PERSONAL HEALTH BUDGETS TOOLKIT Learning from the pilot programme
A personal health budget is an amount of money to support a person s identified health and wellbeing needs, planned and agreed between the person and their local NHS team. Our vision for personal health budgets is to enable people with long term conditions and disabilities to have greater choice, flexibility and control over the health care and support they receive. The online toolkit www.personalhealthbudgets.dh.gov.uk/toolkit brings together learning from the Department of Health s personal health budgets pilot programme, and shows how personal health budgets can be implemented well. The toolkit is for people working in the NHS or working with personal health budgets more widely, and people who are eligible for a personal health budget and their families. Some parts of the toolkit are aimed at particular groups such as frontline healthcare practitioners, or finance managers. Who can have a personal health budget The Government has announced that by April 2014, subject to the evaluation, people eligible for NHS Continuing Healthcare will have the right to ask for a personal health budget including a direct payment for health care. Clinical Commissioning Groups will be able to offer personal health budgets to other people more widely, on a voluntary basis. Even before 2014, the NHS has the necessary powers to offer personal health budgets, although only pilot sites can make direct payments for health care. What is in this toolkit The toolkit comprises a range of good practice guides and other information, focusing on particular aspects of personal health budgets. It also includes people s stories, demonstrating how personal health budgets work in practice. The toolkit is organised into two sections: n How personal health budgets work n Making personal health budgets happen. These sections are broken down further into topics containing relevant guides. Each guide in the toolkit brings together learning from the pilot sites, showing how personal health budgets can be implemented. The toolkit is likely to evolve and develop over time as we learn more about personal health budgets.
THE ESSENTIAL PARTS OF A PERSONAL HEALTH BUDGET The person with the personal health budget (or their representative) will: n Be able to choose the health and wellbeing outcomes they want to achieve, in agreement with a healthcare professional n Know how much money they have for their health care and support n Be enabled to create their own care plan, with support if they want it n Be able to choose how their budget is held and managed, including the right to ask for a direct payment n Be able to spend the money in ways and at times that make sense to them, as agreed in their plan. The steps of the personal health budgets process WORKING OUT THE AMOUNT OF MONEY AVAILABLE MAKING A CARE PLAN UNDERSTANDING THE PERSON S HEALTH AND WELLBEING NEEDS ORGANISING CARE AND SUPPORT MAKING CONTACT AND GETTING CLEAR INFORMATION MONITORING AND REVIEW
CARE PLAN At the heart of a personal health budget is a care plan, developed by an individual in partnership with their healthcare professional. Notional budget: the money is held by the NHS Third party budget: the money is paid to an organisation that holds the money on the person s behalf Direct payment for health care:* the money is paid to the person or their representative. *IN APPROVED AREAS OF ENGLAND The care plan sets out how an individual's budget will be spent to enable them to reach their health and wellbeing goals. A personal health budget can be managed in three ways or a combination of them, as shown in the diagram above. Key learning points n A shift of power: Personal health budgets promote a more effective and equal relationship between NHS professionals and people who use the NHS. They will only work well if they lead to everyone making changes in their thinking, feeling and behaviours. This requires changes of role for individuals, health professionals and commissioners. n Equal access: Personal health budgets should be available to anyone who is eligible. Don t assume that some groups of people can t benefit from a personal health budget.
With good implementation personal health budgets can offer opportunities for much more tailored support for people who may otherwise have a poor experience of the NHS. The public sector equality duty, which was introduced by The Equality Act 2010, requires public sector organisations, and others performing public functions on their behalf, to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good community relations in everything that they do. In practice, this means that providers need to understand how different people will be affected by their activities so that policies and services are accessible to all and meet different people s needs regardless of their age, disability, gender, race, sexual orientation, gender reassignment status, religion or belief, marriage and civil partnership or pregnancy and maternity status. n Leadership: It is essential to work with front-line practitioners, clinicians, managers and people with lived experience to build support for personal health budgets. Personal stories are an effective way to demonstrate the benefits of personal health budgets. It is also important to build peer support networks that connect people to others who have a personal health budget. n Co-production: To be successful, the NHS will need to work with people who hold personal health budgets, and their families, at a local and national level. At an individual level, solutions shouldbe worked out together by health professionals and people, working as equal partners. n Outcomes: Personal health budgets are about moving to an outcome-focused way of working that looks at what people want to achieve, rather than focusing on what services the NHS has previously provided. When people are actively engaged in decisions about their health and well-being the outcomes are significantly greater. Flexibility is important, enabling people to work out for themselves the best way to achieve their goals. n A whole life, whole family approach: Care plans need to focus on the whole of life, not just on health needs. The situation of the person and their family should be explored, with carers offered an assessment of their own needs. n Risk: People may choose to meet their needs in very different ways from those traditionally on offer. It is important to encourage a positive attitude to enabling people to make choices and take risks, balanced with the duty to have proper arrangements in place to protect people. n Sufficient resources: There needs to be good access to information, support to make a plan and a range of ways to manage the money. The budget must be sufficient to enable the person to achieve their health outcomes.
How personal health budgets work Hearing real stories Providing information and advice Ways to set a budget Care and support planning Options for managing a personal health budget Personal accounts on film and in written form showing the benefits that people are getting from personal health budgets. Guides on the information and advice people need about personal health budgets. How to decide the amount of a personal health budget. A care and support plan identifies the outcomes that are important to the person and how these can be achieved. A personal health budget can be held as a notional budget, a third party arrangement or as a direct payment. Making personal health budgets happen Working together with people and families Training and developing frontline staff Developing leadership Developing the market Making personal health budgets financially sustainable Integrating health and social care personal budgets Ensuring equal access Getting the message across Measuring the results Practical examples of showing how the NHS can work together with people who have a personal health budgets and their families. Training and development on personal health budgets for people working in the NHS Getting NHS professionals and other key people on board. Practical examples showing how commissioners and providers can work together to introduce personal health budgets Where will the money come from, and how can personal health budgets be introduced in a way that can be sustained. How can the NHS work with local councils to offer joint personal budgets Making sure that personal health budgets are offered to anyone who can benefit, and that no groups are left out. How to raise awareness of personal health budgets among NHS staff and the public. Ways to check how well personal health budgets are working. www.personalhealthbudgets.dh.gov.uk/toolkit Gateway Ref No. 17808