*NHS credits would empower poorest patients, says Milburn*

*·* Former health secretary wants 'personal budgets'
*·* Blair ally will feed radical ideas into policy group

*Patrick Wintour
Tuesday October 24, 2006
The Guardian <http://www.guardian.co.uk/>*

The former health secretary Alan Milburn, a close ally of Tony 
Blair,
yesterday proposed a new wave of health reforms based on giving 
patients
NHS credits to choose some of their own healthcare.

He said the scheme would empower patients, cut costs and radically
redistribute power in society.

He said the NHS credit or personal budget would eventually be 
offered to
patients suffering long-term conditions. But he said "the 
initial focus
should be on those with complex long-term care needs, including 
patients
requiring palliative care in the most disadvantaged areas where 
health
needs are greatest and where services tend to be poorest".
------------------------------------------------------------------------
He said: "The idea would be to give such patients a choice between
receiving a package of care from the NHS, as they do now, or 
instead
having their own budget - an NHS credit - which they could control
directly."

The patient could then buy his or her care from the NHS or a 
private
provider.

Speaking to a conference in the US, he said: "The value of the NHS
credit could be adjusted upwards for patients who are older or 
poorer.
It would be solely funded by government out of general taxation and
would not be subject to patient co-payment."

Mr Blair has set up six policy groups under cabinet control to 
look at
the long-term challenges facing Britain, and Mr Milburn will 
feed his
ideas into one of these groups.

A scheme has already been introduced in social care to allow 
disabled
and older people to buy their own support rather than relying on 
the
council.

Mr Milburn said: "Patients, particularly those with chronic 
conditions,
want to make choices not just about where and when they are 
treated but
about types of care. So as more information is made available to 
help
patients make informed decisions, those choices should be 
extended to
cover the forms of treatment patients get, not just the location of
treatment."

He claimed the proposal would drive down costs since the price 
of "each
form of care the patient chose with their NHS credit would be
transparent, patients would have strong incentives to opt for 
lower-cost
prevention rather than higher-cost treatment".

He also proposed communities could be given more say over the 
NHS by
opening up primary care trusts to direct elections alongside local
councils.

"Such a reform would be genuinely devolutionary. It would get local
services focussed more sharply on the needs of communities.

"It would fundamentally change the accountability of the NHS 
from one
that is top-down to one that is bottom-up.

"And it would make this great public service open, for the first 
time,
to the voices of the public."

Mr Milburn also urged that the expert patients programme, under 
which
people are taught to understand and manage their long-term 
conditions,
should be "more ambitious".

The government aims to cover 100,000 patients through the scheme by
2012. Mr Milburn said ministers should aim for "at least one 
million".

The Darlington MP, who managed Labour's 2005 general election 
campaign,
was speaking to the Care Continuum Congress in Washington.