Background

Personal Health Budgets (PHBs) aimed to make transparent the resources available for an individual’s care and to maximise patients’ choice on how best to achieve desired outcomes. PHBs were thought likely to be particularly suitable for people with long-term conditions who are frequent users of healthcare. PHBs were piloted in around 70 English Primary Care Trusts from 2009.

Aims

The evaluation aimed to establish whether personal health budgets ensured better health and social care outcomes, compared with conventional healthcare delivery. To achieve this, the evaluation:

• explored the processes of implementing PHBs for patients and carers
• investigated the impacts of PHBs on different groups of patients and carers
• investigated the impacts of PHBs on healthcare professionals
• assessed the cost-effectiveness of implementing PHBs for different health conditions, compared to conventional service delivery
• assessed the impact of implementing PHBs on NHS organisations, staff and the wider health and social care systems
• assessed the impacts of PHBs on the wider NHS and NHS values (especially underpinning equity principles).

Methodology

The evaluation used a comparative, quasi-experimental design; outcomes for specific groups of patients receiving PHBs were compared with those using standard healthcare. Structured baseline and outcome data was collected from patient interviews; patients’ medical notes; patient care plans; and from a wide range of NHS staff involved in implementing PHBs.

SPRU contributed to the evaluation by conducting and analysing semi-structured interviews with subsamples of PHB holders, at 3 months to assess early experiences of receiving a PHB; and 9 months to assess longer-term outcomes. Patients included were:

• those receiving NHS Continuing Care
• those with diabetes, chronic obstructive pulmonary disease or mental health problems
• those suffering from stroke
• people with long-term neurological conditions.

One-off semi-structured interviews were also conducted with PHB holders using maternity services and with carers of people who received a PHB for end-of-life care. Interim reports on these interviews were also delivered.

Policy and practice aims

PHBs represented a major change to NHS practice. The evaluation set out to determine whether PHBs should replace or supplement traditional ways of allocating resources and delivering health care services. The evaluation also informed options for the wider implementation of PHBs beyond the pilots.

The final report on the whole evaluation was published in 2012 - see below.

Publications and presentations

2013

Personal health budgets: experiences of budget-holders and carers. Plenary.
Glendinning, C., Personalisation in the Health Care System: Evaluation of the Personal Health Budget Pilot Programme Conference, London, 5 March 2013. 2012

Personal Health Budgets: Experiences and outcomes for budget holders at nine months: Fifth interim report, 2012
Davidson, J., Baxter, K., Glendinning, C., Jones, K., Forder, J., Caiels, J., Welch, E., Windle, K., Dolan, P. and King, D., Department of Health. Evaluation of the Personal Health Budget Pilot Programme, 2012
Forder, J., Jones, K., Glendinning, C., Caiels, J., Welch, E., Baxter, K., Davidson, J., Windle, K., Irvine, A., King, D. and Dolan, P., PSSRU. 2011

Personal budgets and personal health budgets - learning from the evidence
Glendinning, C., Brain Injury Social Work Group Study Day, Manchester, 5 April 2011. Personal Health Budgets: Early experiences of budget holders: Fourth interim report, 2011
Irvine, A., Davidson, J., Glendinning, C., Jones, K., Forder, J., Caiels, J., Welch, E., Windle, K., Dolan, P. and King, D., Department of Health. The Cost of Implementing Personal Health Budgets: [Third interim report], 2011
Jones, K., Forder, J., Caiels, J., Welch, E., Windle, K., Davidson, J., Dolan, P., Glendinning, C., Irvine, A. and King, D., PSSRU Discussion Paper. 2010

What value is qualitative research?
Glendinning, C., Training Day for Personal Health Budgets Evaluation Research Sites, King's Fund, London, 5 March 2010. What value is qualitative research?
Glendinning, C., Training Day for Personal Health Budgets Evaluation Research Sites, Manchester, 11 March 2010. Early Experiences of Implementing Personal Health Budgets: [First interim report ], 2010
Jones, K., Caiels, J., Forder, J., Windle , K., Welch, E., Dolan, P., Glendinning, C. and King, D., PSSRU Discussion Paper, 2726/2. Experiences of Implementing Personal Health Budgets: 2nd interim report, 2010
Jones, K., Welch, E., Caiels, J., Windle, K., Forder, J., Davidson, J., Dolan, P., Glendinning, C., Irvine, A. and King, D., PSSRU Discussion Paper, 2747/2.

If you require further information about SPRU's contribution to the project, please contact Caroline Glendinning