Personal health budgets are to be rolled out nationally, after an independent evaluation of the 20 pilot sites found that they generally improved people’s quality of life and proved cost effective.
Overall, the evaluation report suggests that personal health budgets are beneficial to individuals and the NHS, especially when they give people genuine choice and control.
A personal health budget is an amount of money given to someone to help them design a package of care and support from clinicians and others, giving them more control over the nature of the treatment provided.
Personal health budgets have been piloted at 20 sites for the past three years. The pilot evaluation found:
• People had a significant improvement in their care-related quality of life and psychological wellbeing. Their health 'status' stayed the same. Benefits were more marked where people had higher levels of need
• Personal health budgets worked better where people were given more choice and control over what they bought and how they received the budget. In contrast, where the pilot site imposed a lot of restrictions, personal health budgets tended to worsen people's outcomes
• People reported positive impacts of their personal health budget for themselves and for other family members. They also talked about the change in their relationship with healthcare professionals
• Family carers were more likely to report a better quality of life and perceived health than carers of people in the control group.
Additionally, the evaluation found that personal health budgets were cost-effective, particularly for people who get NHS continuing healthcare and those who use mental health services. It showed that:
• Where people had a higher budget, savings were made for the NHS as well as people's quality of life improving. This was partly due to people choosing to meet their health needs in different ways that cost less, such as training their care staff to carry out tasks like changing dressings
• Some of these new ways meant that people bought care and support, which the NHS doesn't offer – NHS commissioners will need to plan for this
• In-patient costs fell for people with a personal health budget, suggesting that people receiving personal health budgets had fewer stays in hospital.
As a result, the rollout of personal health budgets will initially target those who currently receive NHS continuing healthcare. By April 2014 up to 56,000 people on NHS continuing healthcare will have the right to ask for a personal health budget. It is also hoped that clinical commissioning groups will offer a personal health budget to more people with a long-term condition who may benefit.
Care and Support Minister Norman Lamb said: “Independent analysis has now shown that personal health budgets can put people back in control of their care and make a significant difference to their quality of life.
“The evaluation shows that those with the greatest needs benefit most from personal health budgets. That’s why we are giving people on NHS continuing healthcare the chance to get one first. And, I hope more people who could benefit will be given the option of one.”
Simon Lawton-Smith, head of policy at the Mental Health Foundation, welcomed the evaluation’s findings: “This report clearly shows that people with mental health problems and people with learning disabilities can benefit from personal health budgets. That’s an important message, challenging the assumption that people who may lack mental capacity, such as those with learning disabilities or dementia, are unable to make choices and decisions about their care.
“It’s also very good news that personal health budgets are associated with significant improvement in the psychological wellbeing of patients generally.
“It’s worth noting that budget-holders appear to secure more of their services from outside conventional NHS providers than the control group. New clinical commissioning groups must recognise this and build it into their commissioning plans for 2013-14 and future years, as personal health budgets become more widely used.”
Think Local Act Personal (TLAP), an alliance of some 30 social care partners committed to improving the delivery of personalised, community-based support, also welcomed the evaluation. TLAP co-chairs Sue Bott and Bill Davidson said:
“It’s great to see that people’s quality of life and wellbeing is improving significantly with personal health budgets and that they are clearly cost effective. We also welcome the positive impact on family carers. It’s obvious from the evaluation that the best results are achieved when personal budgets are implemented using the principles of self-directed support – when people know how much money is available to them at the start, have the flexibility to choose the services they want and can manage the money in a way that suits them best. This mirrors our experiences of personal budgets in social care, particularly highlighted in the personal budgets outcome and evaluation survey last year.
“As personal health budgets are now rolled out, it is important to make strong links across health and social care, to help to achieve integration of support at the level of the individual.”