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Personal budgets need to be called out for what they are



‘The NHS provides a comprehensive service, available to all.’ That it is the first line of the NHS Constitution and is a powerful expression of what the health service is meant to be. But the Government is pushing forward with a scheme that could smash this commitment into a pulp.

A Pulse investigation published today digs into the personal health budgets scheme that is being actively rolled out by NHS England. We found CCGs are planning to spend more than £120m on personal health budgets this year and this is set to rise even further, with NHS England currently touring the country trying to sign patients up to the scheme.

The NHS cash spent on Wii Fits, pedalos and aromatherapy for a small group of patients will make the headlines, but I would argue there is a much more serious issue at stake here.

Since April, all patients with a long-term condition have the ‘right to have’ a personal health budget, and a Government evaluation of the pilots started in 2009 did show these patients could benefit. There were measurable improvements in quality of life and a reduction in hospital use. But this was in small numbers of patients; a subsequent independent evaluation found personal budgets cost £4,000 more per patient compared with usual care and could actually have a negative effect on outcomes.

The crucial difference is the pilots were funded by new money from the Department of Health, but this is not the case now. Some CCGs have had a one-off £20,000 payment to kick-start the scheme, but the money will largely be found by shifting cash from other budgets. And the effects could be catastrophic.

Pulse recently reported that a centre for people with serious mental illness run by charity MIND had been forced to close because of ‘drastic’ funding cuts resulting from the CCG diverting cash to develop personal health budgets.

And this holds a warning for the future. Personal health budgets have widespread (largely unthinking) support from patient groups, think-tanks and others. And it is easy to see that a holiday or a summer house could have a powerful effect on the health and wellbeing of an individual – but what is the wider cost of cutting badly needed services for the rest?

The NHS has to make efficiency savings of £22bn (at least) over the next five years to maintain levels of service. This is a time when it needs to use resources more wisely and maintain the safety net for patients as much as it can. This would be a huge challenge, even without the imposition of seven-day services and ministers’ refusal to consider any more charges for NHS services.

Personal health budgets are trumpeted by the DH as a way to ‘transform NHS culture by putting patients in control’, and patients are bound to think it’s great to have cash to spend as they choose. But they might choose differently if they knew it meant not having access to a local service when they needed it. And who picks up the pieces if the patient’s chosen interventions don’t work out?

Personal health budgets will destabilise the NHS and are simply a way of introducing more competition by stealth. They are an attack on the collectivism that is a central pillar of the NHS and a dangerous step towards a US-style insurance scheme.

The public is being sold a wolf in sheep’s clothing and it needs to be called out for what it is.

Nigel Praities is editor of Pulse