1. Personal health budgets and clinicians Dr Paul Hodgkin Sheffield GP Chief Executive Patient Opinion

3. But shopping for health is problematic because Information asymmetries Power unequal Very unequal vulnerabilities

4. “The health economist’s search for the rational consumer of health care is like the search for powdered unicorn horn - never ending, and always destined for disappointment” Robert Evans Canadian Health Care economist

5. So how can we get the benefits of personal health budgets without the problems? By careful extension out from what we have learnt in social care By mapping where it helps and where it does not By having a variety of budget holders

6. Life enhancing today Avoiding death tomorrow Best solution known/ Good evidence Best solution unknown/ No evidence Co-create using small budget Significant Discretionary budget Vouchers and menu based care +/- discretionary budget Accept/decline best practice advice Multiple Co-morbidities Worried well screening Medical aspects of individual LTC Much mental health Life style: obesity, exercise, smoking Palliative care

7. Budget held by professionals Budget held by client, patient or non- professionals Palliative care Exercise Obesity Smoking Stable LTC + mental Health Provider market highly regulated Provider market less regulated

8. Thank you Dr Paul Hodgkin paul.hodgkin@patientopinion.org.uk www.patientopinion.org.uk