Personal health budgets get the green light following positive independent evaluation

Personal health budgets will be rolled out to thousands more people across England over the next 18 months. The scheme, which allows patients to choose between standard NHS community care or a budget to spend on services and goods of their choice, has been extensively piloted over the last 3 years and has generally been well received by patients and professionals.

The Department of Health have published an independent evaluation of personal health budgets, which was conducted by the Personal Social Services Research Unit at the University of Kent. The report evaluated the 60 pilot sites across England and involved patients with chronic obstructive pulmonary disease, diabetes and long-term neurological conditions, mental health conditions, stroke and patients eligible for NHS Continuing Healthcare.

The evaluation used a mixed design to quantitatively and qualitatively measure patient outcomes, experiences, service use and costs. It involved a controlled trial which compared the experiences of those receiving personal health budgets with those on conventional support.

Here are the main findings of the evaluation:

Personal health budgets had a significant positive impact on quality of life compared with conventional care (ASCOT wellbeing score 0.057 v 0.018 (P<0.001)) and this difference was particularly notable in patients with access to larger budgets
Health status (measured by mortality rates, HbA1C and lung-function tests) was not significantly different between the two groups
Sites that provided patients with more knowledge about the budget amount and flexibility in how it could be spent, saw a greater positive effect on outcomes
There was no overall difference in the cost of care between the health budgets and the traditional NHS continuing healthcare approach. Personal health budgets had lower indirect costs (e.g. inpatient care), but higher direct costs
Overall, personal health budgets were found to be cost effective

The evaluation report made the following recommendations for policy and practice:

The study concludes that personal health budgets were cost-effective, given the assumptions made (esp. regarding the value of ASCOT quality of life) and thus support a wider roll-out
High value personal health budgets were more cost-effective, suggesting that personal health budgets should be initially targeted at people with greater need, to act as substitute for conventional service delivery
Personal health budgets were cost-effective for people with mental health problems and those receiving NHS continuing healthcare but the analyses for other health conditions were inconclusive due to small sub-sample sizes
The budget holders that were interviewed emphasised the value of information and guidance from sites about the size and operation of their budgets, including what services were covered
The use of personal health budgets is likely to result in greater use of ‘non-conventional’ providers. Further research is required to better understand the scale of these changes