The NHS Long Term Plan sets out the vision for the future NHS including a new relationship with patients and communities that supports people to gain far greater control of their own car when they need health services. A key part of this is developing how personalised care is offered to individuals. Read more about personalised care on NHS England/Improvement's website.
delivered, based on ‘what matters’ to them and their individual strengths, needs and preferences. This happens within a system that supports people to stay well for longer and makes the most of the expertise, capacity and potential of people, families and communities in delivering better health and wellbeing outcomes and experiences. This is one of the five major, practical, changes to the NHS service model in the NHS Long Term Plan. It recognises that personalised care is central to a new service model for the NHS, including working through primary care networks, in which people have more options, better support, and appropriate joined-up care at the right time in the optimal care setting.
This shift represents a new relationship between people, professionals and the health and care system. It provides a positive change in power and decision making that enables people to feel informed, have a voice, be heard and be connected to each other and their communities.
Personalised care is about looking at the needs of the individual as a whole and working with them to prepare a care plan that suits their personal needs. There are six components to this:
- Shared decision making
- Personalised care and support planning
- Enabling choice, including legal rights to choice
- Social prescribing and community-based support
- Supported self-management
- Personal health budgets and integrated personal budgets
Personal health budgets
A personal health budget (PHB) is an amount of money to support a person’s individual health and wellbeing needs, as agreed between the individual and their local NHS team. The person’s health and wellbeing needs will be set out in a personal centered care and support plan which will be developed by the person together with a health care professional. How the budget will be used to support the health and well-being needs will be set out in this plan and agreed by both the person and the local NHS team.
A personal health budget can be managed in three ways, or a combination of these.
Notional budget
No money changes hands. You find out how much money is available for your assessed needs and together with your NHS team you decide on how to spend that money. They will then arrange the agreed care and support for you.
Third party budget
An organisation legally independent of both you and the NHS (for example, an independent user trust or a voluntary organisation) holds the money for you, and also pays for and arranges the care and support agreed in your care plan.
Direct payment for healthcare
You get the money to buy the care and support you and your NHS team agrees you need. You must show what you have spent it on, but you, or your representative, buy and manage services yourself.
A PHB and integrated personal budget (IPB) is an amount of money to support a person’s identified health and wellbeing needs, planned and agreed between them and their local CCG. This may lead to integrated personal budgets for those with both health and social care needs. This isn’t new money, but a different way of spending health funding to meet the care needs of an individual.
Design principles: A person will:
- Get an upfront indication of how much money they have available for healthcare and support
- Have enough money in the budget to meet the health and wellbeing needs and outcomes agreed in the personalised care and support plan
- Have the option to manage the money as a notional budget, a third-party budget, a direct payment or a mix of these approaches
- Be able to use the money to meet their outcomes in ways and at times that make sense to them, as agreed in their personalised care and support plan
PHBs can pay for a wide range of items and services, including therapies and personal care, allowing more choice and control for individuals to manage their own health.
Our local offer
NHS Kernow has made PHBs the default method of commissioning care for adults who are eligible for NHS continuing healthcare in receipt of care at home since April 2019.
In addition children who are eligible for children’s continuing care have the “right to have” a PHB. This is fully operational.
Since December 2019 wheelchair users have a right to a PHB to obtain their specific wheelchair. A process is being developed in order for people to access PHBs for this service and should be available in the next few months. Read more about wheelchair services on Cornwall Partnership NHS Foundation Trust's website.
Since December 2019 people who are eligible for Section 117 aftercare have a right to a PHB. A process is being developed in order for people to access PHBs for this service, and should be available in the next few months.
Previously a small cohort of people who have had two or more long term conditions and/or a mental health need, who are also high users of NHS services have successfully used a PHB to access support not available within commissioned services. Following a review of these cases a new cohort of clients is being considered to benefit from a PHB. We are trialling the benefit of health coaching and a PHB with a group of people who have complex long term pain and a long term health condition/mental health need and have prescribed opiate dependency. These people have been identified by the complex pain team and their GP and been invited to participate.
In future we will be considering offering PHBs for the following people:
- Veterans
- End of life care/fast tracks
- Mental health clients
- Maternity
- Long term conditions
- Intense users of services
- Any cohort of people where traditional care has not met their needs and are still accessing services that are not adding benefit
NHS Kernow will monitor its delivery of PHB’s internally and report to the Governing Body and will also report nationally to NHS England. NHS Kernow also welcomes feedback from people and their families about their experience of PHB’s and will use this information to improve the delivery and roll-out of PHB’s in the future.
Contact information
E-mail: personalhelathbudgets1@nhs.net
Telephone: 01726 627659