Personal health budgets are the subject of increasing debate. Some of this debate is well informed, some of it is less so, but the conversation is important to engage with in all its diversity for everyone with an interest in person-centred care and the future shape of the NHS in England. We are currently working to support CCGs, both in offering personal health budgets to people eligible for NHSContinuing Healthcare (who have a legal right to have one) and to enable local dialogue around developing an expanded local offerbeyond this cohort. This supports the current planning guidance Forward View into action: Planning for 2015/16 which set an expectation that CCGs will rollout personal health budgets to others who could benefit, but with flexibility to introduce them at a pace and scale that reflects local priorities. With 2016/17 planning guidance now imminent, our ongoing work will build on these foundations in terms of how and for whom personal health budgets will be further extended in the NHS looking ahead.
As today’s discussion paper published by National Voices and partners helpfully outlines, there is good evidence that personal health budgets can be an important mechanism for improving wellbeing outcomes and making choice and control a reality for people. They are not the only way to do this, and won’t be the right solution for everyone, but as part of a wider move to support people to manage their health and avoid crises, they provide a valuable option for people with more complex needs and an increasingly essential counterbalance to population based approaches to commissioning that upholds the principle of “nothing about me, without me” for people that most need a personalised approach.
Enabling disabled people and those managing complex health needs to take more control over how their care is managed is an undeniable culture shift for the NHS. It's still very early days many lessons are still be learned about how to do this well; in a way that works for people while ensuring the most cost effective use of public resources. Here we need to look towards our colleagues in social care, who have learned some of those lessons by leading the way over the last ten years with implementing a personalised and community based approach including personal budgets, at a time of sustained pressure on budgets.
Many people are passionate about our NHS - I count myself amongst them - and some have perceived personal health budgets as contrary to the core values we associate with it. I strongly believe this is not the case, but there is considerable work to do to engage more fully with professional groups and people with lived experience to ensure our future plans in this area effectively tackle real and perceived implementation issues, win hearts and minds in the process and continue to reflect the growing amount we understand about best practice. Equally it's well understood that the NHS doesn't have the resources to cope with the increasing number of people living with multiple long term health conditions by doing more of the same. The Five Year Forward View is clear on this, we need to do things differently and this includes utilising new approaches to remake the relationship between the NHS and the people with care and support needs, carers, families and communities that depend upon it to coproduce the better outcomes we all want to see.
At the heart of the policy is a need to see people as active participants in their care, not as passive recipients of services. We know that even for people with the most complex health conditions, only a tiny percentage of time is spent in the care of health professionals and that for the rest of the time they find ways to manage their health and get on with life as best they can. Our health service should explicitly recognise and support this, its sustainability depends upon it. This means developing new relationships between people and professionals, where people are valued for the expertise they have about their own health condition and supported to develop their knowledge, skills and confidence to self-manage. Shared decision making, a holistic approach to personalised care and support planning and a “more than medicine” approach are vital to this and the opportunity for people to take direct control of the resources available, with the support they need can also play an important part.
There are plenty of examples where personal health budgets have offered a real solution to do things differently. After years living with mental health problems, Lily had worked out what personally helped her to cope, but the trauma therapy that made such a difference was unavailable by NHS referral. A personal health budget has enabled her to direct the way funding is used to enable her to manage and to avoid repeated contact with crisis services. Personal health budgets are never about new money. They are about people using money the NHS would have spent on their healthcare in a different ways, directly aligned to individual needs and preferences. It’s also really encouraging to see how personal health budgets can encourage the NHS to stretch and adapt in response to what’s really working for people. For most people the goal isn’t to be managing the money themselves, it’s a means to and end of getting the service that best fits with their life, and personal health budgets can help make that happen.
I warmly welcome today’s publication, because the time is right to have an open, transparent discussion about the best way forward. Personal health budgets are in their infancy and we still have much to learn and consolidate. If there are concerns about how they work and how they fit with conventional NHS services, then let’s talk about that. I know there will be issues where our opinions diverge, but I’m looking forward to some interesting conversations ahead. We have a number of examples on our website about how personal health budgets have worked for people. These aren’t isolated incidences and they should be taken seriously. I have also met many of the people who have shared their experiences with us – and for people like Angela, Kevin and Jon I’ve seen the very real difference that personal health budgets can make. That’s not something we should give up on and is every reason to welcome the debate.