Personal Budgets, or, “What do you mean, free holiday?”

Sigh. There’s much ranting and rambling in the press about the NHS’s application of personal budgets at the moment. I’m not a clinician, and I’m not an economist, so I can’t say for certain what the outcomes on both fronts will be, but here’s a couple of bullet points to chew on before spewing bile all over the keyboard about them;

– Anything that is prescribed is being prescribed by the same NHS doctors that are reluctant to so much as book a patient time in the hydrotherapy pool. Can you imagine these people being flash with money for the sake of it?

– No, people aren’t being prescribed “holidays” because “the pills aren’t working, no pill can cure an unhealthy lifestyle”. The majority of disabled and chronically ill people are just unlucky. No amount of healthy living will cure EDS, or CP, or CFS/ME, or arthritis, or regrow an amputated limb. No amount of cheerful thinking will fix depression, and no amount of generic “being better” will fix serious back pain, since those are the two conditions that keep being mentioned by the Angry Foamies. You know what does help? Pills. You know what can work well as a complement to the pills? Exercise, or a change of scenery, or clothes that don’t hurt to wear, or a bit of space that isn’t chaotic to go and sit in.

– No, it shouldn’t “be the patient’s responsibility, all the doctors should do is give them drugs” because fifty years ago, it wasn’t a doctors’ job to fit grab-rails in patients’ toilets, but nobody complains now when the NHS routinely does this, a hundred years ago it wasn’t a doctors’ job to give people talking therapies, that was the priest’s job, but only a few retrograde tossers complain now when people get CBT and other mental health support on the NHS. A few hundred before that, and it wasn’t the doctors’ job to operate, that was the barber-surgeon’s job, the doctor just gave you a bolus, but nobody complains now that you get your medication and your operations from broadly the same organisation. The degree to which doctors meddle in their patients’ lives is open to change, and a change as basically-benevolent as “We can provide you with things that make life easier” is one that we should be embracing, within reason.

The key thing to ask is; “When people say that all of this money could be going to fund children’s heart surgery; Will it really go to fund children’s heart surgery if this initiative is dropped, or will it go to pad out an executive’s bonus?”

The ones that people are really maligning for some reason are the following;

– A summerhouse and/or a shed; Seriously, do you know how difficult it is to maintain sleep hygiene when you’re housebound? Give someone a nice summerhouse to go and sit in during the day, and they will get plenty of sunlight, stop working from their bed, and save the NHS thousands of pounds in years of sleep clinics and medication. Some people need the drugs, some people just need the dedicated sleep space. It’s cheaper in the long run to try the shed before forking out tens of thousands of pounds on a sleep study.

– New clothes; Well, funnily enough, disabled people are often really, really poor. Sometimes poor enough that the thing between us and leaving-the-house is literally not having any suitable clothing (I hit that point last year, before my benefits came in. I had no un-holed T-shirts, so was too ashamed to go anywhere other than the doctors’ or the pool. In the time between then, and getting new clothes, I basically lost the ability to go out independently, through lack of use). Sometimes clothes which someone bought before they became disabled are unsutable now that they’re disabled, but they can’t afford to replace them – I know enough people who can’t wear tight jeans anymore, either because of the fabric rubbing their skin raw, or the cut not being crooked enough to wear for extended periods sitting in a wheelchair. Likewise, over-the-head shirts are impossible to put on if you’ve acquired an arm disability that stops you raising your shoulders. It makes sense for the NHS to buy people clothes, even if it’s just so that they can get to physio appointments.

– A trip in a pedalo; Good for the body and good for the mind, it’s exercise, it’s sociable, it’s probably a bit of relief for both the patient and probably their carer (Also if the carer is a friend, it’s probably nice to go and do something together where they’re able to just have fun, rather than Being A Carer). It’s probably cheaper than paying for respite care, or for paying for an actual paid carer (Hey, where’d that ILF go?) or for the amount of physio sessions equivalent to the amount of pedalling done.

– Horse riding; The same as the pedalo, but plus the morale boost of being around animals.

– A Wii Fit; Improves the efficiency of any other physio sessions, because it’s easier to get someone to comply with a fitness regime in their own living room than to get them to go to the gym every night (I say, twitching like an addict because the pool is closed for rrefurbishments for the next week). Cheaper in the long run to spend a hundred quid on fitness games than to keep someone in physio for months, or to do bariatric surgery, or to pick up the pieces in accident and emergency.

– A sat-nav; Honestly, for someone with a mental illness that wrecks their confidence in leaving the house, a sat-nav can be the difference between being housebound and being able to travel, including that favourite of the Daily Mail, to be able to get to work.

– Music lessons; When you remember that music lessons are used as speech therapy and to help with childhood asthma (How better to teach someone how to control their breathing, than to give them a harmonica or a flute?) and have pretty good compliance rates as compared to basically all other breathing exercises, this makes a lot of sense. Plus, again, mental health, improved coordination, improved hand strength, probably improved posture depending on the instrument. Cheaper than therapy and surgery.

– Massages; If you can’t immediately see why massages might help someone who has tremors, or cramps, or spasms, or muscle wasting, or any number of painful, movement-limiting and life-limiting problems, you probably need to go and have a massage.

– Aromatherapy and acupuncture and all that bollocks; I know, I don’t personally like it, and I don’t think it should be provided as a treatment for anything on the NHS, because, well, it’s not medicine. But if it’s bracketed with the horse-riding and the pedaloes as “This is something which, although not directly helpful, you personally have told us that you find relaxing, and being relaxed makes you better able to manage your own condition, then go for it.” then, well, go for it. I don’t think it should be pushed on patients (But then again, I don’t think that patients should be pushed to go horse-riding or to get massages either) but if they ask for it, and they and their doctor think that their rationale is sound and based in evidence (“I know that acupuncture won’t rebalance my qi, but I really like the feeling of being fussed over and touched and gently hurt, it’s incredibly calming and makes all the treatment easier to bear…”) there’s no harm done.


5 thoughts on “Personal Budgets, or, “What do you mean, free holiday?”

  1. *Applauds*

    This is the sort of thing which should be published alongside all the rather mean-spirited complaining I have read over the last few days.

    Back to a previous discussion about what I pay taxes for: this kind of thing rather than tax breaks for the rich or charitable status for Eton…

    • Thank you 🙂

      It’s at least partially a bitter rant at the people who say “Ooh, swimming, sauna and massages? I’d love to have an illness that was treated with those…”

      • While I am sometimes critical of the concept of “empathy”, especially as used in counselling literature (this may be one for another time), the idea of “walk a mile in my shoes” is something many folk could usefully bear in mind.

        The thought of a chronic physically limiting or disabling condition scares the crap out of me: I hated being off my feet for a couple of months after surgery on my heels and have dreaded anything more serious ever since, which leaves me with great admiration for how you, Inky and others manage (I know there is little comparison).

        And I find that the bitterness of some of my own thoughts and feelings is in direct proportion to the idiocy/stupidity/callousness of what others say and do.

  2. Well said Percy. Thoughtful and well argued. Personal budgets give some freedom to meet defined patient needs in a more imaginative way. That’s the whole point of having them – finding a solution that is not in the BNF, and which clinicians, left to their own devices, might never have thought of!

    Mum had an outing to a garden this week, funded by the NHS, because she has Mild Cognitive Impairment and is desperately socially isolated. She had a wonderful time and was buzzing with the things she had done and seen. Money well spent in my book.

  3. What Murmur said mainly. But with more swears.
    If I had actual control of my budget I might actually have had physio for the last 6 weeks. I might be blessed to adapt my front door for a wheelchair for those times when I need to use one. I might be able to hire hit an to rub out ******* & ***** *** ****…

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