Patients could commission own healthcare, says Nicholson
Patients could soon be handed responsibility for commissioning their own care through individual budgets, the NHS chief executive has revealed.
David Nicholson also sent out a signal that choice could eventually be expanded to allow patients to choose their commissioner or primary care trust.
Asked if he expected patients to be given choice of their own commissioner or PCT, Mr Nicholson said: 'I don't think we will see that in a big scale in the foreseeable future - and by that I mean the next three or four years.'
The exception was for people with long-term conditions. 'I think we will see a move towards [giving] more individual budgets to people - individual allocations of resources, either yearly resource or episodic resource.'
Mr Nicholson said he anticipated this would lead to the development of 'brokerage'. Organisations could bring people together to buy services on their behalf. 'I think we will see that and that we should encourage that development.'
David Pink, chief executive of the Long Term Conditions Alliance, which has worked closely with the Department of Health, said Mr Nicholson's comments were 'significant' and deliberately stated. 'This issue has been talked about and has had phases of being allowed to be talked about and phases of not being allowed to be talked about. For some people in the DoH it's been a no-go area,' he said.
Mr Pink said the difficulty for some was the principle of devolving health resources down to an individual budget level. But this was now becoming more common for social care funds.
'In principle there's no reason why it should be impossible and long-term conditions would be a good area to start.'
Individual healthcare budgets could prove useful in improving access to discrete and specialist parts of healthcare - for example physiotherapy for people with chronic back pain.
Mr Pink said access to such services is hampered by costly and time-consuming 'gatekeepers'.
Giving people the ability to circumvent these and purchase their care directly could improve the quality of care and also reduce costs, he said.
In effect, patients with individualised healthcare budgets would not so much choose their commissioner as become commissioners in their own right. 'They could have agents working on their behalf to pool funds and work as a little practice-based commissioner group,' he said.
Have your say
You must sign in to make a comment.
Share
Readers' comments (4)
Steve Williams | 23-Nov-2007 1:26 pm
Let's hang on here. Surely, it would be better to ensure effective commissioning through PBC and extend this to include long term conditions and other health improvements. PBC is floundering at the moment and truthfully this needs to be sorted out fast. Also, the Local Involvement Networks are not officially created until next April and surely it will be part of their remit to ensure that local health needs are properly met.
Currently, PCT's control the purse strings of PBC and indicative budgets do little to actually influence change. If the government is afraid of allowing the commissioners to hold the real money, then patients holding the purse strings could be a distant pipedream.
Unsuitable or offensive? Report this comment
Anonymous | 25-Nov-2007 0:21 am
I disagree Mr Williams, particularly with the widening health inequalities gap and with those old and new transient hard to reach and disadvantaged communities the question we surely need to ask is with 60 years of running this institute how effective have we really been at involving those most in need? I would truly question health need assessment effectiveness.
I wholly agree with David Nicholson, how do we give power to local communities to change behaviours instead of those we think are truly acting honestly on our behalf? Nothing is impossible if we allow it to be and I for one don't think that patients holding the purse string needs to be a distant dream at all!
Unsuitable or offensive? Report this comment
Martin Wicks | 26-Nov-2007 12:49 pm
This is pure lunacy. It is another attempt to introduce the anarchy of 'the market' into the NHS. We are not 'consumers' we are patients.
Unsuitable or offensive? Report this comment
Daryl Mullen | 27-Nov-2007 12:10 pm
What happens when they've spent their budget?
What if the "purchaser" spends the cash on non evidenced based treatments?
Presumabley they will be told to contact their GP (now known as a "costly gate keeper") Gate keepers explain to the patient the best course of action and negiotiate with them to achieve the best outcome. Trusting the patient to make the right decision may well result in costly non EBM decisions that benefit no one least of all the patient.
This is typical of madness eminating from the DoH at the present where people with no direct patient contact experience appear to come up with daft theories that those of us actually delivering patient care find utterly impractable
Unsuitable or offensive? Report this comment