The Five Year Forward View and the Five Year Forward View Next Steps continue to support the need to put personalisation at the heart of the NHS vision to give people more choice and control of the health care they receive. Personal health budgets (PHBs) are a key mechanism for making this vision happen.
PHBs are one component of the Personalised Care comprehensive model, providing people with choice and control, particularly for people with more complex needs.
A personal health budget is an amount of money to support someone’s health and wellbeing needs, which is planned and agreed between the person, or their representative, and the local clinical commissioning group (CCG) or NHS team.
The amount in someone’s personal health budget is based upon their personalised care and support plan. This plan helps people to identify their health and wellbeing outcomes, together with their local NHS team, and sets out how the budget will be spent to enable them to reach their goals and keep them healthy and safe.
Personal health budgets and personal budgets in social care both aim to give people more choice and control to meet their health or care and wellbeing needs. If someone receives a personal health budget and a personal budget for social care, then it may be possible to join the two budgets together to form a joint or pooled budget.
In some areas, the assessment, planning and monitoring processes may also be joined up between health and social care. The aim of this is to make the experience as straightforward as possible for the person.
Currently only adults who are eligible for NHS Continuing Healthcare and children in receipt of continuing care have the legal right to have a personal health budget, although all areas across England are expected to offer personal health budgets to additional groups of people, based on local need, including people with a learning disability and/or autism.
- People who are referred and meet the eligibility criteria of their local wheelchair service, and people already registered with the wheelchair service, when they require a new wheelchair either through a change in clinical needs or in the condition of the current chair. This group will have a right to a personal wheelchair budget to give them more choice and flexibility over the chair provided.
- People who are eligible for after-care services under section 117 of the Mental Health Act, which is the provision or arrangement of help and support for people who have been detained in hospital under sections 3, 37, 45A, 47 or 48 of the Mental Health Act 1983, when they leave hospital. For this group, a personal health budget may be considered whenever planning is taking place for section 117 mental health after-care needs during an admission to hospital, or at any assessment held to review the person’s section 117 after-care package of support in the community.
What does a PHB involve?
Decisions about who can have a personal health budget outside of NHS Continuing Healthcare are made by local CCGs, who are responsible for paying and planning for most local health services. Every CCG should have information made publicly available about who is able to access one locally.
A personal health budget can potentially be spent on a broader range of care and support than would routinely be commissioned by the NHS, if it is agreed as being appropriate to meet someone’s identified needs.
This could include funding for a personal assistant to help with personal care at home, and equipment such as a wheelchair. There are a small number of exclusions that are outlined in regulation and further outlined below.
Everyone who has a personal health budget should be supported by a suitable professional to think through how they would like to use their budget to meet their health and wellbeing needs. It is the responsibility of local NHS teams to advise people or refer someone to a relevant local organisation who can offer the necessary support. This is often described as brokerage.
What a personal health budget will be spent on, as outlined in their personalised care and support plan, must be agreed between the person or their representative, the local NHS team and where necessary the CCG.
In nearly all cases, people cannot add their own money into a personal health budget, and the budget should meet all the identified health and wellbeing needs of the person.
PHBs can pay for a wide range of items and services, including therapies, personal care, and equipment, allowing more choice and control over the health services and care an individual receives, and the way he or she receives it.
Eligibility for a PHB is determined by national legislation, along with local health needs, financial constraints, and other factors.