The question is not whether personal health budgets will promote privatisation. The more interesting question is how they will do so.
I have been concerned that anyone who legitimately raises concerns about the current direction of travel from the main political parties has been dismissed as a ‘quack’. The scope for conspiracy theories hypothesising is of course enormous, but any CEO trying to formulate strategy will wish to think a few steps ahead.
“Personal health budgets” (PHBs) are normally sold under the truncheon of “look at how it’s worked for X’, and of course single case anecdotes of where they have worked for people are good to hear.
I would be the first to accept David Cameron’s approach, that it is not where you have come from it’s where you’re going to. But I cannot accept this in this scenario.
I do not wish to play the man not the ball here. But to ignore his career experiences would be daft, given that his CV would have contributed to get him his job as CEO of NHS England in the first place.
From 1988 to 1997 Stevens worked as healthcare manager in UK and internationally.
In 1997 he was appointed Policy Adviser to two Secretaries of State for Health (Frank Dobson and Alan Milburn) and from 2001-4 was health policy adviser to Tony Blair. He was closely associated with the development of the NHS Plan 2000.
From 2004-6 he was President of UnitedHealth Europe and moved on to be Chief Executive Officer of UnitedHealthcare Medicare & Retirement and then President, Global Health and UnitedHealth Group Executive Vice President of UnitedHealth Group.
He is more than aware of how the private insurance system works.
Let’s get this straight – it is simply untrue that PHBs are ‘great for mental health‘. Take for example a young lady poorly medicated for bipolar affective disorder, really at risk of making impulsive choices. She goes on a spending spree, thus blowing at one go her PHB.
Or take a 52 yr old man with behavioural variant frontotemporal dementia with normal memory. He is also prone to risk taking behaviour as part of his condition. He goes on a spending spree too, thus blowing his budget.
So we can all play the anecdote game.
Clinical Commissioning Groups do not have any requirement to be populated by clinicians, though ideally this would help. They are responsible for working out how to spend NHS money amassed legitimately from the taxpayer. Therefore the NHS is not strictly speaking free, although a founding value has thus far that it is free at the point of need.
They are also interested in the demographics of their population – how ‘risky’ subgroups might contribute in generating a hefty bill for the local population. That’s why there are gizmos such as the ‘dementia prevalence calculator’, for example. To that end, clinical commissioning groups in allocating resources according to risk function exactly like insurance entities. They just happen to be in the state.
The ‘money following the patient’ strap line hasn’t come from nowhere. It would be perfectly feasible for you with your allocated budget to transfer it to a private insurance entity without any obstacles. This is one of the main concerns of ‘competitive markets’.
The idea that PHBs might be best for people with long term conditions not best for people who are fit and healthy is setting up the NHS for a fall, though. Lord Norman Warner talked this week of how he would like the NHS to be serving people to ‘live well’.
But if people with long term conditions are ‘looked after’ in the early stages of the policy, and people who’ve had good experiences can encourage other people to adopt them, and if ‘brokers’ who have something to gain financially from the introduction of this policy can get their message across, they might endorse this plan.
The plan though is dangerous for them as they’re the ones who are left voluntarily in the State’s system, leaving politicians with the right mood music for healthy living people to leave the system, and to seek private insurance. That is the real danger of the way the system is going.
None of the above is far fetched. None of it is inaccurate. It is simply a statement of fact.
Sir David Nicholson has often remarked that private insurance markets would not work for certain complex conditions such as dementia, where it might be possible to ascertain with a high degree of certainty an individual’s risk of developing some family forms of the condition.
And you can see where this is heading can’t you? Certain people with dementia with strong risk factors for dementia genetically will be obliged to disclose this information to private insurers, here or abroad, and face astronomic premiums (sic) as insurance companies will not want to take on the risk.
And not all old people ‘cost’ the NHS – it is the last few months of life which are really expensive for any healthcare system.
Nicholson is right.
Andy Burnham MP, as Shadow Secretary of State for Health, must have as his primary interest, whatever the inglorious past of some policy decisions of Labour, the concerns of the voters.
They have said clearly on numerous occasions that they do not wish for ‘privatisation through the back door’, whatever one’s views on the private v State debate.
If voters do not want privatisation through the back door, the UK Labour Party should be very wary of going further with this policy. An unintended consequence is that, conspiracy or not, this policy might ultimately be setting up the NHS to fail. And it might be a perfectly intended consequence for some.
