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Personal budgets held back by white paper

By Gareth Iacobucci

Plans to give patients personal budgets to purchase their own healthcare have been grounded by the Government's NHS white paper, according to an interim report of the pilot scheme.

The study, commissioned by the Department of Health, reported ‘many frustrations' with the progress of the pilots to date, including fears that more complex patients are being intentionally ignored because their conditions are more costly to PCTs against the backdrop of huge organisational and financial upheaval.

It comes just weeks after Pulse revealed that schemes around the country have spectacularly failed to get off the ground to date, with several pilot areas chosen nearly a year ago yet to recruit any patients, and GPs left in the dark about plans.

The previous government committed £2m of funding to the pilots in 20 sites across England last December, with the coalition pledging an additional £4m to drive the scheme forward in preparation for a nationwide rollout in 2012.

But the report by leading primary care academics from the University of Kent, Imperial College, LSE and the Social Policy Research Unit said the progress of the scheme had been halted by the white paper, with the abolition of PCTs and SHAs overshadowing the priority given to personal budgets.

The report said: ‘With such significant changes, such as the abolishment of SHAs by 2012 and PCTs by 2013, there has been an impact on the implementation of personal health budgets within the pilot programme. Sites are experiencing difficulties maintaining the momentum of personal health budgets given the context of the abolition of PCTs.'

The report added: ‘The need to provide more support for some groups of people raises the equity question again and whether some people will be intentionally ignored because of the cost implication of having to provide more support to certain people.'

The study said delays in handing budgets to patients were also being caused by issues related to accountability and risk-management, with potential conflicts between patients' needs and wants also causing problems.

It added that there was still ‘significant culture change' required to make real budgets a reality, and said a lack of training was stopping the scheme from getting off the ground, with the care planning process often too complex for staff to engage with.

Dr Helena McKeown, a GPC member and GP in Salisbury, Wiltshire, where personal budgets for cardiac and stroke care have been piloted but failed to take off, said it was the scheme's problems were unsurprising given the huge upheaval presented by the white paper.

She said: ‘It's a big change to be doing at the same time. It is wholly understandable that [PCTs] can't do work for which they haven't had extra resources like training staff to talk to people about personal budgets.'

Dr Helena McKeown: Problems with personal budgets are unsurprising given the scale of the white paper reforms Dr Helena McKeown: Problems with personal budgets are unsurprising given the scale of the white paper reforms