Personal health budgets to be rolled out

People receiving continuing healthcare support from the NHS will have the right to ask for a personal health budget by April 2014.

The announcement has been made by Health Secretary Andrew Lansley and it will give tens of thousands of people who receive NHS Continuing Healthcare - those assessed to have complex health and care needs - more choice and control over their care.

Commenting on the announcement, Andrew Lansley, said: "Personal health budgets clearly fit with the future direction of a modern NHS - an NHS which focuses on quality and gives patients more control and choice.

"[Personal budgets] allow people to work with the NHS so that they can receive more personal, more tailored care which fit with an individual's life and uses resources most effectively.

"This is a solution which must come as part of a cultural shift for doctors, healthcare professionals, providers and patients which sees the patient as an equal partner in decisions about their care. It will personalise the NHS and provide more integrated high quality care across health and social care."

Rita Brewis who leads In Control's health work, said: "In Control wholeheartedly welcomes the latest announcement from the Health Secretary which will open up the possibility of many thousands of people having more power and control over decisions over their health care, and contributing their creativity and ideas to improving or maintaining their health and wellbeing as active participants. We hope that the overall drive for a changed relationship between the NHS and people with ongoing health conditions can evolve across people with a range of illnesses.

"What will be important, from our perspective, is that in time this approach is available for everyone who wants to have more say in the decisions which are effecting their day-to-day lives. We think that those decisions will be most effective when they are informed by best professional health advice on treatment options synthesised with what matters most from an individual's perspective. It will also be necessary for people to have sufficient advice, information and support to enable them to pick up as much or as little shared responsibility for their health care in a way that works best for them. Peer support and information about how other people have achieved good outcomes will be another vital aspect of this evolution in health care."

There are currently over 1,300 people receiving personal health budgets within the Department of Health pilot programme for a range of conditions; long-term illness; mental health; end of life care and NHS Continuing Healthcare.

Those eligible for NHS Continuing Healthcare will be the first group to receive personal health budgets, building on early evidence from the pilots as well as existing demand from this group - many of whom want to keep the control they have for managing their care within social care.

The announcement follows the independent NHS Future Forum report which recommended action to promote personal budgets and implement them within five years to give patients access to tailored services.

Early feedback shows that individuals have already experienced benefits with personal health budgets from using exercise classes to treat depression or enabling people who need 24/7 care to employ and train their own carers rather than relying on expensive agency staff.

See our webpages for information about our work to implement personal health budgets.

2 comments for “Personal health budgets to be rolled out”

julie bridgewater

posted 12 October 2011 at 16:30:19

may I ask if the personal health budgets self directed support payments etc,, would these include choice of where and what kind of rehabilitation a patient/client could have following a brain injury and in ensuring that he gets the right kind of rehab for his needs, rather than being dictated to by a local authority of where he should go rather than where would be best for him to go.
Rita

posted 16 October 2011 at 14:16:32

The quick answer is that it is possible for some-one with any kind of health problem for which they are receiving ongoing health input, to have a personal health budget-but it relies on the willingness of the funding PCT to agree to allow the person to have this amount of control. If they choose, the PCT can say that they are fulfilling their duties by providing care/treatment through the traditional ways- though this, in my opinion, is not really fully in tune with all the latest government policy direction for the NHS. Talking through the various options and the different perspectives of what matters most to some-one as well as what is a recommended treatment, and aiming to synthesise the two, can take some time but can lead to a negotiated and useful way forward.To have a personal health budget from In Control's view point, some-one needs to:
know how much money is available to them (this can be the cost of the current or proposed treatment plan)
agree the health outcomes that the money must achieve and
be able to use that money flexibly to meet the agreed outcomes.

It does not rely on the PCT being able to pay the money as a direct payment, since, if they are not legally able ot do that, they can pay the money to a "third party" to hold the money on the person's behalf. I've explained this in more detail below and made reference to several documents which it says are attached but I don't know how to attach things to this response. I can send you all of these if you email me at rita.brewis@in-control.org.uk.

If the funding is not health but social care please let us know and we can give you further information about that.
I hope some of this helps. Best wishes, Rita

More detail.....
It is possible, and it is definitely legal to have a personal health budget-, from continuing health care funding or other NHS money, provided your PCT is willing to do this. It is though, not yet currently legal to be paid the Health money directly as a direct payment,(other than in a few pilot sites nationally. You can find out if your PCT is one of the pilot sites for direct payments by contacting the personal health budget pilot team on the email address I’ve included below at the end of this email). In the meantime many people will need to find a “third party” to hold the money.
It’s important for you to know that there are other ways for some-one to legally have control over their funding and their personal support/care plan, without having a direct payment. What it needs is for your PCT to agree to paying the money to a “third party”, while allowing the individual, or their representative, control over how the funding is used to meet jointly agreed health outcomes, written into an authorised support/care plan.
The detail about these options, were laid out in the department of Health’s “first steps” document, which I have attached. (Pages 32 to 35 lay out the options for how money can be held on some-one’s behalf, while they decide with you how best it can be spent, to enable them to have support/treatment in the ways that work best for them.)
The CHC guidance letter, also attached, emphasises the importance of personalisation, -for example as follows in this excerpt:

g) Commissioning services using models that maximise personalisation and individual control and that reflect the individual’s preferences as far as possible. It is particularly important that this approach should be taken when an individual who was previously in receipt of an LA direct payment begins to receive NHS CHC; otherwise they may experience a loss of the control they had previously exercised over their care. PCTs should also be aware of the personal health budgets programme as set out in Personal Health Budgets: First Steps’ and particularly that it is only Direct Payments that will be restricted to approved pilots. The other models of personal health budgets are available under existing powers for any PCT to use.

h) PCTs and LAs should operate person-centred commissioning and procurement arrangements, so that unnecessary changes of provider or of care package do not take place purely because the responsible commissioner has changed
We do know of some PCTs who have worked with people and developed an “Independent User Trust”- which is basically a small group of people who are simply set up as a “third party” to which the NHS can give the funding, and this allows the person to continue to have support in the way they wish. There is a booklet called "Trusting Independence" by Andrew Holman and Catherine Bewley, published by VIA, which gives useful information on how to do it- and attached is Jo’s own guidance leaflet too.
To contact the DH personal health budget team and let them know your views or questions, please email them on: personalhealthbudgets@dh.gsi.gov.uk
Finding a provider and recruiting your own staff through them, in a way which truly still enables you to have control, is perhaps one of the main challenges. We know that people are approaching this in many different ways- often through word of mouth using other people’s direct experience.
My colleague, Jo Fitzgerald, has one of the first personal health budgets for her son Mitchell, and you can see their story on our web site through this link:
http://www.in-control.org.uk/media/6258/mitchell's%20story%20%20.pdf
Some of what is important when choosing a third party is getting to know the third party really well and checking out their values and assumptions in terms of who makes decisions and how flexible they will be in allowing you to control what happens, including who is recruited and their role/tasks/times/training etc. It’s also important that there is complete transparency over the money and how it is being used, on an ongoing basis. We know that otherwise the money may be held somewhere else but the power and decision making can be at risk of not shifting. But with the best third party arrangements, people’s lives can be transformed, both individually and as a family.
I have also attached the DH document outlining guidance for those pilot sites which are being allowed to use direct payments, because, even if a PCT is not a pilot site and is not therefore able to give a direct payment of NHS money, the document outlines good practice principles about care planning and empowering people to make decisions about their own care.
I’ve attached the CHC national framework document which contains the following (paragraph 33),
“The process of assessment and decision making should be person centred. This means placing the individual, their perception of their support needs, and their preferred models of support at the heart of the assessment and care-planning process. When deciding on how their needs are met, the individual’s wishes and expectations of how and where the care is delivered should be documented and taken into account, along with the risks of different types of provision and fairness of access to resources. “
And I’ve attached the public information leaflet about continuing health care.
I do hope some of this is useful.
Best wishes in taking this forward ,
Rita