- Personal Health Budgets adopted by just five percent of target group of patients
- Entire cities and counties have take-up rates below one percent
- NHS chiefs want a twenty-fold increase in numbers by 2020
- Critics brand the plans a cover for cuts and privatisation
By Chaminda Jayanetti
Just one in twenty patients targeted by a flagship government NHS scheme has actually signed up to it, Sentinel News can reveal.
Two years after the government made Personal Health Budgets (PHBs) available to all patients receiving Continuing Healthcare from the NHS, barely five percent of those patients have chosen to take them up.
The government and NHS bosses claim that PHBs expand patient choice, but critics say the scheme is just a cover for privatisation and cuts.
Figures sourced under the Freedom of Information Act show that across 162 Clinical Commissioning Groups (CCGs) in England, just 2,986 out of 53,611 Continuing Healthcare patients had opted to receive PHBs.
Just 4,000 people in total have taken up PHBs in the 162 CCGs which provided data. That includes patients who have requested them despite not receiving Continuing Healthcare.
Extrapolated across all 209 CCGs in England, this would indicate around 5,200 patients receiving PHBs – nowhere near NHS leaders’ target of 100,000 by 2020.
A further 603 requests for PHBs are currently pending.
Failure to launch
Continuing Healthcare is a package of free NHS care for people who are not in hospital but need ongoing medical care. Often people with long term health conditions, they can receive their NHS care either at home or in a nursing home, with their fees covered by the NHS.
Since April 2014 these patients have been able to receive PHBs, which are similar to the personal care budgets that now dominate England’s council-funded adult care system. PHBs are sums of money that are allocated to each patient, who can then spend it as they like in order to meet their care needs.
But the scheme is suffering from a failure to launch:
- not a single patient in North and West Reading is receiving a PHB, and there is only one PHB in Harrogate
- only three out of 1,071 Continuing Healthcare patients in West Leicestershire have chosen to take up PHBs – that’s 0.28 percent
- in Leicester itself, PHBs have been adopted by just six out of 1,198 Continuing Healthcare patients – and take-up is hardly any better in East Leicestershire
- across the whole of Derbyshire, take-up of PHBs is struggling below one percent
- similarly tiny take-up rates can be found in Liverpool, West Lancashire, Croydon, Sandwell and West Birmingham and a host of other areas
PHBs have been taken up by more than one in five Continuing Healthcare patients in just ten CCGs, with the highest take-up rate in South Tees, with 73 percent signing up. The most PHBs in one area are the 264 in Hull – around a 50 percent take-up rate.
So slow are the adoption rates for this flagship government scheme that NHS England spent £1.2m of public money just publicising them in 2015/16.
A Trojan Horse?
Critics of PHBs fear they are simply a cover for privatisation and cuts. In particular, they point to the role personal care budgets have played in closures of council-run care homes and respite centres. The choice allowed by personal care budgets has hit attendance levels at many council-run care locations, leading cash-strapped councils to shut them down – to the detriment of those who had chosen to keep using them.
In addition, personal care budgets introduce significant administration costs, and make income streams for adult care providers much more unstable and unpredictable.
There are early signs of these pressures starting to effect health service providers. Last year Pulse reported that a mental health day centre run by the charity MIND in Basildon had shut because the local CCG had diverted resources to PHBs.
Before that, in 2013, Nene and Corby CCGs decided to close the residential respite service at Favell House in Northampton, which was used by the carers of people with conditions such as Parkinson’s and multiple sclerosis, despite a consultation finding two-thirds of respondents opposed to the move.
The CCGs justified the decision partly on the basis that PHBs allowed people to choose their own provider, rather than using one directly funded by the NHS, stating in their report recommending the closure: “In respite care, in particular, there is a move away from bed based respite services to a broader range of options facilitated by the introduction of personal health budgets.”
There are also concerns about fraud levels around personal care budgets, although these remain marginal in the PHB system, possibly due to low take-up – Sentinel has learned of 19 fraud investigations relating to PHBs, but only one allegation has thus far been proved.