Patients should be a given a personal budget to pay for their healthcare directly, according to a new report from the University of Birmingham’s Health Services Management Centre.

The discussion paper suggests that a system of personalised budgets in the NHS would empower patients to take control of their care. Patients would have considerable freedom to purchase services within the NHS or through private providers.

“Our Health, Our Care, Our Say – what could the NHS learn from individual budgets and direct payments?” was produced in collaboration with in Control, which works to develop a system of care that allows individuals to have the choice and control over the services they use.

The authors argue that any system of personalised budgets in the NHS would operate in a similar way to the Direct Payment model that has been successfully used in social care for almost ten years.

Personalised budgets would also help fulfil government plans to give patients a greater say in their care and would help to remove some of the current funding inequalities in the NHS.

Lead author Dr Jon Glasby explains: “A system of direct payments is not about privatising health services, it is about citizenship and the right to be in control of your life.  At present, people with more money can afford to supplement or bypass public health services. Creating a system of direct payments would offer similar opportunities to everyone.

Under these plans health services would continue to be free, the idea is to give patients greater control over how they want to manage their health”

Direct payments were introduced to Social Care in the late 1990’s allowing people to buy their own services and hire their own staff. Despite concerns about how money might be spent, the system has proved popular with users and has led to considerable creativity and innovation. 

More recently in Control has extended and developed this system to give individual budgets to everybody who uses social care, even those who don't want direct control of the cash.

The authors envisage that direct payments in the NHS could initially be piloted in six areas including care for people with long term illnesses, mental health services and maternity services. This could potentially allow women to employ an independent midwife to manage their birth.

Dr Simon Duffy, Chief Executive of in Control, comments: “Developing direct payments in the NHS would not represent a major shift in policy. Many people with long-term conditions have both health and social care needs – receiving a direct payment for social care but not for health care. The boundary between health and social care is artificial and makes no sense to people who need support.  Fundamental reform will be required in the future.”

Dr Glasby adds: “The experience of the last ten years in social care is that people like the opportunity to take control of managing their care. Fears that people would misuse the money have been unfounded and in many ways individuals have the strongest motivation to get the best possible care for their money.

In fact the evidence shows that giving patients individual budgets can actually help save money. There is no reason why the same system shouldn’t be successful in the NHS.”


For further information contact Ben Hill, Press Officer, University of Birmingham, Tel 0121 4145134, Mob 07789 921163


The report “Our Health, Our Care, Our Say – what could the NHS learn from individual budgets and direct payments? is available on the Health Services Management Centre website.

A podcast featuring interviews with Dr Jon Glasby and Simon Duffy will be available from the University website on August 15th  –


The Health Services Management Centre is one of the leading centres specialising in development, education and research in health and social care services in the UK. HSMC’s prime purpose is to strengthen the management and leadership of these services and to promote improved health and well-being.

HSMC currently has a wide range of research grants from major research funders such as the Department of Health Policy Research Programme and the National Institute for Clinical Excellence. Furthermore, we undertake regular research and evaluation work for Primary Care Trusts, Care Trusts, NHS Trusts and Local Authorities.

In Control

In Control is a social enterprise that works to transform the current system of care into a universal system of Self-Directed Support. Established in 2003 in Control pioneered the concepts of Individual Budgets, Self-Directed Support and Support Plans.

 In Control currently has 100 local authority members who have joined in order to help change their own local systems. In Control has helped 2000 people to control their own Individual Budgets in the last 18 months and is currently supporting 10 local authorities who have committed to totally transforming their current social care systems to Self-Directed Support by 2010. More information about in Control can be found at