is the first line of the NHS Constitution and is a powerful expression of what the health service is meant to be. But the Government is pushing forward with a scheme that could smash this commitment into a pulp.

A Pulse investigation published today digs into the personal health budgets scheme that is being actively rolled out by NHS England. We found CCGs are planning to spend more than £120m on personal health budgets this year and this is set to rise even further, with NHS England currently touring the country trying to sign patients up to the scheme.

The NHS cash spent on Wii Fits, pedalos and aromatherapy for a small group of patients will make the headlines, but I would argue there is a much more serious issue at stake here.

Since April, all patients with a long-term condition have the ‘right to have’ a personal health budget, and a Government evaluation of the pilots started in 2009 did show these patients could benefit. There were measurable improvements in quality of life and a reduction in hospital use. But this was in small numbers of patients; a subsequent independent evaluation found personal budgets cost £4,000 more per patient compared with usual care and could actually have a negative effect on outcomes.

The crucial difference is the pilots were funded by new money from the Department of Health, but this is not the case now. Some CCGs have had a one-off £20,000 payment to kick-start the scheme, but the money will largely be found by shifting cash from other budgets. And the effects could be catastrophic.

Pulse recently reported that a centre for people with serious mental illness run by charity MIND had been forced to close because of ‘drastic’ funding cuts resulting from the CCG diverting cash to develop personal health budgets.

And this holds a warning for the future. Personal health budgets have widespread (largely unthinking) support from patient groups, think-tanks and others. And it is easy to see that a holiday or a summer house could have a powerful effect on the health and wellbeing of an individual – but what is the wider cost of cutting badly needed services for the rest?

The NHS has to make efficiency savings of £22bn (at least) over the next five years to maintain levels of service. This is a time when it needs to use resources more wisely and maintain the safety net for patients as much as it can. This would be a huge challenge, even without the imposition of seven-day services and ministers’ refusal to consider any more charges for NHS services.

Personal health budgets are trumpeted by the DH as a way to ‘transform NHS culture by putting patients in control’, and patients are bound to think it’s great to have cash to spend as they choose. But they might choose differently if they knew it meant not having access to a local service when they needed it. And who picks up the pieces if the patient’s chosen interventions don’t work out?

Personal health budgets will destabilise the NHS and are simply a way of introducing more competition by stealth. They are an attack on the collectivism that is a central pillar of the NHS and a dangerous step towards a US-style insurance scheme.

The public is being sold a wolf in sheep’s clothing and it needs to be called out for what it is.

Nigel Praities is editor of Pulse

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Readers' comments (9)

  • For PHB read Politicaly Huge B-----Up. !!!

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  • £4k more? Per year?
    So our uniquely cheap NHS - the second cheapest in the world, and rated as the best on all but cancer diagnosis costs on average $3.5k (as at 2011) per patient per year, and we're adding £4k to that. or more than doubling the cost?!
    Holy shhhh.......£22bn is not gonna cut it folks, not by a long long way.

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  • Well done Nigel for bringing this con to the public's attention.

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  • Good article
    The nhs is being maladministered by delusional irresponsible maniacs

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  • Vinci Ho

    (1) If you hate politics, do not read the latest edition of British Medical Journal(BMJ:5/9/2015; It's time to apologise)The editor of BMJ basically asked David Cameron's government to apologise for introducing Health and Social Care Bill and pointed the spearhead right to Lansley( very PULSE style as we have been 'moaning' about this from day one!). Everything about 'new reforms' from this government including personal health budget is likely meeting strong resistance from the profession. Look at Bottom line is credibility and trust of this bunch of Tories politicians ,no matter how 'noble' the reform introduced can potentially turn out to be.
    (2) And it is also because the Tories know they are not to be trusted to deliver health services by the public(a well known but unpublicised truth) , the only way to gain 'popularity' is monetary measures, hence bribing its way right up to that. The overall cost of bribery is small compared with seriously injecting real , solid money to save NHS(for all their irresponsible promises like seven days NHS) . At the same time , at least voters can be pleased by giving them money to 'look after' their health: win-win situation , favourite term used by economists.
    (3) As Michael J Sandel said in his book , What money can't buy: the moral limits of markets,these economic/financial incentives will crowd out norms which ,in this case, are the core virtues of NHS. The 'new' theory and message that health actually can be 'bought' with money crowd out the norms of providing people the proper health education.
    Like everything else in the eyes of economists , health problems can be solved by economic , monetary measures.
    (4)Professor Martin McKee wrote about personal health budget in the Introduction of the book--NHS for sale: Myths , Lies & Deception (2015), Jacky Davis, John Lister , David Wrighley

    ''After all ? Who could argue with the idea that individuals are best placed to know what health services they need, and indeed this may be true for some people with multiple complex problems . However , as experiences with a wide range of financial services and utilities would have predicted and the Dutch experience with personal health budgets has shown , they also provide numerous opportunities for unscrupulous companies to exploit the vulnerable.''

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  • Vinci Ho

    For those who think this government is telling the truth . I would like to think in a different way:

    'What is it with you people? Would you think not getting caught in a lie is the same thing as telling the truth?'
    Three days of Condor

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  • Elements of the policy could be right for some people in the right circumstances and could save the NHS from wasting money - the whole emphasis of "personal" health budgets should be about doing what is right for the individual. I compare this with the move to have the same approach in education - my son has special educational needs and I had to watch lots of money being spent on things that, as the person closest to him, I knew would not benefit him. They were the preferences of the local school which was given a budget to "meet his needs" and they had decided that the needs of all SEN children were the pretty much the same. In the meantime I had to take on 2 jobs to pay for the input and activities that did make a difference

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  • Probably just a coincidence, but I bet that the vast majority of "Personal" Health Budgets will be sucked up by those who have never contributed to the system!!!

    Call me old fashioned!!!

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