The fifth report by the Personal Health Budgets Evaluation Team has now been published, this being the result of interviews at the nine month point with 52 budget holders with long term health problems and 13 carers drawn from 17 of the 20 PCTs in the in-depth evaluation part of the pilot. This is the last interim report in the series and a final overall report is expected in October 2012. The Government will use the results of the evaluation to inform decisions about the subsequent wider roll-out of the initiative.
In 2009, the DH invited PCTs to become pilot sites for personal health budgets (PHBs). Between them the pilot sites are offering PHBs to individuals with a wide range of conditions, including diabetes, lung disease, mental health problems, stroke, long-term neurological conditions and NHS Continuing Healthcare. Some sites are using PHBs to redesign entire care pathways, while others have offered them in addition to existing services, to pay for preventative interventions. One site has offered PHBs for maternity care and others are trialling them for end-of-life care.
Under the pilot, the personal budget money can be held and managed by a health professional or another third party on behalf of the patient, or taken as a direct payment.
The interviews suggested that whilst there is great potential for PHBs to generate improvements in continuity of care, mental and physical wellbeing, motivation, choice, autonomy and self-confidence, the benefits risked being reduced by the stress caused by delays, lack of communication or information, the timing of the offer (eg, too soon after experiencing a stroke) and problems in PHB implementation.
Although the report is keen to emphasise that the interviewees were amongst the earliest people to be offered PHBs in the pilot, so that caution should be exercised in extrapolating from the findings towards wider conclusions, it is clear that information about the size of the budget, how the amount was calculated and the fact that it is a personalised allocation, are all fundamental to the principles of personal budgets and need to underpin any longerterm roll-out of the programme. Likewise there needs to be greater clarity over what can be purchased with the PHB, the management model adopted, the review process and the overlap with social care funding.
Clearly the autumn report will make for interesting reading.