Factsheet: Personal Health Budgets

1. What are Personal Health Budgets?
2. The benefits of Personal Health Budgets
3. Personal Health Budget restrictions
4. Potential problems with Personal Health Budgets
5. Personal Health Budgets: The results so far
6. The future for Personal Health Budgets
7. Help with Personal Health Budgets

What are Personal Health Budgets (PHBs)?

Personal Health Budgets are intended to enable people with long term conditions and disabilities to have “greater choice, flexibility and control over the health care and support they receive.”

A Personal Health Budget will be agreed between the individual and their local NHS team.

After a period of pilot projects PHBs are now to be “rolled out” to those currently in receipt of NHS Continuing Healthcare. From April 2014, people receiving NHS Continuing Healthcare Funding have had the right to request a Personal Health Budget. From October 2014 this has become a right to receive a Personal Health Budget, rather than a right to request.

The benefits of Personal Health Budgets

The underlying principles for the Personal Health Budget are that the person (or their representative) will:

• Be able to choose the health and well-being outcomes they want to achieve, in agreement with a healthcare professional
• Know how much money they have for their health care and support
• Be enabled to create their own care plan, with support if they want it
• Be able to spend the money in ways and at times that make sense to them, as agreed in their plan
• Be able to choose how their budget is held and managed

1) Self-managed through a direct payment

2) Managed notionally by the NHS commissioner

3) Managed by a third party (agency or relative/friend)

Personal Health Budget restrictions

Personal Health Budgets cannot be used to:

• Part-fund treatment with the patients’ own money
• Fund primary medical and emergency services
• Fund anything illegal or be put towards gambling, debt repayment, tobacco or alcohol
• Pay for carers who live with the PHB holder AND are also relatives (except in exceptional circumstances)

Potential problems with Personal Health Budgets

There are major concerns about the restriction that PHB Budget Holders cannot continue to live with anyone who provides care to them (and is paid for their services). Family members who have spent years caring for their relatives may have to move out of their home in order to continue providing support and assistance to their loved ones and be paid for this at the same time. This exclusion for Personal Health Budgets is not absolute, but it may leave some service users and their family carers feeling that they are being subjected to thorough questioning and investigation by their local Clinical Commissioning Groups. You should seek advice about how to argue “exceptional circumstances”.

Personal Health Budgets are being introduced at the same time as many Clinical Commissioning Groups are reviewing their commissioning responsibilities and looking for economic savings in NHS Continuing Healthcare funded care packages. Some individuals may feel that Personal Health Budgets offer them protection against cuts in funding, but this may not be the case.

If you, or a relative, find yourselves in either of these situations, then we can provide further advice and assistance.

Personal Health Budgets: Results from the research

• Overall, those with Personal Health Budgets found that their health ‘status’ remained stable during the pilot
• Personal Health Budget holders felt significant improvements in their care-related qualify of life and psychological well-being
• Genuine choice, control and clear information are key factors in ensuring that Personal Health Budgets work well, rather than imposing restrictions on Personal Health Budget holders
• The pilot suggests that people in receipt of Personal Health Budgets had fewer stays in hospital as their in-patient costs fell during the pilot

The future for Personal Health Budgets

The Evaluation of the Personal Health Budget pilot program (November 2012) put forward the following key recommendations for the wider implementation of Personal Health Budgets:

• Personal Health Budgets are best offered to people with greater need, to act as a substitute for conventional service delivery
• Personal Health Budgets are cost-effective for people with mental health problems and those receiving NHS Continuing Healthcare but are inconclusive for other health conditions
• Policy makers should anticipate that the use of Personal Health Budgets is likely to result in a higher level of expenditure going to non-NHS providers
• The budget-holders that were interviewed emphasised the value of information and guidance from sites about the size and operation of their budgets, including what services were and were not covered
• Accounting procedures for Personal Health Budgets should be better coordinated with those of social care personal budgets, where relevant. Difficulties with communication and managing social care personal budgets and Personal Health Budgets where an individual receives both were evident – particularly disputes between Health and Social Services over who should be funding what
• Procurement and recruitment support for Personal Health Budget holders are valued by recipients, particularly those managing their own Personal Health Budget without external support
• Regarding the initial set-up of Personal Health Budget systems, organisational representatives indicate the benefits of tackling cultural change issues among staff with good communication, engaging with all representatives, and developing adequate internal systems
• As a result of this, the evaluation report recommends that the Department of Health provides further guidance as to budget setting, coverage and the facilitation of choice

Help with Personal Health Budgets

If you have any questions about Personal Health Budgets, or any other aspect of paying for care, our expert Community Care Team can help. Contact us today on 01273 609911, or email info@ms-solicitors.co.uk.