Exclusive Commissioners are spending as much as £1,500 every year to third party organisations for administrating a single patient’s personal health budget, it has emerged.
The head of commissioning at NHS Shared Business Services told delegates at the Health + Care conference in London yesterday that the organisation has heard of brokers charging these fees, which only includes administrative support.
Benjamin Damazer said that the high costs involved mean that using a third party is hard to justify,even though many patients may not be able to manage a budget for themselves.
CCGs are currently under huge pressure to ramp up the number of patients adopting personal health budgets, as part of NHS England’s ‘personalisation agenda’.
NHS England wants CCGs to give patients direct payments so they can spend the budget as they choose, but many CCGs are using third party organisations to administer the budget on their behalf.
Mr Damazer said that CCGs are finding brokers ‘an expensive option’.
He added: ‘We are aware of one broker that charges the CCG £1,500 per patient per year to act as the broker and intermediary and for that the patient doesn’t get support beyond the admin. Whether it comes off the patient’s budget or not, it’s still the CCG and the taxpayer they are charging. So it is a difficult model to justify financially.’
Around 5,000 patients have personal budgets currently, but NHS chiefs are pushing to increase this to around 100,000 in the next few years, so they are used by a much wider range of patients with long-term conditions – despite concerns from GP leaders and other experts that they do not offer clear health benefits and could destabilise existing NHS services.
CCGs can give patients a direct payment, use a third party, also known as a ‘broker’, or give them a ‘notional budget’ – where the patient’s care team still have control over the budget.
NHS England says that evidence shows patients do best when they receive a direct payment for their budget.
But Mr Damazer explained that direct payments were also causing CCGs considerable administrative burden.
He said: ‘We’ve seen examples of patients coming into CCGs with carrier bags of receipts and some poor junior administrator is left to deal with all those receipts, sort them out and put them in some sort of order and explain why the value of the receipts is not the same as the value of the budget, and account for that through to audit committees.’
An NHS England spokesperson said: ‘NHS England is committed to working with CCGs to ensure that personal health budgets are cost-effective, whilst ensuring that patients receive high quality and personalised care. Evaluation of personal health budgets has indicated that personal health budgets are cost-effective compared with conventional health services.
‘Third party brokers who support the delivery of personal health budgets can offer a range of services besides administration, including care planning and employment support and advice. CCGs have a responsibility to ensure that all third party support services represent genuine value for money for the service being provided.’
Personal health budgets under scrutiny
CCGs are currently being pushed to expand access to personal health budgets for a range of patients, including those with long-term conditions.
NHS chiefs have set a target to have 100,000 people using the budgets by 2020, and Simon Stevens has also gone on record calling for ‘north of five million’ NHS patients with long-term conditions to be using a combined personal budget – covering both health and social care needs – within two years.
The plans are based on Department of Health pilots of personal health budgets, after an evaluation concluded that they could save the NHS money and improve patients’ quality of life.
However, the pilots caused controversy when Pulse revealed that patients had used their budgets to pay for items such as frozen ready meals and theatre tickets. A separate independent evaluation subsequently concluded that the budgets offered no overall health improvements and only benefited patients who spent considerably more than usual on their care.
CCG leaders have expressed doubts about whether the schemes offer value for money, especially for the wider population of patients with chronic conditions that NHS chiefs want to reach, while critics also argue they risk destabilising existing NHS services and serve as a precursor for private medical insurance care packages. Pulse discovered that a day centre in one area had been axed so the CCG could put money into offering the budgets to some patients with mental health problems.
More recently the BMA called for a review of personal health budgets and NICE said they should be evaluated further, after a Pulse investigation revealed the budgets were being used on non-evidence based treatments such as holidays, summer houses, reflexology and pedalo boat rides.