Personal health budgets in long term health care: how will the NHS adapt

Vidhya Alakeson

Vidhya Alakeson

by Vidhya Alakeson, author of Delivering personal health budgets: A guide to policy and practice, published this week 

Luke has Batten’s disease, a rare degenerative condition which means that he needs day-to-day support from a team of six. For six years, he worked with the same team employed by his family, using a direct payment from the local authority. But when Luke turned 18 and his care transferred from Children’s Services to NHS Continuing Healthcare, his family was told that they could no longer employ the team they knew. The NHS would instead select an agency to care for Luke and his family would no longer be in control.

Fortunately, from April this year, fewer families should find themselves in the distressing situation that Luke and his family experienced, thanks to the introduction of personal health budgets. From April, the 56,000 people like Luke with significant health and support needs who qualify for NHS Continuing Healthcare will have the right to ask for a personal health budget rather than receive care commissioned on their behalf by the NHS. From October this year, that right will be strengthened further into a right to have a personal health budget.

Personal budgets have become an established part of the landscape in social care. The same approach is now being extended into the NHS to provide individuals with long term conditions and disabilities greater choice and control over how their healthcare is delivered. Personal health budgets allow them to decide how best to meet their own needs with the resources the NHS allocates to them. For some people, small changes, such as having care staff come to their home at a different time of day, make a significant difference. Others want to make bigger changes, putting together a different mix of services and supports from the one the NHS would purchase for them.

A three year national pilot programme compared outcomes for 1000 people with a personal health budget across a range of conditions, and a control group of 1000 people receiving care commissioned as normal by the NHS. The evaluation found that individuals with personal health budgets had a better quality of life and better psychological well being than those in the control group. Taking control did not result in budget holders experiencing any deterioration in their clinical health. In fact, budget holders made less use than those in the control group of other NHS services such as Inpatient, Accident and Emergency and GP services.

However, the evaluation was also very clear that the way in which personal health budgets are implemented can determine whether or not they have a positive impact. Personal health budgets must offer real choice and flexibility to allow individuals to maximise their creativity and not bind people to pre-determined menus or clinical notions of evidence-based practice. Delivering personal health budgets offers a definitive guide of how to make personal health budgets work well for people, as well as setting out for clinicians and commissioners the positive role they can play in improving the management of long term conditions.

Delivering personal health budgets: A guide to policy and practice by Vidhya Alakeson is now available with 20% discount at

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