But the new health bill proposes piloting direct payments for health care, so people are going to have to start taking it seriously.
The idea of giving patients a defined amount of money and an economic health adviser to decide what sorts of treatment they might like is attractive to policymakers, at least. It makes healthcare provision look even more like shopping.
But how will we amalgamate the principle of patient choice with clinical expertise? What will we do if the patient with a broken leg needing surgery decides he would actually prefer some liposuction? How much of the patient budget will be wasted on setting up a system to administer patient budgets?
Doesn’t the idea of choosing what to do with allotted money undermine things like clinical expertise and, dare I say it, ‘evidence-based practice’?
But notional ‘choice’ remains the buzzword for politicians and so the ‘idea’ of individualised budgets will remain popular. After all, they will reason, who can argue against patients having the power to select treatments the way they select shoes?
But regardless of whether or not we like the idea of personalised budgets and patient choice – and, by the way, I do like the idea of the patient with a long-term diagnosis of schizophrenia being able to choose a mix of massage and solution-focused therapy ahead of those expensive depot injections – surely the real problem with personalised funding is that it will increase conflict between patients and clinicians when we should be working towards a more meaningful partnership.
Conflict has always been present at the heart of giving care – what the patient wants versus what is achievable.
As the NHS has become more clinically capable and administratively complex, the conflicts have centred more around what is deliverable and how it can be administered. We have lots of treatments – it’s just we might not be able to get them to you.
Nurses and doctors become arbiters of care rather than deliverers of it – a significant shift in role and relationship. This will be compounded by patient budgets, creating a tension at the heart of long-term care between what is desired and what is possible.
Health care shouldn’t be a commodity but, it seems, that argument has long since been lost. There will be many more patient budget-related arguments to come.
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