Since 1 April 2014, if an individual is eligible for NHS Continuing Healthcare, they have the right to a Personal Health Budget from the NHS to meet their assessed needs. This factsheet explains Personal Health Budgets, what they are, how they work and how they can be managed.
What is a personal health budget?
NHS Continuing Healthcare is a complete package of care funded by the NHS. To be eligible for NHS Continuing Healthcare it must be shown that an individual has a primary health need. Where an individual is deemed eligible for NHS Continuing Healthcare, they have a right to a personal health budget.
A personal health budget is a direct payment used to meet an individual’s assessed care needs, as opposed to that individual receiving commissioned services. This aims to give individuals greater control over planning their care, enabling them to determine how the money is spent meeting their health and care needs.
No individual can be denied a personal health budget unless there are very good reasons for doing so. If a health budget is denied, a full explanation must be given as to why it was denied.
Application and assessment process
Broadly speaking there are nine steps to the process which are as follows:
- Eligibility for Continuing Healthcare established
- Providing relevant information
- Identification of health and wellbeing needs
- Indicative budget setting
- Care / support planning
- Final budget set
- Payment choice
- Implementing care and support
- Ongoing support and review
The patient must understand their health condition and needs, know which services and treatments are available, how much money is available and how it can be spent to achieve their desired health outcomes.
The NHS Continuing Healthcare assessment process and completed Decision Support Tool helps health professionals identify an individual’s care needs. In order to ensure a budget is fixed that is appropriate for those needs, it is important all relevant needs are identified.
The CCG will fix an ‘indicative’ budget to estimate the sum available to purchase care and support based on needs identified at an assessment.
Care and support planning
A support plan will be created to show how the Personal Health Budget will be spent, which considers:
- Clinical diagnosis information
- Options for treatment or care
- Contextual information about lifestyle and the impact of disability
While care planning has always been professionally driven, Personal Health Budgets are shaped by the individual. The patient helps to manage and design their own care package.
Many people benefit from independent support in the care planning process.
Final budget set
Once care and support planning has been concluded, the budget may need to be revised before it is signed off. The budget is there to meet the individual’s agreed needs in full. The Department of Health states that Personal Health Budgets must be compatible with the core principle that NHS care is based on clinical need, not hours or the ability to pay.
A final cost form will detail prices for each service purchased including start-up costs and any respite care agreed. A direct payment agreement form will then be signed by both parties.
There are three payment options available to an individual in receipt of a personal health budget:
- Notional Budget – The NHS will say how much money the individual is entitled to for their care. Together with the NHS, the individual will agree how they want the money spent and the local NHS team will arrange a care package on that basis.
- Third Party Budget – The budget is held by a third party (e.g. a charity) that will look after the money for the individual and work with them to help decide how it should be spent. The third party will purchase the care and support on the individual’s behalf.
- Direct payment for healthcare – The agreed budget is paid directly to the individual or their representative to purchase their own care and support. The individual is responsible for buying and managing the healthcare services they require and must be able to show how the money was spent.
If an individual’s needs change, Personal Health Budgets can be altered. They are also subject to annual review. This will usually be undertaken at the same time as the annual review of eligibility for NHS Continuing Healthcare.
Sadly, although the process should be person centred, not everyone is articulate or assertive. Because of this there is a real need to ensure personal health budgets are focused on genuine health and care needs. It is also important to ensure all relevant care needs are identified and assessed and a budget commensurate with those needs is agreed so that individuals are not exposed to undue risk or poor quality care.
The Department of Health guidance confirms that individuals may need representation. We can provide you with expert help and assistance through the assessment process. We can make sure that the budget you are awarded is sufficient to meet your care needs and, where appropriate, takes into account your preferences.
How Moore Barlow can help
If you require legal advice or representation, please contact our expert team.