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Don’t be fooled by these pilot personal healthcare budgets

Pilot personal healthcare budgets offer acupuncture, massage and smartphones. The real thing may turn out to be very different indeed.

Health Secretary Andrew Lansley announced at the Conservative party conference that personal healthcare budgets will start in 2014. The Department of Health reports:

"People receiving continuing healthcare support from the NHS will have the right to ask for a personal health budget, by April 2014 ... The announcement follows the independent NHS Future Forum report which recommended action to promote personal budgets and implement them within five years to give patients access to tailored services."

This says that people who needs continuing care (mostly elderly people) will have personal healthcare budgets from 2014, and by 2016 everyone with a long term condition will have one. I do not think "have the right to ask for" means that you can choose not to have a personal healthcare budget because running two systems side-by-side will be too expensive and it is clear which one the government prefers patients to use.

Patients are wary of personal healthcare budgets because they think that they will lead to rationing. Two years ago the government set up pilots for personal healthcare budgets in several areas of the country and these reported that patients and GP practices were reluctant to take part. However, the pilots have gone ahead and the government is now issuing interim reports and will use these pilots to justify the policy.

The latest interim report (pdf) is interesting to read, if only for its cheery language that implies that everyone loves personal budgets. Reading the report you would not think there are any issues with the policy. The reason why the patients love personal budgets is explained by Table 5.1 that lists the items that participants used, or expected to use, their budgets on. Amongst the items listed are: acupuncture, Reiki, massage, reflexology, aromatherapy, yoga, manicure, hair removal, laptop, mobile phone, electronic personal organiser, internet access. Remember: these are personal healthcare budgets offered at a time of austerity when the NHS is underfunded.

Is it really likely that such items will be available on the personal healthcare budgets that will be offered from 2014? If so, can you imagine how long it will be before the Daily Mail will have a headline saying: “The NHS paid for a smartphone but won’t pay for a hip replacement”? It is extremely unlikely that the personal healthcare budgets that all patients with long term conditions will be forced to have from 2016 will have such items. The reason why these items are offered in the pilot is to encourage current participants to give favourable feedback to justify the policy. But the policy will be different to the pilot.

This is not the first time this technique has been used. In 2002 the government set up the London Patient Choice (LPC) pilot (pdf) to test whether patient choice could work in the NHS. The result was that two thirds of the patients who participated were in favour of this form of patient choice. My response is that I am amazed that one third were against, given the incentives offered. Patients on LPC were given: Patient Choice Advisors, travel costs to the alternative hospital (for the patient and a carer) paid by the programme, and the chance of using a hospital in Belgium; none of these benefits are offered under patient choice now, a policy “piloted” by LPC.

So in the future, when you see “data” that shows that patients are in favour of personal budgets, remember that these budgets to buy smartphones will be totally different to the policy the government will impose on us from 2014.

Richard Blogger writes about the NHS and social policy at NHS Vault.

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