Monday, 23 November 2015

More on Personal Health Budgets in the UK

Due to the opportunity of the subject, in this second post about the Personal Health Budget (PHB) British program, I want to raise three questions: a) how the PHB process is being approached, b) what do professionals think of it, and c) illustrating another true story (in the first PHB post I talked about the case of Roger, a patient with COPD):

The 7 steps of the PHB process (according to Nuffield Trust) are:
  1. Individual needs evaluation for the candidate to enter the program.
  2. Elaboration of an indicative budget.
  3. Identification (according to the professional team) of personal health and wellness goals.
  4. Development and approval of personalized plan (there is no other requirement apart from trust).
  5. Flexible money availability: directly from the pocket, intermediaries or service payment.
  6. Commissioning of services and necessary supports.
  7. At least a yearly evaluation.
The National Health Service estimates that this year 55,000 people with chronic and degenerative diseases and complex health and social needs, could benefit from a Personal Health Budget.

What do the professionals involved in the pilot say:

In this video, a group of professionals involved in the PHB pilot (managers, general practitioners, nurses, physiotherapists, etc.) provide their views on 4 subjects:
  1. Flexibility and creativity. According to the professionals interviewed, thanks to PHB, proposals from patients are collected, discussed and adapted; this is a flexible and creative process.
  2. Patient involvement. A project manager explains that, thanks to the PHB, one can buy the clinical experience for the patient and their family, in a process that they know better than anyone else.
  3. Governance and risk. Although admittedly PHB can go wrong, the basis of the project so they say is, trust, and we must not forget that if nothing is done about this, the system ends up simply spending on these patients anyway and often wasting resources.
  4. Efficiency and effectiveness. Although it’s still too early to comment on this, the professionals consider that the observed results are more tailored to expectations and so generate more satisfaction.
A Personal Health Budget real case

On the NHS England Personal Health Budget website you’ll find a good compendium of stories that help facilitate an understanding of the intent of the project, and in order to assist in this understanding, I have chosen one: the case of Charles and Marion:

Charles, a 70 years old man is severely affected by a progressive supra-nuclear palsy. His wife, Marion, 66, is his primary caregiver, a task performed with enthusiasm and love. However, they also rely on a NHS funded - Continuing Healthcare professional support, as on her own, she cannot handle the basic tasks of hygiene and mobilization of her husband. But as time has passed, Marion now feels stifled at home. PHB now allows her to hire 4 extra hours per week of professional support, in order to have a break. This small budget, as she says, has allowed her to breach a very overwhelming routine and gather more strength to carry on.

The system is already spending heavily on people who have complex and long term needs and very probably does it inappropriately. Trying to give patients and their families a voice to find out how they may think a portion of these resources can be spent, can adjust the costs, while improving their experiences.

Jordi Varela


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