Implementing personal health budgets in England: a user-led approach to substance misuse

Abstract

Personal health budgets (PHBs) in England have been viewed as a vehicle for developing a personalised patient‐based strategy within the substance misuse care pathway. In 2009, the Department of Health announced a 3‐year pilot programme of PHBs to explore opportunities offered by this new initiative across a number of long‐term health conditions, and commissioned an independent evaluation to run alongside as well as a separate study involving two pilot sites that were implementing PHBs within the substance misuse service. The study included a quantitative and qualitative strand. The qualitative strand involved 20 semi‐structured interviews among organisational representatives at two time points (10 at each time point) between 2011 and 2012 which are the focus for this current paper. Overall, organisational representatives believed that PHBs had a positive impact on budget‐holders with a drug and/or alcohol misuse problem, their families and the health and social care system. However, a number of concerns were discussed, many of which seemed to stem from the initial change management process during the early implementation stage of the pilot programme. This study provides guidance on how to implement and offer PHBs within the substance misuse care pathway: individuals potentially would benefit from receiving their PHB post‐detox rather than at a crisis point; PHBs have the potential to improve the link to after‐care services, and direct payments can provide greater choice and control, but sufficient protocols are required.

Implementing and delivering personalised budgets for drug and alcohol users: A narrative systematic review

“…Six records from four studies/programmes of work met the criteria for inclusion in the review. Two records report findings from the national evaluation of PHBs (Welch et al., , ), and two report findings from an evaluation of Fulfilling Lives in Islington and Camden (FLIC) Programme for people with multiple and complex needs, which included substance users (Cornes, Whiteford, & Manthorpe, ; Whiteford, Cornes, & Williamson, ). Nevertheless, all records are separately included in the review as they focus on different aspects of the studies and/or draw on different data.…”

“…Nevertheless, all records are separately included in the review as they focus on different aspects of the studies and/or draw on different data. That is, both drug and alcohol users and staff are included in Welch et al., ; whereas Welch et al., centres on the views and experiences of staff. Similarly, Whiteford et al.…”

“…Five of the included studies report the findings of pilot initiatives in England (Callanan et al., ; Cornes, Whiteford, et al., ; Welch et al., , ; Whiteford et al., ); the other was conducted with individuals from mental health self‐direction programmes in the US (Croft & Parish, ). Five of the studies report data from drug and/or alcohol users who received budgets, five include data from staff working with drug and/or alcohol users who received PBs, and four included both drug and/or alcohol users and staff.…”

“…Five of the studies report data from drug and/or alcohol users who received budgets, five include data from staff working with drug and/or alcohol users who received PBs, and four included both drug and/or alcohol users and staff. Two studies were published in peer reviewed journals (Croft & Parish, ; Welch et al., ); four are grey literature reports (Callanan et al., ; Cornes, Whiteford, et al., ; Welch et al., ; Whiteford et al., ).…”

“…Although initiatives have researched the provision of personalised budgets to people with a history of drug and alcohol use (Croydon Drug and Alcohol Action Team, ; Daddow & Broome, ; Welch et al., ), there is a recognised gap in the literature exploring the impact of a person‐centred approach within the substance use care pathway (Welch, Jones, Caiels, Windle, & Bass, ). Reflecting the desire for improved evidence and understanding (National Audit Office, ), a recent report called for the experiences of different people including those who misuse substances to be considered when trying to understand the variation in provision, experience, and outcomes of personalised budgets on different groups (TLAP, ).…”