Personal Health Budgets
A personal health budget is an agreed amount of money to pay for your NHS healthcare and support needs, including treatments, equipment and personal care. The budget is planned and agreed between you (or your representative) and your local NHS team.
A care plan looks at all your needs to make sure you receive the most appropriate care. Everyone with a long-term condition should have a care plan. You don't need to have a personal health budget.
What are personal health budgets?
A personal health budget is an agreed amount of money to pay for your NHS healthcare and support needs. The aim is to help people manage their care in a way that suits them. Anyone receiving continuing healthcare from the NHS can ask for a personal health budget. Everyone with a long-term condition should have a care plan.
The personal health budget is different from a personal budget and an integrated health budget.
- A personal budget is for your social care and support needs.
- A personal health budget is for your NHS healthcare and support needs.
- An integrated personal budget includes both your healthcare and support needs and your social care needs.
The personal health budget is planned and agreed between you and your local NHS team. Personal health budgets work in a similar way to the personal budgets that many people are already using to manage and pay for their social care.
How is a personal health budget planned?
You can develop a care plan with your local NHS team (which may include your GP or other healthcare professionals). A care plan looks at all your needs to make sure you receive the most appropriate care. The plan should set out:
- Your personal health and well-being needs.
- The health outcomes you want to achieve.
- The amount of money in the budget, and how you are going to spend it.
You should have an identified person in your local NHS team to act as your care co-ordinator in the planning process so you have a contact if you have any concerns.
What can the personal health budget be used for?
The budget can be used for a wide range of services, depending on your needs. These services may include therapies, personal care and equipment. The budget cannot be used to pay for emergency care, or the care you normally receive from your GP. A personal health budget can be spent on services recommended by your GP, like physiotherapy.
You don't have to change any healthcare or support that is already working well for you. You can change something that isn't working well. Once you have a personal health budget, you can also change your care plan if your health changes or something in your plan isn't working for you.
You cannot add your own money into a personal health budget. The personal health budget should meet all your health needs. If you want to spend your own money on extra services, you need to organise and pay for this yourself. This would be separate from the personal health budget.
Who can have a personal health budget?
A personal health budget should be offered to people having NHS continuing healthcare, which is NHS-funded long-term health and personal care provided outside hospital. To have NHS continuing healthcare, you must have a medical condition that needs ongoing care. The main need for care must be a problem with your health.
Children, young people, adults and older adults who are living at home and are having NHS continuing healthcare, can have a personal health budget.
Local NHS organisations will be able to offer personal health budgets to other people if they think the person will benefit. The aim is to introduce a right to a personal health budget for all those people who would benefit from it.
You can have a personal health budget if you already have a personal budget for social care and support.
Who decides who can have a personal health budget and what it can be spent on?
Your local NHS will set up local systems for deciding who can have a personal health budget, how big the budget will be and what it can be spent on. These will depend on which groups of people it is working with and which services are included.
Those involved with making these decisions may be a GP, a community matron, a community psychiatric nurse or another health professional.
What if your request for a personal health budget is turned down or you disagree with the amount?
If you are unhappy about any decision whether you can have a personal health budget or the amount you've been offered then you should discuss this with your NHS team and local Clinical Commissioning Group (CCG). If you are still unhappy then you can use the NHS complaints procedure.
How can a personal health budget be managed?
Once your care plan has been agreed, the money can be managed in different ways:
- Notional budget. No money changes hands. You talk to your local NHS team about the different ways to spend the money on meeting your needs. They will then arrange the care and support that has been agreed in your care plan.
- Third-party budget. A different organisation or trust holds the money for you and helps you decide what you need. The organisation then buys the care and support you have chosen.
- Direct payment for healthcare. You receive the cash to buy the care and support you need. You buy and manage services yourself, or your representative can do so on your behalf. You have to show what you have spent it on.
You will need a separate bank account to receive a personal health budget by a direct payment. This account must only be used for your personal care. The same bank account can also be used for receiving and managing a social care budget or Independent Living Fund payments.
If you don't want, or are unable, to manage a budget yourself, someone else can manage the budget on your behalf, such as a carer.
If you don't spend all your budget (underspend) then your NHS team will discuss with you whether the unused money is kept for your future healthcare needs or whether it is returned to the CCG and allocated to other people with a personal health budget.
If you spend more that your budget (overspend) then you should contact your NHS team as soon as possible. You can discuss whether you feel you need additional healthcare and your budget may then be reviewed and increased. However, if you have spent your budget in ways that have not been agreed then you may be asked to pay back the overspend.
Will your personal health budget be reviewed?
Your NHS team will keep your personal health budget under review. Your plan can be updated if there is any change to your health needs. You can ask for your personal health budget to be reviewed and updated if you feel your health needs have change or the current care plan isn't working.
Do you have to have a personal health budget?
You don't need to have a personal health budget. If the personal health budget does not work for you, your care can be provided by the NHS, just as it has always been. You can give up your personal health budget at any time and you will still be able to receive your healthcare and support needs in another way.
Further reading & references
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Colin Tidy
Dr Helen Huins