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Personal health budgets: Let's move on from the idea and focus on implementation

This guest post is by Vidhya Alakeson, one of In Control's associates and Deputy Chief Executive of the Resolution Foundation. Vidhya is a leading consultant in the personalisation of health and social care. She is an internationally recognised expert on personal health budgets and has been closely involved in the development and implementation of personalisation in the NHS.

Today's publication of the 2014 POET survey offers further proof that personal health budgets can make a positive contribution to the lives of people with long term health needs and their carers.  The survey asks personal health budget holders and their carers about their experience of the personal health budget process and about the impact having a personal health budget has on their lives. What has improved, what has stayed the same and what has got worse? The survey offers much to celebrate but also sounds a note of caution: the positive impact of personal health budgets is closely linked to the way in which they are implemented and here, there is room for improvement.

The survey's findings on the impact of personal health budgets echo the findings of the national personal health budget evaluation published in 2012 which found that personal health budget holders enjoyed greater quality of life and psychological well being than those receiving commissioned services. The POET survey finds similarly that more than eight out of 10 personal health budget holders and the same number of carers said that having a personal health budget improved their quality of life. Three quarters of budget holders felt they enjoyed greater independence as a result of having a personal health budget and seven out of 10 felt that their personal health budget gave them greater control of their life.  A small number - fewer than 5 per cent of those surveyed - felt that the impact of personal health budgets had been negative.

It is early days for personal health budgets - the right to have one for those in receipt of continuing healthcare only came into force on the first of this month - and the numbers responding to the survey are understandably small. Therefore, we should take today's findings as indicative rather than the final word. However, it is encouraging that concerns that personal health budgets might favour younger, more able, less sick individuals is not borne out by today's results. Those with the poorest self-reported health were more likely to report a positive impact from having a personal health budget and there are no noticeable differences by age. Once again, this reiterates what we learnt from the national evaluation: personal health budgets don't seem to favour one socio-economic group over another which is critical in not exacerbating existing health inequalities.

What the national evaluation also highlighted was that poor implementation can result in personal health budgets having a negative impact. The POET survey confirms the importance of getting the personal health budget process right. Those who were not given any help with planning were less likely to report a positive impact from having a personal health budget and people were much more likely to report positive impacts if they felt fully included in every step of the process.  Those who found each individual bit the process easy were more likely to report positive impacts and between one in 10 and a fifth of people found the process difficult.

None of these findings will come as a surprise to those who have been following the annual POET surveys of personal budgets in social care. That survey has a much larger sample of more than 4.000 budget holders and carers but the thrust of the findings is the same: personal budgets whether in health or social care can have a tremendously positive impact on people's lives if people are well informed, fully involved in the process and well supported to make good choices about how to use their budget. As NHS England develops its plans for the new Integrated Personal Commissioning programme, the findings of the POET survey highlight once again how much rests not just on the idea but on its implementation.

Read our other POET blog posts here.

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Last Updated : 28 October 2014. Page Author: Laura Bimpson.