NHS Personal Health Budgets: new rights and new guidance

NHS England has issued new guidance to coincide with the extension[1] of the right to a Personal Health Budget (PHB) to cover people eligible for section 117 Mental Health Act 1983 after-care support as well as for people in need of wheelchair services.  These new rights came into force on 2 December 2019.  The 27 page guidance (NHS England Personalised Care:  Guidance on the legal rights to have personal health budgets and personal wheelchair budgets (2019)) can be accessed by clicking here.

A right to have a PHB (which can be paid as Direct Payments) now exists in England for:

  • Adults eligible for NHS Continuing Healthcare funding (NHS CHC);
  • People eligible for after-care services under section 117 of the Mental Health Act 1983;
  • People assessed as in need of a wheelchair (for more than short-term use); and
  • Children and young people eligible for NHS funded continuing care.

The guidance states that there are six key features of a PHB ‘that ensure people experience the best outcomes possible’.  These are that a person should:

Be central in developing their personalised care and support plan and agree who is involved;

  • Be able to agree the health and wellbeing outcomes (and learning outcomes for children and young people with education, health and care plans) they want to achieve, in dialogue with relevant health, education and social care professionals;
  • Know upfront an 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 direct payment, a notional budget, a third-party budget 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.

 

Importantly the guidance stresses that

Any agreed budget must be sufficient to ensure the health and wellbeing outcomes required for a person can be realistically met. For example, if a CCG decides, when planning a personal health budget, to release money based on a monetary valuation of a person’s expected quantity of continence products as would have been provided by the NHS, they must be satisfied that this amount is sufficient to enable the purchase of the products in the open retail market so as to meet someone’s identified continence needs. An exception to this is the provision of wheelchairs. For personal wheelchair budgets holders, this right to have does not affect the existing ability to add to the cost of the wheelchair of their choice.

The guidance concerning the working of the new scheme for wheelchairs is brief – but includes (page 16):

For personal wheelchair budgets the amount in the budget should be based upon what it would cost the NHS to meet the person’s assessed postural and mobility needs via the wheelchair service currently commissioned by their CCG. The introduction of personal wheelchair budgets builds upon the existing regulatory framework which enables people to contribute to the cost of a wheelchair. For people who have additional health and social care needs, the personal wheelchair budget can be pooled with funding from other statutory services (if this is agreed as meeting the person’s assessed needs by all services and is cost effective). With personal wheelchair budgets, people can also choose to access non-statutory funding that may be available via voluntary, charitable organisations both nationally and locally.

 

And at page 17:

For personal wheelchair budgets, manual, powered chairs and specialist buggies are included. CCGs need to consider repair and maintenance and how this will either be supported by existing services or made available as part of a personal wheelchair budget. CCGs need to consider specialist seating and pressure-relieving equipment as it remains a statutory duty to provide these, either as part of a personal wheelchair budget or via existing commissioned services. Decisions on how these are provided will need to be made locally on a case by case basis, based on clinical assessments.

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[1] By amendment of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012, reg 32A.