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NHS England admits ‘double running’ an issue for personal budgets

NHS England admits ‘double running’ an issue for personal budgets


Exclusive The key financial risks of rolling out personal health budgets have been revealed by NHS England. 

Speaking exclusively to The Commissioning Review, an NHS England spokesperson said the risks of double running and cost pressures from meeting previously unknown needs could be a problem for clinical commissioning groups (CCGs). 

And it’s highly likely that CCGs will have to amend the services provided in their local area once personal health budgets are implemented, NHS England said. 

Personal budgets, which would allow patients with long-term conditions to work with a clinician to plan their own care, will be rolled out for people currently on NHS Continuing Healthcare by April 2014. 

Warrington CCG chair Dr Andrew Davies echoed NHS England’s concerns, adding his own around workforce planning. 

He said: “We’ll need to provide an advocacy service for the patients but we’ve not got the staff available because they weren’t employed when we were set up. 

“Also, depending on how restrictive the list of services is, it could become quite risky to our budget if we have to start procuring bespoke services.” 

NHS Clinical Commissioners revealed that many CCGs have already appointed a person to manage personal health budgets. 

Communications lead Jon Sacker said: “Some have appointed someone specifically, while for others it is being managed across those who have various responsibilities for integration and personalisation. 

“We recognise that to get meaningful benefits from personal health budgets will require a great deal of input from CCGs.” 

‘Mitigating’ risks

When speaking to The Commissioning Review, the NHS England spokesperson was keen to point out that introducing personal budgets for people on NHS Continuing Healthcare first could “mitigate” some of the risks. 

The spokesperson said: “We are recommending that CCGs should plan for a phased implementation of direct payments to mitigate financial risks. Plans should be developed and reviewed by CCGs as part of their strategic planning in conjunction with their area teams.

“A more gradual roll-out will enable CCGs to have more time to understand how to introduce flexibility into contracts, how to plan and implement the necessary changes and how to reorganise funds to make funding available for personal health budgets.” 

And guidance will be released by NHS England, who is overseeing the implementation of the service, to help CCGs roll out personal health budgets sustainably. 

NHS England believes that clinical commissioning groups will need to develop “new processes and procedures” if personal health budgets are to be implemented successfully. 

This could require some changes to the way services are commissioned, and what services are commissioned, NHS England’s spokesperson said. 

The spokesperson said: “CCGs will need to develop new processes and procedures to implement [personal health budgets] successfully. They will require some changes to the way services are commissioned and what services are commissioned. 

“For example, commissioners will need to consider what information and support services people wanting personal health budgets may need, such as direct payment support services.” 

But the pilot, which was carried out between 2009 and 2012, did reveal that patients with personal health budgets spent less time in hospital and had better outcomes. 

And better results were obtained when people knew their budgets up front and had access, support, and flexibility on how to use it. 

Care and Support Minister Norman Lamb announced earlier this month that personal health budgets will be a “right” for all patients currently on NHS Continuing Healthcare, a package of care for individuals who are not in hospital but have complex ongoing healthcare needs.  

Personal budgets have been used for social care in the UK since 2008. 

The budgets can be managed in three ways. As a ‘notional’ budget, where no money changes hands, as a real budget held by a third party or as a direct payment, where the patient is given money and must provide receipts to prove how the money has been spent. 


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