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New budgets can change behaviour

Dr Simon Fradd believes we should welcome and support the introduction of patient-held budgets. I am amazed that pilot schemes are already under way, yet the profession seems slow to consider their impact. If widely adopted, personal health budgets would make the current arguments over commissioning both irrelevant and unimportant by comparison.

There are many huge decisions to be made. For example, will we all have the same budget?

That would probably be unworkable, but if we introduce variations then we raise colossal moral decisions about preferential budgeting to those whose lifestyle has contributed to their illness.

Tobacco, alcohol and obesity problems won't go away, but the cause and subsequent effects of all of our lifestyle decisions will be thrown into the sharpest focus.

Surely the ingrained behavioural patterns we have wrestled with for decades will change as people acquire more realistic views of themselves, the NHS and what it should be providing.

Of course there will be failures – not everyone can manage their domestic budget so why should this be any different?

Rescue systems will need to be provided, but I think the vast majority of people will be able to manage their own budgets and live within the boundaries set for them.

From Dr Paul Stillman, Crawley, West Sussex - Member of the Self-Care Forum