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The NHS has a wide range of services to offer patients to meet any issues they may have, but sometimes even that is not enough, and this is where personal health budgets (PHBs) comes in. PHBs aims to replicate the success of the personal budgets and direct payments scheme available within social care, and basically offers a patient a cash payment instead of a direct service.
The creation of PHBs came from a demand from users of Continuing Healthcare, that offers long term at home personal care to individuals with health and social care needs, similar to what local authority social care can offer, but for people with significant health needs. When someone who already receive social care have a new health needs that can only be met by NHS Continuing Healthcare, the whole package is normally transferred to and met by their local NHS funding body. This meant that people who previously had a personal budget or direct payment were being forced to have their care directly managed and so they experienced a lost in choice and control.
PHBs were therefore created to resolve this dilemma. Because of its success, NHS England, who manages the development of the scheme, has extended the scheme to cover a range of other services. These include wheelchair services, learning difficulties services, mental health services, children services and others. Over time, this could be extended further to includes services like continence services, so people can purchase their own continence supplies.
PHBs are still a relevantly new scheme and it is going to take a number of years still for the scheme to be widely known and used. On the ground, outside the realms of Continuing Healthcare, GPs and NHS staff are unlikely to know exactly what they are or how they can be accessed. Every local Clinical Commissioning Group (CCG) has to provide a ‘local offer’ in terms of what services they are willing to offer as a PHB at their discretion. This means some CCGs can be adventurous while others play it safe.
To obtain a PHB you have to have a need and be eligible for a service in the normal way under existing criteria. There is a theoretical right to have a personal health budget and this could mean that if you have a condition that required a treatment, therapy or operation that was not available within the NHS, you can ask for a PHB to purchase it privately from where it was available. I however believe we are a long way off from this happening as it opens up a whole range of issues of the very nature and purpose of the NHS.
Long term, personal health budgets are never likely to replace emergency services or acute services, those services provided in a hospital setting or relates to assessment and diagnoses. However, they may play a bigger role in community based provision that is about the management of long term health issues and terminal illnesses.
A personal health budget is a right that comes with responsibilities. In exchange for receiving a cash payment, you become responsible to purchasing and managing the delivery of the support you require, which may include employing your own personal assistant(s). However, while the lure of choice and control may be attractive, your health conditions may mean this is going to be too stressful or too much work to provide any kind of benefit.
In 2009, I experienced an acute nerve virus that left me paralysed from the naval downwards for several months. During this time, I required full overnight care from NHS Continuing Healthcare, on top of the daytime support I was receiving to employ a personal assistant from my local social services as someone with cerebral palsy. I was offered a personal budget to employ my own staff at night, but it was not what I wanted or needed at that time.
My daytime personal assistant had been with me for a few years and knew my routine and how to support me at this very difficult time when I was very unwell. Having a PHB at this time would have meant taking on the responsibility of recruiting and managing staff. While this would have been my preferred option if I had needed the support in the long term, it was not worth the hassle while I was still in a state of recovery when my long term needs were unknown. Having a care agency, a total of three agencies in the end, caused a whole range of issues that could have been avoided if I had my own staff, I was at least on paper not responsible for resolving issues when they arose.
Having a PHB does not necessarily mean you have to employ a personal assistant directly, and you can still pay for a care agency and other services. In most services currently, a personal health budget is something that is likely to be discretionary, something that is not the norm, and therefore something this is not likely to be imposed on people unwillingly. If your health and support needs are being satisfactorily met through an existing service, then there will be no need to consider a PHB.
Like a personal budget in social care, a PHB is something that you can try for a period of time, and if it is not working for you, return to having a direct service. The specifics of how the PHB will be paid to you and administered, including how you will have to account for the budget, will be determined by the local CCG. Because the scheme is very new in a wide range of services, there is likely to be a lot of discretion on how it is implemented at a personal level.
Mark Bates Ltd
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