Patients to Trial Personal Budgets in up to Half of PCTs

Monday, May 18th, 2009

14 May 09

By Nigel Praities

Plans to give patients cash payments to purchase NHS services will go ahead next year, in the face of fierce opposition from GP leaders.

The controversial direct payments will start as a pilot of 5,000 patients in up 75 PCTs with the aim of leading to a much wider rollout.

The schemes will include end-of-life care, long-term conditions, stroke, substance misuse and mental health.

The final make-up of schemes has yet to be decided, but the DH wants to try using both notional healthcare budgets and direct payments – as currently used in social care – during the pilots.

Direct payments of NHS funds are currently illegal, but the Department of Health is pushing ahead with legislation in the Health Bill to enable the NHS to make cash payments to patients from 2010.

GPs are likely to be expected to take central role in the pilots, advising patients how to spend their on healthcare or other services.

Speaking at the Integrated Health Conference in London, Angela Hawley, self care lead for the Department of Health, admitted the pilots were ‘terribly contentious’ but were part of a move to place the patients at the centre of their care. ‘These will put people in driving seat on health and well-being,’ she said.

Professor Jon Glasby, co-director at the Health Services Management Centre at the University of Birmingham, welcomed the move as direct payments had been successful in social care.

‘They are very popular with patients and have been shown to have better outcomes for the same amount of money,’ he said.

But GPC chair Dr Laurence Buckman slammed the pilots, saying they were against the founding principles of the NHS.

‘What happens when it runs out? If you give people a wad of money then what happens if they use it on their income tax, or petrol, or whatever?

‘This is the absolute antithesis of the NHS, providing the greatest good for the greatest number of people and to manage risk as high up the chain, so that individual bits of the health economy do not run out of money to treat the condition.

‘I am astounded the Government has decided to go down a route that is so irrational,’ he said.

How pilots will work

Three models of personal healthcare budgets will be tested in the three year pilot programme.

1. Notional personal budget – patients are given information about the cost of treatment options and are given a theoretical budget to administer

2. Real personal budget held by the NHS – patients are allocated a real budget held by an intermediary on the patients behalf e.g. GP, care co-ordinator, advocate. The intermediary helps the patient choose the services they will use

3. Real budget as direct payment – patients are given cash payments and are expected to purchase and manage their care themselves

Source: Department of Health

(Our thanks to Steve McNeice for sending us this article.)