Holly Squires is a manager for NHS Continuing Healthcare at Oxford Health NHS Foundation Trust. She and her team of 15 work with 60 adults with high level care needs who, when offered, chose to have a personal health budget.
We first visited people interested in a personal health budget to explain how they might work for them. This could take some time and more than one visit, but it was important.
People who have taken up personal health budgets in Oxfordshire have conditions such as dementia, multiple sclerosis, and major spinal injury, and they all wanted to remain living in their own home. When discussing specifically how they could use a personal health budget, it was essential we understood what healthcare outcomes people wanted to achieve. This often revolved around wanting to avoid being admitted to hospital or being moved to residential care. We also discussed what in their traditional care plan was working, and what was not.
A key early conversation we had was whether the person would use their personal health budget to employ their own carers, or continue using agency staff. Assisting us in this was an independent broker from the charity Age UK. Brokers help people with personal health budgets to buy services to meet health outcomes, and provide expert information, including help on managing finances. The broker also handled recruitment and employment issues, so avoiding the possibility of people getting anxious about this.
“A key early conversation we had was whether the person would use their personal health budget to employ their own carers, or continue using agency staff. “
The problem with traditional care packages has been that people have had no choice but to use agency staff contracted by Oxfordshire County Council. Often people found they just did not know which carer would be turning up next at their door. This inconsistency is unsettling and detrimental to their emotional wellbeing. Traditional care packages were inflexible. It was a question of ‘this is what the care we offer is. You cannot change it.’
But personal health budgets gave people the option to employ their own carers, and so bring about consistency. One example is a woman in her thirties who needed day and night support at her home. Her carers kept chopping and changing until she used her personal health budget to employ people directly. She now has a much better relationship with carers whom she has grown to see as friends. Moreover, the agency staff always used to wear a compulsory uniform, and this made her feel conspicuous going out shopping and to her rock choir classes with them. But with a personal health budget there’s no stipulation for her own employed carers to wear uniforms, so she’s comfortable going to town and her classes with them.
Overall, the positive health impact of personal health budgets has been huge. People have been admitted to hospital less. This is because employed carers often get to know the person so much better, and so can pre-empt problems. Crisis management incidents are also less. Plus, people feel more in control of their lives, and so feel safer and more confident.
“I can confidently say every single person has benefitted from moving to personal health budgets. “
Our working practices have changed in the sense that there are more care options on the table, plus we can have honest upfront conversations with people about the cost of care. With traditional care packages people had little idea how much care cost.
We have also become open to being inventive. For example, people have advertised for carers on the Gumtree website and local parish magazines. In another example, a person with a personal health budget went on holiday with his wife in a hotel equipped with care facilities and with carers on hand. This was so his wife could have a break. Previously, her husband would have had no choice but to go into a nursing home.
My main advice to professionals working with personal health budgets for the first time is that although it can feel a lengthy and daunting process to start with, it is worth it in the end. I can confidently say every single person has benefited from moving to personal health budgets. None of them would choose to return to a traditional care package.