On the surface having control over your own health budget is
an attractive idea, after all politicians, clinicians have been trying to sell
us the idea for quite some time now, as a way of taking some control over who
we have looking after our loved ones. I say, beware of Greeks bearing gifts, ask
yourself what is in it for them? I know that is a very cynical view of the
world, but I have been bitten in the arse too many times by the system over the
span of my lifetime to be anything other.
Argument 1:
It has been proven to work really well in social care.
Counter Argument
: Patients under Continuing Health Care
have a proven on going medical need, their needs are usually complex , their
care workers have to have specialised medical based knowledge. Who is going to
certify that training, competency, on-going refreshers etc. If the patient’s
family take on this role because they have decided to directly hire someone,
this will be a mine field for both the family and the care worker. Who will pay for the training? Only sensible
other option will be to hire staff via an agency, so taking away the benefits
of direct hire and higher wage for the care-worker.
Possible Outcomes:
poorly trained care workers carrying out complex medical procedures, increase
risk of adverse incidents or at best status quo.
Argument 2:
Quality of Care workers can be improved as you can pay more.
Counter Argument:
Yes it is true you do get what you pay for. Care workers are under paid for
they do. Under the direct budget system you will probably have two ways of
employing your care workers. Firstly
directly employ the staff you need, this is not as easy as it sounds and
although there are a few agencies that can do the pay roll side for you, which
will come out of your budget. You become an employer responsible for insuring
recruitment, National Insurance, rosters, annual leave cover, employment
contracts, risk assessments, care plans, discipline and training are taken care
of. I have an MBA, have run my own business, so understand all this stuff, I
don’t relish taking this on.
The second way
will be to recruit through a care worker agency, they will do all employers
stuff for you, but you will still be responsible for negotiating the supply
contract and because you will be a small customer you will not get the same
deals that big organisations like the NHS negotiate.
Possible Outcomes:
If you do it yourself and get it wrong, you could end up in court or employment
tribunal. The papers are full of such stories of things going wrong. If you use
an agency you could end up with contract conditions that are worse than the
current ones under the superior buying power of the NHS. Benefit is that you
take out the middleman and have a direct relationship with the agency.
Argument 3:
The Budget.
How many families under continuing health care think they
have a sufficient budget presently? Not many I would think. It has been made
clear to me on several occasions that if my Hubby requires more than he is
currently getting, he will be forced into a nursing home. This leaves me
covering weekends, and any unexpected extra hours needed. So now you will be
expected to take that already under funded budget and manage it yourself. How
will it work under the new system if the patients requirements change how quickly
will you be able to get the budget reallocated? In an emergency, i.e. all your
staff fall ill with flu, weather prevents staff from getting there, you will be
responsible for using your budget to cover this. If managing the budget becomes too much, what
mechanisms will be in place to have the NHS take things over again.
Possible Outcomes:
Life is messy and so will this be.
Summary.
I have come to the conclusion that rather than improve what
is not working well with the current system the NHS have jumped on personal
budgets as a means of ridding themselves of a problem that they cannot be
bothered to fix.
