The Five Year Forward View and the Five Year Forward View Next Steps continue to support the need to put personalisation at the heart of the NHS vision to give people more choice and control of the health care they receive. Personal health budgets are a key mechanism for making this vision tangible.
PHBs are one component of the Personalised Care comprehensive model, providing people with choice and control, particularly for people with more complex needs.
A personal health budget is an amount of money to support someone’s health and wellbeing needs, which is planned and agreed between the person, or their representative, and the local clinical commissioning group (CCG) or NHS team.
The amount in someone’s personal health budget is based upon their personalised care and support plan. This plan helps people to identify their health and wellbeing outcomes, together with their local NHS team, and sets out how the budget will be spent to enable them to reach their goals and keep them healthy and safe.
Personal health budgets and personal budgets in social care both aim to give people more choice and control to meet their health or care and wellbeing needs. If someone receives a personal health budget and a personal budget for social care, then it may be possible to join the two budgets together to form a joint or pooled budget.
In some areas, the assessment, planning and monitoring processes may also be joined up between health and social care. The aim of this is to make the experience as straightforward as possible for the person.
Currently only adults who are eligible for NHS Continuing Healthcare and children in receipt of continuing care have the legal right to have a personal health budget, although all areas across England are expected to offer personal health budgets to additional groups of people, based on local need, including people with a learning disability and/or autism.
All CCGs have submitted trajectories, as part of operational planning, to deliver their share of 50,000 PHBs by March 2019 therefore putting us on track to deliver the top end of the Mandate ambition, 50,000 – 100,000 PHBs by March 2021 (100 – 200 PHB per 100,000 registered population). For the North, this equates to achieving 18,260 by Q4 18/19.
From 1st April 2019 personal health budgets will be the default/standard operating model for all home-based Continuing Healthcare services. This will benefit around 20,000 each year when in place. Beyond 2020 it is expected that PHB numbers will continue to rapidly increase and we envisage PHBs becoming the mainstream delivery model in other areas of NHS-funded care.
In Q2 2018/19 10,074 people had a personal health budget against a planned position of 11,085. This means at Q2 18/19, the North region is 1,011 behind plan (a reduction of 1,568 since Q1). However, this represents a 33% increase since Q4 2016/17. The below table shows the current position at STP level compared to the north region.
Hartlepool and Stockton CCG currently have 505 people with a PHB and Darlington CCG has 28 people with a PHB against a north average of 162 (Source: NHS England North Joint RMT north region progress update – Quarter 2 2018/19 17 December 2018).
The rate of personal health budgets per 100,000 population has a NHSE expectation of 200 by 2021. The uptake of PHBs currently varies across the region from 6 to 298 with Darlington CCG having 26 and Hartlepool and Stockton CCG having 170. The north region average is 55.
It is noted that 50% of personal health budgets were within NHS Continuing Healthcare or Children’s Continuing Care and 17% within Learning Disability / Autism (Adults & Children).
Decisions about who can have a personal health budget outside of NHS Continuing Healthcare are made by local CCGs, who are responsible for paying and planning for most local health services. Every CCG should have information made publically available about who is able to access one locally.
A personal health budget can potentially be spent on a broader range of care and support than would routinely be commissioned by the NHS, if it is agreed as being appropriate to meet someone’s identified needs.
This could include funding for a personal assistant to help with personal care at home, and equipment such as a wheelchair. There are a small number of exclusions that are outlined in regulation and further outlined below.
Everyone who has a personal health budget should be supported by a suitable professional to think through how they would like to use their budget in order to meet their health and wellbeing needs. It is the responsibility of local NHS teams to advise people or refer someone to a relevant local organisation who can offer the necessary support. This is often described as brokerage.
What a personal health budget will be spent on, as outlined in their personalised care and support plan, must be agreed between the person or their representative, the local NHS team and where necessary the CCG.
In nearly all cases, people cannot add their own money into a personal health budget, and the budget should meet all the identified health and wellbeing needs of the person.
PHBs have been available for some people in Hartlepool, Stockton since 2009 and in Darlington since 2012, giving people greater choice and control over the healthcare and support they receive.
PHBs can pay for a wide range of items and services, including therapies, personal care and equipment, allowing more choice and control over the health services and care an individual receives, and the way he or she receives it. Really, people can be as imaginative as they like, as long as it meets their health and wellbeing needs and have been agreed with their NHS team.
In Hartlepool, Stockton and Darlington eligibility for a PHB is determined by national legislation, along with local health needs, financial constraints and other factors. Within these areas, the CCG is expanding PHBs and the following groups of people have been eligible to apply for one:
- Children receiving NHS continuing care (CC), including children with special educational needs and disabilities as part of their EHC plans (EHCP)
- Adults receiving NHS continuing health care
- Adults or children with a learning disability and/or autism who have complex needs or who display behaviour that challenges
- People with Chronic Obstructive Pulmonary Disease (COPD)
- People with Long Term Neurological Conditions
- People with Chronic pain
Integrated Personal Commissioning (IPC) is one of the pillars of the Five Year Forward View. It empowers people and communities to take an active role in their health and wellbeing with greater choice and control over the care they need.
At the heart of IPC is the premise that with the right support, individuals with significant health and care needs are often better placed than statutory bodies to design and integrate their own care. The CCGs have introduced a care model which includes personalised care and support planning, independent advocacy, peer support and brokerage with a strong emphasis on co-production. People will be able to take as much control as they want including a clear offer of integrated personal budgets for those who will benefit.
The IPC Programme, tested in Stockton as one of a number of NHS England “Personalised Care Demonstrator Sites” in 2018/19, was designed to ensure compatibility with the New Care Models Programme prior to national implementation by 2020-21. The primary aim was to improve care for people over 65 with multiple long term conditions, with an early focus specifically on those living with respiratory problems such as chronic obstructive pulmonary disease (COPD).Health professionals are reporting real impact, for example with a 50% increase in the number of people who have attended pulmonary rehabilitation.
The pilot showed IPC contributed to:
- 12% reduction in emergency admissions for older people with frailty
- 15% reduction in delayed transfers of care
- 10% reduction in A&E attendances
The additional flexibility of a personal health budget has meant people can access community resources such as swimming lessons and other physical activities to help with their managing their condition. People have acknowledged that through the care planning they feel listened to and have control of their care and they have enjoyed the experience.
When someone’s funding eligibility changes, personal health budgets can help to maintain continuity of care and support arrangements, for example by enabling the person to keep their personal assistant, regardless of the source of their funding.
The CCGs are part of the North East Personal Health Budgets Regional Network, working to expand the offer and availability of PHBs, creating the environment for people to explore whether a PHB would be right for them and the financial environment for them to operate so that anyone eligible will be offered a PHB through 2019-20.