The Health Bill, published by the DH last week, introduces pilot schemes for patients holding individual budgets and making direct payments for support and care from a provider of choice. This was first mooted in the NHS Plan 2000, repeated in OHOCOS in 2006, and promised in the Next Stage review by Lord Darzi. He commented that:
“We need to learn how to support and allow eligible service users to design their care and support packages”.
We must assume that Lord Darzi chose his words carefully so we can use them to comment on the potential impact of individual budgets under four headings:
- need to learn
- how to support and allow
Further information on these two points below and in next week's blog we will report on:
Need to Learn
In spite of the strong political drive behind this initiative, the pilots must consider and provide effective solutions to issues of commissioning, funding, staffing and service design, not least the fundamental changes in relationships between professionals and cared for people in planning and service delivery. The assumed benefits of personal health budgets are:
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improved personal control and empowerment encourages self and shared care
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greater choice and responsiveness to needs are promoted
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patients actively involved in designing care packages improve cost effectiveness and reduce waste
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integration of health and social care is improved
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reduced emergency admissions and lengths of stay in hospital
How to support and allow
There are concerns from professionals that patients may spend money "unwisely” or on the ”wrong” services.This may reflect their own uncertainty in changing roles but also underlines that personal budget holders will need support in making the choices available to them and professionals will need training in helping to influence those choices without disempowering the patient. Equally the menu of choice may be restricted and not include high cost medicines or complementary therapies. Patients may need support from independent advocates/brokers in making their choices of care or care provider.
Log into our blog next week for part 2 of this topic!