Everything you need to know about personal health budgets

A personal health budget allows people to have more choice, flexibility and control over the health services and care they receive.

A pilot programme involving around half the primary care trusts in England is currently underway to test out personal health budgets in the NHS. The programme and its evaluation will explore who will benefit most from personal health budgets, and how the NHS can make them work.

This is a very different way of commissioning and managing health care services, and we know there are many details and complexities to work through. That is why we are piloting personal health budgets, and evaluating the work that the pilot sites will do.

The pilot programme is running for three years, with the final independent evaluation report available in October 2012.

What is a personal health budget?

A personal health budget is an amount of money that is spent on meeting the health care and wellbeing needs of people, generally those with a long term illness or disability.

At the heart of a personal health budget is a care plan. This is sometimes referred to by other names, like a support plan. Your care plan should be developed with you in partnership with your health care professional, for instance your community nurse, or someone from your voluntary or community organisation, for instance the MS Society. It must be then be signed off by your NHS primary care trust (PCT). The plan sets out your health care and wellbeing needs, the health outcomes you want, the amount of money in the budget and how this will be spent.

Key points:

• NHS values still hold - no one will pay their own money to get services they need or be denied essential treatment as a result of having a personal health budget.
• Having a personal health budget does not entitle someone to more services, more expensive services, or preferential access to NHS services.
• Services should be safe and effective. Using them should be a positive experience.
• Personal health budgets should help people get a service from the NHS that best suits them.
• You should have as much control over decisions as is appropriate. You're not being left on your own - you'll have support when you make your decisions.
• Organisations should work in partnership with you and with each other. No one will have to get their services in this way if they do not want to.

How can a personal health budget be managed?

Once your care plan has been agreed, the money in your personal health budget can be managed in a number of different ways:

• A notional budget: the cost of different services and the overall budget for your health care will be explained to you. The NHS holds the money, and buys or provides the goods and services you have chosen.
• A third party arrangement: an organisation legally independent of both you and the NHS (for example, an Independent User Trust or a voluntary organisation) holds the money on your behalf, and buys or provides the goods and services you have chosen.
• A health care direct payment: the money is transferred to you, and you buy the goods and services you have chosen. Some direct payments support organisations will act as an agent and help you manage the direct payment. Only approved PCTs in the pilot programme can offer direct payments.

Individuals will need a separate bank account to receive a personal health budget via a direct payment. This account must only be used for purchasing care. However, it can also be used for receiving and managing a social care budget or Independent Living Fund payments.

If you wish to have a budget but don't want to manage it yourself, it may be possible for someone else to manage the budget on your behalf. If you care for someone who does not have capacity to manage a personal health budget themselves, the same arrangement may also be possible. Every effort must be made to ask the person about their wishes and to keep their best interests in mind.

You can also manage the care and support you choose in different ways, ranging from doing this yourself through to getting help from another person or organisation to implement what's in your care plan on your behalf.

You can review and update your care plan with your local NHS team when you need to, for example if your health changes or something in your plan isn't working for you. You can also give up your personal health budget if you prefer to.

What is the aim of a personal health budget?

The aim of a personal health budget is to give you more choice and control over the money spent on meeting your health care and wellbeing needs. This means that you select treatments and services that meet your needs in a way that is most appropriate for you.

We think this approach will increase people's satisfaction with the care they receive, while helping to improve their health. Personal health budgets are one way of helping people to be more involved in discussions and decisions about their care.

How can I get a personal health budget?

Personal health budgets are being tested in some areas of England, and health care direct payments are only available within the pilot programme. The pilot sites are all at different stages, so even if a pilot is happening in your area it might not be available to you just yet.

The primary care trust (PCT) in your area needs to agree to you getting a personal health budget. They also have to agree with you on your care plan and the type of budget you would like. In some cases, for example if the PCT does not think that someone has capacity to manage the budget, or if someone wishes to have a budget but not manage it themselves, someone else can manage it on the person's behalf.

• PCTs participating in the pilot programme
• NHS Choices: Contact your local primary care trust

Even if you can't have the money for your care as a personal health budget, you can still speak to the person who organises your NHS care, like your community nurse or voluntary organisation, about whether your needs can be met in another way that is more personal to you. For example, everyone with a long term condition can have a care plan that sets out an agreement about what care you need and how it will be provided.

• NHS Choices: what is a care plan?
• NHS Choices: Your healthcare
• How can a personal health budget be managed

How do personal health budgets fit with other personalised health and social care initiatives?

Personal health budgets, and personal budgets in social care, both aim to give people more choice and control to meet their care and wellbeing needs. We think this can improve people's satisfaction, experience and outcomes. As part of the personal health budgets pilot programme we are looking at how to join personal budgets in health and social care together, to make them more efficient and easier for people to manage.

If you are receiving a personal health budget and a personal budget for social care, then it may be possible for your primary care trust and Local Authority to join the two budgets together. You could ask the person organising your personal health budget. In some pilot areas, the assessment, planning and monitoring processes may also be joined up.

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 contact your local authority or visit the Think Local, Act Personal website
• "The Right to Control". Shifting the balance of power from the state to the individual and recognising that disabled people are the experts in their own lives. This is being tested by the Office of Disability Issues. For more information visit Right to Control
• "Aiming high for disabled children": Individual budgets for families with disabled children. This is being piloted by the Department for Education.
• "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?

Personal health budgets are part of a wider drive to personalise health and social care which dates back to the 1970s, with the campaign by disability groups for people to have more control over the money that was being spent on their needs. Personal health budgets build on experience in social care and personalised care planning for people with long term conditions, and are the next step in giving people more choice and control over the services and care they receive.

As personal budgets in health are new to the NHS, there are a lot of things we don't know about how they will work. For example we don't know if they will be right for everyone and we are using the pilot programme to look at this. We also do not know yet how they should be implemented in the NHS.

There are some practical issues which we are looking at during the pilot programme like how to set a budget, how to support people through the whole process, and how to develop the market of products and services you can choose from, so people have real choice.

All these things are being looked at as part of an independent evaluation. The evaluation team are due to report back to the Department of Health in October 2012.

What can I spend my personal health budget on?

Everyone with a personal health budget can get support to think though how they would like to use their budget to meet their health and wellbeing needs. Your local NHS team can give you advice on this, and recommend a range of organisations who can support you. This is often described as brokerage.

You can spend your personal health budget on any care or services that are set out in your care plan and agreed with, for example, your community nurse or the voluntary organisation you are working with, and your primary care trust. How your plan gets signed off and things that you can't include in your plan will be explained to you at the beginning of the planning process.

There are a few things a personal health budget cannot be spent on. These are things that it would not be right for the Government to fund like alcohol, tobacco, gambling or debt repayment, or anything that is illegal.

A personal health budget cannot be used to buy emergency care - for example if you break your leg, you would go to A&E as you do now - you would not use or receive a personal health budget to arrange for it to be x-rayed, set or plastered. You can't use your personal health budget to buy the services that your GP already provides to you either, for instance seeing your doctor to discuss your health or get a prescription. Other services recommended by your doctor, like physiotherapy, could be included.

Read what other people have spent their personal health budget on.

Can I add my own money into a personal health budget?

No, you cannot add your own money into a personal health budget. The personal health budget must meet all your identified health and wellbeing needs. You cannot spend your own money on your NHS care.

If you wish to spend your own money on extra services (for example, massage or more physiotherapy than your doctor thinks is necessary to improve your health) you can do this. You would need to organise and pay for this yourself, and it would be separate to the personal health budget.

Contact us

If you want to contact us, please email 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 theDepartment of Health website.