Personal health budgets

The NHS offers personal health budgets and personal wheelchair budgets to certain groups of people.

What is a personal health budget?

A personal health budget is an amount of money to support your health and wellbeing needs, which is planned and agreed between you, your representative (friend, unpaid carer or family member who is supporting you) in, or, in the case of children, their families or carers and the local NHS team. It is not new money, but money that would normally have been spent by the NHS you being spent in a more flexible way to meet your identified needs. In most cases, you will make an arrangement with your local Clinical Commissioning group.

The use of personal health budgets is one way of providing more personalised care and means tailoring services and support to enable you to have choice, control and flexibility over your care. Personal wheelchair budgets are another form of personal health budget

Personalised care and support plans prioritise your strengths and skills, your personal social context, what is important to you in terms of how you want to live and be supported, as well as what is important in relation to identified health and wellbeing needs.

Who is eligible for a personal health budget?

There are two frameworks that govern who is eligible. NHS funded nursing care and Children and Young People’s Continuing Care

NHS funded nursing care and continuing health care

Eligibility is based on a primary health need. If you have a primary health need then that means that the main aspects or majority part of the care you require is focused on addressing and/or preventing health needs.

Eligibility is the same for all individuals, whether their needs are being met in their own home or in care home accommodation

physical, mental health or psychological needs and quality of interventions required to manage them.
quantity and severity of the needs and the support required to meet them, including the need for sustained/ongoing or continuity of care
how the needs present and interact and the skill required to manage or treat the person
unpredictability of fluctuating needs which may create challenges in managing them. There is a prevention or deterioration element that needs to be considered.

It is important than you give consent to the process of assessment for eligibility.

Children and young people’s continuing care

A continuing care package will be required when a child or young person has needs arising from disability, accident or illness that cannot be met by existing universal or specialist services alone.

Some children and young people, up to their 18th birthday, may have very complex health needs. These may be the result of congenital conditions, long-term or life-limiting or life-threatening conditions, disability, or the after-effects of serious illness or injury. These needs may be so complex, that they cannot be met by the services which are routinely available from GP practices, hospitals or in the community commissioned by clinical commissioning groups (CCGs) or NHS England. Those with a learning disability, autism, rare or genetic condition, mental health concern or who needs end of life care may also be eligible.

It is important to give consent to the process of assessment of eligibility. If a child who is under 16 does not have the capacity to give consent, someone with parental responsibility can consent for them, but that person must have the capacity to give consent.

Once eligible needs have been agreed, then there should be a single plan for each child with SEND, which covers their education, health and social care needs.

Personal wheelchair budget

If you have been assessed as requiring a wheelchair as part of your identified needs, then the NHS will base this budget on what it would cost them too meet your assessed postural and mobility needs from NHS Wheelchair services. Maintenance and repairs should be included along with specific seats and pressure-relieving equipment. You can use additional monies (personal or from the voluntary sector) to fund an enhancement.

Key features of a personal health budget

The key points are:

you should be central in developing your care and support plan
you should be able to agree health and wellbeing outcomes
there should be agreement of learning outcomes for children and young people with education with their health and care plans
you should receive an indication of how much money will be available
you should have enough money in the budget to meet your health and wellbeing needs and outcomes
you should have the option to manage the money as a direct payment, a notional budget, a third-party budget or a mix of these approaches

How is the personal health budget managed?

a notional budget where the commissioner holds the budget and helps manage it
a third-party budget where an organisation independently of you and the NHS commissioner manages the budget on the person’s behalf and arranges support by purchasing services in line with the agreed care plan
a direct payment where money is transferred to the person, their representative or nominee, or, in the case of children, their families or carers, who manages for the necessary services.

Useful information and contacts

Last updated: March 1, 2021