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The main focus of this chapter is to explore personal budgets in health care and the main findings from the national evaluation of the personal health budget pilot programme. This chapter focuses on exploring the initial implementation process during the early stages of the pilot. It goes on to discuss the extent to which the implementation of personal health budgets was in accordance with the policy intentions underlying the initiative (as set by the Department of Health) and how much it had an impact on outcomes and cost-effectiveness for patients with long-term health conditions. The results indicated that implementation adhering to the main underlying principles of personal health budgets had the potential to have a positive impact on outcomes for budget holders and whether they were cost-effective compared to conventional service delivery.

Personalized care planning is shared decision making (SDM) applied to the management of long term conditions. Long term conditions require patients to become well-informed about their health issues, the consequences of not taking the appropriate actions and what to do if changes occur. In other words, a collaborative care plan needs to be set. In a collaborative care planning process patients work with clinicians to set goals and agree on action plans for managing their condition and living well. A systematic review found evidence that personalized care planning can lead to improvements in some important indicators of physical and emotional health and self-management capabilities. The process seems to work best when it includes preparation, record-sharing, care coordination and review, involves more intensive support from health professionals, and is integrated into routine care.

This chapter examines the problems inherent in the healthcare system today, and explores what a health system that copes with illness and also helps us to live well for longer might look like. Whether the healthcare system helps or hinders our health may seem a silly question. After all, the NHS has been crucial in saving the lives of tens of thousands of people during the first wave of the COVID-19 pandemic; without it the death toll would have been many times higher. But is our healthcare system helping us to be and remain healthy in the long term? Despite the efforts of the health and care workforce, there were more than 60,000 excess deaths in England and Wales in the three months from March to May 2020. The NHS was not set up, nor was it resilient enough, to cope with normal care and COVID-19 together.

Shared decision making (SDM), health literacy, and patient empowerment are related, partially overlapping constructs, all associated with patient-centred care. SDM focuses on the communication and deliberation process between provider and patient during a health care encounter that aims to support effective decision making about treatment or health behaviour. Health literacy includes functional, critical, and interactional aspects, including the social skills needed to communicate effectively with health providers, and may be a prerequisite for SDM. Patient empowerment has been described as both a process of becoming empowered, and as a state of being empowered, and may be a valued health care outcome for people with long-term conditions. Patient empowerment can be achieved through patient-centred care, including SDM. However, patients can also empower themselves through participation in patient groups, and by improving their health literacy through self education. Relationships between the constructs may therefore be reciprocal.

This chapter looks at how the National Health Service (NHS) and the UK health system as a whole are understood now, and some of the issues that must be addressed. It also explores how to envisage a future that, after the first wave of the COVID-19 pandemic, looks very different to what might have been predicted six months ago. The NHS is a source of deep pride to British citizens because of its founding principles—universal access to healthcare for all, free at the point of use. However, things have changed since the NHS was founded in 1948. Ageing populations present with more and more complex chronic health conditions, but the health and care services have not kept pace and continue to use a single-illness model. This does not work well for patients and is expensive for the payer.