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Time to get real on personal budgets

Our new report says 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.

The new Mental Health Network report 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. 
Today's report (6 October) follows our earlier publications which set out the views of service users and carers, the challenges associated with personal health budgets, and the views of local health and social care leaders.

Read the reports

Download our personal health budget reports from our publications library or by clicking on the links below: 

Differing views

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

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

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. 

Leaders

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. 

Mental Health Network viewpoint

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.  

Five tests

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. 

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