The introduction of personal health budgets for patients will require a “culture change” among nurses, who will need to learn a whole new set of skills, researchers have warned.
Personal health budgets involve patients being given more control – either directly or indirectly – over how money is spent on their healthcare needs. It is part of wider government efforts to make patient care more personalised and open to choice.
The personal budget idea is currently being piloted at 61 sites in England, the majority involving continuing healthcare, long term conditions, mental health, and end of life care. An evaluation of the pilots is due to report next year, which the government has said will “inform wider rollout” across the NHS also in 2012.
NHS staff involved with the pilots said last week that the successful introduction of personal health budgets would require a “huge” change in culture among clinicians, suggesting they were more used to providing direct care in a time-constrained environment than advising patients on their own choices in lengthy consultations.
Speaking last week at a Westminster Health Forum event in London, NHS Nottingham City personal health budgets project manager Gemma Newbery said: “Support planning [for personal health budgets] is time consuming if it is done properly, and the culture change to facilitate personalisation in health is huge.”
She noted that clinicians had differing views about the idea of personal budgets, saying: “There are some clinicians who are really for it, some in the middle and some clinicians that really don’t like the idea at all.”
Birmingham Health and Wellbeing Partnership personal health budgets project manager Azra Iqbal said healthcare professionals were not used to spending the length of time on any one patient that was needed for using personal health budgets.
Karen Walker, director of policy development at skills council, Skills for Health, said the impact of their introduction on the healthcare workforce would potentially be “wide ranging and quite significant”, affecting “their skills, their knowledge, their attitudes, their behaviours”.
She said Skills for Health had carried out a scoping exercise looking at the potential impact, which “very much suggested that staff will very much need to develop a new skillset”.
Ms Walker said: “Some of those…are skills around things such as brokerage, such as advocacy, the skills that allow people to become signposters and navigators, as well as just being just direct providers of care.”
But she added: “This is not just around skills and it’s not just about competence, but it’s also about attitudes and behaviours.
“How do staff need to develop the attributes and behaviours to enable them to engage in a different way on a different basis with service users, and that perhaps, potentially is the hardest thing to deal with,” she said.
Ms Walker also noted that there might be issues around delegation, if patients chose to use their budgets to employ their own support staff.
She said: “If a service user employs a personal assistant and they want that person to undertake some healthcare tasks, for example changing dressings, what is the position of the district nurse in delegating that work to a personal assistant.”