More about making personal health budgets sustainable

As personal health budgets are extended more widely, it will be necessary begin to change the way NHS services are commissioned. For example, people may be offered a personal health budget as an alternative to conventional community, mental health or rehabilitation services.

Currently, these services are usually commissioned from mainstream NHS-funded providers such as acute and community trusts. Some services are commissioned through block contracts. New payment mechanisms have been introduced - such as payment by results in mental health services.

In the pilot programme, commissioners made extra funding available to enable people to be offered personal health budgets as an alternative to mainstream NHS services.

Beyond the pilot, it is clearly be necessary to find ways to make personal health budgets available from within current budgets, while managing the impact on existing services. A group of sites worked with the Audit Commission to explore how this could be done. The recommendation was that commissioners should work with providers through a series of stages.

Initially personal health budgets could be offered to people with the most complex needs, for whom services are already commissioned individually.

This would lead on to a service-by-service redesign, enabling a controlled expansion of personal health budgets. 

A staged approach to rollout of personal health budgets:

• Complex needs and high-end users
• Addressing inefficiencies and inequalities
• Strategic service redesign
• Controlled expansion
• Full roll out
(Audit Commission, 2011)

Subsequently, a number of CCGs have worked with NHS England to explore how personal health budgets could be extended and to model the financial implications. We have developed a simple modelling tool to enable CCGs to produce their own projections, using local estimates. The completed example of the tool illustrates the possible impact of a rollout to between 1 and 2 in 1,000 people in an average-sized CCG.