The Personal Health Budget: personalised healthcare or the end of the NHS?

LIVERPOOL, UK – 12 March 2015:  Personal Health Budgets (PHBs) which were introduced as a means of allocating NHS funds to patients represent the privatisation of the National Health Service, according to research by the University of Liverpool.

PHBs are NHS funds allocated to certain groups of patients to allow them to purchase services of equipment that will meet their healthcare and well-being needs.  They are designed to give patients with long-term chronic diseases individual choice, flexibility and control over the care they receive.

PHBs were rolled out across the country in 2014 after a pilot programme in 70 Primary Care Trusts.

In an article published in International Journal of Health Services, Public health expert, Professor Alex Scott-Samuel, exposes the different views about the effectiveness of PHBs in addressing healthcare needs and about the significance of PHBs in relation to the future of the NHS.

Using specialist email discussion lists/groups such as Politics to Health Group and Public Health for the NHS which comprise of experts within public health, Professor Scott-Samuel reveals the strength of opinion against/towards PHBs from healthcare experts, healthcare providers, patients and support groups.

Baroness Barbara Young, the Chief Executive of Diabetes UK, raises concern over the effectiveness of PHBs to diabetes patients:  “Diabetes is a complex condition.  The development of its complications can be unpredictable and lead to multiple co-morbidities.  Research in this area has identified that personal budgets are likely to work best when conditions are stable and predictable.

“Therefore Diabetes UK takes the position that personal health budgets are not suited for clinical diabetes care delivery and may impact negatively on quality of care and lead to fragmentation of service.”

The pilot programme found that typically, PHBs had been used to pay for services such as physical exercise (GYMS?), alternative therapies or to pay carers.  The services which PHBs can be used for is questioned by an email contributor – and according to one of the emails, can be used to buy a season ticket.  Another contributor points out that PHBS can be used to pay for services no longer provided by the NHS, for example acupuncture.

The email discussions also reveal that there is concern about the ability and /or desire of patients with chronic diseases to manage their own healthcare budget and to negotiate with care providers, assuming that the patient was aware of all of the services available to them , and there relevance.

However, the key area of concern in the discussion groups is that PHBs are part of the transition to an insurance-based system, and the end of an NHS that is available to all, regardless of wealth.

Professor Scott-Samuel said:  “Personal Health Budgets are being introduced at a time when rapid privatisation of the English NHS is taking place and where restrictions are being placed on people’s access to healthcare.

“As a result many see their introduction as a diversionary gimmick designed to help pave the way for the conversion of the NHS into the insurance-based system which may believe is the intention of the UK government.”

PHBs were first proposed by Labour Secretary of State for Health, Alan Milburn, in 2006 as a way of giving patients a choice between an NHS package of care or to have control of their own NHS budget.

In April 2014, patients with a long-term condition were given the right to request a PHB following after what was deemed to be a successful pilot in 70 primary care trusts covering patients with a range of long-term conditions.

The evaluation of the pilot found PHBs improved care-related quality of life and psychological well-being but it did not improve clinical outcomes.

The current Government have committed to making PHBs available to anyone with a long term condition who wants one after April 2015. NHS England estimate as many as 5 million people could be in receipt of one by 2018.

The research is available to read here:
http://joh.sagepub.com/content/45/1/73.full.pdf+html

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