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Personal Health Budgets

Personal Health Budgets for individuals eligible for NHS funded continuing healthcare

There have been some recent changes in funding arrangements for individual that are eligible for NHS continuing healthcare.  This means that anyone in receipt of NHS continuing healthcare can ask for their funding to be provided through a Personal Health Budget. 

What is a Personal Health Budget?

A personal health budget is an amount of money provided by the NHS to support an individual’s assessed health and wellbeing needs.  It is planned and agreed between the individual and Ealing Clinical Commissioning Group and gives more control to individuals to purchase services that are meaningful to them.   They are not a suitable option for everyone. 

What can I spend a PHB on?

Personal Health Budgets are personalised, and so it is not possible to be prescriptive about this, but in essence, people mostly purchase care and support from Care Agencies or employ a Personal Assistant.  Personal Health Budgets can’t be used to purchase:

  • Primary medical services
  • Vaccinations or immunisations
  • The National child measuring programme
  • NHS Health checks
  • Urgent or emergency treatment services
  • Surgical Procedures
  • NHS charges such as prescription or dental charges
  • Alcohol or tobacco
  • Gambling
  • To pay a debt (with the exception of debts relating to the Personal Health Budget)
  • Anything illegal

What Types of Personal Health Budget Are Available?

As you are eligible for NHS Continuing healthcare, there are 3 types of Personal Health Budget available to you. You can choose to have the entire personal health budget provided through one type, or you can receive them in combination:

Direct Payment– This type of payment gives the greatest level of control.  Under this arrangement funds are put directly into a bank account specifically set up to manage the Personal Health Budget.  The money is used to buy the care and support jointly agreed with you. You, or your representative, purchase and manage services yourself.  You have to show what you have spent the money on.  There is flexibility for you to have a Direct Payment, but some or all of the budget could be passed to a third party; to manage (for example payroll, pensions or some Human Resource Functions). 

Third Party/Managed Account– This type of PHB has a moderate level of control.  Under this arrangement, a different organisation or trust holds the money for you and helps you decide what you need. After you have agreed this with the Ealing Continuing Healthcare Team, the organisation then buys the care and support you have chosen.  You can be involved in selecting the care provider and staff, but you wouldn’t have to manage them.

Notional Budget- This No money changes hands. You find out how much money is available and talk to NHS Ealing Continuing Healthcare Team about the different ways to spend that money on meeting your needs. They will then arrange the agreed care and support.

How do I get a Personal Health Budget?

The process of obtaining a Personal Health Budget takes about 6-12 weeks and involves 8 stages as follows

1 - Eligible for NHS funded Continuing Healthcare

Personal Health Budgets are currently only being offered to individuals that are deemed eligible for NHS continuing healthcare.  NHS Ealing CCG will write to you informing you of the outcome of your assessment.  This letter will enclose a leaflet giving an overview of Personal Health Budgets alongside contact details for any enquiries

2 - Requesting a PHB from the CCG

If you are interested in the possibility of having a PHB, the CCG will provide you with clear information so you can make an informed decision about whether to request one.  Once you have made a decision, the CCG should be contacted. If you decide to have a PHB, there are a number of steps to follow which are outlined below. 

3 - Your assessed needs (Care Plan)

A Nurse Assessor from the Continuing Care Team will contact you to arrange a convenient time to visit in order to talk through with you, what your needs are and how they could be met with a package of care commissioned by the CCG.  This information is then captured in a care plan.  The care plan is different to a Continuing Healthcare Assessment and is required in order for the CCG to calculate your indicative budget (step 4).

4 - How much money is available (Indicative Budget)

Using information from the Care Plan, the CCG will calculate your indicative budget.  This is a proposed amount of money that the CCG would need to allocate in order to meet your assessed needs as defined within the care plan.  This is discussed internally to confirm that the Care Plan is robust and safe.

5 - Understanding how your needs can be met (Support Plan)

Once the indicative budget has been calculated, the Support Planner will come to meet you with the nurse assessor.  Their role is to personalise your Care Plan by giving you the power to obtain NHS care that best suits you.  This is your opportunity to say how you would like to spend the indicative budget in order to meet your assessed needs.  This information will be captured your own Support Plan. 

6 - CCG Approval (PHB Panel)

The Support Plan will be presented to the CCGs Continuing Healthcare PHB Panel for consideration and approval.  The role of the PHB Panel is to ensure that the plan is lawful, effective, affordable and appropriate.  The CCG must be satisfied that that the assessed needs identified in the care plan can be met by the services specified in the support plan, and that the amount will be sufficient to provide for the full cost of each of the services.  In the event that the Support Plan is not agreed, the CCG will provide feedback so the Support Plan can be amended.  The CCG may approve, partially approve or decline the PHB.  The outcome will be communicated to you.  In the event that the individual is unhappy with the outcome, they have the right to request a review of this decision.

7 - Organising care and support (Implementation)

If the individual is eligible for NHS continuing healthcare and the personal health budget has been approved, they will be in a position to arrange care as agreed in the Support Plan.  If the personal health budget is declined, the CCG may offer to commission/continue to commission care on behalf of the individual in order to ensure their assessed needs are met.

Individuals that choose to employ their own staff will need to comply with UK employment law, and the CCG can provide some support in order to help employers understand their responsibilities.

8 - Monitoring and review (Governance)

Once care and support is in place, the CCG is required to audit the spending and make sure that the health conditions of the individual in respect of which direct payments are made continue to be met.   Individuals receiving a direct payment will be required to provide the CCG with evidence of how the money has been spent, so it is recommended that receipts, invoices and banks statements are kept for this reason.   At least once within the first three months of the direct payments being made; and subsequently, at intervals not exceeding twelve months.

 

For More Information

  1. More information on Personal Health Budgets can be found in the leaflet here
  2. Or you can visit the NHS England Website : http://www.personalhealthbudgets.england.nhs.uk/ 

How do I request a personal health budget?

If you would like to request a Personal Health Budget, ask for more information about, or if you would like to speak to someone about the option of having a Personal Health Budget, please contact:

Lorraine Charlton at lorraine.charlton2@nhs.net or call her on 020 8280 8085 and she will be happy to discuss the options with you.