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Speech by Paul Burstow MP, Minister of State for Care Services,15 July 2010: Personal Health Budgets Conference

  • Last modified date:
    20 December 2010
Paul Burstow, Minister of State for Care Services

Let me start by saying thank you to In Control for co-hosting this event and for the work they do across the country.

And my special thanks to all of you who are taking this programme forward – both the people leading the projects, and the patients and families shaping the programme and making it your own.

I know it’s been a busy, challenging, sometimes frustrating year for many of you – but I’m grateful for everything you’ve done to lay the groundwork.

Now is the exciting bit, as we start looking ahead to see all this hard work bearing fruit for patients.

The good news I can give you straight away is we’ve now confirmed the budgets to support these pilots: £4 million in total, with the level of funding to each pilot site staying the same as last year.

I am also delighted to announce that Hull PCT has been awarded powers to offer direct payments, joining the eight who have already been given these powers.

Well done to you all – I look forward to others joining this group.

I hope all of this serves to demonstrate that this Coalition Government is committed to personal budgets.

Committed because in so many ways, personal budgets encapsulate what we represent.

Our single, radical, aim.

To change the relationship between the citizen and the state.

To do less to people, and more with them.

And to ensure Government steps back, making the space for people to lead the lives they want, how they want to.

In health and social care, that means giving people real choice over their treatment; real control over how money is spent; and real power to hold local services to account.

The White Paper published on Monday sends the NHS a few very simple and unambiguous messages.

Put the patient first.

Spend less time looking upwards to Whitehall, and much more looking outwards to the people you serve.

And deliver what they need as people not just as patients. The human side, not just the clinical side.

Personal health budgets can help us achieve this.

And so I’d say to you, these pilots are not so much about whether we do personal health budgets … so much as how we do them, where we do them and how they can work for patients and families.

Our commitment is very real and very deep - though, of course, we do have to make sure the evaluation is thorough and that the pilots demonstrate impact and value for money.

But the potential is huge. Let me give you a story that sums this up for me.

An older lady who needed district nurses to come each day to dress diabetic leg ulcers.

On one visit, the nurse took the time to ask her ‘What would make your life better?’

What she said in reply was incredibly straight forward.

Nothing to do with her clinical treatment. Nothing that would break the bank. Didn’t cost a penny, in fact.

All she did was ask if they wouldn’t mind making her a cup of tea before they tended to her leg, rather than afterwards as they usually did.

A simple, human request. Yet it made a massive difference to how she felt about her treatment, and the relationship she had with that nurse.

It made her feel comfortable. Made the procedure more human, and less ‘clinical’ in the pejorative sense of the word.

Or take another example. The case of a lady whose father had advanced dementia, but who didn’t want to move him into a care home against his wishes.

She’s used a personal budget to provide much more flexible support, helping her to cope with the demands of providing 24/7 care.

In particular, she got someone in on Saturday afternoons so that she could take her son out – something she wasn’t able to do previously.

Her verdict is extremely powerful. “I felt in control”, she told us. “Before, it felt as if care was ‘done to us’. But a personal health budget made dad and I feel as though we were valued participants.”

… Valued participants.

That’s the shift in mindset we need to achieve.

That’s what the White Paper is all about – captured in the maxim of ‘no decision about me, without me.’

And that’s the power and the potential that personal budgets have for people and their families.

They can also help us bring health, social care and the voluntary sector together in ways we’ve not seen before.

I want a much stronger focus on integration between organisations than in recent years.

And through personal budgets, we’ve now got the chance to put the tools of integration in the hands of individuals themselves.

I know many of you are working with local authorities to support people with health and social care personal budgets. I commend that.

And I hope it can help to rid ourselves of the barriers that frustrate patients and ultimately deny them the best possible care and outcomes.

I’m talking about the arguments that can happen. Issues you will be familiar with, I’m sure.

Of budget holders from councils and PCTs clashing over who pays for what, whilst patients are left in the middle and left in the lurch.

If personal budgets can achieve one thing, let’s hope they can rid us of the unseemly stories of managers squabbling over whether a bath is a ‘social care bath’ or a ‘health bath’.

I understand why it happens, especially when budgets are tight. But it misses the point.

The person needing help doesn’t care who pays. They don’t distinguish between the organisation providing the services. Nor should they. They just want their needs met. With a little bit of kindness and dignity along the way.

Personal budgets can help us end this stand-off.

They can help us ensure the patient is never again caught in the crossfire.

So I applaud the work you’re doing in this area.

Of course, one of the big myths about personal health budgets is that they cost more and lead to waste.

If you give patients a budget, so the argument goes, they’ll spend it on something ridiculous and the money will be wasted.

Absolute rubbish.

Look at places where they already use personal budgets – in the US and parts of Europe.

And look at the experience of social care in England.

You find this.

People do make sensible choices.

They often don’t want radical changes.

And rather than wasting money, they spend it on better things.

In other words, individuals are actually better guardians of the public purse than institutions sometimes can be. Precisely because they know what they need and know when they need it.

It makes commissioning more efficient.

And it also saves money down the line.

I’ll give you another example. Take a young man with a spinal injury.

He develops regular chest infections needing physiotherapy as well as antibiotics.

Under the old system, he’d have to visit his GP and go through a long process of referral – during which time, his condition may have deteriorated to the point where he would need hospital treatment.

With a personal health budget, his care plan enables his carer to arrange physiotherapy as soon as those early symptoms develop.

Better for him, better for his family, better for the NHS and the taxpayer.

Sounds simple, but I know making it happen is anything but.

And today’s evaluation report shows the challenges you face.

The practical challenges – the budget setting, care planning, the training.

As well as the nuts and bolts of making sure advocacy and sources of advices are in place for patients.

A couple of resources being launched today may help.

First, In Control has produced a new guide which brings their expertise together and gives a clear structure for taking the work forward.

And second, the Department of Health is launching new information on the regulations governing direct payments in healthcare. Some clear advice to make sure your pilots deliver.

But the wider challenge is the cultural one.

Of changing people’s mindsets.

Of getting clinicians, financial managers and commissioners to look again at how they work and how they think about their responsibilities.

And of breaking down the barriers that spring up across departments and organisations, and stand in the way of excellent patient care.

This is tough. It is difficult.

Changes like this need strong leadership and they will take time – but I know there’s plenty of determination and passion in this room to make it happen.

And remember: what you’re doing here can be the prelude to something truly radical, something that can go beyond health and social care and redefine how we think about public services.

Why shouldn’t we be thinking more broadly?

Why shouldn’t we think in terms of personal budgets not only joining up health and social care, but actually linking all publicly-funded support.

In effect, personal budgets could become the plan or agreement covering an individual’s whole needs.

Think of the potential.

An end to artificial boundaries between services and benefits.

More opportunities for the voluntary sector to step in and play a much bigger role.

Maximum choice, maximum control, maximum accountability handed to the individual.

Total personalisation.

That’s my vision. That’s my hope for the future.

You’re at the heart of it, taking those first trailblazing steps in your area.

Thank you again for your support and hard work.

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