Personal health budgets: the local offer

What is a Personal Health Budget?

Personal Health Budgets (PHBs) were first introduced in 2009 as part of a pilot and have been increasingly used to enable people to play an active role in managing their health.

A PHB is money that would normally be spent by the NHS on an individual’s care, but instead is allocated to them directly. This allows individuals to organise their care in a way that suits them and to work with health professionals as equal partners to achieve identified healthcare goals and aspirations.

NHS Bath and North East Somerset Clinical Commissioning Group (BaNES CCG) is a member of the South West Integrated Personalised Commissioning (SWIPC) regional team, a consortium of CCGs demonstrating the implementation of PHBs beyond continuing healthcare funding. The SWIPC have set targets to deliver 2-4 PHBs per 1000 people by 2018, which for B&NES would mean 350-700 people.

How a PHB will be used will be set out in a care plan that will be developed by the person together with a health care professional and agreed by the NHS team. A PHB can be used for any services, activities or equipment that have been identified in the care plan.

These could include:

  • Employing carers or personal assistants to support the person receiving the PHB
  • paying for activities that help the person to be more active in the community
  • aids, adaptations or equipment that help with day-to-day tasks.

Having a PHB will not affect any benefits that a family may be receiving because it is for care needs and is not classed as additional income.

A PHB cannot be used for:

  • Anything illegal or to fund gambling or repayment of debts other than those associated with the provision of the support plan
  • alcohol or tobacco
  • emergency or urgent care services
  • primary care services: GP care, dental care, medicines or inpatient care.

The proposed care model will include personalised care and support planning using funds allocated by the NHS team, and will identify access to independent advocacy, peer support and brokerage if required. People will be able to take as much control as they feel comfortable with.

An easy-read version of information on PHBs is available here.

Statutory legislation

  1. The Secretary of State makes statutory regulations that set out patients’ rights and NHS England’s and CCG’s responsibilities for meeting them. These are known as the Standing Rules.

Section: Part 6a -Standing rules: personal health budgets

The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2013

  1. The Government’s mandate to NHS England for 2016-17 published in December 2015 sets out the clear expectation that:
  • by 2020, 50-100,000 people will have a PHB or integrated personal budget, and
  • in 2016/17, NHS England will produce “a plan with specific milestones for improving patient choice by 2020, particularly in maternity, end-of-life care…and personal health budgets”.

With an approximate population of 175,000 in B&NES this means the target for numbers of people with a PHB will rise to 175-350 people by 2020.

We currently provide 18 PHBs for adults receiving CHC funding and six PHBs for children receiving continuing care funding.

  1. Forward View into action: Planning for 2015/16

Empowering Patients

Section 2.9

“To give patients more direct control, we expect CCGs to lead a major expansion in 2015/16 in the offer and delivery of personal health budgets to people, where evidence indicates they could benefit……….CCGs should engage widely and fully with their local communities and patients, including with their local Healthwatch, and include clear goals on expanding personal health budgets within their published local Joint Health and Wellbeing Strategy.”

Who can have a PHB in B&NES?

Eligibility for a PHB is determined by national legislation, along with local health needs, financial constraints and other factors. Within B&NES, we have identified the following groups of people as eligible to apply for a PHB at this time:

The right to have a PHB:

  • Since April 2014, adults in receipt of NHS continuing health care funding have had the right to a PHB.
  • Since October 2014, children and young people in receipt of continuing care funding have had the right to a PHB.

The right to request a PHB:

  • Since September 2014, children with special educational needs and disabilities as part of their Educational Health and Care plans have been able to request a PHB.
  • Since April 2015, children with complex health needs and long term conditions have had the right to request a PHB.

However, any requests for PHBs would need to be agreed by the CCG, taking the following into consideration:

  • maintaining existing service provision for other users of a block contract
  • offering a reasonable level of health provision
  • commissioning responsibly (i.e. NHS England or CCG).

NHS England has set expectations in the NHS Five Year Forward View that CCGs will lead a major expansion in the offer and delivery of PHBs where evidence indicates a benefit. The further expansion of PHBs will include:

  • adults and children with learning disabilities or autism with high support needs
  • people with complex mental health support needs.

Before we consider expanding PHBs to other groups, we must meet our legal duties with regard to equality and health inequalities, and consult widely as we develop our local plans.  The local offer for PHBs is therefore subject to an Equalities Impact Assessment, which will be refreshed as the offer is reviewed in future years.

How to get a PHB in B&NES

Initially, only a small number of people in the extended groups will be offered a PHB as the processes for developing and monitoring the initiative are being established locally. This is important as the funding will need to be released from block contract funding without destabilising the existing provision of services.

Health professionals will be encouraged to identify people who may benefit from a PHB. If you would like to be considered for a PHB you should approach your health care practitioner to discuss improving your health and wellbeing outcomes via a personalised care plan. Your needs could be met differently with a PHB.

Integrated Personalised Commissioning

BaNES CCG is committed to the NHS Five Year Forward View, which sets out a vision for the future that includes a changed relationship with patients and communities and supports people to take greater control of their own care to support their health.

Key to adopting the visions set out in the Five Year Forward View document is the development of Integrated Personalised Commissioning (IPC). IPC is a new approach to joining up health, social care and other services and builds on what’s been learned from the delivery of personal budgets in social care and PHBs.

You can read NHS England’s IPC Emerging Framework document here.

Personalised care is about looking at an individual as a whole and working with them to prepare a care and support plan that suits their personal strengths, preferences and needs. It supports the improvement, integration and personalisation of services and encourages people to develop the knowledge, skills and confidence to self-manage their care. Partnerships with voluntary and community services, community capacity building and peer support are key to personalised care.

For the majority of the B&NES population, personalised care planning will take place within existing services that are commissioned on behalf of the population. However, in some cases where a person’s health needs are complex, it may be possible for the individual to hold a PHB to meet their needs.

Developing the local PHB/ IPC offer in BaNES

Expansion of PHBs beyond Continuing Healthcare:

Group of service users affected/project Number of people currently in scope How this is delivered Partners involved
These Groups already have a ‘right’ to have a PHB:

 

Children in receipt of  NHS continuing care

 

10 in cohort

 

6 PHBs currently in place

Existing “right to have” approach in place within PHB policy.

These children are also likely to have an Education, Health and Care plan (EHCP see below).

 

CCG, Virgin Care, B&NES Council, schools, PHB recipients, Direct Payment Support Providers, Voluntary and Community Sector (VCS), carers.
Children with special educational needs and disabilities as part of their EHCPs Tbc in cohort

 

2 PHBs currently in Place

Existing “Right to Have” approach in place within PHB policy.

Personal budgets for EHCP are being developed through the Local Authority’s Special Educational Needs and Disability local offer.

CCG, Virgin Care, B&NES Council, schools, PHB recipients, Direct Payment Support Providers, VCS, carers.

 

Adults in receipt of  NHS continuing health care 256 in cohort

 

18 PHBs currently in place

Existing “right to have” approach in place within PHB policy.

The CCG can offer Direct Payments, Brokered Service or Notional Budget.

CCG, BaNES CHC Team, B&NES Council, PHB recipients, Direct Payment Support Providers, VCS, carers.
Further Expansion of PHBs beyond CHC
Children identified as being able to benefit from PHB provision beyond Continuing Care 6-8 PHBs Children’s integrated PHBs from short breaks budget underspend.

CCG may offer Direct payment, Brokered Service or Notional Budget.

CCG, Virgin Care, B&NES Council, Schools, PHB recipients, Direct Payment Support Providers, VCS, carers
Individual with Learning Disabilities (as required by the Bubb Report-health led) 334 in cohort

 

 

Target: 167 PHBs

Through an NHS commissioner.

 

The CCG could offer Direct payment, Brokered service or Notional Budget.

CCG, AWP, Virgin Care LD Service, B&NES Council, PHB recipients (through evaluation), Direct payment support providers, VCS/users/carers.
Individuals included in the top 1-2 per cent indicating complex care needs and increased risk of emergency admissions. 312 in cohort

 

Target: 5 PHBs

 

 

The CCG could offer Direct payment, brokered service or Notional Budget. CCG, GP clusters, B&NES council, PHB recipients, Direct payment support providers, VCS, carers.
Individuals with mental health support needs Tbc

 

Target: 5 PHBs

The CCG could offer Direct payment, a brokered service or Notional Budget. CCG, AWP, Direct payment Support Providers, PHB recipients, VCS, carers.
Individuals in receipt of fast-track continuing health care funding for end of life care 292 in cohort

 

Target: 2 PHBs

The CCG could offer Direct payment, a brokered service or Notional Budget. CCG, AWP, CHC teams, Direct payment Support Providers, PHB recipients, VCS, carers.

The health and social care agencies in B&NES are working together on establishing the process of providing PHBs and integrating the delivery of personalised care.

The separate policies for social care direct payments (adults and children’s) and PHBs that were jointly held by B&NES social care and the CCG have been streamlined to create a single framework policy to improve integration.  You can read the final policy here.

The CCG and the Council will collaborate with support service providers, health practitioners and PHB holders to ensure the support services meet identified needs and that outcomes are achieved.

A team of community champions including existing PHB holders have begun work to inform the development and provision of the strategy for the wider roll out of PHBs and IPC. The community champion meetings provide a platform for the opinions and perspectives of those that have traditionally been under-represented. The community champions are currently meeting monthly to review the issues.

Training and awareness-raising activities will facilitate the further development of IPC and PHBs.

The PHB project team, the community champions and service providers will work together to establish robust processes to monitor the impact and outcomes of the expansion of PHBs and IPC.

Working with the support of the regional South West IPC team, successes in implementing the initiatives in other areas will be considered to identify and adopt areas of best practice.

The Local Offer will be reviewed regularly to reflect developments and provide information on the wider roll out of the service.  The latest version will be made available on the CCG and Council websites.

Find out more

Talk to the health or social care professional that you usually see, they will be able to provide information on PHBs or will be able to find out more.

NHS Choices website: www.nhs.uk/personalhealthbudgets

NHS England website: www.england.nhs.uk/healthbudgets

Information for health and social care professionals: www.personalhealthbudgets.england.nhs.uk

Updated e-learning resource on personal health budgets

In partnership with Health Education England, NHS England has updated the e-Learning for Healthcare (e-LfH) Personal Health Budgets Programme. Suitable for professionals working across the NHS who are new to personal health budgets, this online resource focusses on the steps involved in personal health budget delivery. The programme covers personal health budgets in Continuing Healthcare (CHC), as well as for other groups of people who have complex and long-term health conditions.

In order to access the programme, you will need to have an e-LfH account. You can then access the programme immediately in the My e-Learning section. The Personal Health Budgets Programme is also available to NHS professionals via the Electronic Staff Record (ESR).

Go to the Personal Health Budgets Programme on the e-LfH online hub (once you have an e-LfH account)

Find out more on the e-LfH website

This document can be made available in another language, as large print, Braille, on tape, or in another format by contacting BaNES CCG on 01225 831800 or at BSCCG.information@nhs.net.