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We’re pretty comfortable with the idea of looking beyond a person’s illness or injury to their wider health and well-being. The same goes for giving patients more control over their treatment and care. It all sounds great but how can it be done?
Viewers of prime time hospital-based drama Holby City will be familiar with the extreme lengths to which staff go to improve their patients’ lives.
Finding lost relatives, sorting out troubled relationships, giving employment advice — it’s all in a day’s work for the plucky staff at Holby. But, back in the real world, should the NHS be doing more to improve people’s overall quality of life, even if it means spending money on non-health things?
The imminent roll-out of personal health budgets across England makes this a timely question. Despite the oft-repeated caveat that it is ‘subject to evidence from the current pilot programme’, it is generally held that the roll-out is a done deal. Patients with long-term conditions will be given control of the money spent on them by the NHS so they can spend it in ways and at times that make sense to them. Patients tailoring their care to suit their needs, rather than fitting in with what’s available — sounds good so far.
But what should the money be spent on? In the pilots, patients used their budgets to employ carers and to pay for physiotherapy, wheelchairs and nebulisers. But what about electronic personal organisers? Mobile phones? Massage, reflexology, musical instruments, season tickets and family holidays? Should the NHS be paying for these?
If these purchases help patients feel better overall, then you could argue the NHS should. If buying a satnav system can reduce someone’s anxiety about going out and so help them to get more exercise, combat isolation, feel more confident and improve their general sense of well-being — surely it’s a legitimate expense. Especially since feeling better overall can help people to manage their conditions better and cut down their use of health services.
But, as everyone is all too aware, there is only so much money to go around. Now may not be the time for NHS money to be spent on things that are outside the perceived business of the health service. And what about the impact on the wider NHS? This has the potential to take money away from services that other patients need. Surely it would be wrong for patients without budgets to lose out because budget holders choose to spend their money elsewhere, destabilising existing services.
‘Two-tier service’ might sound like a cliché, but it’s hard to shake off the sneaking feeling that this is what we could end up with.
And then there is the ideological debate around what the NHS is actually for. There will be those who are reluctant to accept the idea that the NHS should be funding things so far outside the accepted norms, regardless of the prevailing economic conditions.
We don’t know how many people will choose to have a personal health budget. People may not want one, particularly if integration takes off across the NHS and, importantly, between health and social care. But this is a big ‘if’ and won’t happen overnight. In the meantime, personal health budgets offer patients a way to create a personalised system of care and support. Joint personal health and social care budgets, looming on the horizon, could hold even greater appeal, allowing people to coordinate their entire package of care.
Personal health budgets are not without flaws, but how else can patients get greater control of their care so it gives them what they need, when they need it? Answers on a postcard to Jeremy Hunt.
Jenny Priest is a policy analyst in the BMA Health Policy and Economic Research Unit
If its about feeling good, some of the items above are really retail therapy, and my experience is that the benefit of that sort of therapy only lasts a day or two. If my tax is being spent on that, I'd not be happy!
We should concentrate on Medicine, for which we were trained.
Fringe medicine and quack remedies are for the patients to fund if they have no more sense.
As to I phones etc *^$++!
The main reason for the over-use of A/E, which has so much press exposure of late, is the fact that we GPs spend so much time chasing targets and ticking boxes that the patients can't get an appointment, especially out of hours, and so go to the open access A/E.
Then there is the time spent on meetings for commissioning,training,safety, diversity etc.
With the loss of control of OOH we are reduced to glorified clerks and the next bright idea that a government will have is to do away with us and go over to 8-8 polyclinics run by salaried doctors at half the cost!
You have been warned!
Who qualifies for a personal care budget ? As relative of an 88 year old who had a stroke 1 year ago in Devon we are still waiting for his continuing care assessment under the rules that came in last April! Although he lived totally independently prior to the stroke and still has medical problems as a result of the stroke because he has assets he qualifies for no help whatsoever except being given the phone numbers of various care agencies. Sadly he is unable to negotiate this mine field alone and I believe has lost out totally on rehabilitation. The so called rehab unit didn't even have potential sample aids for him to try, the physio and OT were only employed 3 days a week and he had very little input. We had to fight for extra time after his alloted 6 week period in rehab and had to find a care home at short notice to take him without help (not easy when you live 250 miles away and work full time) They were prepared to enforce his discharge! The NHS is totally broken and care of the elderly is not the only problem. These changes are only going to make things worse I have yet to meet anyone working in the community in Devon who either knows what they are doing or inspires any confidence in the future.
Watching the Horizon program, "Eat, Fast and Live longer" rather turns all of this on its head. It seems that one of the healthiest things we can do to prevent cardiovascular disease, cancer, obesity and all the nasty things that go with it like diabetes is to actually eat very little. Thats right, a near starving diet for a few days of the week can do all this and more....even prevent dementia ! Imagine the cost savings to a breaking NHS if there was less obesity, cancer, heart disease and dimentia. Imagine the savings on food !! There would then be a chance that the money available would go round and give a better class service to those who need it. Less is more. Forget iphones and satnavs, just fast.
The way to better health, is not through more medicine but through societal change, i.e. legislation on food & alcohol, decent housing and fair wages to lift people from poverty.
Without these in place it is extremely difficult for those in most need to lead healthier lives.
I fail to see how individual, fragmented budgets can achieve this, other than promoting a veneer of choice, and allowing a consumerist approach to health care.
Big problems need big solutions.
BTW What they don't need is untried, expensive, destabilising structural changes in healthcare provision.
personalised budgets can be life changing. we forget with our often relatively large incomes how much a few hundred pounds can make. A laptop may significantly ease the isolation for some patients who are unable to easily get out. what about help with child care for 2 hours a week to get to a meeting, class etc which may help the individual. All personalised budgets and direct payments have to be applied for, assessed and reviewed, it is not as easy as some would have one believe to get them, and many will not go through the process because of the difficulties implied.
We should not be spending central or local government funding on "treatments" or equipment which does not have a good evidence base. If we do, then we should make every effort to inform taxpayers of what their taxes are being spent on.
I don't think we should spend the government fund into something with no past evidence of proving to be effective. I mean mobile phones has been really handy and comes with so many benefits but don't overspend on it because taxpayers won't be happy knowing their money being spent on experimental projects. Better concentrate on better medical facility and quick remedies for the patience that will be far better option.
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Mobile has been such phenomenon method of connectivity that it has been so a necessity for connivence. However it will be better if by not spending much of Government fund for personalized projects be focused more on improving health care and services will be far better investment.
Who qualifies for a personal care budget ? As relative of an 88 year old who had a stroke 1 year ago in Devon we are still waiting for his continuing care assessment under the rules that came in last April! Although he lived totally independently prior to the stroke and still has medical problems as a result of the stroke because he has assets he qualifies for no help whatsoever except being given the phone numbers of various care agencies. Sadly he is unable to negotiate this mine field alone and I believe has lost out totally on rehabilitation. The so called rehab unit didn't even have potential sample aids for him to try, the physio and OT were only employed 3 days a week and he had very little input. We had to fight for extra time after his alloted 6 week period in rehab and had to find a care home at short notice to take him without help (not easy when you live 250 miles away and work full time) By the way thanks for share this mamazing article ... http://www.latestapkapp.com/
hey were prepared to enforce his discharge! The NHS is totally broken and care of the elderly is not the only problem.
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