Personal Health budgets on the NHS

[Issy]

rcgp.org.uk/policy/rcgp-pol...

Does this mean we can all get effective thyroid meds?

[helvella Administrator]

The introduction more or less starts by saying:

A personal health budget is an amount of money that is allocated to a patient to allow him or her more choice, flexibility and control over the care that he or she receives. The budget is intended to cover the individual’s health needs within the context of a care plan to achieve agreed health outcomes.

So the pre-requisite seems to be such a care plan. How many here have a care plan? And the document does seem to accept that getting GP sign-off on care plans is something of barrier.

The Recommendations section then includes this:

¦ while approval should not be withheld on the grounds that there is no evidence of clinical effectiveness, there should be reason to believe that the proposed treatment or service could be beneficial to the health of the individual concerned

Which might appear to open the door to, say, desiccated thyroid products, though I am sure many doctors would still not endorse their use. They will likely use the next statement to deny them:

¦ approval should not be given to services or treatments where there is evidence to

suggest that they will be harmful to the patient

Then they totally squash the idea when you read the next statement:

¦ personal health budgets should not be used to pay for treatments that the NHS would not normally fund because a decision has been taken by NICE or an equivalent body that they are not a cost-effective use of NHS resources.

So, Issy, if, an hour or so ago, when you posted that blog you were feeling really optimistic,you can now settle back down into the pessimism the systems so often engender.

BUT - Let us HOPE that something can be wrangled out of this.

Rod

[RedApple Administrator in reply to helvella]

So the pre-requisite seems to be such a care plan. How many here have a care plan?

When it comes to thyroid health, a 'don't care' plan seems more likely!

[Hidden in reply to RedApple]

Hehehe well said

[Karmine in reply to RedApple]

spot on. Thank you, that comment has got me laughing to bad and I needed that today.

[NBob in reply to helvella]

Hi Rod,

Ineed read the whole document but I take a different view of what

"personal health budgets should not be used to pay for treatments that the NHS would not normally fund because a decision has been taken by NICE or an equivalent body that they are not a cost-effective use of NHS resources" means.

I am not aware of NICE deciding that NDT is not a cost effective use of NHS resources. If there is no evidence of NDT not being cost effective then i read that as the guidance opening the door to NDT. of course, I should be grateful if you make me aware of NICE's view of NDT. Also, I am not sure what other equivalent bodies there are to NICE. the BTA is a private organisation and has no statutory function or standing in the same way that NICE does. Similarly with the RCGP. At the moment, I am hopeful that the personal health budget will help us.

[helvella Administrator in reply to NBob]

There is no NICE view, so far as I am aware.

However, my reading suggests that the view of the PCT (which might include, for example, chief biochemist/chief pharmacist/head endo/anyone else) might be regarded as authoritative for the purposes of health budgets, in the absence of a NICE evaluation.

It has continually perplexed me that BTA is treated as if it did have some legal status. At least the RCGP does have some legal status albeit possibly irrelevant in terms of health budgets and desiccated thyroid.

Yes, I do still hope.

[Issy]

thanks. I'll go and curl up again.

[Hidden in reply to Issy]

Aw - well, you never know change may be good!

Meanwhile that cute little snoring dormouse (seen on youtube) comes to mind J

[Hidden in reply to Hidden]

couldn't resist! nite nite! x (off to hibernate too)

youtube.com/watch?v=DlS3w1G...(Not working as expected?)

[marram in reply to Hidden]

Cute!

[miravgraves in reply to Hidden]

was having a bad day till i saw this very funny im sniggering now as i type

[marram]

I find this whole issue of personal health budgets really, really scary. I cannot see how a doctor can possibly know how much your needs will be for the coming year. An apparently healthy man or woman could suffer a heart attack or a stroke which leaves them unable to care for him/herself and needing medication and specialist/nursing care never needed before. There is just ONE mention of the question 'what happens if the money runs out?' with no suggested solution.

This is just a way of 1.reducing healthcare costs (unlikely to happen according to the NCGP report)) and 2. privatising the NHS sneakily. What they should be doing is fix what is going wrong in a basically excellent provision which the whole world admired at one time. What they should not be doing is copying the US system which is full of inequalities and which the Americans are trying to change!

Before it was so fragmented that it is now a series of regional 'Trusts' rather than a National Health Service, there was central control over procurement of supplies and expensive equipment. now there is an incredible amount of duplication of management leading to millions being wasted and individual Trusts pay wildly differing prices for exactly the same purchases.

Trying to make it more fair? No, trying to fob us off with cuts disguised as 'modernisation' and 'more choice' (c**p).

[Karmine]

I couldn't agree more. I know its often mentioned on here that thyroid patients are often left to self-help care, but it looks sort of like that is what they want to do with every health problem by this budget. I can see it being open to such abuse and not in a way that is in the patient's best interests!

What scares me is the cost of say those who end up with thyroid cancer (or any cancer at all for that matter) The budget would run out right quick on those meds and care costs.

[NBob]

From the RCGP Personal Health Budgets position statement page 9

The RCGP accepts that certain treatments traditionally prescribed by the NHS do

not work for some individuals and that, conversely, some treatments not traditionally

prescribed by the NHS may be effective in improving health outcomes in certain cases.

We should use this quote!

Then

while approval should not be withheld on the grounds that there is no evidence

of clinical effectiveness, there should be reason to believe that the proposed

treatment or service could be benefi cial to the health of the individual concerned

there is plenty of evidence to support the use of T4/T3, T3 and NDT so this shouldn't (althoughsome doctors will) exclude them from the RCGPs recommendations.

Worryingly, the RCGP states that

The RCGP strongly supports the government’s exclusion of general practice and emergency care from the scope of personal health budgets. I didnt realise that GP was excluded! Blimey! So it looks like we have to get referred to an Endo for the PHB to kick in.

BTW

all this document is is a position statement. it is not government policy but a private organisations statement of its views on Pesonal Health budgets. Although its not government policy, it may influence government policy. Ithink that it would be a good idea for Thyroid UK to provide its own position statement.