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Active Patient

Author: Vidhya Alakeson

This policy paper, published jointly with the University of Birmingham, proposes that individual budgets can create a more patient-centred and integrated health and social care system; one that recognises individuals as experts by experience and engages them as partners alongside professionals in decisions about their own care. This will improve health outcomes, prevent individuals becoming dependent on specialist services and make the NHS more efficient.

A National Sickness Service

The current health service categorises individuals according to their diagnoses and disabilities not their assets and strengths. It focuses on services rather than outcomes and the divide between the NHS and social care separates health from other important aspects of life such as work, family and community. It prioritises professional expertise over the experience of individuals, despite the fact that effective management of chronic diseases depends more on individuals than professionals.

What individuals and families need

In life threatening situations, people will always want to hand over control to a professional. But in many areas of healthcare where there is more than one possible treatment, individuals and families want to be supported to be active partners with professionals in decisions about their care.

Individual budgets

Emerging evidence from pilots in England and the USA demonstrate that individual budgets can improve satisfaction with care and help individuals develop a more holistic approach to care. However, individual budgets present a significant challenge to the current organisation of the NHS and there is a risk that they will get bogged down by bureaucracy and be overtaken by structural changes in the NHS.

Making individual budgets work

Making individual budgets work will depend on a shift in thinking in three areas:

  1. A shift in the balance of power between professionals and patients in favour of patients.
  2. A shift from a system defined by the services it delivers to the health outcomes it secures. 
  3. A shift towards a whole person approach with one integrated budget per person covering all health and social care needs.

 Read and download the free pdf in your browser here.



The publisher is the Centre for Welfare Reform.

Active Patient © Vidhya Alakeson 2010. 

All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.

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