Dutch experience shows popularity of personal health budgets, but Health Foundation urges caution

Research published by the Health Foundation today reveals the popularity of personal health budgets in the Netherlands, but analysis of the Dutch experience signals a warning for the English pilot programme.

The Personal Touch is the latest in the Health Foundation’s series of case studies capturing compelling stories about improvement in practice. Through a range of perspectives, from the Health Ministry to a carer, this research explores the challenges and successes of the Netherlands’ personal health budgets programme.

Stephen Thornton, Chief Executive of the Health Foundation, said:

'The Health Foundation believes a radical transformation in the relationship between patients and the health service is needed to improve the quality of patients’ care. Personal health budgets are one of a number of tools that could contribute towards this transformation.

'The Personal Touch makes a valuable contribution to a limited international evidence base. Personal health budgets improve patients’ experience – an important outcome in its own right. But so far there is little evidence that this relatively new innovation improves clinical outcomes.

'While personal health budgets may support a shift towards a more patient-centred NHS, the government must be wary of unintended consequences of their introduction upon other domains of quality, particularly effectiveness and equity.

'Before rolling out personal health budgets across England, the government must consider the Health Foundation’s learning carefully alongside the evaluation findings of the English personal health budget pilot programme.'

While personal health budgets are popular among patients and their carers in the Netherlands, the Health Foundation’s research finds that so far:

• there is little evidence that they improve clinical outcomes
• their introduction has not sparked greater innovation among providers
• the Dutch programme tells us little about designing a personal health budget system that reduces, or at least controls, health and social care costs in the long term.

The Personal Touch highlights a number of lessons from its study of the Netherlands’ personal health budgets system:

• Personal health budgets are popular. Users like the freedom and choice they provide and the ability to tailor care to their needs.
• They have the potential to spark innovations in practice and care provision, though this is not occurring on the scale expected.
• A well-developed supportive infrastructure needs to be in place to enable people to use them. This has cost implications.
• Not everyone wants to take on the complexities of budgeting and employment legislation that becoming a budget holder entails. This may exclude some groups, particularly the elderly.
• It is difficult to provide objective measures of success and to address regional variations in eligibility criteria.
• Unless carefully designed, personal health budgets will not necessarily reduce health and social care costs in the long term, nor will they automatically improve quality of traditional services through competition.
• There is a risk that, as the schemes expand, people for whom a personal health budget may not be suitable will be forced to use them as traditional care services decline.
• Too many restrictions on eligibility criteria may destroy the flexibility of personal health budgets.

Notes to editors

Media inquiries

Bobbie Lakhera, Public Affairs Officer
Tel: 020 7257 8067
Email: pressoffice@health.org.uk

About the Health Foundation

The Health Foundation is an independent charity working to improve the quality of healthcare in the UK. We are here to inspire and create the space for people to make lasting improvements to health services. Working at every level of the system, we aim to develop the technical skills, leadership, capacity and knowledge, and build the will for change, to secure lasting improvements to healthcare.

Our case studies

The Health Foundation’s case studies aim to capture compelling stories about improvement in practice. Writers spend time onsite interviewing teams and individuals and, where possible, patients affected by the changes.

Download The Personal Touch.

Personal health budgets

A personal health budget is an amount of money that is spent on meeting the healthcare and wellbeing needs of people, generally those with a long-term illness or disability. The budget is held by the service user or their carer themselves with the intention of providing greater flexibility, choice and control for service users.

Personal health budgets in the Netherlands

Personal health budgets are an increasingly popular option for people with long-term care needs in the Netherlands. They were first introduced in the Netherlands in 1996. In July 2010, there were 123,000 personal budget holders.  

Personal health budgets in England

A pilot programme involving around half the primary care trusts in England is currently underway to test out personal health budgets in the NHS. It will run for three years until 2012. Find out more at http://www.personalhealthbudgets.dh.gov.uk/.

The NHS Future Forum report Choice and Competition, Delivering Real Choice states that 'Personal health budgets are very powerful tools in driving choice and greater control and could be particularly effective where people are receiving both health and social care services'. In response to the NHS Future Forum’s recommendations the Government has pledged to extend personal health budgets as a priority, subject to evidence from the current pilots.