Dr Erica Wirrmann Gadsby
Centre for Health Services Studies, University of Kent
The Government has committed to expanding the use of personal health budgets for health service users following the evaluation of the pilot programme which ran from 2009-20121. This is part of a wider ‘personalisation’ agenda, which has become a central theme in the reform of health and social care in England, and also features increasingly prominently in the policies of other UK governments, in addition to governments of many other developed countries around the world.
Personalisation is defined by central government as “the process by which services are tailored to the needs and preferences of citizens. The overall vision is that the state should empower citizens to shape their own lives and the services they receive” (Cabinet Office 2007 p33). There are a number of drivers behind the desire to ‘personalise’ health care in England: 1) it is expected that personalisation is a route towards better integration of health and social care services, through its focus on the whole person; 2) personalisation might help to improve people’s management of long term conditions through a strategic shift towards early intervention and prevention; 3) personalisation will encourage the provision of services that will allow people to be maintained at home; and 4) personalisation will improve patient experience and outcomes through promoting choice, control and flexibility.
As a concept, however, personalisation remains vague and can be defined and interpreted in a number of ways, and with different implications for service users and providers – particularly in terms of the mechanisms used to achieve a greater degree of personalisation (Dickinson et al. 2010). Some mechanisms, such as personalised care planning, are about addressing an individual’s full range of needs, taking into account their health, personal, social, economic, educational, mental health, ethnic and cultural background and circumstances. They recognise that there are other issues in addition to medical needs that can impact on a person’s total health and wellbeing. Other mechanisms, such as individual or personal budgets and direct payments, are concerned with extending the service-user’s choice and control over how money is spent on meeting their care needs.