Abstract
In social care, there has for some time been the option for individuals to use direct payments to manage their own support, and more recently individual budgets have been piloted. While this approach has not been available for healthcare payments, there is the potential for this to change. This paper outlines the implementation of direct payments and personal budgets and then discusses some of the issues which should be considered if such arrangements are introduced in healthcare. These include: preparing existing staff for such changes in funding and the implications for them; clarifying the new roles and responsibilities of community nursing teams, training opportunities for staff who are employed directly by individuals; staff recruitment and retention, and designing evaluation mechanisms which assess quality as well as cost.
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