Government set to push ahead with personal health budgets
2 November 2012
The government looks set to push ahead with the implementation of personal health budgets in spite of widespread doubts or ignorance about the initiative among doctors
How ready do you feel to help your patients get to grips with PHBs (personal health budgets)?
If the answer is ‘not very’ or ‘what’s a PHB?’ then you are not alone. Seventy-two per cent or 155 of the 214 doctors who responded to a recent BMA survey said they felt not very well informed or not at all informed about the introduction of PHBs.
Yet the announcement of the further implementation could be just weeks away, and doctors will have a vital role to play, helping their patients to access PHBs and make the best choices.
For the government, PHBs are key to its aim of making healthcare more modern and personalised. Its vision is to enable people with long-term conditions and disabilities to have greater choice, flexibility and control over the healthcare and support they receive.
Pilots are taking place in more than 60 PCTs in England, including 20 that are looking at aspects in particular depth. A final evaluation of the pilots is due to be published this month, but the government seems so sure PHBs will be seen as beneficial it has already earmarked £1.5m to continue to support PHBs until April 2013 when responsibility will pass to clinical commissioning groups.
The BMA has taken a keen interest in PHBs since they were first proposed back in 2008, and is currently developing resources to support the frontline doctors who will be involved in implementation.
It has expressed a number of concerns about the policy that it hopes will be addressed in the final evaluation. But it is particularly concerned by how many doctors feel uninformed and unprepared.
So what exactly is a PHB? The idea is that patients with certain long-term conditions are allocated pots of money to spend on their individual needs. The patient works with their local NHS team to agree a care plan, setting out how the budget will be spent.
The amount of money in a PHB varies according to the patient, and there are a number of ways the budget can be held.
A PHB can be used to buy, for example, extra or more flexible carer support to enable people to live at home.
DH case studies
One Department of Health case study describes how Anita, who has Huntington’s disease, and her husband, Trevor, were able to fund carers who could take her swimming, which made her feel better, and help her do ‘normal’ things such as shopping or visiting the cinema.
Trevor says: ‘Anita’s psychiatrist has written a letter noting how much improved Anita has become since she has had carers from her PHB.’
Another case study describes how Sandra, who has COPD, used her budget to buy an exercise bike to help her lose weight and improve her symptoms.
But there are also instances of PHBs being spent on items less closely linked to health, such as laptops, travel passes or personal assistants. There are limits to what PHBs can be spent on. These include alcohol, tobacco, gambling or debt repayment, or anything that is illegal.
The fifth interim report into the pilot programme also says that some pilots were stricter about what the budgets could be spent on than others, which meant what had been approved in some areas was rejected in others, leading to frustration among those whose care plans were turned down. The report suggests national guidance could be needed on this.
Doctors believe it would be beneficial for patients with long-term conditions to have more control over their care (58 per cent of those responding to the BMA survey), but only around a fifth think PHBs would be effective in putting patients in control of their care.
About 30 per cent of doctors agreed patients should be able to spend their budget on care not traditionally funded by the NHS, but a larger proportion (40 per cent) felt this should not be allowed.
The new BMA position statement says: ‘Using PHBs to pay for non-traditional services could take money out of the NHS … This could lead to the destabilisation of existing services as the loss of funding from budget holders leaves providers unable to maintain the level of service they wish to provide to non-PHB holders.’
When the BMA submitted its response to a government consultation on direct payments for healthcare, one of its key concerns was that they promoted the idea of healthcare as a commodity; the association does not believe this is in patients’ best interests.
The latest BMA survey also reveals:
- Doctors remain unconvinced of the benefit of PHBs and therefore broadly unsupportive of their introduction. Much of this could be due to a lack of information and knowledge about PHBs
- A feeling that if patients are to be properly supported to choose and use PHBs, any proposed implementation should be delayed until doctors have a thorough understanding of the initiative
- Doctors are concerned that PHBs will make it more difficult for the NHS to control costs, and that they will not improve clinical outcomes for patients
- More evidence is needed of the benefits of PHBs on patient outcomes if doctors are to support their implementation. More doctors thought PHBs could improve well-being or patient experience outcomes than actual clinical outcomes
- More work should be done to explore how existing frameworks could be used to meet the needs of patients better — more effective care planning focusing on genuine partnership between patients and health professionals, for example.
The BMA position statement says: ‘Doctors are strong proponents of evidence-based medicine, so may be reluctant to embrace initiatives without proper evidence that they will be beneficial and will not do harm.
'If doctors are to be expected to play a central role in supporting patients with PHBs, much more work needs to be done to explain the thinking behind PHBs and how they can benefit patients.’
The BMA would be keen to work with the DH to improve PHBs if any outstanding concerns have not been allayed.