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About Personal Health Budgets

My care package is a Personal Health Budget (PHB), and I thought I’d explain what PHBs are for those who are unfamiliar with them.

A Personal Health Budget is an amount of money to support the identified healthcare and wellbeing needs of an individual, which is planned and agreed between the individual, or their representative, and the local clinical commissioning group (CCG). It isn’t new money, but a different way of spending health funding to meet the needs of an individual.

Personal Health Budgets are one way to give people with complex health needs, long term conditions and/or disabilities more choice and control over the money spent on their health and wellbeing needs, enabling more flexibility over how the money is spent and what on, and putting people in the driving seat of their care.

What Can A PHB Be Spent On?

A Personal Health Budget may be used for a range of things to meet agreed health and wellbeing outcomes. This can include:

  • Personal care
  • Therapies
  • Equipment and Assistive Technologies
  • Training for those providing care.

However, there are some restrictions in how the budget can be spent.

Personalised Care and Support Planning

An essential component of Personal Health Budgets (and personalised care more widely) are personalised care and support plans. A personalised care and support plan is a plan created between the individual and the local NHS team, and often involve input from a multidisciplinary team of professionals, and it enables people to identify their health and wellbeing goals, and to set out how the budget will be spent to enable them to reach their goals, to have quality of life and to keep healthy and safe. The process of personalised care and support plan also seeks to identify how these needs and outcomes will be met, and allows the NHS team and the individual to begin to think about who is going to meet these needs, how and when.

Expectations From The Process

The person with a personal health budget (or their representative) should:

  1. Be central in developing their personalised care and support plan and agree who is involved
  2. Be able to agree the health and wellbeing outcomes* they want to achieve, together with relevant health, education and social care professionals
  3. Get an upfront indication of how much money they have available for healthcare and support
  4. Have enough money in the budget to meet the health and wellbeing needs and outcomes* agreed in the personalised care and support plan
  5. Have the option to manage the money as a direct payment, a notional budget, a third party budget or a mix of these approaches
  6. Be able to use the money to meet their outcomes in ways and at times that make sense to them, as agreed in their personalised care and support plan.

*And learning outcomes for children and young people with education, health and care plans.

How PHBs Work

Personal Health Budgets can be used and managed in different ways.

  1. Notional Budget
  2. Third Party Budget
  3. Direct Payment

One option doesn’t have to be used in isolation, individuals can use different forms of PHB depending on their needs.

Notional Budget:

The CCG will still manage the individuals’ care entirely, commissioning the services and organising the provision of care, but the individual has greater choice over how the funding is spent, which providers are used, and what care is provided when and how.

Third Party Budget:

An organisation legally independent of both the individual and the NHS (for example, an independent user trust or a voluntary organisation) holds the money for the individual, pays for and arranges the care and support agreed in their care plan, but the individual will still have greater control over the care provided, when, how and by who. It is a collaboration between the third party and the individual (or representative).

Direct Payment:

Direct payments give the individual/representative the ability to manage the package themselves and employ staff directly and/or commission and arrange their own care from providers.

The financial aspect can be managed in one of two ways.

The individual/representative can open a dedicated bank account for their package funding, have the funding paid into that account and manage the package entirely themselves, including responsibility for paying wages, tax, pension contributions and national insurance, and/or paying invoices for providers and other costs.

The other option is to use a financial brokerage service who will manage the payment of staff wages and tax, NI and pension contributions and payment of invoices and other costs, whilst the individual/representative manages the care aspect of the package and is the legal employer.

My PHB

My Personal Health Budget is a direct payment, in which I am the legal employer and manage the package myself, but the finances themselves are managed by a brokerage service.