From 1 October 2014 if you have been awarded NHS Continuing Healthcare you have a right to a personal health budget set up to fund your ongoing care needs.
This gives you greater choice and control over the manner in which your assessed needs can be met. If you have a fluctuating health need, which means you move in and out of NHS Continuing Healthcare funding, the right to have a personal budget is not available but you retain the right to ask for a personal budget.
As always there is some small print which means that personal health budgets are not appropriate for all types of healthcare so reviews are undertaken on a case by case basis. This means there might be parts of your care for which a personal budget is suitable but other parts where it is not. For example there may be cases where the Clinical Commissioning Group (“CCG”) does not consider a personal health budget to be appropriate. This could be due to a specialised element of care or it would not be value for money. Your case will be considered on its merits. What this does mean is that your budget can be used not just for care but for the purchase of alternative therapies and equipment and will enable you to purchase care in a way which works best for you.
The budget will be the amount of money that is identified as needed to support your identified health and wellbeing need. This budget is agreed with you and the local NHS team. The budget could be:-
- a notional budget – held by the commissioner but used to secure services for you;
- a third party budget – where an independent organisation manages the budget on your behalf; or
- a direct payment – where money is transferred to you or your representative who purchases the required services
All three options should be explored and considered when looking at the best ways to manage a personal budget as part of the care planning process.
Just because a personal budget is implemented it does not mean that is it. The management of the budget will be reviewed and the care plan detailing the care required will be reviewed to ensure it is achieving the outcomes established for you. The first review will take place three months after the first direct payment and thereafter at least once a year.
If you have a right to have a personal budget and this is turned down the CCG must set out in writing the reason why it has been refused and can be asked to reconsider. This must be in a timely manner with an acknowledgement being made by the CCG for the request for a review within ten days and the completion of the review 28 working days from the date of the original request.
The right to have a personal budget is not limited to care at home. The Regulations do not expressly prevent personal health budgets from being used for care home funding. Where a request is made for a personal NHSCC budget for a person living in a nursing home the CCG must be certain that providing care adds value to the person’s overall care. The funding of nursing care in this way was not subject to the recent pilot schemes which have taken place so the CCGs will exercise caution in granting personal health budgets in this way.
If you need any help, support or advice in relation to personal health budgets please do not hesitate to call our team……
T: 01227 700 702
Published by Kelly Duke 10 November 2016