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.