Direct payments for healthcare moved a step closer this week with a new consultation launched by care services minister Phil Hope.
Personal health budgets are being piloted in PCTs to 2012. Direct payments are an important part of these pilots, having been offered in social care since 2005.
Millions of people now receive money to buy their own social care and the Health Bill is set to legalise direct payments in healthcare next month. It is intended that personal health budgets will help to create a more personalised NHS, by giving people more choice and control over how money is spent on their treatment and care.
The consultation discusses the three ways a personal health budget could work: through a notional budget being held by a commissioner, such as a patient’s doctor or PCT; a budget managed on the individual’s behalf by a third party, like a charity or User Trust; or a cash payment to an individual patient and managed by them (a direct payment).
Trusts are already able to offer the first two options, which do not involve giving money directly to individuals. The consultation seeks views on the rules for making direct payments as well as proposals for setting up and evaluating direct payment pilots.
The proposed regulations show there will be more restrictions in the use of direct payments than in social care.
PCTs would have to carry out a Criminal Records Bureau check on anyone employed by a patient to care for a patient who is not a friend or family member of the patient, or a member of their household, and tell the patient the results. There is no such obligation on councils in relation to people hired by adult direct payment users so long as they possess capacity.
Patients would also have to provide more information to the PCT on how the direct payment is being spent. The consultation says PCTs should set local policies on what direct payments could be spent on, such as a course of physiotherapy or hydrotherapy for people suffering from long-term chronic pain; an air conditioner for someone suffering respiratory conditions, or complementary therapies, such as acupuncture.
A BMA spokesman expressed concern that direct payments further establishes the idea of healthcare as a commodity, reinforcing the concept of the market and undermining the principles of the NHS.
He added: “While we recognise that these proposals are being piloted, the BMA would welcome a range of practical questions being addressed as soon as possible.
“For example, if a patient’s budget runs out, would they be allowed to access it in subsequent years? If a patient spends less than their allocated budget, would they be encouraged to spend the remaining balance or would the money be returned to the NHS pot? How will care be priced? Will prices differ from PCT to PCT and/or between NHS and private providers?”
The consultation will run until 8 January 2010.
Care services minister Phil Hope said: “There are some really inspiring stories already from people whose lives have been transformed by personal budgets - they get more choice and control over their own care.
“By making direct payments available in healthcare I know many more people will feel the benefits. We want to make sure we get this right and I want everyone to have their say to make sure we do.”
Earlier this year, 70 sites from across the country were granted provisional pilot status - 20 will be evaluated in depth. Personal health budgets were originally proposed in Lord Darzi’s Next Stage Review.
Tags: Direct payments, Personal budgets
