Lesley Hoare is clinical lead physiotherapist for Oxford Health NHS Foundation Trust’s physical disability physiotherapy service. Lesley and her team worked with around 50 people with long term neurological conditions who were offered personal health budgets for community exercise programmes to improve mobility and wellbeing.
As part of the personal health budgets pilot each person was offered a one-off budget of £400 to purchase community exercise programmes to manage and improve their health condition.
Our six physiotherapists first worked with each person on a support plan. This included deciding with them what form of exercise suited them most and would provide best health outcomes. Usually it was swimming and gym-based exercise at leisure centres. One person chose accessible sailing on a local reservoir, and others purchased hand cycles or power-assisted bikes for their homes, or enrolled on Pilates classes.
“Brokers help people with personal health budgets to purchase services to meet care plans, and they provide expert information, including help on managing finances.“
At first my team and I found helping people manage the money side of personal health budgets to be alien. We were not used to it, and sometimes helped by the fact that people were able to use the independent brokerage services of Age UK. Brokers help people with personal health budgets to purchase services to meet care plans, and they provide expert information, including help on managing finances. The broker was particularly useful when working with complex cases, such a person who had been bankrupt and so had additional bureaucratic obstacles to overcome. Also, some people have severe disabilities, so opening a separate personal health budget bank account can be demanding for them.
The broker helped in this respect. Having gone through the process, handling the money side is now clearer to us and we are more comfortable doing it, particularly in partnership with a broker who has appropriate skills and experience in this area.
Overall we found that people were tremendously keen to get the most for their money, and make it last for as long as possible. We were also struck by the value for money of some forms of exercise. For example, a two year gym membership cost £400, and this included one-to-one instruction and access to all machines.
Offering personal health budgets also required our team to develop sound knowledge about local community facilities, including gyms at leisure centres and hotels with pools which are warmer than leisure centre pools and hence more suitable. We can pass this knowledge on to other people, and so help them make decisions.
All in all, the whole process has been a learning curve for my colleagues and I. We can see, for example, how personal health budgets mean people have more choice, and how we can work in partnership to help them get good outcomes. Personal health budgets are as much about people leading us with their expertise, as us leading with ours. This is positive, although it can get some getting used to.
On a clinical level, the exercise purchased has been beneficial. We can see, for example, that one person doing Pilates now has improved muscle power. Another who purchased a power-assisted bike can now cycle further in 10 minutes. People find such improvements motivating. At the end of the day, we know that people would like more physiotherapy. The reality is the NHS is limited in the resources and physiotherapy services it can offer. Through personal health budgets I have seen how exercise programmes, as an adjunct to physiotherapy, can have a valuable role in the self-management of people’s conditions.
“Personal health budgets are as much about people leading us with their expertise, as us leading with ours. This is positive, although it can get some getting used to.“
My top tip to professionals when they start working with personal health budget is to get a clear understanding of their ethos and the processes involved. The sooner you understand this, the quicker you can, as a professional, embrace the value of personal health budgets.10
It is now 3 years on from when we started the personal health budget project. We have seen great outcomes for some patients, who are still attending exercise sessions. One lady with MS, who chose to attend 1:1 Pilates sessions feels she has really benefitted and has progressed to a higher level. There were some patients who didn’t spend their budget. For some this was due to medical reasons, but there were a group of patients who didn’t continue or even begin exercising. The patients were randomly selected for the project, and the physiotherapists feel that it would be important if budgets were offered more widely, to ensure that patients are selected who are motivated and “in the right place” to make the change in their lifestyle. In order to be effective it is therefore important to spend adequate time working with the patient initially to work on their support plan and ensure they are ready to embark on the exercise as part of their self-management. This can be difficult with limited resources but is more likely to produce a successful outcome long-term. For us as a team this has been a really useful bit of learning from the project.