Personal health budgets

Professor Lord Darzi's review of the NHS in 2008 introduced the idea of personal health budgets in the English National Health Service. From October 2014 patients were given the 'fundamental right' to personal health budgets, at Norman Lamb's insistence. NHS England’s Five Year Forward View called for a ‘major expansion’ of the scheme. NHS Choices summarises the aim of the scheme as "to give people with long-term conditions and disabilities greater choice and control over the healthcare and support they receive."

In Scotland a similar idea is called Self-directed Support, and was the subject of the Social Care (Self-directed Support) (Scotland) Act 2013 but only applies to social care.

A personal budget may be used by a patient to buy services not normally available on the NHS, or to pay for services like nursing care which are provided by the NHS, but giving them more autonomy in deciding where, how and when they are provided. This can enable people with long term care needs to go on holiday, for example.

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The Royal College of General Practitioners produced guidance for its members on the use of Personal health budgets in 2012. PHBs have been mainly used for people with continuing health needs. The RCGP explained that "At the heart of a personal health budget is a care or support plan – an agreement between the local NHS 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."

By 2015-16 expenditure on PHBs was estimated at £123 million per year, just over 0.1% of NHS spending. The number of people with a budget was 4,800, so the average package costs £25,600. PHBs have been targeted on people with most significant needs, generally people on continuing care packages.

Personal budgets have been widely adopted in social care and have been championed by, among others, Liz Kendall, who advocated extending the idea into health services. Simon Duffy, who was the chief executive of the influential social enterprise company In Control, was one of the creators of Self Directed Support which piloted the idea with people with learning disabilities. According to him "If you don't tell people what the budget is, as a local authority you are forced into a position of planning for them in order to ration, but if you give them a budget, doing the rationing up front, you liberate people and their families to do their own planning, and liberate service providers to do creative planning. Philosophically, this is a shift towards clarity about rights and duties." His ideas were formulated in the Deinstitutionalisation of social care, where there has been much greater progress in the development of personal budgets. He was awarded the Albert Medal by Ivan Lewis who was at that time the minister for social care and championed his ideas in the Department of Health.

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