What is a Personal Health Budget?
Local Authorities across England have been offering Personal Budgets to people to enable them to take as much control of their care as possible for several years. Personal Health Budgets sees a similar mechanism available for people who are eligible for NHS Continuing Health Care.
A Personal Health Budget offers a person control of the money used to support a person’s identified health and wellbeing needs, planned and agreed between the person and their local NHS team.
Currently a Personal Health Budget is only available for people who are eligible for NHS Continuing Health Care, or are jointly funded through that route. Our longer terms vision for personal health budgets is to enable people with long term conditions and disabilities to have greater choice, flexibility and control over the health care and support they receive.
What are the essential elements of a personal health budget?
The person with the personal health budget (or their representative) will:
- Be able to choose the health and wellbeing outcomes they want to achieve, in agreement with a health care professional
- Know how much money they have for their health care and support
- Be enabled to create their own care plan, with support if they want it
- Be able to choose how their budget is held and managed, including the right to ask for a direct payment
- Be able to spend the money in ways and at times that make sense to them, as agreed in their plan
How can a personal health budget be managed?
Personal health budgets can be managed in three main ways, or a combination of them:
- Notional budget: the money is held by the NHS
- Third party budget: the money is paid to an organisation that holds the money on the person's behalf
- Direct payment for health care: the money is paid to the person or their representative
What are the principal stages of the personal health budgets process?
Assessment/Review - The first step in developing a personal health budget is a full assessment whereby a person is recognised as having a health need. For people eligible for NHS Continuing Health Care this is the Decision Support Tool used under the NHS Continuing Health Care Framework.
Indicative Budget - Having established a clear understanding of an individual’s needs, it is then necessary to identify the cash value of the personal health budget which that person can use to meet their identified needs. This is the indicative personal health budget for that particular individual, which gives a guide as to how much the NELCCG usually pays for care for people with similar levels of need.
Plan Support - The in-depth understanding of needs to be met provides the starting point for developing a care plan, which identifies the goals a person has for their health and wellbeing and how those goals could be met. There is no set menu, allowing people to develop highly personal, creative solutions. The Indicative Budget gives a ‘ball-park’ as to what level of resource may be appropriate to meet similar needs. The individual can complete their care plan by themselves, with the support of family and friends, or with their case worker, and clinicians should also be closely involved in the planning process.
Agree Plan - The care plan is approved on the basis of being financially and clinically appropriate. Since there is no fixed menu, approval should focus on the likelihood that the plan will meet the individual’s identified goals or outcomes, and do so within reasonable financial limits.
Individuals can exercise as much or as little direct control over the money in their personal health budget as they choose. They can receive it as a direct payment that they manage, they can use a third party to manage it on their behalf, or it can be held by a provider or commissioner. However the money is held, individuals should be able to spend it flexibly to meet their needs.
Implement Plan - With decisions made about what needs are being addressed towards what outcomes (and how the money will work) the services and supports in the plan can be put in place, either by the person themselves , their representative, or by the organisation that holds the budget in collaboration with them.
Review & Learn - A person’s care plan is reviewed at least annually and its effectiveness is judged on the basis of whether the outcomes identified in the plan are being met, and the money spent appropriately. If a person’s needs change significantly, they will complete a new assessment and will be allocated a new personal health budget.
General Grounds for which a Personal Health Budget plan will not be agreed
By regulation PHBs cannot be used for:
- Something that is illegal
- gambling, alcohol, or tobacco
- Emergency or acute services
- The majority of primary care services (including visits and assessments of GPs)
- Debt repayment
As commissioners of Health and Social Care, NELCCG is responsible for the proper and ethical use of public, or taxpayers, money. NELCCG will not agree a Person’s plan we think the plan is likely to do harm to somebody, if the package of care or cost of the package of care is disproportionate to the level of need identified through the assessment process, or if identified needs are not met through the plan.
How do I get a Personal Health Budget?
If you think you may be eligible for a Personal Health Budget and wish to give it a go, contact your Case Manager or Lead Health Professional.