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Personal health budgets to drive decommissioning of NHS services, says think-tank

CCGs will need to decommission unpopular services to make personal health budgets work when they are rolled out to all patients with long-term conditions in 2015, a leading think-tank has warned.

The Nuffield Trust says services that are not chosen by budget-holders will have to be decommissioned, but done at a pace that prevents the market from shrinking.

The think-tank’s new report, entitled personal health budgets: challenges for commissioners and policy-makers, also says there will need to be new infrastructure around budget setting and care planning, but this will need to be found in existing budgets.

The personal health budgets scheme is due to be rolled out by April 2014 to 56,000 patients on continuing care and be offered to anyone with a long-term condition who could benefit by 2015.

But it has proved controversial, with pilots of the scheme drawing criticism after a DH report revealed that patients were using their budget to buy theatre tickets, ready meals and complementary therapies.

The Nuffield Trust report said that pilots have ‘barely exceeded 100 people’ using the scheme and that using them at scale will present new challenges for CCGs.

It added: ‘Their extension to people in receipt of continuing care, and after that to those with long-term conditions, presents a much larger challenge for commissioners, who will need to reassure themselves that a wider range of providers demonstrate sufficient quality to merit inclusion.’

It added: ‘CCGs will also need to be ready to decommission services not chosen by budget holders; but at a pace that allows providers the chance to adapt and minimises the risk of market shrinkage (leaving individuals with fewer choices than before).

‘Likewise, efforts aimed at diversifying the market of providers need to be carried out with care to avoid destabilising existing providers.’

Commissioners will need to implement new systems, but using existing budgets, the report added.

It said: ‘For the system to work, new infrastructure around budget setting, care planning and system monitoring is required; funding for which would need to be found in existing budgets.

‘There is some evidence to suggest that some efficiency can be achieved by “piggy-backing” on the systems that already exist to support personal budgets in social care.’

This follows a report by another think-tank, 2020 Health, that called on the Government to consider putting GP practices in charge of the administration of patients’ individual personal health budgets.