Personal Health Budgets
Invitation Only Event
Host: Rt. Hon. Stephen Dorrell MP, Chairman, Health Select Committee,
Speakers: Julie Stansfield, CEO, In Control
Martin Cattermole, Development & Delivery, Department of Health
- Date
- June 19, 20122012-06-19T08:30:00 - June 19, 2012 2012-06-19T10:00:00
- Time
- 8:30 AM 2012-06-19T08:30:00 - 10:00 AM 2012-06-19T10:00:00
- Location
- House of Commons
Minutes
KEY ACTION POINTS
- Don’t want to destabilize current commission based services that do work as
we introduce PHBs
- Need to make sure that the clinician is just as engaged with the programme
as patients – don’t want to damage the clinician patient relationship. PHBs
are about making decisions together.
- Need to consider how the contracting and funding side of PHBs will work, as
well as weighing up any difficulties against potential benefits that PHBs will
bring to patients.
- Must learn from the Dutch experience.
- Need to be able to manage patient’s expectations.
- Need to look at healthcare culture in the UK – how do clinicians work and
what do patients expect from health care.
INTRODUCTORY COMMENTS
- The Personal Health Budget (PHB) pilot was launched in 2009, with 1000
patients with a PHB and control group.
- Ideas behind the PHB pilot: Many people are in the middle of social and health care or on the cusp of one
or the other.
PHBs can be seen as a way of overcoming boundaries or as an end in themselves. At the moment health and social care in the UK does not make the most of the
fact that people are experts in their own health. To try to make things work at a personal level for the patient – an attempt to
bridge the gap between services around the patient.
- Difficulties behind introducing PHB In our society a dependency culture exists where people see it as the state’s
responsibility to look after them and those dependent on them. In order to introduce PHBs this needs to change.
- PHBs should be seen as only one part of a bigger picture.
- PHBs give people greater choice about their own healthcare and so also
greater empowerment, but with this also comes greater responsibility.
- Giving people greater responsibility has benefits – people would be more
aware of how much money healthcare costs and how much they can
feasibly spend.
- But disadvantages including damaging the patient clinician relationship and
patients making harmful decisions.
- Also important to bear in mind that whilst money does give people control,
people also need information to be in control of the decisions they’re making.
- When politicians discuss the idea of PHBs, they can become preoccupied
with ‘patient choice’ – it then becomes a more sensitive issue – do patients
what choice or quality? But the reality of this pilot is that it’s about
engaging with the patient and respecting them as an individual. Clinicians
make different decisions about the healthcare of their patient; it is
important to listen to them and not say that every objective clinical decision
is the right decision for everyone.
- If PHBs are going to help the integration of social and health care, what
direction are they going in and how far?
TOPICS DISCUSSED
What kind of care is appropriate to be covered by PHBs?
- The pilot is helping to define what we want from PHBs and what kind of care
is appropriate for them. - Some suggest that coverage should be as broad as possible – possible to
bring A&E into the money flow, this could help less reduce unnecessary
spend; even discourage abuse of NHS services. - PHBs allow money to be spent on certain things which may not traditionally
be thought of as healthcare but have enormously positive outcomes on the
health of patients. Many innovative actions being tried in the health pilot –
for example one patient bought a Wii fit and is no longer a diabetes patient;
his son has also lost weight. - In this way, PHBs allow us to focus more on outcomes of health policy, rather
than focusing on the services that sit in the middle. - Allows greater flexibility
- The type of person who benefits from PHB is someone who has experienced
lots of different commission based services which haven’t worked in the past,
or someone who can’t easily access commission based services e.g.
because of child care. - Need to be careful to note that we don’t want to take money out of current
services or destabilize them – PHBs will work for only certain types of people,
and not all these may want PHB.
Clinician – patient relationship
- From the pilot it is evident that a number of GPs have been resistant to the
program – many didn’t understand why they were giving their patients
money and felt it threatened their job. - Need to assess how clinicians are going to relate and work with their patients
‐ PHBs are about a partnership between clinician and patient. Patients know
what is best for themselves whilst clinicians have the clinical knowledge to
make expert decisions. - By introducing PHBs we don’t want to damage the clinician-patient
relationship – there needs to be a strong relationship to ensure that
good decisions are made. Need to ensure that patient’s are supported
throughout the process. - Need to define what PHBs are going to mean for the professionals – this is
perhaps something which the NHS needs to undergo anyway, we can’t
continue to train staff as we used to. - We really need clinicians on board for this work – may take five years of so
for clinicians to free up pathways and change ways of working. - What if patients make a decision which doesn’t deliver? How can we
reconcile the dilemma of engaging the patient and achieving the best
outcome?
Managing Expectations
- Need to ensure that patient’s expectations are raised about what they are
able to achieve through PHBs.
Integration of services
- One of the greatest advantages of PHBs is that they facilitate the integration
of health care, social care and education.
What can be learnt from the Dutch experience of PHBs?
- In the Netherlands they double funded everything so spending went out of
control. - Must make sure we take their mistakes on board.
Contracting and funding
- The contracting and funding side of PHBs is crucial. In the past, the DH has
put in place standing contracting roots to give power to the commissioners;
PHBs go back on that and give money to the patient. There needs to be
some control over how money is spent – highly inefficient for separate
contracts to be written up every time. - Important to think of the contracting side of things from an early stage.
- However, must weigh this up against the practical benefits and outcomes
PHBs could have on a patient’s experience and changing the culture of
healthcare.
‘Topping up’
- A benefit of topping up would be to allow the public and private sector to work
together more dynamically, which could create great amounts of synergy. - But would this be challenging the fundamental principles of the NHS?
Other
- Whilst it is true that personalization in healthcare wouldn’t have happened
without PHBs, is this ever going to become a norm? How much has it really
changed? - Should they be seen as an end in themselves or just a lever for future
development? - Perhaps there will be always be the majority of people who don’t want the
hassle of making decisions about their own healthcare. Or perhaps PHBs
could change societies thinking on healthcare and patient involvement in
this process. - Need to ensure that the public is aware of how we’re changing healthcare
and ensure that we are opening up these bigger questions to government.
ATTENDEES
1 Rt Hon Stephen Dorrell MP Chairman, Health Select Committee
2 Clare Whelan, Head of Stephen Dorrell MP Office
3 Adam Asmal, Student, Office of Stephen Dorrell MP
4 Julie Stansfield, CEO, In Control
5 Martin Cattermole, Delivery Programme Manager, Personal Health Budgets Pilot Programme,
Department of Health
6 Roger Matthews, Chief Dental Officer, Denplan Ltd
7 Gemma Newbery, PHB Project Manager, NHS Nottingham City
8 Jay Dobson, PHB Lead, NHS Midlands and East Cluster SHA
9 Dr Jonathan Shapiro, Consultant Director, 2020health
10 Gail Beer, Consultant Director, 2020health
11 Jonathan Paxman, Senior Researcher, 2020health
12 David Walden, Director of Adult Services, Social Care Institute for Excellence (SCIE)
13 Dr Sarah Carr, Senior Research Analyst, Social Care Institute for Excellence (SCIE)
14 Andrew Sanderson, Deputy Director, NHS Commissioning NHS Policy & Outcome Group, DH
Department of Health
15 Stuart Lane, PHB Project Manager, NHS Hull and City Health Care Partnership CIC
16 Jamie Foster, Partner, Hempsons Law Firm
17 Anne‐Marie Mason, PHB Coordinator, Cheshire Centre for Independent Living
18 Charlotte Morris, Intern, 2020health