The NHS reaches an important milestone today in its promise on personalisation – with some of the people who rely most on our services getting “the right” to have their care delivered through a personal health budget.
One of the biggest challenges to the NHS is that ‘making people better’ isn’t always an option, and how we support people to live well and manage their chronic, often multiple, long term conditions is something we can still do much to improve.
Estimates suggest almost three million people could have three or more long term conditions by 2018, so this isn’t something we can ignore. Allowing people more control and flexibility over their care is something that can be achieved by offering personal health budgets – a key feature of the new Integrated Personal Commissioning (IPC) Programme recently launched by Simon Stevens.
Between 2009 and 2012 personal health budgets were piloted at sites across England, and the evaluation demonstrated some positive outcomes for patients and the NHS. When budgets were introduced well, people appreciated more control and flexibility in how their care was delivered, experiencing a better quality of life and an overall reduction in hospital costs. This can also be seen in surveys of budget holders and carers who have experienced an improved quality of life.
The pilot also showed that people with higher needs, and therefore a larger budget, were more likely to benefit from the flexibility of managing their care more proactively.
There are around 60,000 adults in England who are eligible for NHS Continuing Healthcare (CHC). They are people who have complex and ongoing health and care needs, and it is this group of people who have had a ‘right to ask’ for a personal health budget since April 2014, which becomes a ‘right to have’ from today.
Children in receipt of continuing care also have the same right to have a personal health budget.
Finances are tight in the NHS and personal health budgets are not ‘new’ money. However by looking at the amount of NHS money that is spent on someone’s care, and working with them to creatively explore other ways to meet their health outcomes gives people real control in managing their health, and their life.
NHS Dorset CCG has already administered almost 300 personal health budgets to adults eligible for NHS Continuing Healthcare and children eligible for continuing care, and has started to look at how other patient groups may be able to benefit from this more flexible approach.
Their brain injury rehabilitation work is a great example of how personal health budgets can offer a solution where a care pathway isn’t working well for patients or the NHS. In order to receive the intensive rehabilitation programme required after a life-changing injury, people were staying in hospital far longer than they needed to, so personal health budgets were an opportunity to do things differently and allow speedier discharge from hospital and therapies available from home.
Following a brain haemorrhage in 2011, 20-year-old Tom was one of the first people in Dorset to benefit from this new rehabilitation package. Tom lives on a farm with his family, and was keen to return home as soon as possible.
The community rehabilitation team would normally have struggled to provide for him at his remote farm location and, in particular, a personal health budget enabled an independent occupational therapist and a personal assistant who knew Tom, and the farm environment, to be employed.
He was able to use the money for gym membership to build back muscle strength, and his rapid recovery surprised everyone – including his medical team. Within a year Tom was back working on the farm, had started a college course and was able to play five-a-side football again.
Personal health budgets offer an exciting opportunity to enable people, like Tom, living with long term health conditions to become ‘patients in control’. Equally, those of us working in the NHS need to step up to the challenge to shift our thinking and truly work with patients as partners.
Giles Wilmore is Director for Patient & Public Voice & Information, NHS England.