Personal health budgets are a wolf in sheep's clothing
Dr Youssef El-Gingihy on the move towards giving patients purchasing power
Personal health budgets are exactly what they sound like - a patient can use money directly for purchasing health and other services.
For example, they might purchase a block of physiotherapy sessions for £500. Or they might feel that they would better spend that money on a gym membership. Or buying a bike.
Personal health budgets have been used for personal care for many years. Pilots are now being rolled out to 50,000 patients and will be extended nationwide from April 2015. It’s all about empowerment, right?
Wrong. They represent the logical end-point of the journey with the self-paying consumer in a market for health-care.
The real question is: what happens when your personal health budget runs out?
Easy, people say, you top it up. But it’s not so easy if you don’t have the money.
In other words, they enable insurance for top-ups (co-payments). Hence why insurance companies like WPA and AXA PPP are reportedly enthusiastic.
At the same time, Bupa has been busy preparing its own clinical guidelines and creating networks of doctors gearing up for this brave, new world. Personal health budgets undermine the fundamental NHS principle of equity of care. They are a Trojan horse for privatisation.
The publication of the Dalton review in December 2014, commissioned by the government, has looked at whether public or private companies could own and operate chains of hospitals. Case studies for this review included Spain and Germany, where privately-run public hospitals have expanded. Alternatively, this might pave the way for ‘new conglomerations of super NHS trusts, some privately managed’, which could entice private investors and even buy-outs from private equity groups.
So we will have budget-holding patients under an NHS that is modelled on state insurance providers like Medicare in the United States with CCGs acting as insurance pools - able to exclude undesirable patients, buying healthcare from private companies and making funding decisions supported by privatised commissioning support units. Top-up co-payments as well as care pathways and packages would then allow integration of this system with private healthcare insurance giants.
Although ministers, including Prime Minister David Cameron, continue to omit the P word, what is happening on the ground is clearly privatisation according to the World Health Organisation’s definition of healthcare privatisation: ‘a process in which non-governmental actors become increasingly involved in the financing and/or provision of healthcare services.’
You see, the privatisation of the NHS affects us all. One bandies around the platitude that you never know when you will need the NHS. But as a fit young person, you don’t seriously believe it. That is until something happens, as I discovered in 2013 when I ruptured my Achilles’ tendon playing football – the textbook injury of the dilettante weekend sports-player. I was on crutches for four months under the care of the orthopaedic team and then required weekly physiotherapy for several months after. At the same time, my father - a retired consultant psychiatrist - was very unwell in hospital, requiring intensive care at one point. We have since both made a good recovery - all thanks to the NHS.
To think that the Government allied with the private healthcare sector wants to take the right to healthcare away from each and every one of us - when we are at our most vulnerable - makes my blood boil.
How to Dismantle the NHS in 10 Easy Steps, out now from Zero Books.
This article is an extract fromDr Youssef El-Gingihy is a GP and author. He tweets @ElGingihy