What is a personal health budget?
A personal health budget is an amount of money given to patients who receive continuing healthcare from the NHS to meet their identified healthcare and wellbeing needs. It gives them more choice and control over the services and care they receive.
In Birmingham and Solihull, we are offering personal health budgets to people who live in their own homes, are registered with a Birmingham or Solihull GP and are eligible for fully funded NHS continuing healthcare (a package of care that is arranged and funded by the NHS for people who are not in hospital but have complex ongoing healthcare needs).
Patients, or their representatives, work in partnership with their nurse to plan and agree the budget that is right for them.
At the centre of every personal health budget is the patient’s care plan. This helps patients, or their carers, to decide their health and wellbeing goals with their nurse who supports them, and sets out how the budget will be spent to enable them to achieve these aims.
Who is responsible for delivering personal health budgets for patients in Birmingham and Solihull?
The following organisations are working in partnership to offer personal health budgets in Birmingham and Solihull:
- The Continuing Healthcare team at NHS Midlands and Lancashire Commissioning Support Unit
- Birmingham City Council
- Solihull Metropolitan Borough Council
- NHS Birmingham CrossCity Clinical Commissioning Group (CCG)
- NHS Birmingham South Central CCG
- NHS Solihull CCG
- NHS Sandwell and West Birmingham CCG (West Birmingham area)
Why have personal health budgets been introduced?
The Government’s vision is to enable people with long term conditions and disabilities to have greater choice, flexibility and control over the healthcare and support they receive. Personal health budgets are one way of helping people to be more involved in discussions and decisions about their care.
Who can have a personal health budget?
All patients who receive NHS continuing healthcare have the right to ask for a personal health budget to take control of their own support.
Why might patients want a personal health budget?
Some people would like to have more choice and control over the money spent on meeting their healthcare and wellbeing needs. This means they can choose treatments and services that are most appropriate for them, so that they can benefit from an improved service.
What happens if people don’t want one?
Personal health budgets aren’t compulsory and people should have as much control over their health and care decisions as they want.
If they don’t want a personal health budget, they will continue to receive the same services that they do at present from the NHS. There will be no change.
How can patients get a personal health budget?
To find out more, they should talk to their nurse.
Even if a personal health budget isn’t right for them, patients can ask their nurse about other ways to make sure that they get the healthcare and support that works best for them.
Will everyone who asks for a personal health budget get one?
Whilst many people will benefit from personal health budgets, this doesn’t mean they are right for everyone. Therefore, in exceptional circumstances requests may be refused. Should this happen, a full explanation will be provided for the refusal.
Can people appeal if they are turned down?
If a patient’s request for a personal health budget is refused, they will be told why. Anyone who wishes to appeal should contact their nurse, who will advise on the next steps.
How are personal health budgets managed?
Once the care plan has been agreed, personal health budgets can be managed in three ways:
Notional budget: the budget is held by the NHS and no money changes hands. Patients find out how much money is available and talk to their nurse about the different ways to spend that money on meeting their needs. The nurse will then arrange the agreed care and support.
Third party budget: the money is paid to an organisation that holds the money on patients’ behalf and helps them decide what they need. After these services have been agreed with their nurse, the organisation then buys the care and support, which the patients have chosen.
Direct payment for healthcare: the money is paidto patients or theirrepresentatives, who buy the services that have been agreed with their nurse.They have to show what they have spent the cash on, but are in control of buying and managing the services.
How does direct payment work?
Patients will be given a direct payment card which will be topped up regularly. This card can only be used for buying care.
Can patients still have a personal health budget if they don’t want to manage it themselves?
Yes, patients can nominate someone else to manage the budget on their behalf. If a carer is responsible for someone who doesn’t have the capacity to manage a personal health budget themselves, the same arrangement may also be possible. However, every effort must be made to ask the patient about their wishes, and their best interests must be kept in mind at all times.
Patients can also manage the care and support they choose in different ways. They could take control of this themselves, or ask another person or organisation to implement what’s in their care plan.
What happens if something goes wrong?
Personal health budgets are intended to give people more choice and not to leave them to take care of everything. Patients can review and update their care plan with their nurse whenever they need to, for example, if their health changes or something in the plan isn't working for them. In an emergency, they would be treated by the NHS as usual, as personal health budgets don’t apply to emergency care.
If they decide they don’t want a personal health budget any more, they can give it up at any time and the NHS will continue to provide the care they need, as before.
What can personal health budgets be used for?
Patients can spend their personal health budget on any care or services that are set out in their care plan and agreed with their nurse. These could include personal care and equipment. Healthcare professionals will give advice and support to help them make best use of the money. This will include explaining how the plan is signed off and what patients can’t use a personal health budget for.
Personal health budgets can’t be used to buy emergency care or the services that a family doctor already provides. However, other services recommended by a doctor, such as physiotherapy, could be included.
Patients are not allowed to spend the money on non-health related services or goods.
Can patients add their own money into a personal health budget?
No. The personal health budget must meet all the patient’s identified health and wellbeing needs.
Patients can spend their own money on extra services (for example, massage or more physiotherapy than their doctor thinks is necessary to improve their health). However, they would need to organise and pay for these services themselves, and this would be separate from the personal health budget.
Does having a personal health budget affect benefit entitlements or eligibility?
Personal Health Budgets are not a welfare benefit and are not part of the welfare system. This means they are not taken into account when calculating your benefits entitlement.
Are there any tax implications?
For most patients, there should be none. However, we would advise people to contact HMRC to discuss their particular circumstances if they have any concerns.
What happens if patients underspend, or overspend, their budget?
Proper planning with their nurse should mean that patients don’t underspend or overspend their personal health budget.
If there is an underspend, the nurse will discuss with the patient what happens to the money. It may be kept for their future healthcare and support, or returned to their local Clinical Commissioning Group.
Patients who have spent more than planned should contact their nurse as soon as possible and discuss this with them. No-one with a personal health budget will be denied healthcare.
Can personal health budgets be used to pay for services outside a patient’s local area?
This will be explored when the support plan is put together and may look at services outside the local area that would benefit the patient.
How do personal health budgets fit with other personalised health and social care initiatives?
Personal health budgets, and personal budgets in social care, both aim to give people more choice and control to meet their care and wellbeing needs. We believe this can improve people’s satisfaction, experience and outcomes.
The Government is currently exploring a number of other personalised health and social care services in England. These include piloting individual budgets for families with disabled children and carrying out a single assessment process and a combined education, health and care plan for children with special educational needs and disabilities.