What can I spend my personal health budget on?
Your personal health budget can be used to buy the items linked to your health and wellbeing outcomes and that have been agreed in your Care Support Plan.
Some examples of what can be purchased are:
- Employing Personal Assistants (PAs)
- Hiring agency care staff or self-employed carers
- Respite care
This list is not extensive and can be discussed further with your case manager.
What can’t you spend your personal health budget on?
- Anything illegal
- Gambling
- Debt repayment
- Tobacco
- Alcohol
- Anything not directly linked to the agreed health and wellbeing outcomes in your Care Support Plan or agreed with your All Age Continuing Care Team.
You can find more information on national guidance on the NHS.uk website.
What happens if I disagree with the amount I’m offered?
During the care planning process, you will be working closely with your case manager. Funding agreed must be sufficient to provide for your assessed needs. These discussions are detailed, and you will be involved at every stage and your final Care Support Plan will be reached by agreement. If you do not agree with your proposed final budget, you may appeal the decision if you email the CHC PHB team.
What happens if my budget runs out?
Your PHB should be enough to meet your needs in the way that has been agreed. It is your responsibility to manage your budget.
The budget is set on the amount of care and support you need and if you stick to this (and your needs don’t change) you should be ok.
We provide one week of contingency funding in case of emergencies (for example, if your informal carer is unable to look after you for a period of time and you need to employ additional help). This contingency does not form part of your PHB itself, and the expectation is that it will be returned if it has not been needed. It is there to provide you with a financial support should you need it quickly. It is important that you let the team know when you use your contingency fund.
If you have concerns that your budget isn’t going to be enough to pay for a change in care needs, please make your AACC team aware as soon as possible. Please email the CHC PHB team.
Your team will work with you on any necessary revisions to your Care Support Plan or budget.
What happens if I overspend my budget if I am receiving a direct payment?
Don’t worry if you accidentally overspend, or have a need to overspend, as long as you let us know the reason why (for example, you need extra care if your health suddenly deteriorates) or you make a genuine mistake. Just let us know as soon as possible and we’ll work through it together.
We will audit your PHB every 3 months with the help of Surrey Independent Living Charity (if applicable) and if, at the end of a three-month period, you have overspent your budget, we will work with you to understand why.
If you deliberately misuse your PHB, the Integrated Care Board may stop your direct payment and instead commission your care directly.
What happens if I underspend my budget?
If you underspend on your PHB, we will work with you to understand why, to ensure that your health and wellbeing needs are being met.
In the circumstance where funds have accumulated in a PHB holder’s account beyond the monthly value, plus contingency, the team will inform you before activating a payment break, which will remain in place until your account is returned to the acceptable balance.
What happens if I go into hospital?
When an individual who holds a PHB through direct payment or payment to a third party is admitted to hospital they must ensure that they continue to support their employed staff and adhere to the statutory responsibilities of an employer and the contractual obligations of the PHB Agreement.
All Age Continuing Care funding is intended to deliver your package of care in the community. Therefore, when you go into hospital your PHB funding would not cover the cost of agency care or care through a self-employed carer for that period.
There may be some circumstances whereby a self-employed or agency care worker who knows you well, may be asked to support you on a ward for a short period of time. The AACC team would agree this at the time of the hospital admission with the budget holder.
Personal Assistants employed by you should continue to be paid in accordance with your statutory obligations as an employer. However, they are not to work in the hospital unless previously agreed, for specific tasks. The ICB would look at any request from a PHB holder for their Personal Assistant to accompany them on a case-by-case basis.
Generally, Personal Assistants who continue to be paid from your budget during your admission, would be encouraged to visit you and offer ancillary support. However, any additional cost in terms of travel and accommodation incurred would not be covered in your budget.
Depending on the length of your hospital stay, your case coordinator may arrange to suspend PHB services that you are not using while you are in hospital. Through the normal budget reconciliation process, any money you haven’t spent as a result from your stay in hospital will be discussed and the unused funds will need to be credited to the NHS.
Can I employ my wife, husband, son, daughter or other family member who lives in the same household as me?
You can’t normally use your PHB to make direct payments to close family members (see below for a definition of a close family member) or anyone living in the same house.
However, you may be able to do so if your Case Manager is satisfied that a service from that person is necessary to meet the needs of the person receiving care, or to promote the welfare of a child for whom direct payments are being made.
The All Age Continuing Care team will make these decisions on a case-by-case basis.
Who is a close family member?
A person’s close family members are described in the regulations as:
- the spouse or civil partner of the person receiving care;
- someone who lives with the person as if their spouse or civil partner;
- their parent or parent-in-law;
- their son or daughter;
- son- in- law or daughter- in- law;
- stepson or stepdaughter;
- brother or sister;
- aunt or uncle;
- grandparent; or
- the spouse or civil partners of those above, or someone who lives with them as if their spouse or civil partner.
These restrictions are not intended to prevent people from using their direct payments to employ a live-in personal assistant, provided that person is not someone who would usually be excluded by the regulations.
The restriction applies where the relationship between the two people is primarily personal rather than contractual, for example if the people concerned would be living together in any case.
Can I take my agency carer with me if I decide to have a personal health budget?
If you already have a carer who works for a care agency and you wish to continue to contract them, you can discuss this with your case manager.
What happens if my plan isn’t working for me or my needs change?
Your plan should be a living document and will change as your needs change. If you feel that your plan isn’t working for you as well as you’d like, or your needs change, please let your case manager know as soon as possible, and they will discuss how your budget and plan may be changed to meet your assessed needs and agreed health and wellbeing outcomes.
Can I have a personal health budget and a personal budget?
If you are moving from a Social Services package of care to an NHS package of care, then, in most cases, All Age Continuing Care will fund ALL your health and wellbeing needs. In some cases, a jointly funded package of care may be agreed and, in this case, you may receive funding from both Social Services and AACC.
Do I have to have a personal health budget?
Not at all. A personal health budget may not be the best option for everyone and it’s up to you whether you choose to have one or not. If you do choose to have a personal health budget, you can also choose to swap back to receiving CHC funding in the usual way at any time if you feel that the personal health budget isn’t working for you. Please let CHC know if you’d like to change anything. If you wish to employ your own personal assistant(s), you will need to have a personal health budget (either as a direct payment or as a third party budget if you would prefer not to directly employ and manage the PA yourself).
How long will it take to put a personal health budget in place?
It can take up to 3 months to develop and agree your care support plan, we work at your pace with as little or much support as you need. During this time we will not leave you without care.
For a direct payment, it can take up to 6 weeks to set up.
For a Supported Managed Account it can take up to 2 weeks.
How is the personal health budget set up?
Our standard approach is to offer a Supported Managed Account (SMA) to all prospective PHB holders in the first instance. This is to help with the set-up, which can be quite complicated given the statutory requirements to act as an employer.
Thereafter, and in discussion with your case manager, there will be the option to move to a different type of PHB.
Will my direct payment account automatically transfer from social care to healthcare?
NHS Surrey Heartlands ICB does not have access to the same type of payment card account system as social care. The ICB has a separate process which requires that individuals have their own bank account. It can take up to 6 weeks for the NHS to set up a direct payment to your approved bank account.
Will I be able to continue to employ the care team I have with social care?
Your NHS budget is for the delivery of healthcare tasks. During the care planning process your case manager will discuss with you the requirements to ensure that any staff you may employ through the NHS PHB are trained in line with the outcomes of the care support plan.
I am a self-funder and employ a Personal Assistant – will the PHB pay for that?
Your NHS budget is for the delivery of healthcare tasks. During the setup process of the PHB your case manager will discuss with you the requirements to ensure that any staff you employ in future through the PHB are trained to meet the outcomes of the care support plan.
Can I keep the care agency that I have in place?
If you are purchasing the care from an agency yourself, you should work within the budget you are allocated. NHS funding allocated to PHBs for homebased care is in line with the rates Surrey County Council and the AACC team have agreed with approved homebased care providers covering Surrey. The agency must be registered with the Care Quality Commission (CQC) with a rating of Good or Outstanding.
Can I revert back from a personal health budget?
If you do choose to have a PHB, you can choose to swap back to the option whereby Surrey All Age Continuing Care arranges your care directly at any time if you feel that the PHB isn’t working for you. You may also choose to keep your PHB but try different way of managing the money.
Does my personal health budget fund my equipment?
The PHB will not be used to fund equipment. Any request for equipment will be considered through the standard All Age Continuing Care Equipment Panel process.
Personal Budgets for wheelchair services are available separately through the ICB. Please contact Surrey Heartlands ICB for more information.
Does my personal health budget fund therapies?
The first step to access therapy is through a GP referral. If the therapy is not available through NHS community services, then the clinical team will review the request for the therapy funded under the PHB. The PHB will only be used to fund therapies if there is evidence of a clinical need.
Can I have a product list and how much do services cost?
You can find information on Surrey Information Point from Surrey County Council at Connect to Support Surrey. Different products and services will be appropriate for different people according to their individual needs. Through the care planning process, we (or your chosen care planner) will be able to provide help and advice about the services that are available to you and their costs.
What about other NHS services?
You will continue to receive other NHS services (for example district nursing, GP services) as you usually do.
Does my personal health budget fund transport?
NHS Surrey Heartlands ICB commissions a non-emergency patient transport service for Surrey-registered patients, including All Age Continuing Care patients who need to attend NHS appointments.
Any budget for transport for an education setting as part of an Education Plan, should be arranged through your Education Officer, at Surrey County Council.
Funding for specialist transport to a day centre will be considered in accordance with mileage to the closest available facility.
Any requests for funding for transport for healthcare that cannot be provided by the ICB’s commissioned transport service will be considered on a case-by-case basis.
Information about how you can use your qualifying mobility allowance to lease a brand-new vehicle is on the Motorbility Scheme website.
How is parental responsibility determined?
Parents and carers with parental responsibility have the primary responsibility for the care of their Children or Young Person with statutory agencies supporting them to meet their identified outcomes. The AACC (CYP) team assesses and supports the delivery of identified health outcomes for the Child or young person.
Who is eligible for respite?
Patients who are living in their own home are eligible for respite, that includes PHB holders.
Respite is to fund gaps in care when an unpaid carer takes a break. The budget can be spent by hiring a care agency or a Personal Assistant or, by purchasing a placement in a care home.
Respite arrangements should be discussed with the case manager as part of the care support plan development.
How to be a good boss – what will be expected from me?
When setting up the PHB, the holder or their representative or nominee, will be able to access support from the Supported Management Account provider, Surrey Independent Living Charity. The holder can find out how to set themselves up as an employer, including statutory responsibilities and how to employ staff.
Does NHS continuing healthcare have any effect on benefits?
If you receive Attendance Allowance (AA) or Disability Living Allowance (DLA), and you receive funding, your benefits may be affected. You should contact your benefit provider for more information.
How will my information be protected?
Your information will be protected as it usually is by the AACC team. You can find out more about our how we use your information on our website.
Where can I find out more?
If you want to know more, or have any questions about personal health budgets, please contact the Surrey Continuing Healthcare (CHC) Team in the first instance. If you do not have access to email, please contact us on 0300 561 1421 or 0300 561 1347.
