Leading the charge towards patient empowerment

I’ve recently joined NHS England as the Director of Personalisation and Choice, bringing together the teams who have been responsible for Personal Health Budgets (PHBs), Integrated Personal Commissioning (IPC) and Patient Choice.

I was previously the Chief Executive of the Independent Living Fund, which supported disabled people to live independently with choice and control over their lives.  This is an agenda which I am passionate about and I’m delighted to be working with people who share the same determination to make our health service ‘person centred’ with real choice being offered to patients.

It’s been a busy first few weeks in post. I’ve had the pleasure of attending one of our ‘developing a local offer for personal health budgets’ events. The Personal Health Budget Delivery Team are working hard to support CCGs as they make their business cases to extend the availability of personal health budgets to others who could benefit, in ways that are sustainable and affordable.  It was great to meet with staff from CCGs, their support services and healthcare providers to hear the opportunities and challenges that personalisation presents.

More importantly I’ve met with some of the peoplehub peer leaders and heard them share their real, personal experiences of managing personal health budgets which always puts our ‘big ideas’ into perspective.

It’s easy to envisage high level concepts, but these concepts are meaningless unless what we’re doing enables people to make meaningful choices that give them more control and flexibility in the way they manage their long term health needs and live their lives.

If you haven’t had an opportunity to speak with people who have made personal health budgets work for them, I would really encourage you to hear them tell their stories.

I have also been engaged in work to improve the choices that women are provided with in maternity services, and discussions to improve the approach to end of life care.  It is clear that we have much work to do but the passion I have seen demonstrated for making a real difference to the current approach provides an excellent energy to drive forward what is needed.

At the Health Service Journal annual lecture on 29 October, Jeremy Hunt talked about an “Irresistible, inescapable shift to patient power”.  It is clear that opinion is converging in support of a health service built on the principles of patient choice and control.  However, there is still a long way to go to achieve a position where personalised approaches are the default setting.

What’s also clear is that one agency or organisation isn’t going to achieve this alone. Delivering a universal culture of personalisation and choice in the NHS will only be achieved if we work together across commissioning organisations, provider trusts, the voluntary and community sector and with people themselves. We need strength in numbers to lead the charge towards patient empowerment. One of the cornerstones of the IPC Programme is the need for CCGs and local authorities to work co-productively with people and communities.  The challenges ahead aren’t ones that statutory services can fix alone.

This week Together for Short Lives  published an excellent guide for young people with life limiting conditions and their families to help them navigate across health, social care and education systems in order to access personal budgets. This is exactly the kind of collaborative working we need to not only embed person centred practices in the NHS, but to be engaging directly with people to enable them to get the best from health services, in ways which are efficient, effective and work for them. For seriously ill young people getting this right, so that they can live a full life, simply can’t be more important.

When personal health budgets are delivered well the impact can be overwhelmingly positive for people.  It’s also clear that by empowering individuals to take control of their support, the wider system benefits through reduced use of emergency services, unplanned hospital admissions  and overall cost savings.

Personal health budgets are still relatively new and represent a real shift in culture for the NHS, so it’s not altogether surprising that support for them is not universal. We have seen recent articles that attempt to trivialise the complex, considered work that professionals in the field undertake in order to deliver positive outcomes for individuals.

We need, therefore, to continue to champion the need for wider personalisation and choice, to articulate what patient empowerment means and how it can be delivered, and work hard to listen to concerns and change opinion where needed.

While I’m sure there will be interesting conversations ahead, I’m also determined that we move past talking to see real change happen so that we deliver on the commitments of the Five Year Forward View and ensure that people are enabled to take greater control over their own health.


James Sanderson

James Sanderson is the Director of Personalised Care at NHS England where he leads on a range of programmes that are supporting people to have greater choice and control over their health and wellbeing. James also became the CEO to the National Academy for Social Prescribing (NASP) in 2019 where James leads on creating partnerships, across the arts, health, sports, leisure, and the natural environment, alongside other aspects of our lives, to promote health and wellbeing at a national and local level. View the NASP strategy.

James joined NHS England in November 2015 and was formerly the Chief Executive and Accounting Officer for the Independent Living Fund (ILF). The ILF was an arm’s length body of the DWP and supported disabled people across the whole of the UK to live independent lives through the provision of direct payments enabling the purchase of personal assistance support.

Prior to joining the ILF in 2002, James had a career in the motor industry within a number of sales and marketing roles, in both corporate and retail environments. James is a performing arts graduate with a background in community theatre.


  1. M. Iqbal says:

    Hi, Sent you an email about my experiences with the PHB particularly the fact that the CCG has taken the view that the whole of the cost they incurred in providing services cannot be given to me as a PHB which does seem to be against what you and your colleagues are saying in blogs and publicity. it seems PHB are being used as a means to cut costs. you response would be most welcomed.

  2. Francesco Palma says:

    How does personal Health Budgets work where a section 75 agreement is in place with the local Authority and CCG where the Mental Health Provider is party to the section 75 agreement, Does the Mental Health provider have the authority in acting on behalf of the CCG to refuse such a request or should the decision to grant/deny/assess rest with the CCG?

    Thanks in advance

  3. Sherry Reynolds @cascadia says:

    Thank you for sharing your thoughts not only with those in the UK but the renegade patient centered design advocates over here in the US can learn about your teams work as well..

    One reason the US has double and triple the cost of health care is because we spend so much less on support services and I was very interested in hearing about your personal health budgets.


  4. clive says:

    the first step must be to kick start the process of giving patients access to their health data, what do you think?