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Personal health budget scheme ‘wholly inadequate’ and may worsen care

An independent assessment of the Government’s flagship scheme to give patients cash NHS budgets from September shows that the scheme will cost thousands of pounds more per patient and is ‘wholly inadequate’ to improve care.

The assessment by experts at the University of Glasgow and King’s College London finds that on average personal health budgets cost £4,000 more per patient than usual care, but that in some cases it had a ‘negative impact’ on patient outcomes.

Millions of patients with long-term conditions will get a right to have a personal health budget from September, after a DH-commissioned evaluation of pilot schemes showed they required additional investment, but were ‘cost neutral’ overall.

But the authors of this latest review say the evaluation used by the DH had come to the ‘wrong conclusions’ regarding the benefits of personal health budgets and that the scheme was being rolled out due to a consumerist ‘ideology’ rather than hard evidence.

The pilots have proved controversial as patients have been allowed to use NHS funds to buy theatre tickets, frozen meals and complementary therapies under the scheme that gives them a lump sum for patients to spend as they choose on their healthcare needs.

CCGs are currently preparing to offer a ‘fundamental right’ to a personal health budget to all patients with a long-term condition from September, with GPs expected to play a central role in the scheme.

Patients were given a range of options for a personal health, including an up-front ‘notional’ budget, or an actual NHS cash payment for them to spend directly.

However, the study – published in April in the Royal Society of Medicine’s Journal of Health Services Research and Policy – found personal health budgets had a negative impact on outcomes when patients were offered an up-front lump sum.

And, contrary to the Department of Health’s assertions that the scheme had been shown to be at the least ‘cost neutral’, and could even save money, the researchers said personal health budgets cost on average £4,000 more than control support packages – and this was not just down to patients having greater health needs.

It says: ‘We argue that there is a danger that the wrong conclusions from the evaluation are being drawn and that, far from endorsing that the policy improves outcomes, the evidence from the evaluation contradicts this view and, indeed, the conclusions of the evaluation team.’

The team warned that pursuing the up-front budget model without any evidence it will yield health benefits could see costs to the NHS spiralling; use of similar up-front budgets in social care led to an 8% increase in staff at the same time as a 20% reduction in productivity, they noted.

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As revealed by Pulse early this year, one of the authors also reported that the pilots showed personal health budgets would only favour more ‘pushy’ patients.

The team concluded: ‘On the basis of this evaluation, the Government’s endorsement of the policy appears to owe more to a commitment to a particular ideology than to the evidence, which not only fails to support their view but actually contradicts it.’

They added: ‘The notion of an “up-front” sum of money to allow the person to make their own support plan is very attractive to politicians, fitting current rhetoric about consumer power and carrying no cost implications…. However, it is a simplistic strategy and wholly inadequate for the task.’

GPC chair Dr Chaand Nagpaul told Pulse: ‘This study reinforces our view that personal health budgets are not a panacea. We need to tread very carefully.

‘What is more important is that CCGs commission care that is sensitive to patients’ needs and GPs have the time to spend with patients to ensure healthcare is organised according to their needs

‘What we do not need is to start devolving budgets to individual patients. Patients with complex conditions need different parts of the system to work for them, giving them a budget won’t solve [problems with] the myriad of different services they need from social care, home care, community nursing and how this is co-ordinated.’

A Department of Health spokesperson said: ‘This is a total misrepresentation of the overall financial impact of personal health budgets. Evidence shows that they are cost effective, they improve people’s quality of life and reduce the need for emergency care, such as hospital admissions. Implementing them in the right way is key, which is why NHS England is providing support to CCGs.’

J Health Serv Res Policy 2014; available online 3 April