The potential perils of Personal Health Budgets and Direct Payments

My colleague Jane Williams recently blogged on our Health Commissioning Portal about the Government's intention to amend regulations so as to give NHS Continuing Healthcare Patients a right to receive a Personal Health Budget if they want one - see For what we are about to receive - Right to request personal health budget morphs into right to receive for NHS CHC patients 21 Oct 2013 09:42 | Posted by Williams Jane | Permalink.

This forms part of a broader rollout of personal health budgets to people with many kinds of long-term health conditions. As Jane pointed out a Personal Health Budget is not something that everyone wants but for those that do want them they can be very useful in supporting self management and care planning and do emphasise the patient as being at the centre of the care provided.

However a recent case reported in the Times newspaper does illustrate the potential perils of Personal Health Budgets especially when they are delivered in the form of Direct Payments and may put quite a few people off the idea altogether.

In this case widower George Lomas was held liable to pay £3,569 compensation to his deceased wife's carer who claimed unfair dismissal after the wife died and Mr Lomas cut her hours from 30 to 16 per week. The carer had resigned claiming that she was not given enough notice of the change in her hours.

This case highlights the potential legal and financial risks of using Direct Payments to employ carers directly - whether the person holding the direct payment is the patient in receipt of the Direct Payments or their representative or nominee. Of course poor Mr Lomas could not have known when his wife was going to pass away but perhaps he acted a little hastily in immediately reducing her carer's hours If the Lomas's had received appropriate support on entering into the contract of employment they might have avoided this situation by ensuring the carer's hours could be varied on reasonable notice or that they had a contingency sum available to them in their Personal Health Budget in the event that they had to make their carer redundant.

Unfortunately many people will be put off employing carers directly because of cases like this and may prefer to use agencies to provide care even though they often cost more and cannot always provide the continuity of care that can be so valuable to people like Mr and Mrs Lomas.

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