Giving patients greater choice over who provides their care

Apr 11 2008

Patients with long term, chronic conditions should be given money to organise and purchase their own care, according to an article in this week's BMJ.

Direct payments for social care were introduced in the UK in 1996. They are available to disabled adults, the elderly and carers of disabled children and allow services to be more accurately tailored to individual needs.

Vidhya Alakeson, an expert in healthcare policy at the US Department of Health and Human Services, believes that this scheme should be piloted in health care.

Instead of receiving services organised and provided by a local authority, direct payments and individual budgets give patients greater say over the types of treatments and services they receive and have been shown to improve satisfaction and outcomes, and reduce costs for local authorities.

Piloting individual budgets in the NHS would signal a real commitment from the government to creating patient-centred healthcare, says Alakeson.

Yet scepticism remains about an expansion of this individualised funding into the NHS.

However, early evidence from pilots in the US suggests that much of this is misplaced, she says.

She acknowledges that individual budgets would not be appropriate for all types of healthcare, but at the boundary between health and social care, patients are strongly in favour of including NHS resources within individual budgets and ending the arbitrary divide between health and social care, she says.

Indeed, one study found that people with both health and social care needs were already unofficially using their direct payments to purchase a range of services that would be defined as healthcare, such as physiotherapy, injections, and pain management. Their reasons for doing so were to overcome capacity constraints in the NHS and to integrate healthcare tasks better into their daily routine.

Giving patients greater choice over who provides their care goes some way to meeting the objectives set out in the ‘Our Health, Our Care, Our Say' White Paper, writes Alakeson.

The time has come for governments to match their rhetorical commitment to a patient-centred healthcare system that delivers high quality, integrated care for long term conditions, to a real commitment to pilot individual budgets in healthcare, she concludes.

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