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Delivering personal health budgets by Vidhya Alakeson

Vidhya Alakeson, one of In Control's associates writes about her new book 'Delivering Personal Health Budgets'.

I first came across the idea of a personal health budget in 2006. I had been lucky enough to get a Harkness Fellowship to spend a year in the US and I wanted to see if I could find any interesting examples over there of individuals controlling their own healthcare services. I was convinced that personal budgets in social care were a way of giving people better lives and recognising that the boundary between health and social care is a bureaucratic not clinical invention, I thought that there was a strong case for individuals having more control through a personal budget in some areas of healthcare.

Much of what I found in the States offered warnings rather than positive lessons. But in such a vast country, there are usually pockets of innovation in one state or another and I found one on a trip to Florida: the Florida Self-Directed Care programme. In one small part of the state, individuals with significant mental health problems were deciding how best to spend money the state would otherwise have spent on their behalf. Individuals who many would have deemed too ill for such decisions were making different choices and getting better outcomes as a result. I found similar experiments going on in Michigan, Oregon, Maryland and in a number of other parts of the country.

But back in the UK, the idea that individuals with long term conditions and disabilities could have a budget to control some of their care seemed far from likely in 2006. Eight years on and personal health budgets are national policy. From April this year, adults and children eligible for continuing healthcare will have the right to ask for a personal health budget. Come October, their right will be strengthened to a right to have a personal health budget and in 2015, thousands more with long term conditions will be able to benefit. A combination of advocacy from organisations like In Control as well as individuals and families themselves, academic research, able policymaking, some pioneering NHS commissioners and trusts and some politics got us to where we now are.

But this is just the beginning. The policy commitments that the government has made to personal health budgets will not give people greater choice and better lives if personal health budgets are not implemented well. Thankfully, the national evaluation led by the University of Kent  is clear about what effective implementation entails. Personal health budget holders need good clear information and advice; transparency in how their budget is allocated; ongoing support; a partnership with their clinical professionals, options for how the money in their personal health budgets can be held and above all, the flexibility to identify their own health and well being goals and to determine how their budget can be used to meet those goals.

I wrote Delivering personal health budgets as a small contribution to the wider effort to get implementation right, knowing that good implementation is the route to better lives. The book offers a thorough explanation of what a personal health budget is, where the idea came from and a step by step guide to implementation. Eight years on from my Harkness Fellowship, the UK has now outpaced the US in taking forward personal health budgets. We are leading the world in policy terms and with effective implementation, we could also lead the world in giving those with long term conditions the control to improve their health and well being and live better, more fulfilling lives.


Delivering Personal Health Budgets: A guide to policy and practice now available to buy from Policy Press at http://www.policypress.co.uk/display.asp?ISB=9781447308522& /display.asp?ISB=9781447308522&

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Last Updated : 15 January 2014. Page Author: Laura Bimpson.