More power to the patient

Patients will be offered more choice and control over their healthcare with the launch of the first direct payment scheme, Care Services Minister Paul Burstow announced today.

Eight Primary Care Trusts will begin to road test direct payments for personal health budgets. This will allow Primary Care Trusts to give the money for someone’s care directly to them, allowing individuals to decide how, where and from whom they receive their healthcare, in partnership with the local NHS.

Previously, personal health budgets could only be held by a Primary Care Trust or third party.

The cost of providing direct payments will come from existing funding within PCTs. Direct payments can be paid to patients in a number of ways, including monthly direct payments or a lump sum for a one off purchase such as a piece of equipment.

The scheme is designed to help individuals with a range of health conditions including people with diabetes, stroke, heart disease, end of life care and mental health conditions.

People can use their personal budgets in a number of ways. For example, one patient who suffers from chronic pain following removal of a spinal tumour uses her personal health budget for long term, extensive massage and hydrotherapy sessions to relieve chronic pain without the side effects of painkilling drugs, drowsiness and disorientation.

Another patient’s personal budget enabled him to spend his last few months at home with his daughter and grandchildren. The budget was used to provide flexible care while his daughter was at work, rather than the more traditional four times a day short visits.

Piloting direct payments is part of wider programme testing personal health budgets. More PCTs will be authorised to offer direct payments over the coming year. The pilot programme will inform decisions around how to proceed with wider, more general roll-out.

Care Services Minister Paul Burstow said:

‘This is an important step towards putting patients at the heart of everything the NHS does.

‘Direct payments have real potential to improve the lives of individuals with long-term health needs by putting treatment choices in their hands. That is why we are driving forward the commitment in the Coalition Agreement to extend access.

‘There is strong evidence from the social care sector that direct payments help achieve better outcomes, and give people more choice and control over the care they receive. It also encourages a more preventative approach. It is a step away from the rigidity of the Primary Care Trusts deciding what services a patient will receive.

‘Direct payments will not work for everyone or for all patient groups or services, but we want to identify whether, for whom and how they could offer an opportunity to help achieve the best health and wellbeing outcomes. That is why we are developing this pilot programme.

‘It will stop healthcare from slipping back to the days of one-dimensional, like-it-or-lump-it services.’

Notes to Editors

The authorised PCTs are:

(Lead PCT: Conditions or services included in pilot)

Doncaster PCT: Continuing healthcare and mental health

Eastern and Coastal Kent PCT: Continuing healthcare, end-of-life care, maternity, and mental health

Central London (joint bid from Hammersmith and Fulham PCT, Kensington and Chelsea PCT and Westminster PCT): Continuing healthcare, stroke, COPD, diabetes and long term neurological conditions

Islington PCT: Continuing healthcare (in limited circumstances, with expansion subject to further approval)

Merseyside (Joint bid from Knowsley PCT, Liverpool PCT and Sefton PCT): Mental health

Oxford PCT: Continuing healthcare and end–of-life care

Somerset PCT: Children in transition to adult services, learning disabilities, long-term neurological conditions

West Sussex PCT: Carers of people who have recently been diagnosed with dementia, children in transition to adult services, continuing healthcare

These pilots will run until 2012.

A personal health budget involves:

  • An individual knowing how much money they can spend on their health care (their budget) before discussing and deciding what care and services they want.
  • The PCT and the individual agreeing a care plan which sets out:
    - what the individual’s health needs and desired outcomes are;
    - the amount of money in their budget;
    - how this money will be spent to meet the individuals needs/outcomes.
  • Regular review of the care plan (at least once a year), and monitoring of how the money is spent. The money should meet the full cost of the agreed care plan.

The direct payment sites are all part of the Department of Health personal health budget pilot programme, which involves around seventy PCTs across England.

The cost of direct payments will be borne out of existing funding streams. In most cases PCTs are carving money out of the relevant condition specific budget. The evidence from social care suggests that personal budgets are cost neutral across the system.

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