NHS patients to get cash to buy care

Patients with long term medical conditions are to be given cash to buy their care.

The move could encourage more private and not-for-profit providers to enter the market for treatment currently given by the NHS. The cash option is one of a range of “personal health budgets” to be piloted.

The health department estimates that some 3m people – out of the 16m with long-term conditions ranging from multiple sclerosis to chronic pulmonary disease, diabetes and mental illness – may eventually be interested in some sort of personal budget.

The pilots range from a notional budget held by a commissioner, to a budget held by a third party, or a direct cash payment, similar to those already used by some 70,000 social care clients. They were announced as a new health bill was published yesterday by Alan Johnson, the health secretary.

Putting patients in control of their own care will lead to innovation and competition, the department believes, “with patients and care providers seeking novel ways to meet their healthcare needs”.

Direct cash payments will also produce “a transparent pricing system, and a level playing field for alternative providers to enter the market,” the document adds.

The NHS Confederation, which represents health authorities and trusts, welcomed the pilots. But Steve Barnett, its chief executive, said the policy raised big issues and carried risks.

“Should patients be allowed to spend their personal budgets on non cost effective treatments?” he asked. “Should they be allowed to top up their care? And should they keep any underspends for later use?” The department’s document says that if needs are less than expected, those with a budget “may have spare resources to buy services of higher quality, or to meet more marginal needs”.

Unison said the result would be a two-tier health system, with the move “paving the way for top-up payments”. That would undermine the founding principle of the NHS that care should be delivered equally, Karen Jennings, the union’s head of health, said.

Patients who took the cash would be able to buy additional services outside their NHS care plan from the private sector as they can now, the health department said – though they would not be able to buy additional services from the NHS.

The British Medical Association said giving patients cash seemed “further to establish the idea of healthcare as a commodity”, something it believed was “not in patients’ best interests”.

The department’s background paper says there is a risk, “as budgets start being used in non-traditional ways”, that “the public will perceive that the money is being used frivolously”. That has happened in social care with controversy over one client using his cash to buy a football season ticket.

A background document produced by the department admits “we do not know the likely take-up” or which patients would benefit most – hence the pilots.

The bill also legislates to ban the display of tobacco products in shops, with only a plain price list permitted.


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