The needs of patients are more important than the needs of the institutions that care for them.
This is hardly a controversial statement. Putting people at the centre of how care is delivered has become a key policy priority for successive governments in recent years. Every policy document now talks the language of 'personalisation', and is generously peppered with the associated buzzwords of 'choice' and 'control'.
A prominent example of giving people greater choice and control, and designing services around their needs, are personal health budgets. They have become an important part of the policy agenda for the NHS in England.
But what do they mean in practice for care providers such as hospices?
Hospices have been providing high quality, person-centred care for decades. They cover the whole spectrum of health and social care for those with a life-limiting or terminal illness, taking care of a person's medical needs but also their emotional, spiritual and social needs too. Hospices offer such services as palliative rehabilitation to help people stay independent, psychological and social support, and practical and financial advice.
A personal health budget is a sum of money that is made available to someone who requires support for their healthcare and wellbeing needs. It is planned and agreed between a person, or their representative, and the local NHS team. It is designed to enable patients to have greater say in the care they use to support them and meet their requirements.
The personal budget can be spent on any care or service that has been agreed with the relevant healthcare professionals. And it could be anything that is deemed to benefit a person's health and wellbeing: from physiotherapy and psychotherapy sessions, to employing personal assistants to help care for them at home.
Personal health budgets are likely to revolutionise the way that people use health services, in a similar way to the transformation that direct payments brought to social care services. But like direct payments, it is likely to be a 'velvet revolution'.
So who can benefit from a personal health budget? From April, those eligible for NHS continuing healthcare have the right to ask for a personal health budget and from this October, this right to ask will be strengthened to the right to have their care delivered in this way. From April 2015, it is expected that anyone with a long-term condition who could benefit from a personal budget will have this option.
There are of course many challenges for health and social care providers with the introduction of personal budgets. Notwithstanding the complex technical and practical issues of budget setting, risk and accountability, the shift towards personalisation will have a huge cultural impact as a new type of relationship will have to be forged between healthcare professionals and newly-empowered patients.
Personal health budgets also raise many specific issues for hospices. New opportunities will present themselves including the potential to increase integrated care across the health and social care divide. Hospices are ideally placed to develop new services such as the provision of advice, brokerage and representative services for those with palliative care needs who are in receipt of a personal budget.
There are many challenges too for hospices. Not everybody will choose to hold a personal health budget at the end of life. Some will prefer to receive their care in the more traditional way. Organisations such as hospices will need to be able to support people whose care will be organised and funded in very different ways, while at the same time ensuring that the quality of care remains constant for everyone. This is especially true if the level that the NHS sets a person's budget is not sufficient to cover the costs of meeting their needs at the quality that a hospice would want to provide.
Hospices were pioneers of person-centred, holistic care and today still continue a tradition of innovation. Whatever the challenges to come, personal health budgets are undoubtedly a key part of the new health landscape. And if they result in people having more choice and control, and ultimately better outcomes, then the revolution will be well worth it.