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Concern at hasty PHBs launch

Doctors will need urgent information and guidance if they are to help patients navigate new PHBs (personal health budgets), the BMA has said.

The government last week announced it planned to press ahead with the wider implementation of PHBs, initially targeting 56,000 people in England who are already part of the NHS continuing healthcare scheme.

Doctors leaders have always recognised the benefits of PHBs in giving patients powers to take more active roles in decisions about their care. But the association is disappointed that the final report does not address some of the shortcomings identified in its survey of doctors earlier this year.

The report, Evaluation of the Personal Health Budgets Pilot Programme (pdf), suggests there was an improvement in psychological well-being and quality of life, which the BMA has welcomed as these are important factors in the overall quality of patient care.

However, PHBs do not appear to have a substantial impact on clinical outcomes. The report says ‘no significant effects were found with regard to two clinical measures … and there was no significant difference in mortality rates.’

This reinforces concerns expressed by doctors in the BMA survey which suggests that doctors would be uncomfortable with initiatives introduced without clear evidence of improved outcomes.

Stronger evidence needed

The BMA would like to have seen much stronger evidence of cost-effectiveness across the board before implementation was given the go-ahead.

The study shows PHBs are cost effective using one quality-of-life measure, the adult social care outcomes toolkit. But using other measures, the report admits the results are ‘inconclusive’.

BMA council chair Mark Porter said: ‘Many of the conclusions in the report are based on the results of small pilots with relatively limited numbers of patients involved.

‘Given these concerns, among others, we are disappointed that the government has decided to move ahead with a roll out without spending more time evaluating key elements of their proposals.

‘If the government is to move ahead, more information and guidance needs to be issued urgently to doctors so they can understand the implications of these changes.’

The government has already put aside £1.5m to help implement PHBs across England.

Health minister Norman Lamb said: ‘The evaluation shows that those with the greatest needs benefit most from personal health budgets. That’s why we are giving people on NHS continuing healthcare the chance to get one first. And, I hope more people who could benefit will be given the option of one.’

The BMA hopes to work with the Department of Health to ensure doctors have the right kind of information they need.