Personal Health Budgets: empowering individuals

Source: NHE March/April 2019

Jon Baker, PHBChoices director at NHS Shared Business Services (NHS SBS) believes that the extension of Personal Health Budgets (PHBs) is a great opportunity for clinical commissioning groups (CCG) to expand and improve care provision – provided that the right infrastructure is in place.

The personalisation agenda is transforming our NHS as we continue to migrate from a one-size-fits-all model of care towards care provision that is patient-led.

The direction of travel was further evident in the government’s recently published NHS Long-Term Plan, which details ambitious targets for the growth of PHBs.

Offered to people with long-term health conditions, PHBs are designed to empower individuals by giving them control of their budget to meet their agreed health and wellbeing needs – enabling them to fund everything from personal assistants, to specialist equipment to enhance their daily life. 

NHS England reports that there are currently around 40,000 people managing their care in this way.  The NHS Long-Term Plan intends that this number will increase to 200,000 by 2023-24, and will be extended to cover mental health, learning disabilities, maternity services, and those receiving end-of-life care.

For CCGs, this expansion of PHBs presents both an opportunity and a challenge. PHBs are seen as a huge opportunity to meaningfully improve standards of care and patient experience, and as a way of achieving greater ‘value for money.’ Working closely with individuals to allocate existing health budgets in a different way is proven to increase the quality of healthcare and associated outcomes.

Empowering individuals to take ownership and accountability for their budget provides real benefits. Who better than the individual to choose the type of care they know will make their day-to-day life better, whether that is a particular piece of equipment, or carers coming at the time of day that is most appropriate for their needs. Similarly, the PHB care model has the potential to drive up the quality of provision. Rather than receiving care provision that is centrally allocated with little opportunity to switch suppliers if they are unhappy, PHB holders are free to shop around for the best quality care – leading to better value for money for CCGs and improved health outcomes for the individual.

The challenge for CCGs is the need to ensure they maintain governance so as to avoid clinical, reputational, regulatory, and financial risks associated with the administration of these care budgets.

Managing the risks and rewards

For the increased adoption of PHBs to work, CCGs must find a way to ‘balance the books’ – effectively managing the risks of giving the individual direct purchasing power while maximising the rewards. To this end, NHS SBS has developed PHBChoices – a financial management system that includes a secure online marketplace for the administration of PHBs. The platform enables PHB holders, or their carer, to purchase products and services direct from national, regional, and local suppliers in line with a care plan agreed with their CCG.

The individual still experiences all the benefits of the PHB model – the care they need, when they need it, delivered by their supplier of choice – but has far less hassle when it comes to administration. PHBChoices provides individuals with an online account and budget, which provides a virtual wallet for cashless transactions. It means they can do everything from managing their personal assistants’ timesheets and payroll, to managing their own care schedule – all online.

For CCGs, it supports the fulfilment of NHS England personalisation targets, with a focus on health outcomes and providing the best possible patient care. Crucially, it also reduces administration and management overheads by increasing productivity and efficiency through automation and self-service, as well as improving oversight and control. PHBChoices is fully integrated with the NHS Integrated Single Financial Environment – the payment platform used by all NHS commissioning organisations – so the CCG can retain cash until the PHB holder spends their budget, whereby funds are transferred direct from the CCG to the supplier.

Control up, costs down

There are also clear financial benefits for CCGs who need to provide greater personalisation within existing budgets: it is clear that there is no ‘new’ money to fund the migration to personalised care. PHBChoices provides CCGs with opportunities to achieve both cash releasing savings and avoid future increases in administrative costs, as well as improving cash flow.

As the personalisation agenda continues to gain traction, it will become increasingly important for CCGs to balance the requirement to meet national targets, empowering more individuals to manage their own care whilst retaining appropriate financial oversight and control.

Our solution, which we have worked alongside CCGs, PHB holders and suppliers to develop, is PHBChoices.

Whilst personalisation empowers the individual to choose and pay for their own care, which is a significant change in ownership and accountability from the current model, the benchmark of success will be whether or not better health outcomes are achieved.


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