In 2018, the Department of Health and Social Care and NHS England ran a public consultation on extending the legal right to PHBs. A PHB is an amount of money provided to an individual by their local NHS team, to pay for their health care instead of the NHS team arranging the care themselves.
We made written submissions requesting PHBs should be extended to s.117 aftercare and those who engage with NHS mental health care services. We also highlighted the current lack of legal framework around the assessment process and delivery of s.117 aftercare, the delays in finding suitable aftercare and difference in aftercare depending on where you live.
In response to the consultation in February 2019, the Government announced that PHBs will be extended to s.117 aftercare. They also committed to expand their offer in community based NHS mental health services.
Aftercare should be specific and tailored to the individual. Giving an individual more control over the planning and coordination of their aftercare is a step forward in ensuring that the services received are suitable for the individual’s health needs. Having more control over aftercare enables the individual to change care to suit their needs more frequently (i.e. payment to an IMCA advocate to attend a single meeting, payment for a 10 week mindfulness course etc.). Individuals arranging their own aftercare may in turn, increase the range of aftercare services that the NHS provide by highlighting alternative provisions.
On the other hand, this added responsibility does have the potential to create stress and anxiety. Managing a direct payment and researching appropriate forms of aftercare is more work for the individual. For this change to be a long term success, regular reviews and checks would have to be in place. This is to ensure changes could be made and that the individual is satisfied with services received. The Government and NHS England did mention in their response that no one will ever be forced to have a PHB if they don’t want to. We also agree with this and that the provision of PHBs should be judged on a case by case basis.
Aftercare varies location to location. Those with mental health problems in one area may not have a vast amount of aftercare services available to them due to locality (i.e. a rural location vs. a busy, inner city). This creates a barrier to good, quality aftercare. PHBs give individuals’ flexibility to access support online and outside of their immediate location. This could work for individuals on a short term basis but, this is not suitable long term. Everyone should be able to access the support they need in their immediate area and work should be done to make this happen.
Overall, we are pleased with the proposals and believe they should be implemented very soon. We would expect the Government and NHS to provide lots of support and information to individuals and provide training to frontline staff to manage this change. A good working relationship between frontline staff and the individual is very important. These changes have the potential to empower individuals to have more control and support over their aftercare, but care must be taken to ensure that the burden of arranging care is not shifted to the individual.