Personalisation is more than just a personal budget
by Claudia Wood
Andrew Lansley announced on Tuesday that people with continuing health care needs will have the right to request a personal health budget by 2014.
This is a hugely ambitious task, and makes me wonder whether Lansley has thought through the implications of his promise.
Personal budgets have become a valuable method of giving people in need of care and support or health services greater control over the services they get. By controlling the purse strings, people can design their own support package and purchase services from wherever they choose. Getting the cash directly and sorting out your support yourself put a stop to decisions being made on your behalf and having services “done to” you.
But they are most developed in social care, where 340,000 personal budget holders are now purchasing the support they want. In health services, personal budgets are still being piloted. Several groups entitled to ongoing NHS support are trying them out, including those with mental health needs and long-term health conditions, and those using continuing health care. The pilots are tackling some of the practical problems associated with health budgets – such as putting a monetary value on what is essentially a ‘free’ NHS service and which has never properly been quantified and costed at an individual level, and working which services they can purchase from (complimentary health therapies? Homeopathy?).
These issues are tricky for every personal health budget user. But for those eligible for continuing health care, personal budgets may be much more challenging. To be eligible for continuing health care (where your health and care needs are funded by the NHS) a person must have a complex medical condition that requires a lot of care and support, or be in need of end of life care.
This is hugely challenging situation for someone to use a personal budget in, and many questions remain unaddressed: are personal budgets flexible enough to allow for swift changes in service use or equipment for end of life care, where time is of the essence? Are the information, advice and brokerage or support systems for personal budgets developed enough to help very ill people – and more often their relatives – manage a budget effectively without adding too much of a burden? Are personal budgets able to secure health and social care services simultaneously without too much duplication or bureaucracy?
All these – and many more – questions need to be hammered out before personal health budgets become a viable and attractive option for those receiving continuing care and the families who support them. Of all the groups eligible for personal health budgets, those with continuing care needs are perhaps the trickiest group to ensure personal budgets actually deliver personalised services.
Forthcoming Demos research considers this issue in more detail – we ask: for people in care settings where the implementation of personal budgets is most challenging, are they actually the best and only way of achieving person centred services? The fact is, personal budgets and personalisation are becoming interchangeable terms. Whilst life changing for many, personal budgets don’t guarantee person-centred services. And there are outstanding examples of person centred services (often, in fact, in end of life care) where personal budgets aren’t being used.
By focusing only on personal budgets, do we risk missing the bigger picture on what makes a truly person centred service? Someone with continuing health care needs may be given a ‘virtual’ personal budget by their local authority, but not have any more control in how their services are delivered or what they receive.
When Lansley stated those receiving continuing health care would be first in line for personal health budgets, he should have said – they will be first in line for greater personalisation. Now that really would be ambitious.