Personal Health Budgets (PHB)
About Personal Health Budgets
A Personal Health Budget (PHB) is an amount of money, from the NHS Clinical Commissioning Group (CCG), allocated to pay for the care and support needed to meet an individual’s identified health and wellbeing needs. Personal Health Budgets are aimed at helping people maintain their independence by giving them the opportunity to have more control over the care and support services that they receive. Personal Health Budgets allow people to plan how and when care and support is delivered and to use their budget to buy services and equipment that best meet their needs.
Who is eligible to have a Personal Health Budget?
Since October 2014, Personal Health Budgets have been available to anyone receiving NHS Continuing Healthcare and are now automatically offered to all patients. From October 2019, anyone receiving Section 117 aftercare or accessing the Wheelchair services can also ask for a Personal Health Budget or Personal Wheelchair Budget. The amount of money that you receive will be based on an assessment of your needs.
How can you use a Personal Health Budget to get the care and support that you need?
There are three methods of managing your Personal Health Budget and you might choose one or more of the following options to give you the level of choice and control that you want.
The options are:
1. A Notional Budget.
You will still be involved in care planning, but the CCG will commission, purchase and pay for any services that you need. You will receive all of the care and support that you need to achieve your health outcomes but there will not be any requirement for you to manage any staff or payments. The CCG will continue to support you and review your care and will work with you to make changes if your circumstances change.
2. A Third-Party Budget.
You can nominate a Third-Party organisation, independent of the CCG or NHS, to hold your budget and arrange your care for you. This could, for example, be a care agency that will employ and manage personal assistants on your behalf. Your case manager can help you to arrange this and your Personal Health Budget will pay for the Third-Party service.
3. A Direct Payment
Money will be paid directly into a separate bank account and you can use it to buy the services, or equipment, that you and your case manager agree that you need. You will have to keep financial records and receipts to show how the budget is being spent. If you decide to take a Direct Payment you will be asked to enter into a formal agreement with the CCG.
What are the advantages of having a Direct Payment or Third-Party Personal Health Budget?
A Personal Health Budget can give you even more choice and control over the way that you receive your care and support. It allows you to think about how you would like to meet your health and wellbeing needs and it provides greater flexibility over how and when you receive your care. It gives you more control over your own health and wellbeing
If I am eligible, how can I get a Personal Health Budget?
Talk to the NHS or CCG team that helps you with your care. They can discuss ways to make sure that you get the healthcare and support that works best for you
How is the value of a Personal Health Budget calculated?
Your health and wellbeing needs will be assessed by an assessor and used to develop a care plan. This assessment is used to calculate how much money is needed to support your health and wellbeing. You will be told how much money is available and your support worker will work with you to decide how best to use your Personal Health Budget and to develop a support plan with you. Once the support plan is agreed by you and your case manager, your Personal Health Budget will be confirmed, and your plan implemented.
What is a support plan?
A support plan sets out what care and support you need and how you will use your Personal Health Budget to meet those needs. Your support plan should cover the following key points:
- The health and wellbeing outcomes you want to achieve
- How you want to achieve those outcomes
- Any risks to your health, wellbeing, safety and independence
- How your Personal Health Budget will be managed
- Contingency arrangements you will have in place should any support arrangements fail
The support plan and budget need to be approved by the CCG before your budget can be spent. There must be sufficient money in your Personal Health Budget to pay for all the support and services outlined in your support plan. Everything in your support plan must be lawful and comply with Department of Health guidelines. Once your support plan is approved, you can then purchase, or arrange, the services you need.
What can I spend my personal budget on?
You can only spend your budget on services or equipment that meet the personal health outcomes that you and your case manager have agreed.
Examples of how you might choose to spend your money include:
- Employing your own personal assistant to help you manage your daily living
- Live-in support in your own home
- Aids, adaptations and equipment to help you manage day-to-day tasks
- Taking a break to give an unpaid carer or family member some respite
- Activities that will help you to improve your physical and mental health
- Support can also be designed in ways to help your family carers.
Is there anything that I cannot spend my Direct Payment PHB on?
Personal Health Budgets cannot be spent on anything inappropriate such as alcohol, tobacco, gambling or debt repayment. Some other things that Personal Health Budgets cannot be spent on are:
- Emergency or acute health care services
- Primary care services (including GP services)
- Optical, dental or other services that everyone has to pay for (unless exempt)
- Prescription charges
- Day-to-day living expenses
- Residential or nursing home costs
- Community nursing
- Rehabilitation through therapies, such as occupational therapy, speech therapy, podiatry and dietetics
- Continence advisory services
The CCG reserves the right to terminate any Direct Payment or Third-Party arrangement if the Personal Health Budget funds are not being used for the agreed purpose.
If I have a Direct Payment PHB who can I employ to provide my care?
You must ensure anyone employed to provide your care is DBS checked and is trained to the right skill levels so that you are supported correctly and safely. You cannot take a Direct Payment and employ your own family members. If being cared for by family is the safest way to overcome care issues we would explore the option of using a Third-Party organisation to employ them on your behalf.
Anyone providing care and support as a Personal Assistant (PA) must be properly employed with a job description, a contract and terms and conditions. We do not allow the use of any self-employed PAs or carers to provide personal care unless they are registered as a care provider with CQC.
What if my Personal Health Budget runs out? Can I top it up with my own money?
You are not able to top a Personal Health Budget with your own money. Your Personal Health Budget will be calculated to meet all of your agreed health needs. If circumstances change, we will review your needs and, if necessary, re-calculate your budget.
Should you wish to purchase complementary services, (for example, more massage or physiotherapy than your doctor has prescribed, in order to improve your wellbeing) it would be acceptable to fund these from your own money. You will need to organise and pay for this yourself, and it would not be included in your support plan and Personal Health Budget.
What happens if I do not spend all of the funds?
You might be given more money than you need so that any emergencies can be covered. Periodically, surplus money in your bank account, beyond any agreed contingency funds, will be reclaimed by the CCG.
Will having a Personal Health Budget affect my benefits?
A Personal Health Budget is not classed as income and so it will not affect any welfare benefits that you receive.
What if I don’t want to have a Third Party PHB or Direct Payment?
If managing your own care and support does not suit your lifestyle you will be allocated a Notional Personal Health Budget and the CCG will purchase and manage the care that you need. You will still be involved in all care planning and any decisions that affect you or your health and wellbeing.
Other places where you might find helpful information on Personal Health Budgets:
You can find more information about PHBs and how they are being introduced in England at http://www.personalhealthbudgets.england.nhs.uk/
A charity and social enterprise that has played a very important role in the introduction of personal budgets and personal health budgets in England. https://in-control.org.uk/
A national organisation run by, and for, people with Personal Health Budgets. You can contact the network and get in touch with other people with Personal Health Budgets. https://www.peoplehub.org.uk/
Herefordshire and Worcestershire CCGs PHB policy can be found here:
NHS Herefordshire & Worcestershire Clinical Commissioning Group (CCG) Operational Policy for Personal Health Budgets (PHBs) (herefordshireandworcestershireccg.nhs.uk)