Personal health budgets – why we can’t stop here

January 15, 2018

This guest post is by Vidhya Alakeson, one of In Control's associates and Deputy Chief Executive of the Resolution Foundation. Vidhya is a leading consultant in the personalisation of health and social care. She is an internationally recognised expert on personal health budgets and has been closely involved in the development and implementation of personalisation in the NHS.

Yesterday 56,000 people who are eligible for continuing healthcare got the right to have that care delivered as a personal health budget instead of receiving services commissioned on their behalf. This is an important enhancement to the right to ask for a personal health budget that came into force for the same group in April of this year. But we can't stop here if we want to realise the full potential of personal health budgets. The right to have a personal health budget must be extended to the millions of people with a long term conditions if they are to significantly change the culture of the NHS.


Personal health budgets have already established a strong track record in improving the care and quality of life of individuals in receipt of continuing healthcare - those with the highest levels of ongoing care needs. Take Malcolm, for example. Instead of attending a day programme where they found his dementia hard to manage and relied on medication to calm him, his personal health budget allows him to be supported at home, to reduce his medication and specialist health input and to be calmer, safer and more content. Similarly, a specialist care agency was unable to meet Stephen's needs in a way that was sensitive to him as a person, leaving him depressed and with recurrent lung infections. Hiring his own care team using a personal health budget ensures that Stephen's complex health condition is well managed but in such as way that also allows him to play an active role in family life.


There are many other stories of success like these; stories of people's lives and those of their families being transformed by having a greater say over their care. In some cases, there have also been considerable savings to the NHS, or at the very least the creation of much greater value for money. But success in continuing healthcare will have little impact on the wider NHS. Continuing healthcare is a small and discreet part of the health service and one that very few people know about. It is closer to social care than to much of the wider health system so while yesterday marked an important moment in the development of personalisation in the NHS, if the right to have a personal health budget goes no further, we will lose waste the policy's huge potential to change the NHS for the better.


The biggest challenge the NHS now faces is managing the growing number of individuals with long term conditions, often multiple long term conditions  -  such as diabetes, cancer, chronic obstructive pulmonary disorder and mental health conditions. Effective management of these conditions requires three critical shifts in the NHS: a greater focus on prevention and early intervention to avoid unplanned admissions and the use of emergency care; greater individual engagement to better support people's ability to manage their own health on a day to day basis; and a stronger focus on integration to deal with comorbidities and multiple overlapping needs. That means not just integration across health and social care but also between physical and mental health care and between different levels and specialties of the NHS.


These are all areas where personal health budgets have demonstrated positive impact in the national evaluation. Individuals with a personal health budget were found to make less use of unplanned care than those receiving commissioned services, making personal health budgets a cost effective way of delivering care. Budget holders also reported feeling more in control of their care with a personal health budget, with much of the improvement in quality of life and psychological well being that the evaluation identified being attributable to this increase in control. Budget holders also reported being able to integrate their physical and mental health needs more easily with a personal health budget. Those who had a personal health budget for mental health reasons felt that their physical health also improved and vice versa and the evaluation team concluded that personal budgets were an important vehicle for integration between health and social care.


With so much potential, it is imperative that politicians and policymakers do not lose their nerve on personal health budgets and pause where we currently are. Some clinical commissioning groups who have already invested in personal health budgets for individuals with long term conditions will continue regardless of whether or not a new right is put in place. But for the majority, the freedom to offer personal health budgets to address the long term conditions challenge is less likely to change their behaviour than giving people the right to have their care delivered in a new and different way.