NHS Confed's issues with Personal Budgets and Integrated Care

  • Like many health systems around the world, the NHS struggles to find ways of delivering integrated care. Nowhere has this struggle been more evident than in services cutting across the health-social care divide: a decades-old problem that has, for the most part, confounded local and national leaders.

    This Briefing introduces joint personal budgets for health and social care. It gives the context behind their development, explains how they might work and lists some of the issues that need to be considered before they could be used at scale.

    Interest in how to better join up health and social care has reached a peak in recent years, with particular focus since the passage of the Health and Social Care Act 2012.

    Various solutions have been tried and tested in recent years - local area partnerships, joint financing arrangements, care trusts and now health and well-being boards.

    The direction of travel for personal budgets in social care is much clearer than in health. Local authorities have been giving personal budgets to social care users for many years. There are now more than 338,000 people in England who have one (representing almost £1 in every £7 spent by councils on care and support).

    The distinction between health and social care makes little sense to the individual service user, whose needs cannot be easily categorised into two separate groups. Given that even front-line staff also have trouble understanding the distinction between health and social care, it may be too much to expect service users to do so if they have more than one type of need and, therefore, potentially more than one budget. Evaluations of personal budgets have shown that some individuals can benefit from taking control of their care, but few will want to do this if the separate processes make no sense to them.

    Joint health and social care personal budgets may offer the chance to create a simplified process for service users to navigate. If the two systems’ separate assessments, plans, accounts and reviews can be successfully brought together, service users are less likely to feel that the burdens of controlling their own care outweigh the benefits. It could also allow service users to make purchasing decisions based on what best suits all their needs, rather than having to spend one budget on something to help their ‘health’ needs and another on their ‘social’ needs. The goal is for integrated commissioning and provision at a micro level.

    In previous papers, the NHS Confederation has identified a number of barriers that stand in the way of personal health budgets having a positive impact on NHS patients. We support the Department of Health’s proposal to introduce personal health budgets at a pace determined by commissioners. We also support the suggestion to start with continuing healthcare, which is a relatively self-contained part of healthcare that may be exempt from some of the risks we believe personal health budgets might pose. As one of the most blurred boundaries between the NHS and social care, continuing healthcare is an ideal test-bed in which to develop joint personal budgets.

    However, a number of issues remain that will need to be resolved if the potential benefits of joint personal budgets are to be realised. The NHS Confederation have requested all of your views on the issues below, to guide their future work on this topic.

    Issues to consider:

    1. Does the ‘dual carriageway’ approach described in this paper (see page 4) offer a viable way to introduce joint personal budgets at scale?

    2. How big a barrier will top ups and self-funding in social care be to integrating two systems of personal budgets?

    3. How acceptable would it be for treatments not traditionally commissioned by the NHS to receive funding through a joint personal budget?

    4. How would your staff react to the idea of joint personal budgets? What kinds of engagement and/or workforce development would be needed?

    5. What questions would you want to put to the pilot sites that have been trialling joint personal budgets?

    6. Do you agree with the NHS Confederation’s support for the Department of Health’s intention – subject to the national evaluation – to make personal health budgets a legal option for all NHS commissioners from October, and from 2014 to give people on NHS continuing healthcare a right to request a personal budget?

    Source: NHS Confed


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