This research summary describes what personal health budgets are and how they are supposed to work in practice. It explores the evidence from the national evaluation and some of the challenges that commissioners and policy-makers face in implementing personal health budgets.
- The numbers of personal health budgets implemented in each local area has barely exceeded 100 people. Their extension to people in receipt of continuing care, and after that to those with long-term conditions, presents a much larger challenge for commissioners, who will need to reassure themselves that a wider range of providers demonstrate sufficient quality to merit inclusion.
- Clinical commissioning groups will also need to be ready to decommission services not chosen by budget holders; but at a pace that allows providers the chance to adapt and minimises the risk of market shrinkage (leaving individuals with fewer choices than before). Likewise, efforts aimed at diversifying the market of providers need to be carried out with care to avoid destabilising existing providers.
- For the system to work, new infrastructure around budget setting, care planning and system monitoring is required; funding for which would need to be found in existing budgets. There is some evidence to suggest that some efficiency can be achieved by ‘piggy-backing’ on the systems that already exist to support personal budgets in social care.
- Policy-makers need to be aware that there is a risk of a postcode lottery emerging, with much of the decision-making as to whether to offer personal health budgets, for whom and at what pace remaining in the hands of clinical commissioning groups. Not only will the value of a personal health budget be different in each area, but also the availability of personal health budgets for particular conditions is likely to vary.
- Bringing personal health budgets together with personal budgets in social care to create integrated individual budgets potentially offers a new route to service integration at the level of the user and carer. A ‘dual carriageway’ approach which brings together the referral, assessment, budget setting, planning and monitoring of different budgets without the complexities of structural integration between organisations and government departments may be helpful in this respect.