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Health minister says patients should have right to buy luxury goods with personal health budgets



Exclusive Patients should be allowed to spend NHS funds on theatre tickets and frozen meals if it improves their experience of the health service and wellbeing, the care minister Norman Lamb has said.

In an exclusive interview with Pulse, Mr Lamb argued that the Coalition’s policy to make personal health budgets a ‘fundamental right’ for patients on NHS Continuing Healthcare was integral to a shift from ‘paternalistic’ NHS.

Pulse had reported that patients in personal health budgets (PHB) pilots had been allowed to spend their budgets on theatre tickets and ready meals, and Mr Lamb defended the pilots, claiming that giving people control of their budget has ‘massively improved’  patients’ experiences.

The minister pleaded with GPs to ‘not have a closed mind’ about the benefits PHBs bring.

However, the GPC said the scheme was ‘wholly inconsistent’ with the NHS ethos of funding treatments based on their efficacy.

PHBs will become a ‘fundamental right’ for patients with a long-term health condition receiving continuing care support next month.

This was after a DH evaluation of the pilots, which ran from 2010 to 2012 across 75 sites, concluded that ‘personal health budgets had a significant impact on well-being and quality of life’ and found them to be cost neutral after the initial investment – a point later disputed by a follow-up study.

The DH assessment revealed that patients were being allowed to spend money on frozen meals, theatre tickets and complementary therapies.

The pilot report said: ‘The majority of the budgets were being spent on social care-related services, although there were signs that budget holders were choosing more innovative services to support their outcomes and needs, such as complementary therapies, leisure and education.’

Examples from an interim pilot report list examples of PHB expenditure as ‘facilitating social activities and hobbies: season ticket, craft materials, musical instrument, driving lessons, childcare, clothes, activity day with friends, theatre trip.’

When asked by Pulse whether this was a good use of taxpayers’ money, Mr Lamb replied: ‘Do we really say that an objective, and an analysis that shows people having a better experience, improved well-being, are we saying really that that is not a good use of taxpayer’s money?’

He recounted one example where patients who had care budgets in social care, qualified for NHS Continuing Care funding after their condition deteriorated, but were told they couldn’t continue with their previous care team.

Mr Lamb told Pulse: ‘Now that’s paternalism, and it’s a disgrace. Surely we should be giving those people the power to control and manage their care better, collaboratively with the GP that surely must be the objective.’

He added: ‘I think there are loads of GPs who really see that, and who see the extraordinary potential value of empowering an individual, both to self-care but to improve their life. So my plea is don’t have closed minds about this.’

NHS England’s head of personalisation had previously explained that the focus should be on patient outcomes, and that benefits are diminished when restrictions are placed on how money is spent.

But GPC chair Dr Chaand Nagpaul said that the spending of PHBs were not subject to the same scrutiny as other NHS spending.

He said: ‘At a time of severe financial pressures on NHS budgets, and at a time when commissioners are scrutinised over spend of NHS money in an evidence based approach, it would be wholly inconsistent to have a separate rule that applied to another budget that was not subject to the same scrutiny or evidence-base requirements.’

He added: ‘Because we’ve got to remember this is a resource, that’s a public resource that comes from taxation. We have to make sure the effective use of that is subject to the same rules as any other healthcare budget.

‘Patients are denied all sorts of medical treatment because they’re not shown to be effective enough, so I think the same rules should apply.’

Doubt has been cast over the cost effectiveness of the scheme, with an independent study finding that handing PHBs to patients costs the health service £4,000 more per patient on average.

The same research group also identified that PHBs were more likely to benefit more assertive patients,  and suggested benefits were linked to patients being given proportionally more money.