A decade ago, the idea of the NHS allocating money directly to individuals to make choices about how best to meet their health needs was considered impossible. Direct payments in social care had been legal for only five years, and there were fierce objections to extending the approach into health, not least of which was that paying money to individuals was illegal. It is, therefore, remarkable that as of April 2014, PHBs will become an established feature of the NHS, starting with the 56,000 people eligible for NHS CHC. The speed of change has been impressive in a sector that is generally slow to adopt innovation.

PHBs have no doubt benefited from the cross-party support that personalisation as a strand of public service reform enjoys. This has meant that a pilot started under the previous Labour government has been picked up by the current Coalition one, and the decision to extend PHBs is unlikely to be reversed by any future government. But their success owes more to the evidence of their impact than to political favour. When subjected to a rigorous academic test through a national evaluation, PHBs passed with flying colours. They were shown to improve the quality of life and wellbeing of individuals with long-term conditions and disabilities, and to do so in a way that is cost-effective. A large part of that improvement stems not just from the way in which people choose to use their PHBs, but also from the very fact that they have that choice and control. This allows them to define their own outcomes and to use their lived experience and creativity alongside the expertise of clinicians to develop their own solutions.

We know from the stories in this book that PHBs can transform the lives of budget holders and their families. We have heard how much difference they have made to Stephen, Alex, Tom, Yve, Martin and Malcolm, and there are hundreds of others across the country who have benefited from the pilot programme. And they have the potential to benefit thousands more. However, that will all depend on how well they are implemented as they move beyond the pilot stage. The evaluation is unambiguous in its message: PHBs implemented in line with the policy of choice and control for individuals have the strongest impact.