Personal health budgets

A personal health budget is an amount of money to support a person's health and wellbeing needs, planned and agreed between you and your local NHS team. This personalised care and support plan offers people of all ages greater choice and flexibility over how their assessed health and wellbeing needs are met.

This starts with a care and support planning conversation to agree the care, support and services the personal health budget will be spent on. This can include a range of things care, support and services that are holistic, innovative and build on your strengths.

Personal health budgets are flexible. They can be used to meet a variety of needs:

  • Ongoing care and support to meet a person's assessed health and wellbeing needs, such as NHS Continuing Healthcare, children and young people’s continuing care, or aftercare services under section 117 of the Mental Health Act.
  • To support children and young people with education, health and care plans (aligned to expectations in the SEND code of practice).

And they can be:

  • Pooled to support several individuals to come together to achieve a common health and wellbeing goal, like a group health weight management programme for people with a learning disability or autism.
  • Integrated with social care and/or education personal budgets.
  • Used to target and address wider system priorities such as identified health inequalities.

If you are eligible for a personal health budget, you (or your representative) can expect to:

  • Be at the heart of developing your care and support plan and agree who is involved.
  • Be able to agree the health and wellbeing (and for children, learning) outcomes you want to achieve, together with health, education and social care staff.
  • Get an upfront indication of how much money you have available for healthcare and support. There may be flexibility when this is for a one-off budget.
  • Have enough money to meet the health and wellbeing needs and outcomes agreed in the plan.
  • Have a range of options for how you manage the money. You can find out more about this on the NHS England website.
  • Be able to use the money in ways that make sense to you, as agreed in your personalised plan.

If you are in one of these groups, you have a legal right to a personal health budget:

  • Adults who receive NHS continuing healthcare
  • Children and young people eligible for continuing care
  • People who are eligible for aftercare services under section 117 of the Mental Health Act
  • People who are eligible for an NHS wheelchair

These are not the only people who can have a personal health budget. We want to help more people to benefit from personalised care.

A personal health budget is an amount of money to support the health and wellbeing needs of yourself or someone you care for. They can help by giving you more choice and control over the support and services you use. A personal health budget can be a way to receive care and support that suits your needs better. Both adults and children can be eligible for a personal health budget.

Across the North East and North Cumbria, we work with local councils to offer personal health budgets to people who are registered with a local GP and live in their own home. You can manage your personal health budget yourself if you or your child are eligible for:

  • NHS continuing healthcare
  • Children’s continuing care
  • Jointly funded health and social care package for complex needs
  • After-care services under section 117 of the Mental Health Act

Or

  • Are referred and meet the eligibility criteria of the local wheelchair service, and people already registered with the wheelchair service, when they require a new wheelchair either through a change in clinical needs or the condition of the current chair

If you would like a personal health budget for yourself or someone you care for, talk to the local NHS worker who helps you most often with organising care. This might be a care manager, a nurse or social worker. They can discuss personal health budgets with you.

If you’re eligible and would like to consider a personal health budget, you can work with your NHS worker to develop a support plan. This then has to be agreed by North East and North Cumbria Integrated Care Board (ICB).

If your child gets continuing care, they will have an education, health and care plan (or EHCP), or will be transferring to one very soon. For children, personal health budgets can contribute to some or all of the social, health or educational elements of this plan. 

Even if a personal health budget is not right for you, you can talk to your NHS worker or care co-ordinator about other ways to make sure you get the care and support that works best for you and your family.

There are three key steps to a personal health budget:

Step 1 – Assessment of needs

Your NHS worker or care co-ordinator will ask you questions to find out what you need for your health and wellbeing.

Step 2 – Allocating the budget

This is then used to calculate an ‘indicative budget’ – which is an estimate of the money you need to meet your health and wellbeing needs.

Step 3 – Support planning and using the budget

Your NHS worker or care co-ordinator will then work with you, and those who support you, to decide how best to use the personal health budget to meet your needs. This will include your choice of how care is delivered.

This is written in a support plan, which both you and your NHS worker or care co-ordinator must sign. It can take some time to set up your health budget, but we will make sure this doesn’t cause a delay in being discharged from hospital.

The support plan sets out your or your child’s personal health and wellbeing needs, the health outcomes you want to achieve, the amount of money in the budget and how you are going to spend it.

You can use a personal health budget to pay for a wide range of items and services, like therapies, personal care and equipment. You don’t have to change any support that is working well for you - but if something isn’t working, you can change it.

Your NHS worker or care co-ordinator will advise you and can recommend a range of organisations that can offer support. There are some things you can’t use the budget for, such as alcohol, tobacco, gambling, debt repayment or anything that is illegal.

You also can’t use a personal health budget to buy emergency care (if someone who has a personal health budget had an accident, they would go to A&E like everyone else) or for primary care services like dental treatment. But other services recommended by a GP, like physiotherapy, could be included.

Personal health budgets are not a welfare benefit and they are not a part of the benefits system. But personal health budgets are currently only available to people who are awarded NHS continuing healthcare (a jointly funded health and social care package for complex needs or mental health aftercare) so it is possible that some of your benefits may be affected.

This depends on your circumstances, and it's your responsibility to inform the Department for Work and Pensions. You can find out more via the NHS website or GOV website.

Personal health budgets are for your health and wellbeing needs, and cannot be spent on anything else. The ICB will ensure that payments are used for the care agreed with your NHS worker or care co-ordinator and set out in your plan. The ICB is entitled to recover any money that is not spent appropriately.

Whatever form of personal health budget is used, the assessment and review process for continuing healthcare, jointly funded packages of care and mental health do not change.

If you already have a personal or individual budget for care and support from social services, it may be possible to combine this with a personal health budget. You can also use ‘direct payment’ to manage these budgets. Your NHS worker or care co-ordinator will be able to help you with more details.

If you need a wheelchair, you have a range of choices to meet your needs. A wheelchair assessment will confirm whether you are eligible for a personal wheelchair budget.

Before your assessment, you may need to complete a short questionnaire. This will help us find the most appropriate wheelchair for your needs. If you qualify for a personal wheelchair budget, you will be able to choose from a range of options.

  • NHS continuing healthcare means a package of care that is arranged and funded solely by the NHS for people who are not in hospital but have complex, ongoing healthcare needs.
  • Some patients who do not qualify for continuing healthcare but have complex needs may have package of care jointly funded by health and social care services. This type of care can also be covered by a personal health budget.
  • NHS continuing care is support provided for under 18s who need a tailored package of care because of disability, accident or illness. The main difference is that while continuing healthcare for adults focuses mainly on health and care needs, continuing care for a child or young person considers their physical, emotional and intellectual development as they grow up (for example, most continuing care packages will have elements of health and local authority funding to enable for their education).
  • Mental health aftercare is available if you have been compulsorily detained for treatment in a psychiatric hospital. This free aftercare can help to prevent your condition getting worse and you needing to be re-admitted to hospital.
  • People entitled to free mental health aftercare don’t need a financial assessment for any social or health services related to their mental health condition.