The Health Bill 2009 introduced into Parliament on 15 January boosts the personalisation and choice agendas by enabling direct payments for healthcare to people in England. There are already 60,000 people receiving direct payments for social care. This is a big step towards the objective of individualised commissioning which joins up health and social care. MAC strongly advocates this for people with long term conditions who wish to take greater degrees of control over planning and delivering their own comprehensive services. It also points towards the achievement by 2010 of individually agreed care plans. That is a key reason why we worked with the Motor Neurone Disease (MND) Association to create the MND Year of Care commissioning tool, which will be invaluable in creating and costing individual care plans for people with this condition.
All of this was trailed in the Darzi Next Stage Review report High Quality Care for All along with the suggestion that individual budgets might be most advantageous to people with complex and generally deteriorating conditions such as MND or multiple sclerosis or Parkinson’s disease. We agree, provided that assessment processes linked to budget setting do not become burdensome in the face of what can be a rapid pace of deterioration in these neurological conditions. Using the MND year of care tool to predict needs should reduce the need for reassessments.
The Health Bill coincides with an NHS Confederation report claiming that direct payments could “revolutionise” patient care. Personal Health Budgets: the shape of things to come? argues that giving patients control over healthcare funding could provide enhanced outcomes and change the nature of the patient-professional relationship. We hope personalised budgets and individualised commissioning for those who want to use it with support and help available from expert 3rd sector organisations will be the shape of things to come.
As Secretary of State Alan Johnson said launching the Bill, “People rightly have high expectations of the care the NHS offers, and they want more control over their own health – which is why the bill will give more power to patients and drive up the quality of care.” Conservatives and Liberal Democrats also welcomed this, so the chances of making progress are even better.
Of course there are the inevitable nay-sayers amongst some of the self-interested professional groups. Unison warned of a “real danger of creating a situation where patients use their personal budget ineffectively and then, like Oliver Twist, go back for more. Or, patients will be persuaded to top up their budgets from their own savings, undermining the founding principle of free healthcare for all.” Unlikely we think, especially if there is s strong link between users and 3rd sector bodies to advise them about making good choices, or even holding the budget for them and spending it with their agreement.
The BMA made the rather eeyorish observation that it was “currently very unclear how such a system would work in practice – for example, what would happen when a patient’s budget ran out? Moreover, this policy seems further to establish the idea of healthcare as a commodity, which the BMA does not believe is in patients’ best interests.” Those presently in control would say that sort of thing, wouldn’t they?
In rebuttal, we can think of no one better than Jon Glasby, professor of health and social care at Birmingham University, who said, “personal budgets have allowed people in social care to be much more imaginative and use funds more carefully than the system did. There is no reason why this should not happen in health. However, it will need to be carefully introduced.”
An agreed individual care plan is the essential first step to identifying a personalised budget. Real choice, as the MND Association said in their response to the Health Bill’s publication, also means the choice to opt out of personal health budgets and still receive high quality and timely care and support. Expert organisations like the MND Association which are close to their members and understand in great detail what it is like for individuals, carers and families to live with a devastating disease feel that even with the risks, individual budgets are worth exploring.
Helping patients and carers raise their expectations about what should be acceptable is part of this. As Heidi Macleod, Director of Care Development at the Motor Neurone Disease (MND) Association said, “we support and promote the principal of increased patient choice. This initiative has the potential to improve control and flexibility in care. A further benefit is raising the expectations of patients about what should be acceptable in terms of quality care and shared decision making so that they can make better choices, including end of life decisions, for themselves.” MAC believes that with the right kind of support, that is a prize worth striving for.