Health Service Focus


Taking back control of personal health budgets

Colin Royle, director of Peoplehub, explains why third party providers for personal health budgets can often be the best option for patients. 

When people first discuss the option of receiving a personal health budget, it’s not uncommon for questions to be raised. Many aspects sound appealing to individuals, such as the ability to have choice and control over who it is that provides your care and support, and the opportunity to look at what may work for you outside of standardised NHS services. But the prospect of managing a budget, possibly employing your own staff, as well as managing your long-term health condition on a day-to-day basis may also feel somewhat daunting and overwhelming.

Looking at the bigger picture

This is why it’s crucial to look at the bigger picture for each individual, to gauge how much control they want, and the level of support they might require to manage certain elements of the care package.

This means it is important to have a range of existing deployment options and support available for everyone who could potentially benefit from a personal health budget – regardless of their skills, confidence or financial acumen.

Receiving a personal health budget as a direct payment is one option, but it’s not the only way of managing the budget.

For someone with very complex needs, the costs to ensure they are well cared for are substantial, and can involve managing a team of personal carers to undertake medical tasks around the clock. In these situations a CQC registered third party organisation, often a charity or social enterprise, can receive the money and manage this on behalf of the family. This option allows the family to still have the flexibility they need, whilst taking responsibility for tasks which often feel overwhelming or burdening to individuals, such as payroll, help with recruitment and sourcing appropriate staff training.

Whilst it is acknowledged that the costs of a third party organisation managing a personal health budget can be substantial, they are not simply to provide a direct payment support service or managed account, or for simply moving money around. The role of third parties can be much more in-depth and involve a range of ‘back room’ services that people need in order to co-ordinate complicated care needs. 

Dawn Krueger’s profoundly disabled son Spencer has had a personal health budget for three years. She says: “Our third party provider manage Spencer’s care package on our behalf for the same cost as a traditional care agency, with the only additional costs related to paying for the clinical trainer who ensures PAs are skilled in essential medical tasks. 

“However, this needs to be balanced against the cost of reduced hospital admissions and money that goes to agencies for uncovered shifts. This is very common as the CCG contracts out to care agencies… where staff turnover and retention is very poor… we’ve really benefitted from the consistency of staff who stay with us over time”. 

“Spencer was in hospital for four years and it was the personal health budget that meant he could be discharged and cared for at home. We had two failed care packages and 15 staff through a care agency…who all left. Managing care on this scale is not easy, but the third party have been able to manage this in a way that’s more cost effective than employing agency staff and ensures continuity of care. He’s been living at home for three years now”. 

Dave Johnson’s son Thomas has profound and multiple learning disabilities. A personal health budget is used to fund 24/7 care and support for Thomas at an independent annex adjacent to his parents’ home.  

“This isn’t a simple issue, as it’s important to understand the spectrum of support services that can be needed by families wanting to manage a personal health budget. Broker services initially developed to support direct payments in social care and provide administrative support to help individuals employ carers and to signpost other services,” said Dave. 

“Third party arrangements for PHBs are a very different proposition and are more like provider managed accounts. They take on the burden of employing PAs, running a payroll, arranging insurance, and sourcing equipment and services away from individuals and their carers to help them focus on delivering quality care”. 

Traditional modes of care aren’t working 

Speaking as someone who used a third party to manage the care of my late father who had dementia, Dave’s experience echoes my own.  Traditional models of providing care for people with complex needs aren’t working and personal health budgets offer a new approach to help deliver safe, high quality care that represents good value for money. Third party arrangements help facilitate this. Personal health budgets allow people to benefit from greater choice and control but also critically enable them to take greater responsibility for their own health and wellbeing. 

As Dave highlights: “Our third party enables us as family carers to have the time to focus on what is important to us and our CCG – delivering safe quality care for our son and embracing new, effective and innovative ways of doing this. This means working in partnership with clinicians to meet specific needs. We coordinate these resources and communicate as experts by experience within Thomas's circle of support to ensure the care plan and its outcomes are delivered”. 

Allowing individuals to take responsibility through greater choice and control will require a cultural shift in the NHS, but it will lead to better targeted use of limited resources, more effective partnerships between clinicians and service users and greater efficiency in the NHS. Third parties have an important role to play here, and enable families to take advantage of the flexibility offered by a personal health budget more equitably. 

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