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Personal budgets: NHS leaders in call for system to get real about the challenges ahead

The NHS Confederation Mental Health Network has set five tests for successful implementation of personal health budgets as it encourages Government and the NHS to get real about the challenges ahead.
Personal budgets are an idea whose time has come but, if power is going to stick in the hands of all patients, the Government and NHS needs to be realistic about the challenges of implementation.

So says a report from the NHS Confederation's Mental Health Network, which draws together evidence from polling, focus groups and in-depth interviews to give the views of hundreds of service users service users, clinicians and 40 local NHS and social care leaders across the country.

While the overwhelming majority of respondents agreed that personal budgets could be a change for good, they are a radical change and each group has different views of what increased personalisation will mean for them.

Clinicians support greater personalisation and most thought that they already offered personalised care this was not a view shared in the survey of service users. Service users also felt that, even if they were offered more choice through personal budgets, they would still need support and to work with clinicians to make properly informed choices.

Service users said they would move their treatment and support away from drugs and hospital visits towards less medical treatments. Many of their preferred options do not have a clinical evidence and the clinicians we spoke to found this unacceptable. This concern was shared by local system leaders as guardians of taxpayers money.

At the same time, local leaders were concerned that only a significant minority of people would choose personal budgets. This means effectively 'double-running' support systems for those who choose not to use budgets and those who do.

The Mental Health Network is concerned that there is not currently sufficient confidence or consensus in the system to roll out personal budgets with much momentum.

Without steps to address these cultural and practical issues, personal budgets risk failing to deliver on their potential. It is simply not enough to announce a policy is available from now on when little has been done to implement it.

Everyone from Government down to clinicians and patients in the consulting room have to tackle these issues. Otherwise, personal health budgets risk being one in a line of policies that promise to increase personalised care but deliver little as the barriers to effective change are either ignored or underestimated.

The Network sets out five tests that the NHS and Government should meet in order to make personal budgets work for services users.

  1. Has the national evaluation generated evidence that personal health budgets improve outcomes, experience or costs? A positive evidence base is important to persuade clinicians and NHS leaders that such a radical overhaul will work.
  2. Does the roll-out establish guidance for a significant expansion of the brokerage and advocacy systems? Without proper support only the most articulate and well-informed would benefit from personal budgets.
  3. Has a viable solution been found for how to release funds to finance personal health budgets at scale? Not everyone will choose to use a personal budget which poses a funding headache for local systems having to run two systems in tandem.
  4. Have sufficient preparations been made to integrate personal health budgets in the NHS with personal budgets for social care? Different assessments in health and then in social care for the same level of need would be a powerful disincentive to use personal budgets
  5. Does the plan to roll out personal health budgets contain sufficient levers to drive take-up? Evidence from personal budgets in social care shows the Government will have to do more than simply allowing personal budgets to happen.

NHS Confederation Mental Health Network director Steve Shrubb said:

"Personal budgets is an idea whose time has come and the overwhelming majority of people we spoke to in the course of our research supports their introduction of personal budgets.

"Equally, however, clinicians, patients and local leaders have very different ideas of what they will mean for them.

"The power given to patients by personal budgets will not stay in their hands unless there is a shared view on how they will work, what support is available and what the evidence base is.

"Simply building the structures and expecting people to come and take up personal budgets will not be enough.

"This kind of thinking belongs to an undistinguished line of policy initiatives that have promised so much and delivered so little.

"The Government and the whole health and social care system have to look at these practical and cultural issues before we can hope to successfully role out personal health budgets.

"A slow but sure approach will ultimately be more effective than a big bang of a launch that ignores or underestimates the challenges of implementation."

Quotes from previous reports:

“You have to be shown what your choices are, as people don’t know. You go into a supermarket and you can see what’s there. But something like this... if you said to my mum ‘you have a choice’, she wouldn’t know.” - Carer

“I’d go from my medication to more holistic treatment, so tap into other things that might help me, save popping pills every five minutes, because that’s all they do. You’ve got this symptom, you take this drug. You’ve got that symptom, you take the other drug.” - Service user

“The traditional view of a pilot is that you do something and see if it works. In the NHS we do a pilot and it has to work.” - PCT chief executive

“I’m a highly trained, highly expert specialist in a field which has involved many, many years of  training, many years of clinical experience, and my job is to know the best evidence and best practice for the kind of presentations that I’m expected to see within my field. It would be completely against my code of practice to say to a young person, yes go ahead and spend money on something that has no evidence base.” - Psychiatrist

Notes to Editors

The NHS Confederation is the only body to bring together the full range of organisations that make up the modern NHS. We are an independent membership organisation that represents all types of providers and commissioners of NHS services in England. We also represent trusts and health care boards in Wales; and health and social service trusts and boards in Northern Ireland.

You can read more about the Mental Health Network's personal health budget research here

Contact Francesca Reville 020 7074 3312 or Niall Smith 020 7074 3304. For out of hours media enquiries, please call the Duty Press Officer on 07880 500726.

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