From today (1 April 2014) the NHS has introduced personal health budgets. These are pots of money to support an individual patient's health and well-being and to offer individuals an opportunity to influence how their health and well-being needs are met and paid for by the NHS. Those with particularly complex healthcare needs will be the first to whom the budgets are offered.
Patients must first decide if they wish to adopt this approach and, if so, to meet with their local NHS team to decide whether they are eligible and to devise a budget for the NHS to approve. The budget centres on a health care plan that includes funding for not only therapies but also for personal care and aids and equipment.
There is no obligation to have a personal health budget and an eligible patient who opts to have one is not under any obligation to change an existing care package. The key benefit is that these budgets offer flexibility. So, where patients find the care they receive is inadequate, or is no longer needed by them, they can adapt how their budget is spent to deliver more effective care to meet their current and future needs. A patient may feel, for example, that therapies are having a beneficial effect and enabling them to do more at home. They may, therefore, chose to increase the provision for more therapy and reduce the amount of support received from personal carers.
Certain services remain outside the scope of the personal budget. For example, it is not required to cover any needs that may arise for emergency services or services normally provided by a GP. The funds are controlled to ensure they are spent only on appropriate services.
Such budgets have been common in social care services for some time and proponents praise the 'self-directed' ability to spend on social care needs that suit the individual. These budgets are not, however, without their critics who identify frequent and significant mismatches between initial funding estimates and the actual amounts paid or actual costs of services as local authorities struggle to balance their legal duty to provide certain services with the overall cap on funding.
Andrew Clayton, associate in the Penningtons Manches' clinical negligence team, expresses a cautious welcome: "This is a major step in enabling patients to influence the provision of services to meet their own needs. By tailoring care to individuals' specific requirements, there should, in theory, be greater flexibility and cost-effectiveness. This regime will not be suitable for all patients and it is important that proper checks and balances ensure that only those for whom it is an appropriate means of managing and funding health care needs are eligible. It is also imperative that there is flexibility to adjust budgets to take account of changing healthcare needs.
“It will take some time for healthcare providers to adjust and the greatest difficulty is likely to be how service commissioners work out how to release funds from existing contracts. Those controlling the purse strings are likely to need to access a broader range of services and will require providers to be adaptable to individual patients. Providers will therefore have to become more flexible but, in appropriate cases, patients should be able to access services that are designed better to meet their personal needs."