From 1 April 2016 the’ right to ask’ for a Personal Health Budget expands to include not only those who currently receive, or will receive in the future, NHS Continuing Healthcare or Children’s Continuing Care but also people with a formal diagnosis of Learning Disability.
The option of a personal health budget (sometimes referred to as a PHB) offers you the opportunity to have more choice and control over how your health and wellbeing needs can best be met. It is a way to get personalised treatment and care that can benefit you most.
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What is a personal health budget?
A personal health budget is a set amount of money to spend on the support and services that will meet your assessed health and wellbeing needs, as agreed between you (or if you do not have the capacity to make decisions yourself, a representative acting on your behalf, for example someone to whom you have given a power of attorney) and your local NHS team. It can be provided in a number of ways – including direct payments – to suit each person.
You will be able to use it for a range of things to help you meet your health and wellbeing needs, such as therapies, personal care and some types of equipment. These might come from the NHS, or the private sector, or voluntary organisations – but they will be tailored to you.
Who is eligible for a personal health budget?
People with long term conditions and disabilities who are eligible for NHS Continuing Healthcare, or children eligible for continuing care, currently have a right to have a personal health budget if they wish. From the 1 April 2016 South Warwickshire Clinical Commissioning Group (CCG) will be extending the PHB offer to include people who have complex needs as a result of their Learning Disability.
Personal health budgets are part of the CCG’s much wider programme of making services more personalised. The CCG will continue to consider whether other groups, not currently included in the South Warwickshire offer for a personal health budget, may benefit from one. There is no new money available to do this and it will take time to change the way in which services are funded to release money to expand the provision of personal health budgets.
Why should I have a personal health budget?
The aim of a personal health budget is to give individuals more choice and control over the money spent on meeting their health and wellbeing needs. PHBs support the vision of a more personalised, patient-focused NHS that recognises you (or your representative) as the expert in your own care. It allows you to have a conversation with your NHS Team to ensure that the outcomes that matter most to you and the way you would like your care delivered are the main focus of your care plan.
Do I have to have a personal health budget?
No. You don’t have to change your healthcare and support if it is working well for you. But if there’s something that isn’t working, or maybe it could be improved if it was delivered in a different way, you can change that through a personal health budget.
It’s important to remember that a personal health budget doesn’t need to cover all of your needs if some of the support you currently receive works for you. A personal health budget is just another option available to those that are eligible, as an alternative way to meet the needs where current support or care isn’t working as well as you would like.
Who decides who can have a budget and how big is it?
NHS South Warwickshire CCG will ultimately decide your budget, in line with your assessed needs, proposed care plan and local policies (based upon national guidance).The CCG will work out your budget based on the cost of delivering your care in the traditional way. You should always be told how much money you will have before you start planning the things you could spend it on. You can find further information within our policy.
What can a personal health budget be spent on?
Everyone with a personal health budget can get support to think through how they would like to use their budget to meet their health and wellbeing needs. Personal health budgets are based upon agreed outcomes. These are written by you (or your representative) with the support of the professional team working with you.
It is the responsibility of local NHS teams to advise people about the option of considering a personal health budget. The team may recommend a range of organisations who can offer local support.
A personal health budget can be spent on any care or services that are set out in the outcome based care and support plan put together with the NHS team or voluntary organisation working with you (or your representative), once this has been agreed by the CCG.
There are a few things that a personal health budget definitely can’t be spent on (see below). The CCG will keep an open mind when considering what you would like to spend your budget on to meet your needs. If it appears that the intervention or support is likely to meet your health needs and your defined outcomes, and as long as it is acceptable from a risk perspective, we would look to include it in your personal health budget.
What can a personal health budget not be spent on?
There are some things that it would not be right for the CCG to fund such as alcohol, tobacco, gambling or debt repayment, or anything that is illegal. These areas are set out in national guidance.
A personal health budget cannot be used to buy emergency care - for example if someone in receipt of a personal health budget had an accident, they would go to Accident & Emergency like everyone else – their treatment would be free and they would not be expected to use their personal health budget to arrange for an x-ray, or get a broken leg set or plastered.
A personal health budget also cannot buy primary care services such as seeing a GP, Dentist or Optician. Other services recommended by a GP, like physiotherapy, or other services that have similar outcomes to traditional physiotherapy, could be included, subject to agreement in the plan.
Can I have a personal health budget as well as a personal budget from social services?
Yes. At present these budgets are kept separate however the CCG is currently working with social services to enable you to have a single budget and plan in the future so you can plan for all your needs. This may be referred to as an Integrated Budget.
If you are a child and you have an Education Health and Care (EHC) Plan your personal health budget should be put together with any personal budget you may have from social care or education and your outcomes for each element of the budget would be set out in your Education, Health and Care Plan.
Will I have to manage my own care?
No. You will not have to do everything on your own. You and your family or carers will agree a care plan with your NHS team. This will say how you will spend your budget to keep you healthy and safe and how the budget will be managed. There are options available for people who want more choice and control over their healthcare but who do not feel able or willing to manage a budget.
Your NHS team can also let you know about organisations that can assist with employer responsibilities if you choose to employ personal assistants. These organisations can help with payroll, tax responsibilities and insurance etc. and their fees will be included in your personal health budget allowance.
However, you can manage your care and budget if that is what you (and your representative) would prefer to do.
What happens if something goes wrong or my needs change?
If your health changes or your plan is not right for you, you can look at it with your local NHS team and change things. You will always get NHS care in an emergency. You can go back to having NHS care like you did before if a personal health budget does not work for you. Your NHS team will also review your needs and care plan three months after your PHB starts and then every year.
Will I have to pay towards my healthcare if I can afford it?
No. There should be enough money in your personal health budget to pay for the care agreed in your care plan.
How can I apply for a personal health budget?
If you are eligible for a personal health budget ask your health professional for more information about how to apply.
For general information:
For more information visit NHS England's Personal Health Budgets website https://www.england.nhs.uk/healthbudgets or email firstname.lastname@example.org
You may also find the following websites of interest: