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- Author or Editor: Julien Forder x
Personalisation and consumer direction are well-established policy initiatives in long-term care (OECD, 2005). With close links to long-term (social) care, these measures are also being considered for health-related support for people with long-term conditions. In 2009, the Department of Health (DH) in England announced a pilot programme to explore the use of personal health budgets (PHBs) for people with long-term health conditions such as chronic obstructive pulmonary disease (COPD), diabetes, mental health, and also for people likely to have significant co-morbidities using NHS Continuing Healthcare services. The underlying rationale was similar to that expounded in long-term care initiatives. Personalisation was viewed as a mechanism to encourage choice and control among individuals who use services, which in turn would have the possibility to control increasing costs.
The potential scope of these initiatives in healthcare is substantial. The DH in England estimated that around 15 million people in England (30% of the population) have at least one long-term health condition, accounting for 70% of the health and social care budget (DH, 2012d). In addition to the costs that can be attributed to long-term health conditions, there is a significant impact on people’s lives that also needs to be considered (DH, 2012d). The personalisation agenda acknowledges this impact by putting individuals at the centre of all decisions made about them, with the aim of giving them greater choice and control over how services are managed. It has been suggested by the DH that personalisation, information, choice, supported self-care, shared decision making and service integration will become the norm for people with a long-term health condition (DH, 2012d).
Unpaid care is an important part of long-term care systems. It is increasingly recognised that carers have their own health and well-being needs. Carer-specific interventions, as well as support for the care-recipient, may enable carers to maintain their own health and well-being alongside caring. This study seeks to establish whether and how community-based care services affect carers’ quality of life. The Adult Social Care Outcomes Toolkit for Carers was used to capture carers’ social care-related quality of life through qualitative interviews and a survey of carers in England in order to provide insights into the impact of community-based care services on carers’ quality of life outcomes.
The main focus of this chapter is to explore personal budgets in health care and the main findings from the national evaluation of the personal health budget pilot programme. This chapter focuses on exploring the initial implementation process during the early stages of the pilot. It goes on to discuss the extent to which the implementation of personal health budgets was in accordance with the policy intentions underlying the initiative (as set by the Department of Health) and how much it had an impact on outcomes and cost-effectiveness for patients with long-term health conditions. The results indicated that implementation adhering to the main underlying principles of personal health budgets had the potential to have a positive impact on outcomes for budget holders and whether they were cost-effective compared to conventional service delivery.
The social care reforms of the early 1990s have had profound effects on the domiciliary care system. The adoption of markets and the ‘enabling’ role for local authorities are central features. In contrast to much of the original rhetoric that lay behind these reforms, economic theory emphasises the importance of the institutional arrangements in affecting performance. Given the discretion that local authorities have over the specific form of transactions with providers, questions about contract choices are especially pertinent. This article describes the range of arrangements being used and the different implications of contract choices. In the context of relatively competitive markets and organisations exhibiting a range of business motivations, the evidence supports the hypothesis that for otherwise equivalent providers, prices are significantly affected by contract type. In short, institutional arrangements matter.