Family members or carers could be paid a management fee for looking after cash payments of public money designed to support patients to improve their health, under the Government’s plans to roll out personal health budgets nationwide.
The proposals – revealed in a consultation document published this month – also reveal the Department of Health is determined to push ahead with the programme by changing the law to enable local authorities and CCGs to put cash payments under the scheme into patients bank accounts for them to spend them as they wish.
The eight-week consultation will gather views on whether patients with long term conditions should be given a cash budget they can spend on personalised care – in the form of a direct cash payment, or whether it should be held by the NHS or a third party.
Pilots of the scheme have drawn criticism after a DH report revealed that patients were using their budget to buy theatre tickets, ready meals and complementary therapies.
A promise that everyone who could benefit should be given a right to ask for a personal health budget was included in the Government’s first mandate to the NHS Commissioning Board, with patients receiving continuing healthcare the first to gain access to the scheme before April 2014.
The consultation on rolling out the scheme to all eligible patients, invites responses on whether family members or carers should be paid for managing complex or large direct payments and what services should be excluded.
While initially the RCGP said personal health budgets should not be given out for treatments that are not clinically proven to be effective, such as some complementary therapies, this year they modified their position and said that GPs should not block personal budgets even if there is no evidence that the treatments work.
The DH’s consultation document said: ‘The Department proposes to update these two regulations so that a one-off direct payment for healthcare can be paid into an individual’s personal bank account… Provision of receipts can be used to review how the money was spent.’
‘Local authorities already make direct payments for social care and we wish to give them the powers to fund part of a person’s direct payment for healthcare where treatment includes public health services and it is appropriate to do so.’
It added: ‘Before coming to a decision on whether to give CCGs (or where relevant, the Board) the option to pay close friends/family members to manage complex care packages we would like your views on this.’
Launching the consultation, health minister Norman Lamb said: ‘We want patients to be fully involved in their care, allowing them to make decisions with their clinicians to improve the quality of their life.
‘Personal health budgets help people to think outside the box in terms of treatment and how their health can be improved.
‘This is the next step in our programme to roll out these budgets to eligible people. I would encourage everyone to have their say on how this will work.’
Dr Peter Swinyard, chair of the Family Doctor Association, said he opposed the move towards direct payments to patients. He said: ‘There’s an awful temptation when you’re feeling rough if someone gives you £30 to go down to the pub and make yourself feel better.
‘While most people would be responsible, it does seem to be a very strange way to improve healthcare. If you pay people in cash there’s no way of knowing that they’ll spend it on their health. There’s no way of auditing what they spend.’
He added that carers and family members ‘should not’ be paid for managing payments. He said: ‘We already have heaps of bureaucrats being paid for things, it would be much better to have things agreed by commissioning and allow patients to choose what they want and make a direct payment to them.
‘If it happens to be alternative therapy so be it – although the country isn’t full of taxpayers money at the moment and so it’s a bit ridiculous to be spending on junk.’