There are moves in both the health and social care arena towards greater personalisation of services. There is widespread agreement that placing the patient at the centre of their care will allow more joined-up care, the design of better care pathways and a improved management of long term conditions.
However, with current funding constraints, the question must be asked – can we afford the personalisation agenda?
Recent developments in the coalition government show an increase in pace in the move towards personalisation. Personal care budgets are to be rolled out across the country, so that everyone eligible should be able to access a ‘personal budget’ by April 2013. In addition personal health budgets are being piloted.
Personal budgets were designed with the aim of being ‘cost-neutral’. The money that was previously used to provide services, would instead be made available directly to the client, so that they could spend it as they wished, hopefully leading to services more in line with the clients needs and wants.
More recently, with funding shortages in social care, it has been suggested that savings may be associated with the personal budget system. The provision of better quality services in the home may lead to reduced decline in health, and fewer hospital admissions. In addition it has been suggested that individuals may be able to source services at lower cost, than was previously done by local authorities.
However, there is a difficulty with such efficiency savings. Once you have calculated the value of a personal budget, based on factors such as the current spend on health/care provision for an individual, and handed over the budget in the form of ‘direct patients’ to the client, any increase in efficiency will simply allow the client to purchase more services, rather than feed back as a saving into the system. There is no possibility of the entire budget not being taken up.
In addition costs will be incured around assisting patients or clients to find and choose services. Many clients will not be able to use their personal budgets without some direction or provision of information.
There are also questions as to the types of services that personal budgets should be spent on. As well as carers and personal assistants, there are reported cases of budgets being spent on cleaners, gardeners or handymen, as well as trips to the pub or to football matches or the installation of air conditioning to help reduce asthma attacks. Whilst such interventions may have a great deal of worth to the individual concerned, there are difficulties about where to draw the line. More freedom around the spending of budgets, and the possibility that budgets can be spent on such ‘life-improving’ rather than ‘life-sustaining’ interventions, or contribute towards wages for a relative who may be helping in a caring role, may lead to additional uptake of personal budgets from those who previously managed without.