The spiralling health crisis requires a disruptive solution like personal health budgets that put people in charge of their own healthcare and support staff, notes Alex Fox
When things feel like they are slipping out of control, our instincts are to hold things tighter: the idea of “grip” is a satisfyingly strong management concept. There are parts of the health system where managing large numbers of brief contacts efficiently is the key challenge: and at a time of extreme financial pressure, ideas of managing demand and controlling patient flow feel vital.
But behind the current crisis is a longer term chasm between what public services can do and what our ageing population needs and expects. It is not a problem of efficiencies, flow, or grip. It is grounded in the relationships, which people have with services, but also with their own health and with each other.
The current crisis requires a non-traditional response, about how we reshape our offers around those individuals, who see themselves as people, not patients
These are not traditional management challenges and they require a deeply non-traditional response, which is not about how we fit growing numbers of patients into our current services, but how we reshape our offers around those individuals, who see themselves as people, not patients.
Long term support
Personal health budgets are one way that people who need long term support can take charge of that support and insist it is shaped around their lives, for instance, through hiring and firing their own support staff.
Personal budget approaches are intended to be disruptive and there will be many in the health system who feel that disruption is the last thing they need right now. But we have over 20 years of social care experience to draw on in understanding what that disruption can achieve.
There are now hundreds of thousands of people taking some level of control over their support, with well over a hundred thousand taking complete control; those people have created an entirely new social care model and workforce: the directly employed personal assistant and that has allowed many to live independently, have a social life and get a job: outcomes which have incalculable impacts upon people’s health and wellbeing and which had proved out of reach to many traditional approaches.
If the same narrow range of big public and private organisations remain the only choices available, real change won’t happen, so it’s vital that voluntary, community and social enterprise organisations are supported to work with people
There are also many poor experiences of personal budgets – or something called a personal health budget – being introduced without people getting the support they need to make the choices that are right for them.
If the same narrow range of big public and private organisations remain the only choices available, real change won’t happen, so it’s vital that voluntary, community and social enterprise organisations are supported to work with people with long term health needs both to help them make choices, and in some cases to provide the more holistic, community based and individually tailored support which the VCSE sector is often well placed to offer, particularly to those groups and communities who feel underserved by the NHS at present.
For instance, Hanif moved in with a Shared Lives carer to continue his recovery from a stroke, post-hospital. Shared Lives carers are trained and supported by one of the UK’s 150 local schemes, and are matched with an adult who needs support, who either visits their chosen Shared Lives carer, or moves in with them to get the personal care they need.
Hanif’s Shared Lives carer was a former nurse who spoke his community language. She ensured he was accessing the medical support he needed but also that he was staying connected with his family and community, and rebuilding his confidence to live independently again.
To enable Hanif to choose this unusual kind of support, clinicians and health managers had to be willing to “let go”. They recognised that success did not lie in their own “grip” on what was happening in Hanif’s life, but in his.