Getting the sums right - How to sustainably finance personal health budgets

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Getting the sums right - How to sustainably finance personal health budgets is a new briefing paper published by the NHS Confederation today in partnership with Think Local Act Personal.

The 11-page document includes case studies from organisations which have already introduced personal health budgets and sets out how organisations can address financial challenges when implementing them.

Personal health budgets can be either a direct payment to the person, a notional budget or a real budget held by a third party and give people a greater say in how money for their care is spent.

From April, the government in England wants people with long-term conditions who could benefit from a personal health budget to be offered one. It also wants them to be an option for people with learning disabilities by April next year. People receiving NHS continuing healthcare and children receiving continuing care already have the right to a personal budget.

The briefing paper covers identifying and allocating funds for personal health budgets from existing budgets and managing the risk of paying to run two services at the same time. It includes recommendations for care purchasers such as clinical commissioning groups (CCGs) and service providers such as mental health and community service organisations.

The paper highlights that a gradual roll out of personal health budgets can allow time for commissioners to develop and improve approaches to budget setting and adapt to the financial changes involved if, for example, budget holders stop using some existing services. It also warns that clinicians such as nurses and mental health workers should be supported to enable people with health and care needs to be in control of decisions about their care, in order for personal budgets to improve patient experience.

Think Local Act Personal Director Dr Sam Bennett said: "The pressures on the system demand we think differently and embrace the transformations necessary to drive forward a new model of care and a truly person-centred NHS. This means people with health and care needs leading the change, with support, through using personal budgets. Sustainably financing personal health budgets is a complex task, but evidence suggests there will be clear benefits for people with long term conditions. It's a challenge we should embrace and there is already a wealth of learning we can build on to do this."

NHS Confederation director of policy Dr Johnny Marshall said: "People want more control and choice over the care they receive and there is evidence that patients who are more involved in choosing their care with healthcare workers make good decisions."

"It will be crucial for commissioners and providers to work in partnership to manage the risks and develop alternative service provision. We are still some way from perfect, tried and tested solutions, but as this briefing shows, there is much useful learning from areas that are have been offering personal health budgets for some years, and from social care colleagues. However, financial challenges in implementing personal health budgets are complex and our members tell us that they have lots of unanswered questions about how to manage the financial aspects of their expansion. NHS England has an important role to play in supporting commissioners and providers, including by sharing emerging learning."

Personal health budgets were piloted and evaluated between 2009 and 2012.

This builds on two earlier joint briefings between TLAP and the NHS Confederation:

A Wealth of Information: your questions answered on personal health budgets and Joining up health and social care personal budgets: key points on implementation.

Download Getting the Sums Right