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16 May 2019

People with multiple physical and mental health conditions have long felt that the NHS’s one-size-fits-all approach to health and social care does not always meet the complexity of their needs. In line with a national approach to delivering personalised care, Bedfordshire Clinical Commissioning Group (BCCG) is addressing this problem by increasing access to Personal Health Budgets (PHB) to give patients more choice and control over their own care.

A PHB is an amount of money allocated for the cost of the patient’s support and care which has been discussed, planned and agreed between the patient, or their representative, and the local NHS team. This is not new money; it is NHS money that would normally have been spent on traditional healthcare being spent more flexibly to meet the patient’s individual needs.

All patients, adults and children, receiving continuing healthcare (CHC) from BCCG are entitled to have their care funded by a PHB. A PHB can be part of a joint package of care with, for example, social services, although at present PHBs are not available for residential care.

So how does it work?

Personal care plan

First, the patient – or if appropriate, their parent or guardian – discusses with the CCG’s relevant team (CHC, children’s, mental health or learning disability) whether a PHB is the right funding option for the support and care they need.

The professional will discuss with the person and their family/carers what is important to them to meet their health and wellbeing needs and jointly agree a personalised care plan. A PHB cannot be used to pay for routine GP care or emergency care. These services will continue to be accessed in the usual way. The personal care plan can also be adapted should any changes occur in the patient’s circumstances.

The amount of money making up the PHB will vary from person to person depending on their individual needs. The money can be spent on any care or services agreed with the NHS team as part of the personal care plan. This can include therapies, personal carers and equipment. For example, someone with profound learning disabilities and complex health issues who needs care 24 hours a day may receive person-centred care at home funded by a PHB.

A wheelchair user with a sporting interest could spend part of their PHB on a specially designed and adapted wheelchair to enable them to take part in their chosen sport.

Someone whose physical disability is creating a sense of isolation may use a PHB to pay for an assistance dog, which would help with the day-to-day tasks they previously had found so difficult, and provide companionship to break down the feelings of loneliness that can have such a devastating effect on mental health. 

As these examples show, a PHB can be used to pay for services and care that many people would view as being outside the traditional definition of healthcare. But research has found that by adopting this whole person approach to delivering care and support, an individual’s health and wellbeing can improve significantly.

Quite often this means patients don’t have to go into residential care, it can reduce the amount of medication they take and avoid costly referrals and other medical interventions. So NHS resources are being used far more effectively too.

Managing a PHB

Like all budgets a PHB has to be managed and this can be done in one of three ways. It can be provided as a “notional” budget, where no money changes hands, and the NHS team organises payment for the care and support agreed in the patient’s personal care plan. This is similar to the way continuing healthcare has been delivered up to now.

A PHB can also be provided as a real budget held by an independent third party. When a decision has been made on the type of care the patient needs, the third party would release funds to pay for it. For example, if a patient decides to employ a carer direct rather than from an agency, the third party would be responsible for the carer’s salary being paid. They could also offer support with employment issues such as recruitment, tax and payroll.

The other option sees the PHB going direct to the patient or their representative who would then be responsible for buying and managing the care and support agreed with the NHS team. But the patient or their representative would have to show how the money is being spent.

A PHB gives people in need of healthcare greater choice, increased flexibility and more control over their care and support. If you would like more information about personal health budgets, email BCCG’s Continuing Healthcare Team at chcadmin@nhs.net or call 01525 864430.

More general information is available at https://www.england.nhs.uk/personalisedcare/ 

Diana Butterworth
NHS Bedfordshire CCG
Head of Continuing Healthcare and Personalisation

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