NHS Personal Budgets: An Opportunity to Empower Angela Mawle CEO, UK Public Health Association The NHS White Paper Equity and excellence; Liberating the NHS launched by the Coalition Government last July aims to embody the Government's vision for patients to be at the heart of the NHS, with a real voice in determining the care they receive and from whom. A refashioned NHS where providers are accountable to patients and responsive to their preferences and needs and where the commissioning process ensures quality assurance and flexibility of approach.

In other words "No decision about me without me" with an empowered patient at the heart of the system.

Personal budgets form a central plank of this agenda and are intended to form a foundation stone in the building of the new culture and the shift in power essential to deliver patient-centred care.

It is expected that personal health budgets will be managed in one of three ways:

• a "notional budget," where the NHS holds the money for the patient and buys the services on their behalf;
• a "third party arrangement," in which an independent organisation holds the money;
• or a "direct payment," where money is transferred directly to the patient to buy their own services.
  

In all cases, the person at the heart of this knows about the costs of services offered and what can be afforded within the constraint of the personal health budget. The money available can be spent on addressing the health and wellbeing needs as set out in their care and support plan.

There is a real opportunity here for patients/clients to become actively involved in preparing and developing their care plan. To become effective co-producers of their own good health and wellbeing rather than passive recipients of whatever may be deemed the best on their behalf. The sense of control over their own lives and the collaborative partnership based approach which has to underpin this process can only help to reinforce a patient's self-esteem and the value of what they, as an individual, can contribute to improving their health.

This important shift of focus can and should have ramifications on how whole communities can become more central to planning and developing healthy sustainable neighbourhoods. Where assets are valued as well as needs. John McKnight, Barak Obama's mentor who encouraged and developed his community activism, has shown that when a perspective of a glass half full rather than a glass half empty is taken a whole new energy and resource is opened up. 'Place based budgets' could be liberated to transform their neighbourhoods.

Of course all of this is dependent upon a professional and voluntary workforce who are courageous and committed enough to work in new and different ways with the individuals and communities that they serve. Are they out there? If they are, it will be beholden upon them to make sure that they use every opportunity that comes with the Reforms to make a real difference to the lives of the most vulnerable in our society.

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