My two blogposts on Personal Health Budgets (PHBs) (1, 2) reminded me of a very interesting meeting I attended a couple of weeks ago.
This was part of the broad Future Forum structure that’s been put in place to help guide and shape the current health service reforms, and focused in particular on Personal Health Budgets.
It was the first meeting of 4, so necessarily focused on orientating all the participants in the purpose of the group, the current position from both a policy and practice perspective with regard to PHBs, and setting out on what we hoped the group would achieve.
The intent of the group was highlighted by the presence of both Paul Burstow, the Care Services Minister, and Mike Farrar, the Chief Executive of the NHS Confederation, and it was a privilege to be involved.
It was also a privilege to hear from Stephen and Nicola – a patient/user and his carer – who had direct experience of using a PHB and the difference it made to their lives.
Inevitably, there were a number of challenges when it comes to PHBs that were highlighted throughout the meeting. My personal reflections on what these included covered:
- The perception and reality of PHBs resulting in double running costs
- “The system” when it comes to NHS commissioning and procurement Staff culture within the health system PHBs being seen as an “add on” to the overall health system reforms, especially when current change is already somewhat fatiguing for those involved
- The perceived and actual lack of evidence when it comes to the role of PHBs in improving patient/user outcomes and/or reducing costs.
The NHS Confederation’s own research – which set out five tests with particular regard to PHBs for people with mental health conditions – reflects some of these issues.
This said, there were also many potential opportunities associated with PHBs (again, personal views):
- With the advent of Clinical Commissioning Groups, there is an opportunity to embed PHBs from the start of their work, including ensuring a patient-centred way of thinking (with PHBs essentially represent) in their approach PHBs and the drive towards them will enable the NHS and its staff to be even more person-centred
- Direct Payments could be a means by which some of the difficulties and bureaucracies of regulation can be proportionately managed or circumvented
- There is a huge amount of learning that can be taken from adult social care in particular (both positives and negatives) and applied to PHBs.
On that last point, one of the significant differences between PHBs in health and PBs (and Direct Payments) in adult social care is the following: in the NHS system, a significant proportion of the spend is with NHS providers; in adult social care, the majority of spend is with private or voluntary sector providers, rather than local authorities themselves.
The implications of this are substantial.
Nevertheless, the role that users and user-led organisations have played in the personalisation of adult social care – particularly with regard to providing peer support and in coproducing in system design and delivery – was one made and acknowledged at the meeting.
I’m hopeful, therefore, that users and their organisations will have a key role to play in the development and delivery of PHBs.
As far as possible, I’ll try to keep you up-to-date with the progress of this work around Personal Health Budgets.