It’s not just about the money

In the latest in our series of blogs focussing on Personal Health Budgets, Manda Williamson, Director of Positive Opportunities for Wellbeing (POW), a Community Interest Company (CIC) based in Devon, explains her motivation for supporting people to access PHBs.

It’s a question I both dread and, sometimes, look forward to trying to answer: “What do you do?”

For nearly thirty years the answer was simple: “I work for a charity that provides services for people with mental health problems”.

Now it’s more complicated because the full answer is that I’ve set up a social enterprise developing the resources that support personalisation and self-directed care. And that is meaningless in the real world, outside the health and social care community.

But sitting in a taxi recently I came up with a simple answer, when the driver posed the question.

I just said that POW (Positive Opportunities for Wellbeing) works with people to help them use their personal budgets, and then went on to say a bit about personal health budgets and the possibilities they present.

Then came the next predictable question: “Is this about privatising the NHS then?”

No, no, no. For me it’s about people getting the support they need when they live with long term conditions that get in the way of living life to the full.  I launched into a rant about how it allows support to be turned on its head, because personal health budgets are about outcomes and not needs, strengths led rather than deficit led, being the best we can be rather than just filling in the holes in our life.

Then I gave an example of someone who had been allocated a social care direct payment budget.

This was a woman in her forties who had been living with quite debilitating depression for many years. She was assessed as needing low to medium level support. In the ‘olden’ days this would have meant a referral to a floating support service for six hours a week of support. Her indicative budget was £90 a week.

But, I said, when we looked at what she wanted to achieve, rather than what she ‘needed’, it led to a very different support plan.

She wanted to:

  • feel safe in her own home, as she lived alone and was often frightened;
  • feel less lonely;
  • get out more and feel safe when out;
  • have a reason to get up in the morning;
  • get more exercise; and
  • meet new people.

“So she got a dog?” said the driver.

Yeah! Support plan sorted.

So that is pretty much what the support plan was. She used her direct payment to employ a support worker for a couple of hours a week, and the support worker helped her choose a dog.

She then went to dog training, so she felt confident in managing the dog. This made her feel confident not just in this, but in general, as she felt good having learned new skills and being good at something.

The support worker then went with her on her first walks with the dog, and they met new people in the dog-walking world – there was a good community in the local park. All outcomes met. Infact, more than met, because she is also now considering setting up a dog-walking business, as she feels able to walk other people’s dogs.

She continues to employ her support worker, but only for a couple of hours a week, so she has someone to talk problems through with, and to help her take on new things. This means, that once she had paid for the first costs of getting a dog, she only needs £30 a week. Wins all round.

The taxi driver was enthused and then told me a story about himself. He was in his thirties, with a couple of young kids. He’s had quite severe asthma since childhood, relying on inhalers several times a day.

“But then I saw a different asthma nurse and she changed everything. She didn’t just talk about my asthma, but talked about my life. Somewhere in the conversation she suggested I go swimming regularly, because I was talking about putting on weight now that I’m a taxi driver and sitting all day. So I tried it, going for a swim before every shift. It’s amazing. I feel fitter now but the incredible thing is that the swimming really helps my lungs. I hardly use inhalers now, maybe once a week and only on days I haven’t been swimming.”

So that’s what inspires me about personal health budgets. It’s not just about the money, it’s about the conversations that happen in working out a plan to achieve something, not just deal with problems. Sometimes those conversations can lead to unexpected results.

  • Personal health budgets are designed to be flexible, taking personal needs and preferences into consideration, with a range of support options available to ensure people have access to more personalised care. Many voluntary and community sector organisations, such as POW, play a vital role working with clinical commissioning groups (CCGs) to support people with aspects of setting up and managing their budget, such as developing care and support plans, brokerage and direct payment support services.


Manda Williamson is the Director of Positive Opportunities for Wellbeing (POW), a Community Interest Company (CIC) based in Devon.

After a long career working as the Chief Executive of a mental health voluntary sector organisation, a few years ago Manda set up a social enterprise which aims to support people to take control of their health and their life.

She is a passionate advocate of personalising care for people with long term health needs, including people living with mental health concerns..

Leave a Reply

Your email address will not be published. Required fields are marked *