Money and small things in the NHS


Spending taxpayer’s money sometimes gives rise to much indignation, at times hilarity, and even incredulity. One recently reported lists of expenditure tell us much about our views of deserving and non-deserving recipients and the sacred ‘cows’, in ideological terms, of medical prominence and consumer choice.

One that may be particularly relevant to readers of Health Matters is the list of items spent as part of Personal Health Budgets by citizens whose long-term health problems or disabilities were such that NHS professionals agree that they could spend public money (NHS) on items to improve their health and wellbeing outcomes. These ranged from music lessons, to Wii games, consoles (computer exercise games) to the one payment of £7.34 for a ride on a pedallo. As the Guardian newspaper put it, ‘Holidays, a summer house and satnav, courtesy of the NHS’ (1 September 2015 page 7). The Guardian, drawing on the investigation by the GP focussed magazine Pulse that had acquired the itemised lists from CCGs by a Freedom of Information Act application, painstakingly explained to its readers that Personal Health Budgets were a matter of entitlement to people receiving continuing healthcare and had to be approved by the local NHS team. It contained a quote indicating the complexity of the process, ‘(people) have to meet their agreed health outcomes aligned to their assessed health needs’. However, the reaction to Pulse’s findings of total £120m expenditure on personal health budgets was intriguing.

The Guardian quoted the Deputy Chair of the British Medical Association, Richard Vautrey, referring to the risks of such sums (presumably not the £7.34 on the pedallo) as destabilising other provision… it could ‘jeopardise a whole service’. Of course this may be exactly what people would want to do – why not music lessons instead of a place in a day centre? Why not aromatherapy instead of a visit to a support worker? But the telling small word from this BMA representative is that such choices were ‘whims’. No matter the thinking about goals or outcomes, no matter that well paid professionals have to help plan the support package, work out its outcomes, review and monitor the effects and expenditure, the matter of patient choice is a ‘whim’. So should we expect to see NHS Choices become NHS Whims, as that is how some in the medical profession see choice? And forget ‘expert patients’ too.

If personal health budgets are to be trusted as a way of helping sick or disabled people recover or to increase or even just sustain their quality of life (wellbeing is the generally fashionable term for this) then they need to be trusted. Clearly doctors who talk of them as ‘whims’ are unlikely to give patients the confidence in their potential benefits. For those patients and their carers who are already finding personal health budgets make a positive difference to their lives, their trust in their medical practitioners is likely to reduce, pushing doctors back into a cupboard as simply there for prescriptions since they are so dismissive of what matters to their patients.

Outraged of Westminster, 9th September 2015

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