Personalised Health Budgets in the NHS

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2009 Health Care Service Group Conference
17 April 2009

Conference notes with serious concern the plans in Lord Darzi’s ‘High Quality Care for All’ report to pilot-test personal budgets and direct payments for long-term conditions in the NHS in England with a view to a national roll-out. Whilst conference supports the objective of empowering service users and, as much as possible, putting them in control of the services they receive, there remain crucial questions around how personalisation is being linked to marketisation and a consumerist agenda.

Conference notes with anxiety that personal budgets will further destabilise and fragment health care provision. Commissioners will have to encourage a choice of health service providers so that personal budget holders are able to choose how spend their budget. Conference is concerned that this will merely result in commissioners providing a long list of inadequate options rather than providing sufficient resources to enable health workers to develop on a one-to-one basis with their clients, genuinely personalised care.

Putting a price tag on elements of health care paves the way toward further ‘top-ups’ and means-testing, and conference is particularly concerned at the consequences this may have for equity as those unable to ‘top-up’ individual budgets with their own resources may be left without adequate support.

Conference notes that the introduction of personal budgets into social care, affecting UNISON’s Local Government members, has raised a number of concerns, including:

·the radical alteration or collapse of services when individuals do not purchase existing types of care provision (e.g. day centres, home care);

·accountability – questions over who is ultimately responsible for managing risk and monitoring success;

·individuals using independent ‘brokers’ to facilitate the spending of their budget;

·service users directly employing Personal Assistants as part of their care plan;

·new models of employment which provide unique challenges for UNISON’s future organising and recruitment.

Personal budgets will increase the use of private and community and voluntary organisations which may have a detrimental impact on the terms and conditions of staff transferring to these organisations. Job insecurity will increase as long-term commissioning, the take-up of services and workforce planning become more difficult to predict.

Conference believes there must be firm parameters and clarity over what client groups, services, medication or equipment will be included in the NHS pilots, and which staff will take on new responsibilities to assess patients’ needs, provide advice on treatment and sign off budgets.

Conference therefore calls upon the SGE to:

1.campaign for personalised care without the need for the introduction of personal budgets in the NHS;

2. campaign to maintain a tax-funded NHS, free at the point of need, and for the necessity of well funded, properly trained, publicly accountable in-house services as the bedrock of high quality and equitable service provision;

3. work closely with the local government service group to ensure that lessons learned from the social care pilots are able to influence our response to the pilots in health and the advice we provide to members affected by the introduction of the personal budgets;

4. press the government to ensure that feedback from the pilots is rigorously evaluated and oppose any extension of personal budgets in the absence of adequate research to assess their likely consequences for staff and service users; firm assurances from Government that any personal budgets within these pilots are restricted to the purchasing of NHS services only; to ensure government and employers put risk management procedures and staff training in place within the pilot sites.

7.develop strong links with stewards in the pilot sites, including opportunities for national meetings or seminars, and encourage branches to engage with the stewards to ensure UNISON is fully monitoring the process;

8.produce briefings and fact sheets and assist branches to influence any future decisions on the roll-out of personal health budgets in the NHS; alongside colleagues in branches, regions, national office and other service groups, in all four countries, to campaign against personal budgets as part of the union’s ongoing campaign against creeping privatisation in the NHS, and against the two-tier system that will result from the introduction of ‘top-up’ fees; alliances with service users to ensure strong and effective support for high quality public services for all who need them.