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Personal health budgets

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 (or someone who represents you), and your local NHS team. It is not new money, but it may mean spending money differently so that you can get the care that you need.

A personal health budget allows you to manage your healthcare and support such as treatments, equipment and personal care, in a way that suits you. It works in a similar way to personal budgets, which allow people to manage and pay for their social care needs. See below, can I have a personal health budget as well as a personal budget?

The right to have a personal health budget only applies to adults receiving NHS continuing healthcare (NHS-funded long-term health and personal care provided outside hospital) and children in receipt of continuing care. Find out more about continuing care for children and young people (PDF, 560kb).

If you do not fall into either of the eligible patient groups but you are interested in a personal health budget then you should speak to your local clinical commissioning group (CCG). CCGs make the arrangements for personal health budgets and are all encouraged to offer them to other patient groups. Find your local CCG.

If you are able to have a personal health budget, then together with your NHS team, you will develop a care plan. The plan sets out your 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. Also read the FAQs in the sections below:

A care co-ordinator should be identified in the planning process who will be your first point of contact in case you have any concerns.

Visit the peoplehub website, where people with a personal health budget and their families and carers can talk about their experiences.

A personal health budget will not be right for everyone and it won't always be the best way to receive support. You are not allowed to spend the money on gambling, debt repayment, alcohol, tobacco, or anything illegal. Emergency care, medication and the care you get from your GP is separate and will not need to be paid from your budget.

 

Monitoring and review

Once you have a personal health budget, your NHS team will periodically review your care plan with you. You can also ask your NHS team to review and update your plan because your health needs have changed or you feel the current plan isn't working for you.

You can give up your personal health budget at any point if you wish to, you will still be able to receive care and support in another way.

 

Can I have a personal health budget as well as a personal budget?

Yes. If you already have a personal budget for care and support from a social care services and your NHS team agrees, you can also have a personal health budget and ask for both to be paid into the same account.

 

What is the difference between a personal health budget, a personal budget, an integrated personal budget and a direct payment?

  • A personal health budget is for your NHS healthcare and support needs.
  • A personal budget is for your social care and support needs.
  • An integrated personal budget is for both your healthcare and support needs and social care needs.
  • A direct payment is one way of managing these budgets, where you get the money to buy the agreed care and support you need.

 

What happens if I disagree with the amount I'm offered?

The discussion around your plan should include what to do if you disagree with something, or if something goes wrong. If you're not sure what to do, first speak to your NHS team, but if you're still not happy you can use the NHS complaints procedure.

 

What if my request for a personal health budget is turned down?

If your request for a personal health budget is turned down, you should be told why. If you wish to appeal, your local CCG should explain what to do. If you're still not happy you can use the NHS complaints procedure.

 

Managing your personal health budget

A personal health budget can be managed in three ways or a combination of those.

1. 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.

2. 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, pays for and arranges the care and support agreed in your care plan.

3. Direct payment for healthcare
You get the money to buy the care and support you and your NHS team agree you need. You must show what you have spent it on, but you, or your representative, buy and manage services yourself. Find out more about the direct payment regulation (PDF, 665kb).

 

What happens if I underspend, or overspend, my budget?

There are likely to be times when your healthcare needs will change and this may affect your budget too.

If you have underspent, your NHS team will discuss with you what happens to the money. It may be kept for your future healthcare needs, or returned to the CCG  and allocated to other budget holders.

If you have overspent, contact your NHS team as soon as possible. No-one with a personal health budget will be denied healthcare. If you feel you need additional support than is agreed in your care plan, then those arrangements should be reviewed. You can request a review of your needs and care plan at any time. If you have spent your budget in ways that have not been agreed with your NHS team, you may be asked to repay it.

Page last reviewed: 31/01/2017

Next review due: 31/01/2020

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