Arrogant , regressive and out of context: GP magazine rubbishes Personal Health Budgets

The GP magazine Pulse are running  a story today on Personal Health Budgets stating that the NHS allows patients to splash cash on holidays, summer houses and Wii Fits’.

Out of context this sounds scandalous, but, it is out of context.

The background to this is that the Government offered the right to have a personal health budget – which provide patients with their own budget to spend on care they feel would benefit them – to any patient on NHS Continuing Healthcare nationally from 2014, and it was rolled out to any patient with a long-term condition in April 2015. People assessed as requiring Continuing Healthcare (CHC) usually have complex clinical needs requiring life-long care.

The GP magazine Pulse undertook FOI requests and heard back from 33 Clinical Commissioning Groups on what PHB monies have been spent on.

Whilst all NHS spending should be undertaken wisely and open to scrutiny, to smear people who have received a PHB like this is shameful. 2020health produced a balanced report in 2013 Personal Health Budgets: a revolution in personalisation highlighting the benefits and concerns around PHBs. We spoke to NHS PHB leads who implored cynics to examine expenditure of state money by the outcome (remember those?!) not by the thing bought. Results have shown that from the 2009-2012 personal health budget trial there was a majority view (70%) among users that the PHB had increased their sense of what could be achieved in terms of outcomes and lifestyle.

PHBs allow people to

  • identify what is important to them in their health and wellbeing
  • consider what will be of the most help
  • take more control and responsibility for their health
  • make efficiencies and savings in their care costs

Pulse seems to have run successive biased articles against personal health budgets, which in our opinion reflects some GPs unwillingness to allow patients to make decisions about their care and let go of their treasured professional status.

We know that medical treatments have limited efficacy and all have side effects. Evidence shows that at most, 60% of people comply with their prescribed medication, and experts claim that 90% of drugs only work in 30-50% of people[1] (hence the drive for pharmacogenetics). Pills are not enough. The growth in Social Prescribing surely also mirrors the PHB ethos that people often need non-medical treatment to meet their health and wellbeing needs.

To ridicule patients through their choice of treatment is arrogant and regressive; some GPs have been superb at encouraging patients to take control and seen the benefits to both their health and in reduced expenditure.

Examples of ‘alternative’ PHB use in context are:

  • people suffering from depression paid for leisure activities to reduce social isolation
  • some patients with diabetes improved wellbeing by using the money for a Wii fit or personal trainer
  • a patient with cancer bought a wig of their choice
  • an iRobot vacuum cleaner was bought by a disabled person
  • archery lessons for muscle training for an MS Sufferer
  • air-conditioning or de-humidifying equipment – to help with breathing difficulties
  • singing lessons, as an alternative to respiratory therapy – for a COPD patient

However the statistics show that the vast majority of funds (80-90%) are spent on carers, PAs and nurses. Our 2013 report showed how essential and effective it is when the NHS involves patients in the planning of their own care. Only the patient themselves know why improving their health matters to them – which is why we need to start thinking of ourselves as PARTICIPATIENTS. It is absurd that patients are still not being treated as an essential partner in their health – and some professionals need to stop being so paternalistic. The PHB encourages a dialogue between GPs and patients where each share their expertise, motivation and a shared plan is shaped together.

PHBs treat a person as a whole – allowing them to consider their social, mental and physical needs through one budget. PHBs are finally a way of making integration and whole person care a reality for people.

We are not the only ones who think this. In 2012 the Royal College of Psychiatrists said:

“PHBs are important tools for recovery. They

give greater control to individuals and allow

them to go beyond statutory services…the very

approach embeds the three core components of

recovery: hope, control and opportunity.”

The final proof goes to Northampton, one of the in-depth (pilot) sites specialising in mental health, collated the following list of measurable health outcomes in April 2012. These are outcomes that their MH patients with PHBs were at the time either making progress towards or achieving:

  • An increase in their independence and their confidence, they feel much more in control
  • An increase in social interaction and social activities of many different types
  • Improvement in mood, reduction of stress/anxiety and a change in behaviour, which has enabled increased contact with family, children and friends
  • Being able to give much more support to others
  • An increased understanding of their condition/ disease and how and why it is impacting on their life
  • Improvements in general physical health including losing weight, learning to swim, attending a gym regularly
  • A reduction or ceasing of self-harming
  • Studying for new qualifications, gaining or returning to employment both paid and unpaid/voluntary work; development of a back to work plan
  • Reduction of, or stopping, medication
  • Managing crisis/exacerbation of condition/ disease, recognising triggers and managing symptoms, keeping safe
  • Reduction in the need for and use of acute and primary care services



About Julia Manning

Julia is a social pioneer, writer and campaigner. She studied visual science at City University and became a member of the College of Optometrists in 1991, later specialising in visual impairment and diabetes. During her career in optometry, she lectured at City University, was a visiting clinician at the Royal Free Hospital and worked with Primary Care Trusts. She ran a domiciliary practice across south London and was a Director of the UK Institute of Optometry. Julia formed 20/20Health in 2006. Becoming an expert in digital health solutions, she led on the NHS–USA Veterans’ Health Digital Health Exchange Programme and was co-founder of the Health Tech and You Awards with Axa PPP and the Design Museum. Her research interests are now in harnessing digital to improve personal health, and she is a PhD candidate in Human Computer Interaction (HCI) at UCL. She is also dedicated to creating a sustainable Whole School Wellbeing Community model for schools that builds relationships, discovers assets and develops life skills. She is a member of the Royal Society of Medicine’s Digital Health Council. Julia has shared 2020health's research widely in the media (BBC News, ITV, Channel 5 News, BBC 1′s The Big Questions & Victoria Derbyshire, BBC Radio 4 Today, PM and Woman's Hour, LBC) and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week.
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