Government proposals to hand out cash to patients to spend on healthcare have not gone down well with the British Medical Association, which opposes a number of aspects of the scheme.

Plans to offer patients personal health budgets were first announced in 2008 in Sir Ara Darzi’s report High Quality Care for All, with the general idea being that handing patients a greater degree of control of their own care will help create more personalised National Health Service.

However, according to the Association, giving patients their own cash pots to pay directly for national health services - one particular option for personal budgets currently being explored by the Department of Health - could potentially “undermine some of the fundamental principles of the NHS and their very existence appears at odds with the workings of the system”.

For one, it argues that while enabling patients to better meet their own healthcare needs could well foster a more equitable health service, the scheme could also open up yet another pathway by which patients could be given different levels of care, “raising significant equity concerns”.

In addition, the Association points out that embedding such a policy into NHS culture will “add a new layer of bureaucracy and administrative burden upon primary care trusts”, and that ensuring budget controllers are equipped with adequate levels of information and support, as well as establishing appropriate patient budget monitoring systems, “will be an additional call on the time and resources of the NHS and its staff”.

Furthermore, the organisation stressed the importance of safe-guarding NHS resources particularly in the current difficult economic climate, and voiced concern over the potential for patients to pay for “inappropriate and/or non-evidence based services or treatments”, including alternative and complementary therapies and others not approved by the National Institute for Health and Clinical Excellence.

Waste of resource?
“Such use of personal budget funding could be considered a waste of NHS resources and may call into question the validity of personal budgets in the eyes of commissioners, whose role is to balance the population’s health needs with the finite resources,” the Association said.

“We believe in choice and flexibility for patients but these plans are worrying for a range of reasons,” concluded Dr Hamish Meldrum, Chairman of Council at the BMA. “Apart from the practical difficulties and added bureaucracy involved, direct payments would take us even further towards a model where healthcare is a commodity to be bought and sold rather than something to which people are entitled,” he noted, and stressed that the proposals “potentially undermine the principle of equal access on which the NHS is based”.

The BMA’s comments are in response to the Department of Health’s consultation on the feasibility and regulation of direct payments for care, plans for which were unveiled on Friday. Personal health budgets are already being tested in practice in a number of pilots across the country, and schemes to explore the direct payment method will be in place by the summer, the DH said.