FAQs for health care professionals

What is a personal health budget?

A personal health budget is an amount of money that is allocated to a person to allow them to meet their health and wellbeing needs in the way that best suits them.

At the heart of a personal health budget is a care plan (also referred to by other names such as a support plan) which sets out the person's health and wellbeing needs and desired outcomes, the amount of money in the budget and how this will be spent. This care plan should be developed in partnership with either the health care professional or the person taking the lead, but it must be signed off by the primary care trust (PCT).

Within the pilot programme, the majority of pilot sites are offering personal health budgets to one or more of the following groups:

• people in receipt of NHS continuing healthcare
• people in need of end of life care
• people with a long-term condition
• people with mental health needs.

There also are a few pilot sites investigating the effects of personal health budgets on people with drug or alcohol problems, people receiving maternity services and people receiving renal dialysis (where the budget would cover their transport to and from hospital).

How can a personal health budget be managed?

The personal health budget can be managed in a number of different ways:

• A notional budget: the person knows about the cost of different services and what the overall budget is. The PCT holds the money and commissions or provides the goods and services chosen
• A third party arrangement: an organisation legally independent of both the PCT and the person (for example, an Independent User Trust or a charity) holds the money on behalf of the person, and commissions the goods and services for them
• A direct payment for health care: the money is transferred to the person, and they commission the goods and services themselves to meet their health and wellbeing needs.

All PCTs can offer notional or third party budgets, but only approved Department of Health personal health budgets pilot sites can offer direct payments.

What is the aim of a personal health budget?

The aim of a personal health budget is to give people more choice and control over the money spent upon meeting their health care needs. This can potentially result in improved health outcomes, improved patient experience and satisfaction, and reduced overall cost to the NHS. They will also facilitate better integration of health and social care at the level of the individual.

Personal health budgets can also help facilitate the cultural change within the NHS which is needed to deliver the vision of a more personalised, patient focused NHS. Personal health budgets transfers some of the control to a person around what services or care best meets their needs. This helps decisions to be made which incorporate the knowledge of both the person and the healthcare professional.

The aim is to give people the opportunity to develop solutions to their health care needs, to have a plan that is individual and tailored to them.

How is a personal health budget set?

Setting a budget is one of a number of key practical and operational challenges being explored within the personal health budgets pilot programme. We currently do not have enough information on the cost of NHS services at the level of individual patients to say how this should be done. During the personal health budget pilot programme, sites are considering different approaches to budget setting. This could be set through existing spend on the individual, through a needs assessment, through an outcome-based approach or potentially a combination of these options. As part of the pilot programme, we will be looking into how pilot sites are setting budgets and how accurate they have been.

Can an individual add their own money into a personal health budget (topping up NHS services)?

No, a person cannot add their own money into a personal health budget. The personal health budget must meet all of their identified health and wellbeing needs. As is the case in traditionally commissioned services, an individual cannot spend their own money on their NHS care.

If a person wishes to buy additional services (for example, more physiotherapy sessions than thought to be clinically necessary) this can still be done, as it can currently. The additional services would need to be arranged by the person outside the personal health budget and care plan, and be seen as a separate transaction with separate billing and payment.

How do personal health budgets fit with other personalisation policies in health and social care?

The aims of personal health budgets and personal budgets in social care are very similar, around giving people more choice and control over money that is spent on their care, improving outcomes and experiences, and reducing unnecessary costs.

If a person is receiving both a personal health budget and a personal budget for social care then the PCT and the Local Authority could join the two budgets together, or develop joint planning and review procedures. This would make it easier for the individual and address some of the confusion around the boundaries between health and social care. It could also help facilitate better integration of services and increase efficiencies by reducing duplication of back office functions.

During the pilot programme, pilot sites are working closely with their local authority colleagues to share learning and, where feasible, join up services. A group of pilot sites are specifically looking at how they can develop processes for people to have an integrated budget which meets their health and social care needs. The experiences from these pilot sites will help to develop practical solutions to some of the challenges to integration more widely.

By April 2014, subject to the evaluation of the pilot programme, people eligible for NHS Continuing Healthcare will have the right to ask for a personal health budget.

Personal health budgets are one of a number of different personalised health and social care services being explored by the Government in England. You may come across:

• Personal budgets in social care. For more information please visit the Think Local, Act Personal website
• The "right to control" being developed for various services and benefits provided by the Office of Disability Issues for disabled people
• "Aiming high" run by DfE piloting individual budgets for families with disabled children
• "SEND pathfinders": testing out a single assessment process and a combined education, health and care plan for children wtih special educational needs and disabilities. This is being piloted by the Department for Education and the Department of Health.

Why are personal health budgets being piloted?

The journey of personalisation across health and social care began some 20 years ago, when social care service users lobbied for more control over the money that was spent on meeting their needs. This resulted in direct payments being introduced to social care in 1996, and was expanded in the piloting of individual budgets to include other funding streams. Personal health budgets builds on both the experiences of personal budgets in social care and personalised care planning for people with long term conditions, and are simply the next step in providing people with choice and control over the services and care they receive.

Personal budgets in health are a recent concept, and there is much we do not yet know. We anticipate that they will be more suitable for some services and patient groups than others and we are using the pilot programme to explore this.

In addition, we do not yet know how best to implement them. There are a number of practical issues we are looking at during the pilot programme, like how best set a budget, how best to support people through the whole process, and how to develop the market so people have real choice.

The pilot programme is being underpinned by an independent evaluation, which is due to report in October 2012.

In the longer term, it is the Government's aim to introduce a right to a personal health budget for people who would benefit from them. On 4 October the Secretary of State for Health announced that, subject to the evaluation, by April 2014 everyone in receipt of NHS Continuing Healthcare (NHS CHC) will have a right to ask for a personal health budget, including a direct payment. It is planned that Clinical Commissioning Groups will be able to offer them on a voluntary basis more widely.

What can a personal health budget be spent on?

A personal health budget can be spent on any services or care which meets the individual's agreed health and wellbeing needs. The services and care will need to be set out and agreed in a care plan. The only restrictions set by the Department are that personal health budgets cannot be spent on things that are inappropriate for the state to fund, such as alcohol, tobacco, gambling or debt repayment, or anything that is illegal.

At this time, some aspects of a person's care will also be excluded from a personal health budget - primary medical services (i.e. GP services) and emergency services. As GPs provide a holistic service it was not felt appropriate to include this funding at this stage. This will very broadly cover the consultation and assessment functions that GPs perform things like diagnostic tests, basic medical treatment or vaccinations; however some services organised and managed by GPs, for example physiotherapy, counselling or nursing services could be included. Emergency services are also excluded from the budget as personal health budgets are unlikely to be appropriate in this context.

Who can have a personal health budget?

A personal health budget can be given to anyone the PCT feels is appropriate to have one - although nobody will be forced to take more control than they wish to have. An individual can also ask for one, and both notional budgets and third arrangements are legal within the NHS. At present, only pilot sites specifically approved to do so by the Department of Health can offer direct payments.

There are different methods of managing the budget (see question 2, 'How can a personal health budget be managed?') and the method chosen will depend on a number of factors. In some cases, such as where people lack capacity, or where the recipient is a child, it may be appropriate for somebody to manage the budget on behalf of the person. Pilot sites should consider the preferences, capacity and capability of the person when offering them a budget and supporting them through the process of developing the care plan, deciding what services they would like to use to meet the needs as set in the care plan, and then using the budget to meet these needs.

How do you ensure and maintain quality of services?

All services the person receives as part of their personal health budget must be set out in the care plan which must be signed off by the PCT. All services that are currently regulated by the Care Quality Commission (CQC) will continue to be regulated in the same way regardless of wither a personal health budget is used to commission them. If the service chosen is something not traditionally provided by the NHS, then the PCT will need to be satisfied that the necessary safeguards are in place. This should be done in a proportionate way.

What can I do to provide personalised health services if I am not involved in a pilot?

Personal health budgets are not the sole method of providing personalised health services, nor will they be appropriate for everyone. Listening to people and including them in discussions about how best to meet their health needs is not restricted to personal health budgets, but rather at the heart of personalising services. There are other initiatives which support personalisation in the NHS: for example people with long term conditions are entitled to have a personalised care plan.

There are a number of ways of delivering a personal health budget. Only the direct payment option is restricted, as it is currently legal only within pilot sites specifically authorised to offer direct payments by the Department of Health. The other methods - notional budgets and third party arrangements - are legal everywhere. You could consider offering one of these forms of personal health budgets to people who you feel would benefit. For example, if somebody moving from a position where they receive a direct payment within social care to fully-funded NHS continuing health care, then they may wish to maintain some of the control that they used to experience. The PCT can achieve this through notional budgets and third party arrangements.

Will the eligibility criteria in the National Framework for NHS Continuing Healthcare and NHS funded Nursing Care continue to apply?

Yes. Personal budgets are not intended as a way around other existing policies. Other best practice in the revised NSF should also be followed - this includes the request that the PCT 'maximise personalisation and individual control' (paragraph 136). To view the framework, click here (opens new window).

Contact us

If a PCT has questions about what flexibilities exist to personalise the services a person receives or they want to find out more about joining the pilot programme, they should contact the personal health budgets team in the Department of Health at personalhealthbudgets@dh.gsi.gov.uk

Information on personal health budgets is available throughout this online Learning Network for the pilot, and on the personal health budgets policy pages of the Department of Health website.