Direct payments for NHS services could undermine equality, BMA warns - 22 Jan 10

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Plans to allow patients to pay directly for services could undermine equality in the NHS in England, create a new layer of bureaucracy, divert funding to unproven treatments, and result in some patients not getting the care they need, the BMA says today (Friday 22 January, 2010).

The Department of Health in England is currently exploring the possibility of personal health budgets. One option would be for some patients, for example those with long-term conditions, to hold their own budget and pay directly for NHS services.

In its response to a government consultation on direct payments, published today (Friday 22 January, 2010), the BMA raises concerns that:

•  they would result in a new layer of bureaucracy and administrative burden on Primary Care Trusts (PCTs)
• they could result in an inequitable system that funds services or treatments for patients who hold a personal budget, but not for those who do not
• in the event that a patient’s budget is held by a third party, there would need to be safeguards to prevent exploitation
• a mechanism could be created to allow PCTs to refuse or ration further care to patients who had spent their whole budgets
• allowing patients to have money “banked” could encourage them to save it “for a rainy day” rather than spending what they need on their care
• the idea of healthcare simply as a commodity would be reinforced

Dr Hamish Meldrum, Chairman of Council at the BMA, says: “We believe in choice and flexibility for patients but these plans are worrying for a range of reasons. Apart from the practical difficulties and added bureaucracy involved, direct payments would take us even further towards a model where healthcare is a commodity to be bought and sold rather than something to which people are entitled. These proposals potentially undermine the principle of equal access on which the NHS is based.”

Notes

• View the full BMA response at:
  http://www.bma.org.uk/healthcare_policy/responses_consultations/directpayconsjan10.jsp
• The Department of Health consultation is at:
  http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_107451.pdf

BMA response to Department of Health consultation on 'Direct payments for health care: a consultation on proposals for regulation and guidance' - January 2010

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Introduction
The British Medical Association (BMA) welcomes the opportunity to respond to the Department of Health’s consultation on direct payments for healthcare.

The BMA is an independent trade union and voluntary professional association, which represents doctors and medical students from all branches of medicine all over the UK. We have a membership of over 143,000 worldwide. We promote the medical and allied sciences, seek to maintain the honour and interests of the medical profession and promote the achievement of high quality healthcare.

This response provides comments on the aspects of the consultation proposals on which we have specific concerns and or suggestions. Many of these comments apply equally to the other two forms of personal health budget, namely notional budgets and real budgets held by a third party.

The BMA welcome the government’s commitment to undertake a comprehensive and robust pilot programme on personal health budgets before developing its policy in this area further. As the Department of Health is already aware, while the BMA will certainly look at the findings of the pilot, we have a number of overarching concerns about personal health budgets being introduced into the NHS in general, which are amplified in relation to direct payments. Whilst this may not be the Government’s intention, we believe that the introduction of personal health budgets has the potential to undermine some of the fundamental principles of the NHS and their very existence appears at odds with the workings of the system. We understand that there is an argument that where personal health budgets enable individuals to better meet their health needs (which will be different to the health needs of others) equity could said to be promoted. However personal health budgets could introduce another mechanism by which NHS patients could potentially receive different levels of care, raising significant equity concerns. The policy also seems to further establish the idea of healthcare simply as a commodity, which the BMA does not believe is in patients’ best interest.

It is also clear that personal health budgets will add a new layer of bureaucracy and administrative burden upon PCTs. Providing budget holders with the required level of information, advice and support will be an additional call on the time and resources of NHS and its staff, as will the arrangements that will need to be in place to continually monitor and review patients’ use of budgets. In light of this, the benefits to patients both in terms of clinical outcomes and improved wellbeing would have to be considerable to justify personal health budgets being rolled out more widely in the future.

The imbalance perceived by individual patients who are heavily reliant on the health service, but who feel they have little or no control over their care and treatment is a very real issue. Personal health budgets do not pose the only solution to this problem however, and there are alternative approaches that could be adopted that would not lead to such a fundamental shift in the way in which NHS care is delivered. We have provided an additional commentary on these overarching concerns where not covered by our comments on the specific consultation proposals at section 18 of our response.

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