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Better health and wellbeing for the residents of Lincolnshire

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Personal Health Budgets

Did you know that anyone who is currently eligible, or becomes eligible, for NHS Continuing Healthcare funding now has the right to have their own Personal Health Budget (PHB)?

By April 2019, NHS England expects that unless there are exceptional circumstances, everyone living in their own home who is in receipt of NHS Continuing Healthcare funding will have a personal health budget.

Personal health budgets work in 3 different ways:

  1. Notional budget
    The NHS arranges the care and support for you as agreed in your support plan.
  2. Third party budget
    Someone not connected to the NHS or yourself who will provide the care and support agreed in your support plan.
  3. Direct payment for healthcare
    We give you the money to buy and manage your own healthcare and support as agreed in your support plan.

On the page you can find out more information about local PHB in Lincolnshire. You can also read about it in our personal health budget leaflet.

The option of a PHB provides an opportunity to have more choice and control over how your health and wellbeing needs can best be met. With the help of our PHB team, it’s a way to get personalised treatment and care that can benefit you most.

What is a Personal Health Budget

A PHB is a set amount of money to spend on the support and services that will meet your health and wellbeing needs, as agreed between you (or your representative) and your local PHB team. It can be provided in a number of ways – including direct payments – to suit each person and their support plan.

You will be able to spend it on a range of activities, services and some types of equipment, tailored to you in order to meet your needs in way that suits you best.

PHBs are not ‘new money’ but represent the opportunity to utilise money already in the NHS in a different way, to maximise impact and benefit of that money by personalising the way that people receive healthcare.

Who is eligible for a Personal Health Budget

People with long term conditions and disability who are eligible for NHS Continuing Healthcare have a right to have a PHB if they wish. Children and young people with continuing care needs also have the right to have a PHB. We are now also able to offer a PHB to people with learning disabilities and complex needs where they would benefit from one and we are working with the local authorities to develop joint processes for these individuals.

For individuals receiving services from health and social care and/or Special Education Services where they are eligible for a Personal Budget from these organisations, the CCG can pay into an integrated Personal Budget to ensure holistic needs can be met. The CCG will continue to work with Local Authority colleagues and the rest of the local health economy to widen the PHB offer to those with an Education, Health and Care Plan over the next three to five years, in line with national guidance.

Most of the money that could be used for PHBs is currently tied up in ‘block’ contracts with providers of traditional NHS services. These will require to be separated in order to free the money from the system for individual budgets. The processes for doing this are complicated and therefore the expansion of PHBs to cover these types of services will take time.

Why should I have a Personal Health Budget

The aim of a PHB is to give individuals more choice and control over the money spent on meeting their health and wellbeing needs. PHBs support the vision of a more personalised, patient-focused NHS that recognises you as the expert in what is right for you. It allows you to have a conversation with your PHB team as an expert of lived experience to ensure that the outcomes that matter most to you and the way that you would like your care delivered are the main focus of your care plan.

NHS England’s website has more information and advice about the scheme.

How do I apply for a Personal Health Budget

If you think you may be eligible and would like to apply for a PHB, or would like more information about what a PHB involves, please contact the Lincolnshire PHB team in the following ways:

Tel: 01522 515344 (CHC direct line)
Email: agcsu.lincsphb@nhs.net
Write to: Personal Health Budgets team, NHS Continuing Healthcare department, Cross O’Cliff, Bracebridge Heath, Lincoln, LN4 2HN

Who decides who can have a Personal Health Budget and how big is it

The four Clinical Commissioning Groups (CCGs) in Lincolnshire are currently led by National Guidance to determine who can have a PHB.

They will work out your budget based on the cost of delivering your care in the traditional way. However the CCGs are currently working with a software company to develop a resource allocation system that produces a budget based on assessed need and following testing. You should always be told how much money you will have before you start planning the things you could spend it on.

Which organisations are involved in delivering Personal Health Budgets locally

The NHS Continuing Healthcare Service (CHC) is delivered by a range of providers on behalf of the four Lincolnshire CCGs who are involved in the assessment for eligibility and identifying healthcare needs for adults and children with healthcare needs. These include Arden GEM Commissioning Support Unit and Lincolnshire County Council.

In addition the CCG employs children’s and adult’s nurses specifically for the purpose of assessing needs and support planning for PHB. Based on these assessments and the recommendations, the CCG make decisions regarding the funding of packages and allocation of resources.

Lincolnshire County Council currently provide direct payments to children and adults, many of whom are also receiving an element of their package or funding from the CCG. The local authority is working jointly with the CCG to develop processes to facilitate the delivery of integrated personal budgets for those that are eligible.

What can a Personal Health Budget be spent on

Everyone with a PHB can get support to think though how they would like to use their budget to meet their health and wellbeing needs.
It is the responsibility of local PHB teams to advise people on a range of organisations who can offer local support.

A PHB can be spent on any care or services that are set out in the care and support plan that has been put together with the PHB team or voluntary organisation working with the person – and this needs to be agreed by the CCG.

There are very few things that a PHB definitely can’t be spent on and the CCG will keep an open mind when considering what you would like to spend your budget on to meet your needs. As long as it is clear that the intervention or support is likely to meet your health needs and your defined outcomes within the budget allowed, and as long as it is acceptable from a risk perspective, it is likely that your proposed plan will be accepted.

What can a personal health budget not be spent on

There are things that it would not be right for the government to fund such as alcohol, tobacco, gambling or debt repayment, or anything that is illegal.

A PHB cannot be used to buy emergency care – for example if someone in receipt of a PHB had an accident, they would go to A&E like everyone else – they would not use their personal health budget to arrange for an x-ray, or get a broken leg set or plastered for example.

A PHB also cannot buy primary care services such as seeing a GP or dental treatment. Other services recommended by a GP, like physiotherapy, or alternative interventions that have the same outcomes as traditional physiotherapy, could be included, subject to agreement in the plan.

Can I have a personal health budget as well as a personal budget from social services

Yes. The CCG is currently working with the local authority to develop joint assessment and planning processes that will facilitate an integrated budget across health and social care/education. Whilst this work is ongoing, it is still possible for you to join up your care by receiving a budget from social care/education and health, and using the funds to meet your needs.

If you are a child and you have an Education Health and Care Plan your PHB should be put together with any personal budget you may have from social care or education and your outcomes for each element of the budget would be set out in your Education, Health and Care Plan.

If I have a personal health budget, will I have to manage my own care

No. You will not have to do everything on your own. You and your family or carers will agree a care and support plan with your PHB team. This will say how you will spend your budget to keep you healthy and safe.

Your PHB team can also let you know about organisations that can assist with employer responsibilities if you choose to employ personal assistants. These organisations can help with payroll, tax responsibilities and insurance etc. and their fees will be included in your PHB allowance.

What happens if something goes wrong or my needs change

If your health changes or your plan is not right for you, you can look at it with your local PHB team and change things. You will always get NHS care in an emergency. You can go back to having NHS care like you did before if a PHB does not work for you.

Will I have to pay towards my healthcare if I can afford it

No. There should be enough money in your PHB to pay for the care you need.
For more information about personal health budgets, visit:
NHS England’s Personal Health Budgets website
Download an easy-read version of understanding personal health budgets

If you want any of this information in a different language or format such as large print, email communications@lincolnshirewestccg.nhs.uk.