Patient-held budgets become more widespread

The patient choice agenda will lead to more people holding a personalised health budget with which to choose and buy the types of care they want, and as the case manager role develops, experienced nurses may be well placed to work with patients.

Personalised health budgets are part of current Government policy. In theory, personal health budgets allow people to have more choice, flexibility and control over the health services and care they receive. At the heart of a personal health budget is a care plan. The care plan is the agreement between the primary care trust and the individual that sets out the person’s health needs, the amount of money available to meet those needs, and how this money will be spent.

Based on interviews with 52 patients and 13 carers, an interim report into piloting personalized health budgets in June 2012 found there was widespread potential for personal health budgets to lead to improvements in health and wellbeing. The majority of people with a personal health budget reported better health and increased satisfaction levels. Increased self-confidence, reduced use of GP services and prescriptions and better relationships with health professionals were among the other reported benefits.

However personalized health budgets have yet to take off. As the case manager role develops, experienced nurses will be well placed to work with patients to make this more widespread. The patient choice agenda will lead to increased numbers of people holding a budget with which to choose and buy the types of care they want. This could have a range of mostly uncertain effects.

For example, will it lead to care deficits due to unrecognised needs that then need to be met via emergency intervention, therefore increasing overall nursing demand? Or, alternatively, could it better match actual need and reduce overall nursing demand? People could choose to buy more social care than nursing, or care from cheaper suppliers, e.g. more HCA care. The experience of holding a budget could see people becoming better informed and confident about managing their own care, which might reduce nursing needs. Alternatively, nursing may well stay robust but the profession’s role may change to that of patient adviser and care gatekeeper. This would have implications for education and training.

Sources or references

• Suggested by number of stakeholders in workshops during CfWI research on nursing.
• From unpublished CfWI report (report available on request)
• Department of Health, 2012, “Personalised health budgets”
• Department of Health, June 2012, Personal health budget pilots: fifth interim evaluation report

Some of the information in this section is provided by stakeholders and expert groups, and does not necessarily represent the views of the CfWI.