Personal health budget - frequently asked questions

What is a Personal Health Budget?

A Personal Health Budget (PHB) is an amount of money from the NHS allocated to an individual to support their identified health and wellbeing needs. PHBs are not about providing additional money but using the same allocation in a different way to meet assessed care and support needs. PHBs are aimed at helping people maintain their independence, giving them more control over the care and support services they receive.

At the centre of a PHB is a personalised care and support plan which is developed jointly with the individual and those who are involved in their care. This plan helps to identify the individuals’ health and wellbeing goals and sets out how the budget will be spent to enable them to reach their goals and keep healthy and safe.

What are the benefits of having a PHB?

A PHB gives you more choice and control over the support you receive. It allows you to think of new ways to meet your health and wellbeing needs and provides greater flexibility over how and when you receive your care. It gives you more control over your own care and health and wellbeing.

Watch a video from a local Tower Hamlets family and how they have used and benefited from a PHB.

Who is eligible for a PHB?

Since October 2014, adults receiving NHS continuing healthcare and children in receipt of continuing care have had a right to have a PHB. From 1 April 2017 all individuals in receipt of continuing healthcare and continuing care will automatically receive a PHB to meet their eligible needs. They will then have a choice about how this is managed.

All Clinical Commissioning Groups (CCGs) in England are now required to extend the offer of PHBs to people other than those who have continuing healthcare/continuing care needs. Tower Hamlets CCG is widening the availability of PHBs through the Integrated Personal Commissioning (IPC) programme to the following groups of people:

  • Adults with long term conditions, such as diabetes, Chronic Obstructive Pulmonary Disease (COPD) and Chronic Kidney Disease (CKD);
  • Adults with learning disabilities;
  • Adults with mental health problems;
  • Children and young people with disabilities, including those eligible for education, health and care (EHC) plan.

The process for adults in receipt of continuing healthcare and children eligible for continuing care has been in place since 2014 and has been outlined below:

  1. Your health and wellbeing needs are assessed by your CHC/CC team to develop your care plan.
  2. This assessment is then used to calculate how much money you need to support your health and wellbeing.
  3. You will be then be advised how much money you will receive and your support worker will work with you and your carer(s)/family to decide how best to use your PHB and develop a support plan with you.
  4. Once the support plan is agreed and signed off by the CCG, your plan will then be implemented.
  5. Your care and support plan will then be reviewed on an annual basis.

As the offer of a PHB is now being rolled out to a wider group through IPC, work is currently underway to finalise the process for these groups which will be similar to above. If someone receives a PHB and also a personal budget from social care, then these two budgets can be joined together as an Integrated Personal Budget. This is an area of work currently being tested through the IPC programme.

We are striving to join up the assessment, planning and monitoring processes for people who will receive a PHB and have a personal budget for social care, to give people even greater choice and flexibility. The expectation is that this will also improve people’s satisfaction, experience and outcomes as processes will be more efficient and easier for people to manage.

What is a care and support plan?

A care and support plan sets out how you will use your PHB to support your health and wellbeing needs. Your support plan must cover the following key points:

  • The health and wellbeing outcomes you want to achieve
  • How your outcomes will be achieved
  • Risks to your health, wellbeing, safety and independence
  • How you will manage your PHB
  • Contingency arrangements you will have in place should support arrangements fail

Your support plan and budget need to be approved by your local Clinical Commissioning Group (CCG) before your budget can be spent. The lead professional involved in developing your support plan will help you with this. They will decide whether there is sufficient money in your PHB 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 and support plan is approved, you can then buy or arrange the services you need.

How much money will I receive?

This depends on your health and wellbeing needs. Once your budget is confirmed, you will have regular reviews to look at whether your health and wellbeing outcomes are being met and to ensure it is being spent on things identified in your support plan.

What can I spend my PHB on?

You can spend your budget on care, services and/or equipment that meet the personal health outcomes that have been agreed with you. 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 and carers.

How will I receive my PHB?

Adults with continuing health care and children with continuing care needs can choose to receive a PHB using one of the following options:

  • Direct Payment - Money will be paid directly into your bank account and you buy the care and services set out in your plan. 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. There are organisations that can provide support to individuals who decide to choose a Direct Payment.
  • Notional Budget - NHS staff will arrange and pay for services on your behalf.
  • Third Party - You can nominate a third party to hold your budget and arrange your care for you. For example this could be a care agency that will employ a care worker
    on your behalf.

The same payment options will also be made available to the wider group of individuals being offered PHBs. We will undertake a financial risk assessment to evaluate the individual’s ability to manage their PHB before a decision is made about which of the above options is best.

Is there anything that I can’t spend my PHB on?

PHBs cannot be spent on anything inappropriate such as alcohol, tobacco, gambling, debt repayment or anything illegal such as drugs. Other things PHBs cannot be spent on are:

  • Emergency care
  • Primary care 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

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 happens if my PHB runs out?

Your PHB should be calculated annually or as your needs change. This will enable you to plan your care and spend of budget. People will be offered support to manage their budget and this includes having reviews so that any changes to their situation can be looked at and the care plan and budget changed to make sure it continues to work for them.

Are you allowed to top up your PHB with your own money?

PHBs cannot be topped up with your own money. However, if you wish to spend your own money on extra services, (for example, massage or more physiotherapy that 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 PHB.
11.

What happens if I don’t spend the full amount of my PHB?

Any unspent money, beyond the contingency agreed, will be returned to the NHS.

Will having a PHB affect any state benefits that I’m claiming?

No, it will not affect any welfare benefits you may receive as a PHB is not regarded as income.

I am interested in a PHB, who do I contact for further information?

If your needs meet the criteria outlined under point 3 – ‘Who is eligible for a PHB’ please contact a member of the Personalisation Team at Tower Hamlets CCG on 020 3688 2559 or email: thccg.towerhamletsipc@nhs.net with your contact details and a member of the team will be in touch.