Personal Health Budgets

(PHB)

Information Booklet 2015

Introduction

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NHS South Tees Clinical Commissioning Group (CCG) offers personal

health budgets to people in receipt of NHS Continuing Healthcare and

additionally to people who suffer from Chronic Obstructive Pulmonary

Disease (COPD), Long Term Neurological conditions and Chronic pain.

This leaflet aims to give you information about personal health budgets - what

they are, what they can be used for, how they are managed and how to get

one.

The NHS is exploring a lot of new ideas to help patients have more choice and

control over the care they receive. Personal health budgets are one of these

ideas which the Department of Health is now exploring.

You may already know about personal budgets and the use of direct payments

to receive care and support from social care department - this is very similar,

but for health.

What are personal health budgets?

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A personal health budget is an amount of money that is

available to you for your NHS care, for you to decide how

best to spend it. The aim is to give you more choice and

control over your healthcare.

Personal health budgets can be used very flexibly for a range of

things to help meet your individual health and wellbeing needs. This

might include therapies, self-management courses, personal care, or

lifestyle advice.

You can be as imaginative as you like, as long as it meets your

health and wellbeing needs and have been agreed by a clinician or

care coordinator in your personalised plan.

How much will a personal health budget be?

Each personal health budget will be individual to you and your

local NHS Team will discuss this with you.

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Is there anything it can’t be used for?

Providing everything you wish to spend your budget on meets an

agreed health and wellbeing outcome and does not cause you or

anyone else any harm, personal health budgets can be used very

flexibly.

However there are a few things that you can’t spend your personal

health budget on:

Anything illegal

Emergency services Gambling

Debt repayment Tobacco Alcohol

The money allocated in a personal health budget cannot be used as a

part payment for privately funded healthcare.

The budget is there to meet your agreed needs in full - not to part fund

them - so you are not allowed to ‘top up’ your budget with your own

resources.

If for any reason you wanted to purchase additional care privately, this

would need to take place separately.

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What is a personalised plan?

As part of your Personal Health Budget a personalised support/care

plan will be completed with you and/or your representative. A

personalised plan tells us about you and how you would like to use

your personal health budget to meet your health and wellbeing needs. It

is an opportunity to discuss the outcomes you would like to achieve to

improve the quality of your life.

Personalised plans (or support/care plans) can be in any format, however it

must clearly show what health and wellbeing needs you have, how you plan

to use your personal health budget to meet them and cover the 7 areas

below*:

1. What is important to you?

2. What do you want to change or achieve?

3. How will you be supported?

4. How will you spend your budget?

5. How will your budget be managed?

6. How will you stay in control of your life?

7. What you will do to make this plan happen? *A separate guidance document is available for more details on what a personalised plan

should contain.

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Managing your personal health budget

Managing a personal health budget involves not only spending the money

on goods or services as agreed in your personalised plan, but keeping a

record of this so we can see that your health needs and outcomes are

being met and that your personal health budget is being used

appropriately.

There are three main options available to you to manage your personal health

budget.

It is important to remember that whichever option you choose; you still have

choice over how your personal health budget is spent and how your health and

wellbeing needs are met. Anyone you choose to look after your personal health

budget for you must listen to you and respect your views and opinions.

Notional Budget

NHS South Tees CCG will look after your personal health budget for you and

continue to commission the goods or services you want to meet your health and

wellbeing needs. If you choose this option you will only be able to choose from

goods or services currently commissioned by NHS South Tees CCG.

Third Party Held Managed Account

This is where an organisation has the contract with the CCG and is the employer

but the organisation offers choice and control to the budget holder so they have

the benefits of a direct payment without the employer responsibilities

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Direct Payment

A direct payment gives you full choice and control as you choose where, when

and how you purchase goods and services to meet your health and wellbeing

needs. Your personal health budget will be paid directly into a separate bank

account that you own and you then decide on and arrange the services and

goods you want to purchase. Support services are also available if you require

help with any aspect of receiving a direct payment and support services are

available from a brokerage organisation to manage the money.

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How do I get more information?

The personal health budget pilot finished in 2012, following on from the

end of the pilot NHS South Tees CCG are continuing to offer personal

health budgets to patients over 18 years old who have:

Chronic Obstructive Pulmonary Disease (COPD)

Long Term Neurological conditions (e.g. Motor Neurone Disease, Multiple Sclerosis)

Chronic pain management needs

NHS Continuing Health Care*

From April 2014 individuals that are eligible are able ‘to ask’ for a PHB and from

October 2015 have a ‘right to have’.

*NHS continuing healthcare is the name given to a package of care that is

arranged and funded solely by the NHS for individuals who are not in hospital

who have complex ongoing healthcare needs that have arisen as a result of a

disability, accident or illness.

Eligibility for continuing healthcare is determined following an in-depth

assessment which looks at all aspects of someone’s health and care needs. To

be eligible for 100% NHS continuing healthcare funding, the individual’s primary

need must be a health need.

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Important Information

Personal health budgets are completely voluntary

No one will ever be denied essential treatment as a result of having a

personal health budget

A Personal health budgets does not entitle someone to more services,

more expensive services, or preferential access to NHS services

Approval for treatments (like medicines) that the NHS would not normally

fund because they are not shown to be cost-effective must be obtained in

the normal way

There should be good and appropriate use of NHS resources with clear

accountability for the choices made

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Frequently Asked Questions (FAQ’s)

Frequently Asked Questions

Are Personal Health Budgets means tested?

No. The personal health budgets should be enough to meet your needs in

the way you have agreed without having to spend your own money.

Can I have a Personal Health Budgets as well as a budget through Social Care?

Yes. If the professionals who help you agree that you should try a personal

health budgets and you already have a social care budget they may be able

to find a way to combine all this into one budget.

Will I be responsible for my own care?

You will not be left to take care of everything. You and your family/carers will

need to agree a care/support plan with the professionals who support you. In

an emergency you will get NHS care as normal. If your needs change and it’s

not an emergency you should be able to agree a new care/support plan and a

change in the budget.

What happens if the budget runs out?

In theory the budget shouldn’t run out. The support planning process is de-

signed to make the best use of the budget to meet your assessed needs.

Should any additional amount be sought, your support plan will be reviewed in

light of your change in circumstances.

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What is the referral process?

For further details please contact the personal health budgets team that are part of the wider CCG Continuing Health Care (CHC) Team.

Can personal health budgets be used to pay for medication that GPs won’t

prescribe or that the NHS won’t routinely fund?

No. Personal Health Budgets do not change existing policies and so cases like

this need to be referred to the CCG Funding Panel, as is currently the case.

What is a personalised (support/care) plan?

A personalised plan (or support/care plan) is a detailed plan that tells us about

the individual and how they would like to use their Personal Health Budget to

meet their health and wellbeing needs. It is also an opportunity for them to tell

us about their aspirations and goals and the outcomes that they wish to achieve

to improve the quality of their life.

How long do personal health budgets last?

Budgets are a plan for the following 12 months and cannot be agreed

retrospectively.

If I get a budget does that mean I will stop receiving the health care I use

now?

A personal health budgets is about being clear about the costs that accessing NHS

services incurs. Each patient’s personal health budgets will depend on their

individual health and well-being needs. Having a personal health budgets is about

having the choice to stay with the same services or using the budget to meet your

needs in a different way.

For more information about personal health budgets please contact the:

Personal Health Budgets & Care Management Team

on 01642 746982.

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If you want to share experiences, advice and support with other people

who have a PHB, their carers and families, you can visit the peoplehub

website: www.peoplehub.org.uk.

NHS Choices helps people find reliable information about treatments,

conditions and healthy living, and to comment on their own hospital

experience at www.nhs.uk Find out more about PHBs on NHS Choices at

www.nhs.uk/personalhealthbudgets

To find out all about choice go to:

www.nhs.uk/choiceinthenhs/yourchoices/allaboutchoice/pages/

allaboutchoice.aspx

For more information about the right to choose where you get treatment,

ask your GP, CCG or visit:

www.nhs.uk/choiceintheNHS/Yourchoices/Pages/Yourchoices.aspx

Your health, your way (also called the patients’ prospectus) supports

people to take a more active role in decisions about their care, control

their condition better, and have a better quality of life visit:

www.nhs.uk/Planners/Yourhealth/Pages/Yourhealth.aspx

Information Prescriptions are a quick and easy way to provide information

about your condition and local services at:

www.nhs.uk/ipg/Pages/IPStart.aspx

For further information visit www.southteesccg.nhs.uk