Nov

The Good, The Bad And The Ugly – Direct Payments For Health Care

By gbaker

Alright everybody!

I had an email from someone the other day asking me some very valid questions about Direct Payments for health care and I was so surprised by the clarity of my answers I thought it was worth posting them on here.

Their questions were:

-Are there any negative consequences to the extra patient choice that comes with NHS Direct Payments?

-Have I noticed any unfairness in the social care system, i.e. people in some areas getting more than others?

-They had never thought about healthcare and money being directly linked before, were worried it could become unfair and wanted my thoughts on this?

My response was something like this:

Ok, I can answer those fine, but first I need to explain a bit of the context for it to make sense.

By and large direct payments from the NHS are an excellent idea, they are something that should have been started long ago and the reasons why are quite simple.

Firstly, as time progresses the burden on social services to provide care for the elderly and disabled is increasing rapidly and the situation just isn’t sustainable, especially considering the way the system is organised, the NHS is going to have to pull its weight.

At the moment it is very difficult to navigate the assessment process for social care, which is what necessitates my book, and a lot of the time the amount of support people get is determined by how much effort they, or other people, are able to put into fighting their case.

Actually, it is only fair to point out that the inherent personalised nature of Direct Payments means you will only get what you ask for (or should I say demand?), nothing more, nothing less. This can been seen as an advantage or a disadvantage depending on your perspective. In addition, this doesn’t take into account the fact that the eligibility criteria are different in every county and determined, at least partly, by how much money the local authority has to hand.

One would hope that NHS funded Direct Payments would be much easier to obtain because they should flow naturally from a diagnosis and therefore require less input from the patient (or service user, whatever).

Secondly, in reference to your question about increased patient choice, it is not yet clear whether this will actually happen, it relies entirely on what funding and ’scope of operation’ direct payments for health care are given when they are fully rolled out.

Put simply, people will only have more choice if the NHS A) puts enough money in the pot and B) finds ways to justify the extra spending any increased services will demand.

Thirdly, I don’t think there are any particularly negative consequences to note, yet, but the effectiveness of the whole shebang hangs on three things:

-How ill you have to be before they will give you any funding (the eligibility criteria)

I suspect these will be quite high because the NHS will want to keep as many people using social services funding as possible

-What you can do with the funding.

This is particularly interesting because at the moment it would seem you can buy whatever services you like (hydrotherapy, medicine etc) provided you can justify them as therapeutic for your condition. What will probably happen in practice is there will be a period of time when the rules are very liberal and funding is easy to obtain, but once the cost becomes obvious, the situation will reverse itself.

-How much control you have over where the services you purchase come from.

If you can only purchase services from the NHS I doubt patient choice will improve dramatically because no new services will be offered. However, if you can purchase services from private companies then things may get a lot better because the natural force of competition will come into play. I suspect however that this will be heavily regulated so don’t get too excited!

And finally, when it comes to healthcare and money, the two are inextricably linked whichever way you look at it anyway, and you could argue that the NHS is actually less fair than just subsidising the purchase of personal private healthcare insurance.

But anyway, I understand your concern, and its very valid in that introducing the concept of having a personal healthcare budget into the NHS (which is meant to be free at the point of delivery) seems like a bit of a strange thing to do. Effectively, what it might mean is that one would pay their taxes to the NHS, be given a budget, and then allowed to purchase services from whomever they want when it’s meant to be the NHS’s job to provide healthcare!

As you can see, that situation would, to an extent, subvert the principals the NHS was built on.

However, that would only be the case if direct payments were rolled out for a large proportion of patients AND they were permitted to purchase services from private companies.

I don’t think there is anything wrong with allowing people to, for example, privately hire their own personal assistants, because it is by far the most effective and cost efficient way to provide care for many disabled people.

Of course, even if it is subverting the principals of the NHS, that isn’t necessarily a bad thing, depending on your point of view.

I must admit, I’m surprised direct payments for health care are actually happening, I doubt people would have expected something like this to happen, even only a few years ago.

In a way, it could even be construed as part privatisation of the NHS!

What is interesting is that this hasn’t come to be out of an ideological argument, but because it seems to be the most effective and practical approach.

If the idea was taken to it’s logical extreme we could end up with a situation where the NHS just acts as a non profit health insurance company (paid for by taxes) that gives us a budget based on whatever ails us and lets us decide who to buy from. Interesting idea eh?

What do you guys think?

George

P.S. if you want to know more about Direct Payments for social care and the care system in general, you might like to check out my free guide to the care system at www.howtogetcare.com/freereport

Share and Enjoy: