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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

Michael Dixon 300x300

YES

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

Investigation: The luxury goods purchased with NHS money

Azeem Majeed 300x300

NO

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

 

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Readers' comments (25)

  • Interesting debate on the use of scarce NHS resources. There is a huge crossover between what the NHS spends its money on and what should be funded by social care budgets. The increasing fragmentation brought about by the disastrous Health and Social Care Act has only made this situation worse. In Wales, the current approach is to integrate services, but it's a long way off achieving a joined-up service, leading to situations such as recently seen in Powys.
    I agree with Professor Majeed - if a patient is to be able to use a personal care budget wisely, they need to be competent to make those choices. No-one is competent at everything! Evidence and knowledge are vital and must lie at the heart of any such process. Patients must be given the information they need to make the right choices and the risks and benefits of each choice made laid out in a way they can understand. Health care has advanced enormously through the application of science and scientific methodology. It's a shame that the same cannot be said of government policies. Before such a scheme as personal health budgets is allowed to be further deployed, a proper assessment of the quantity, quality and costs needs to be undertaken and subjected to proper scientific critical appraisal.

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  • Azeem Majeed

    Paul Morgan | Other healthcare professional | 04 September 2015 1:33pm

    I agree with Dr Paul Morgan about the need to use scarce NHS resources wisely and to evaluate rigorously any new health and social care interventions - such as the introduction of personal health budgets.

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  • Dr Dixon is the only person here who seems to understand the point of PHBs.

    The point of individualised healthcare provision is that it is individualised, so how do you propose to measure outcomes with an RCT given that each individual has individual needs and will make individualised choices based on their highly complex, individual health, social, economic and other circumstances?

    And having done the RCT, how do you propose to extrapolate from that limited piece of "evidence" to individuals for whom the RCT may have little environmental applicability?

    It's time to move away from the obsession with EBM (that is designed to meet the needs of doctors) and start thinking about how care can better address the individual needs of individual patients who may have different needs, goals and aspirations to those of their healthcare providers.

    Whose needs does medicine serve? That should always be the question one asks.

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  • Other healthcare professional

    what naive tosh, medicine should be focused on health and improving out comes.

    the only tension should be the healthy conflict between popn based studies and the difficulties in translating that into individualized care.

    Are there other important areas of care/life - of course but they fall outside the remit of medicine

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  • Vinci Ho

    While I can see where the argument of the 'Yes' camp is coming from , this is about priority , reality and the big political picture of NHS right now :
    (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 care.data. 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.

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  • Vinci Ho

    And this is song 'dedicated' to this wonderful government :
    Timbaland
    "Apologize"

    I'm holding on your rope
    Got me ten feet off the ground
    And I'm hearing what you say
    But I just can't make a sound
    You tell me that you need me
    Then you go and cut me down
    But wait...
    You tell me that you're sorry
    Didn't think I'd turn around and say..

    That it's too late to apologize, it's too late
    I said it's too late to apologize, it's too late

    I'd take another chance, take a fall, take a shot for you
    And I need you like a heart needs a beat
    (But that's nothing new)
    Yeah yeah

    I loved you with a fire red, now it's turning blue
    And you say
    Sorry like the Angel Heaven let me think was you,
    But I'm afraid

    It's too late to apologize, it's too late
    I said it's too late to apologize, it's too late
    Woahooo woah

    It's too late to apologize, it's too late
    I said it's too late to apologize, it's too late
    I said it's too late to apologize, yeah
    I said it's too late to apologize, yeah

    I'm holding on your rope
    Got me ten feet off the ground...

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  • Vinci Ho

    Correction
    Apologize by One Republic featuring Timbaland

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  • Azeem Majeed

    Vinci Ho | GP Partner | 05 September 2015 9:38am

    Good to see you taking an interest in this topic Vinci.

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  • 7:03pm "Are there other important areas of care/life - of course but they fall outside the remit of medicine."

    But what you fail to understand is that "medicine" is not the only way of addressing "health" and "improving outcomes" for patients. And medicine is not the only kind of healthcare provision that the NHS offers.

    What do you think occupational therapists do?
    What do you think psychologists do?
    What do you think psychotherapists do?
    What do you think physiotherapists do?
    What do you think speech therapists do?

    There's a lot more to health and health outcomes than medicine. The fact that so many comments that are anti-PHBs are doctor-centred/medicine-centred comes as no surprise on this site though.

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  • "if a patient is to be able to use a personal care budget wisely, they need to be competent to make those choices. No-one is competent at everything! Evidence and knowledge are vital and must lie at the heart of any such process. Patients must be given the information they need to make the right choices and the risks and benefits of each choice made laid out in a way they can understand."

    This is patronising to patients and this attitude is the whole reason why PHBs were developed in the first place.

    Why do you think you are wiser or better placed to "give" patients information about conditions or disabilities that they themselves manage and deal with 24/7? Many patients with LTCs or disabilities may well be more knowledgeable, experienced and skilled in managing their conditions on a day-to-day basis than the doctors they see.

    Why not try listening to patients and asking them what their goals are regarding their conditions and how they think the NHS could better support them to manage their own conditions?

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