Personal budgets in the NHS


On Friday the Department of Health announced the extension of 'personal budgets' to healthcare (following their successful introduction in social care) for people with long-term conditions such as Multiple Sclerosis. What this means is that patients will receive direct payments that they are then able to spend on the health services of their choice. 

This is good news. Individuals know their own needs and preferences far better than the state or its agents ever can. Putting them in charge of directing their own care improves outcomes and increases cost-effectiveness.

But why can't the government make the very small leap of logic from saying that people with long-term care conditions should have personal budgets, to saying that we should all be given the freedom to manage our own healthcare. If it's good for people in social care, and good for people with long-term conditions, then why not for the rest of us? The same logic applies regardless of who you are talking about.

It's easy to see how it might work. Assuming we stick with an egalitarian, tax-financed system, we could all be given health savings accounts, which the government would credit annually with our basic personal budgets. Then we would simply pay directly for the care we needed, as we needed it.

The best thing about this is that we would quickly get a healthcare sector shaped by the individual choices of hundreds of thousands of people and driven by consumer control, rather than one designed by central planners and commanded from the top-down. In other words, we'd have a market instead of a Soviet-style 'service'.