Are personal health budgets beneficial for older people?

Vidhya Alakeson, deputy chief executive of the Resolution Foundation, which is working to improve outcomes for people on low and modest incomes

Mo Smith, founder and chair of trustees of Regenerate-RISE, which is working to eradicate isolation among elderly people in the UK

Thousands of patients in England will soon have access to their own NHS personal health budgets giving them more control over the type of treatment they receive. The scheme is designed to help patients who have complex conditions and require care and support.

However in the pilot scheme, the take up among older people was low and it is questionable how well the initiative will work among the older population.

Vidhya Alakeson believes it is vital to ensure that personal health budgets work well for older people and “they are supported to make the most of this new approach to maximise their health and wellbeing.”

She says: “There is a long held perception that personalisation doesn’t work well for older people. This is firmly refuted by the evaluation of the national personal health budgets pilot that was published recently.

“However, the evaluation is unequivocal that the way personal health budgets are implemented affects their impact,” she adds

“To fully benefit from personal health budgets, older people will need clear information, access to advice and support in deciding how to use their personal health budget and the rules will have to be kept flexible to allow maximum choice and control.

“The independent evaluation found that personal health budgets were cost effective for people over 75 compared to care as usual and lead to fewer inpatient stays. They also improve the quality of life of family carers. In part, this is because over 75s are more likely to need higher levels of care than younger people and personal health budgets work better for larger, more complex packages of care,” she says.

Vidhya Alakeson is currently working on a book called Delivering Personal Health Budgets: A guide to policy and practice.

Mo Smith believes it is unfair to put the onerous responsibility of personal health budgets onto older people.

She says: “I think it is unfair to give older people the responsibility of being an employer as there is a high risk of them being taken advantage of. Generally speaking I have found that older people do not understand the personal budgets system and do not want the responsibility.

“It may work well with younger people who have the mental capacity to make their choices, but older people are at a higher risk of developing dementia or even general deterioration of the brain and would prefer simply to have their needs met.”

As the founder of Regenerate-RISE (Reaching the Isolated Elderly), Ms Rise has found in terms of personal budgets for the elderly “there isn’t really choice as all their budget goes on their primary need – homecare”.

She adds: “It seems to me that when the panel decides the amount for a Direct Payment, it is based on the cheapest care provider and not on the preferred provider of the client and I fail to understand where the choice is in the decisions that local authorities make.

“In the beginning we were informed that clients would be able to choose how they spent their personal budget, but in fact this isn’t the case. It was suggested that they could pay for activities such as paying for a carer to take them to the cinema, but older people on personal budgets want their basic needs met with a quality service and today we are failing to provide that quality service.”