This article looks at how personal health budgets in England work, as well as how to draw up effective care and support plans. It is taken from a Community Care Inform guide on this topic. The full guide covers a history of personal health budgets, law and policy, direct payments, drawing up and reviewing care and support plans and the integration of both personal health budgets and personal budgets. Inform Adults subscribers can access the full content here. The guide is written by Mark Ivory, editor of the Journal of Dementia Care and an experienced social care journalist.
Personal health budgets (PHBs) are the NHS equivalent of personal budgets in local authority social care and are designed to give people more choice and control over how their healthcare needs are met and help them to live more independently.
The NHS in England has been targeted with significantly expanding the number of people with PHBs over the next two years and many will have social care needs and so already be known to adult social services. In light of this, it is important for practitioners to understand how PHBs work, including who is entitled to them, how they may interact with social care personal budgets and the role of health professionals in managing them.
PHBs are mainly intended for people with long-term health conditions, complex needs and disabilities, enabling them to live more independently, take control of their own care and support, and improve their chances of staying out of hospital. PHBs were introduced in England – they are not available in Wales – as a mainstream service in 2014, when adults eligible for NHS continuing healthcare and children and young people eligible for continuing care were given the right to have a PHB.
They are designed to be used flexibly, but it should be remembered that PHBs are not new money – they are about using existing resources/budgets in a different way, to enable people to achieve their health and wellbeing outcomes. The service user’s clinical commissioning group (CCG) must grant a request for a PHB unless this is an inappropriate way of providing their healthcare.
Service users with local authority personal budgets who move on to continuing healthcare have sometimes found it easier having a PHB because the NHS then takes funding responsibility for their social care as well as their healthcare needs, which can both be delivered through a PHB.
Just like local authority personal budgets, PHBs involve allocating a budget to an individual to meet their needs. The two systems also involve a similar series of stages in establishing the budget – an assessment that establishes an ‘indicative budget’, followed by care and support planning that leads to a final budget. There are also a similar range of options for managing a PHB as for a social care budget: a notional budget, held by the CCG, a third-party budget, held by another organisation, or a direct payment, where the service user manages the budget themselves. Whichever budget option the service user chooses, it is important that they always know how much money they have in the budget and are able to manage it in line with their care and support plan.
Drawing up care and support plans
PHB support plans are similar to those in social care with a corresponding emphasis on personalisation, choice and control, and should be drawn up once agreed by the CCG that the individual has an eligible health need and an indicative budget has been decided. The care and support plan should state what outcomes the service user wants to achieve and how they are to be achieved in the context of the care and support options available in the community, as well as any social and family support networks.
Care and support plans should be built around the service user’s wishes so they are individually tailored to their health and wellbeing needs and outcomes, going beyond immediate needs to consider their life as a whole.
As with social care personal budgets, PHBs should be regularly reviewed to check whether they are achieving their desired outcomes. Social care staff have a key role in linking with health professionals to join up care and support arrangements for personal budgets with those for PHBs. PHBs and personal budgets can often be used in conjunction to pool the two kinds of budget together, for example, to help a family with multiple problems by creating one larger budget that can deliver more personalised outcomes.
The full guide on how personal health budgets work provides more in-depth information on their history, how law and policy defines them, how direct payments work and on the integration of PHBs and personal budgets.
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