Twenty pilot sites across England will test whether giving patients direct control over their own healthcare budgets leads to better outcomes than conventional NHS care. This matters because the NHS is moving toward "personalisation"—letting patients decide how their care money is spent—but no one yet knows whether personal health budgets actually improve health, or whether they undermine the principle that everyone gets equal treatment. The evaluation compares 1,000 patients managing their own budgets with 1,000 receiving standard care, tracking health and social outcomes over 12 months starting in 2010. If personal health budgets work, patients with long-term conditions or needing continuing care could choose services that fit their lives—home adaptations instead of hospital visits, for example—rather than accepting whatever the system offers. For the NHS, the question is whether this flexibility delivers better results for the same money. But there is a real risk: giving some patients more control could create a two-tier system, where those who can navigate budgets get better care than those who cannot. The evaluation is designed to catch that trade-off before any national rollout.
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BackgroundPersonalisation in an important new policy direction for health care in England. The piloting of personal health budgets (PHBs) is being viewed as the central feature of this policy. However, this new way of delivering health care represents a major cultural shift within the health care service. To assess whether PHBs offer a better way of supporting people, an evaluation will be carried out (incorporating a controlled trial without randomisation) to compare outcomes between those receiving PHBs and those receiving health services in the conventional way. The evaluation will also explore the processes, impact and consequences of personal health budgets on organisations, health professionals and the wider health and social care system. AimsThe overall aim will be to explore whether PHBs ensure better health and social outcomes when compared to conventional service delivery. The seven specific aims can be found in Section 9. Plan of InvestigationA controlled trial (without randomisation) will be used to make comparisons between the new and conventional support arrangements. The evaluation will include 20 sites focussing on implementing personal health budgets among people in need of NHS continuing care and/or among people with long term health conditions. A total sample of 3,000 will be recruited with the aim of reaching an overall sample of 2,000 individuals. The design aims to recruit 1,000 patients in the personal health budget group and 1,000 patients in the comparison group in 12 months starting in 2010. Potential ImpactThe implementation of personal health budgets could represent a route for personalisation in the health service. They could promote choice and control for individuals in deciding the services that best meet their needs. For the organisation, personal health budgets could be cost effective both for health and social care outcomes - they could produce better outcomes for the costs incurred, compared with conventional care. However, the implementation of personal health budgets could potentially compromise the equity principles of the NHS.
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