Are personal health budgets a good idea?
Dr Michael Dixon says that personal health budgets are a very important initiative, while Professor Azeem Majeed argues that they take money away from other services
This is a very important initiative but it needs to be taken forward with caution.
Overall it moves the pendulum towards the patient. I think in the past, care may have been a bit too skewed towards scientific evidence and clinical objectivity and away from the patient’s own perceived wishes, needs and beliefs. But it is not just about what the patient wants, it is also about them being often in a better position to decide what is cost effective for them than a distant commissioner using population-based evidence.
I don’t think that the point of personal budgets is to move money out of the system and effectively give those with personal budgets more money for their care than those without. Rather, if anything, it is to save money, as often happened with direct social care payments, where an individual’s budget was often underspent. Clearly if a given patient is consistently spending over budget then the commissioner should have the right to withdraw it.
A two-tier system may emerge in some cases, but that might actually be a good thing. If patients with personal budgets fare better than those without, the latter might be encouraged to do likewise (themselves or using advocates) as a means of improving and personalising their care. It’s only inequitable if some patients with a given condition are allowed to have personal budgets and others aren’t.
Those with personal health budgets may well be more satisfied. If they get greater relative satisfaction that is no reason why they should be deprived of their budgets with everyone lowered down to the same common denominator.
If personal budgets are successful then we need to level all patients up to be able to hold them and achieve a generally better service for all.
Dr Michael Dixon is chair of the NHS Alliance
It’s very difficult to know what CCGs are spending on personal health budgets. Currently, the NHS is stretched and this will take money away from other services.
Some things like gardeners and cleaners – though they may be important to people’s wellbeing – are really not about healthcare and should be taken from another budget, such as social services or benefits.
Not everyone will be able to choose competently or wisely. Also, GPs do not have the time to spend with every patient to ensure that they are using their budget properly.
CCGs can’t budget for it. It is known to expert patients now, but people will start to use it more and more.
There was a very low-key pilot for the scheme – we need much better evaluation of the costs and benefits.
You have a better view on whether things are working if they are consumed on a large scale that you can regulate and measure.
Professor Azeem Majeed is head of the primary care and public health department at Imperial College London, and a GP in Lambeth