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:

Personal Health Budgets: good beginnings in the UK

Two-thirds of hospital emergencies correspond to chronic patients’ decompensation which is why the health care system has a vested interest in helping people with chronic diseases to take care of themselves and learn to decrease their attendance to hospitals. Knowing that this can not be prescribed, the English have developed a system of budgetary self-accountability.

In 2009, the National Health Service launched a Personal Health Budget (PHB) Pilot Program in 70 localities and after an evaluation, it has been extended to the entire population, according to the following principles: People who need long term health and social care agree with their local professional teams (social services, primary care and NHS administrators) the arrangement of an amount of money that should allow them to reach the objectives of the individualized therapeutic plans previously agreed.

The PHB’s intention is that people with multi-pathologies or with degenerative or disabling diseases, have their service buying options nearby such as social services, psychological or physical therapy support. However, primary care services, pharmacies and hospitals are excluded. The first assessments offered by Nuffield Trust are positive in terms, particularly, of life quality. The economic aspects of the evaluation are more controversial as it is very difficult to quickly collect the savings of inappropriate hospital services that have been reduced thanks to PHB.