09.07.14
PHBs could help keep people out of hospital – Stevens
NHS England boss Simon Stevens is to outline how, from April next year, billions of pounds of health service money will be handed over to approximately five million patients in the form of Personal Health Budgets (PHBs).
Speaking at the Local Government Association (LGA) Conference in Bournemouth today, Stevens will discuss the roll-out of the long-debated PHBs, which he believes will help keep people out of hospital.
Under the proposals, disabled children, frail elderly people and those with serious mental illness or learning disabilities will be given PHBs – some as little as a few hundred pounds, though most are likely to get more than £1,000 – which can be spent on services such as carers, physiotherapists and psychotherapy sessions, in an attempt, to keep them out of hospital.
Those receiving the funds will still receive free GP and hospital care, but will be able to control the budget for their extra care after a plan has been agreed with their doctor.
Stevens said the extension of ‘patient power’ is needed to help ensure patients get a better deal from services many find frustrating to deal with, reduce unnecessary stays in hospital by keeping them healthy while still living at home, and also to overcome the shortages of money which are increasingly visible in the NHS and social care.
It has been forecast that by 2018 more than five million patients could have combined health and social care PHBs, paid for by the NHS and local councils.
Despite support from many quarters, the proposal has faced criticism too. One of the most vocal critics is journalist and clinician Dr Ben Goldacre, whose concerns played a role in the postponing of the care.data scheme. He has asked why a proper trial has not been done ahead of the multi-billion pound roll-out. On social media site Storify, he said: “NHS England is rolling out PHBs to five million patients. This will cost £1,000 a patient, at a total cost £5bn, over 5% of the NHS budget. The claim is that this will reduce hospital admissions. So why aren't they doing a trial to see if that's true?
“What would good evidence look like here? Easy. We can take, say, several thousand patients who are eligible for PHBs, and split that group in half, randomly assigning them to either get a PHB, or not. Then we follow all these patients up, to see if the people with PHBs really do have fewer hospital admissions.
“Admissions into hospital are a very easy outcome to measure: we can get that data almost for free, if we design our trial with that particular kind of follow-up in mind (we could do it in "CPRD" GP practices, for example, where medical records data is already available for research). That would be a Randomised Controlled Trial (RCT), the gold standard in evidence. It would cost a couple of million quid.
“But to the best of my knowledge, nobody is doing that RCT, and we're not waiting for a trial with a robust positive result before rolling out the intervention. We're just spending the money.”
But the LGA has, in principle, welcomed the plans from Stevens. Cllr Katie Hall, chair of the LGA's community wellbeing board, welcomed the plans to extend personal care budgets to include health as well.
However, she added that the new budgets will not resolve all the structural or funding problems faced by the health and social care sector.
A Department of Health spokesperson, in favour of the PHBs, added that “better out of hospital care is essential for both patients and the long-term sustainability of NHS”.
(Picture credit: Owen Humphreys/PA Wire)
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