Since October 2014, anyone who receives continuing healthcare has the right to have a personal health budget.
What is a personal health budget?
Am I eligible for a personal health budget?
Under NHS (Direct Payments) Regulations 2013, anyone in receipt of NHS continuing health care has the right to have a personal health budget. The amount of money you receive is based on an assessment of your needs.
Currently, adults eligible for Continuing HealthCare and children receiving Continuing Care are those eligible for a PHB. NHS West Norfolk CCG is committed to expanding PHBs/Integrated Personal Budgets (health and social care) to other groups of patients.
What are the advantages of having a personal health budget?
How does it work?
What is a support plan?
A support plan sets out how you will use your personal health budget to support your health and wellbeing needs. Your support plan must cover the following points:
• The health and wellbeing outcomes you want to achieve
• How your outcomes will be achieved
• The risks to your health, wellbeing, safety and independence
• How you will manage your personal health budget
• Contingency arrangements you will have in place should support arrangements fail
Your support plan and budget need to be approved by the Clinical Commissioning Group where you live before your budget can be spent. Your support manager will help you with this. They will decide whether there is 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 care plan is approved, you can then buy or arrange the services you need.
How much money will I receive?
That depends on your health and wellbeing needs. Once your budget is confirmed though, you will have a regular review to look at whether your health and wellbeing outcomes are being met. Depending on the way you receive your money, the management of it will also be reviewed to make sure it is being spent on those things identified in your support plan.
How will I receive my personal health budget?
There are different options for you to choose from and you can choose more than one of the following options to give you the level of choice and control that you want. The options are:
1. As a Direct Payment
Money will be paid directly into your bank account and you buy the services or equipment you and your care co-ordinator agree that you need. You will need to keep financial records and receipts to show how you have spent your budget. If you accept a direct payment you will be asked to enter into a formal agreement and set up a separate bank account for the PHB.
2. A notional budget
NHS staff will arrange and pay for the services for you.
3. A budget held by a third party organisation for your care
You can nominate a third party to hold your budget and arrange your care for you. This could, for example, be a care agency that will employ a care worker on your behalf.
What can I spend my personal budget on?
You can spend your budget on services or equipment that meet the personal health outcomes that you and your Care Co-ordinator have agreed as long as they are lawful. 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 you and your carer some respite
• Activities that will help you become more active in the community and improve your physical and mental health
• Support can also be designed in ways that will also help your family carers.
In exceptional circumstances you may be able to use your direct payment to employ a close relative. The NHS is not responsible for any claims, damages, losses, expenses or liabilities arising from the support or care provided to you by those employed or engaged by you or your representative.
Is there anything that I can’t spend my personal health budget on?
Personal health budgets cannot be spent on anything inappropriate such as alcohol, tobacco, gambling or debt repayment or anything illegal such as drugs. Other things 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 which everyone has to pay for (unless exempt)
• Prescription charges which everyone has to pay for (unless exempt)
• Day-to-day living expenses
• Residential or nursing home
• Community nursing
• Rehabilitation through therapies, eg occupational therapy, falls prevention, speech therapy, podiatry and dietetics
• Musculoskeletal treatment
• Continence advisory services
• Intermediate care services eg rehabilitation before returning home from hospital
• Wheelchair users’ service
The NHS reserves the right to terminate your direct payment or third party arrangement if the money is not being used for what it was intended.
What if my personal health budget runs out? Can I top it up with my own money?
Your personal health budget should be calculated annually on the basis of your specific needs. You cannot top it up with your own money.
If you wish to spend your own money on extra services however, (for example, massage or more physiotherapy than your doctor thinks is necessary to improve your health) you can do this. You would need to organise and pay for this yourself, and it would be separate to your personal health budget.
What happens if I don’t spend it all?
Will having a personal health budget affect my benefits?
Do I have to have a personal health budget?
How can I get a Personal health budget?
Talk to your local NHS team who help you most often with your care - this might be a care co-ordinator or your GP. Even if a personal health budget is not right for you, you can talk to them about other ways to make sure that you get the healthcare and support that works best for you.
NHS Choices also has more information on PHBs. Visit their website here http://www.personalhealthbudgets.england.nhs.uk/