NHS personal health budgets – an opportunity for digital innovation?

Written by Lesley Soden, Head of Innovation at Health Innovation Network

Just weeks ago it was announced that personal health budgets will be expanded for people with complex health needs. The Department of Health says that this will “put power back in the hands of patients”. Indeed, the proposed roll out of personal health budgets could achieve genuine patient power and drive bottom up demand for innovation. By funding services such as online health support and remote monitoring for patients in areas where these aren’t currently commissioned, digitalised innovations that have been shown to be clinically effective and provide cost savings could become more readily used and available across the country.

Consider the range of potential scenarios:

• Harry has diabetes and respiratory problems. He wants to use a self-care management app to better manage his diabetes; using his personal health budget he purchases the app. Could personal health budgets help to drive innovation from the bottom up by empowering patients like Harry to have greater control over own healthcare through innovation and technology?

• Priya has acute asthma and attends A&E frequently suffering from asthma attacks, she would like to manage her medication better and wants to use Aerobit, an online asthma management platform that transforms inhalers into smart devices using sensor-based technology that gives users the ability to connect them to a mobile app that reminds them to take their medication. In her local area, this app is not available through the NHS but she is eligible for personal health budgets and uses this funding to purchase Aerobit. As a result, she has had less A&E and GP attendances.

• Mary is in her 80s who lives by herself in her own home, she has had several falls and complex health conditions but would like to keep her independence by staying at home. Her family are concerned that they can’t physically check on her every day. Mary, in partnership with her GP, uses her personal health budget to fund a discreet activity monitoring and alert system using sensors positioned in the home to monitor movement and temperature. Mary’s daughter can monitor her movement and keep a gentle eye on her by being notified via text or email if something out of the ordinary happens to Mary. This ultimately saves health and social care funding by keeping Mary independent for longer rather than requiring residential care.

• Ahmed requires continuous physiotherapy for his rheumatic condition but struggles to travel to his physio appointments and often misses his appointments. His physiotherapist tells him about Mira Rehab which uses gamified online physio exercises but could not be paid through his local NHS physiotherapy service. Ahmed uses his personal health budget to pay for this online solution and this means his physio can monitor his use of Mira Rehab and his progress. This saves the physio time and improves Ahmed’s clinical outcomes.

The opportunity to fund assistive technologies as part of an integrated care and support package is a further example of the potential. Adults with learning disabilities could choose to buy ‘My Health Guide’, an app to help them take an active role in their health care. The app lets them record important items (text/audio/video/image) in easy-to-make ‘boxes’.

In situations like these and no doubt many others, personal health budgets could help to drive the spread and adoption of innovation from the bottom up, by using patient power to drive those solutions that meet their individual needs.

For our commissioners within the Health Innovation Network, the expansion of personal health budgets could help groups of your patients that would benefit from the many digital services that could help with self-management, remote monitoring or most importantly improved quality of life for patients.

For providers, you may discover innovative health technology to help your patients but know that your service would not fund the technology at present. If so, these personal health budgets are a possible avenue of funding.

How does it work?

Under the Department of Health proposals, the money will be paid directly to eligible patients to pay for their own healthcare for both goods and services, if their support plan is jointly agreed by their local Clinical Commissioning Group (CCGs).

In the past, personal health budgets have been criticised for wasting NHS money on unconventional treatments and ‘luxury’ items. However, the budget and care package must be agreed by CCGs with a clear healthcare need being met. The Department of Health’s evaluation in 2012 found that the costs under personal health budgets were overall cost neutral with savings in some areas. There could also be wider system benefits:

• Reduced A&E attendances;
• Reduced unplanned hospital admissions;
• Reduced social care costs.

It is worth noting that The Department of Health evaluation also found better outcome indicators where pilot sites had:

• Explicitly informed their patients about the budget amount;
• provided a degree of flexibility as to what services / goods could be purchased;
• Given greater choice as to how the budget could be managed.

Further information can be found here.