Personal Health Budgets explained

What a Personal Health Budget is

A Personal Health Budget — usually shortened to PHB — is an amount of NHS money identified to meet a person's agreed health and wellbeing needs, planned and agreed between that person and the NHS.

The principle is the same as personalised care generally: the person who lives with the condition is involved in deciding how the support is shaped, rather than being handed a standard package. In practice a PHB is built around a personalised care and support plan that records what matters to you, what needs are being met, what the budget is for and how it will be used.

The key point, and the one this guide will keep coming back to: the NHS decides. Whether a PHB is available in your situation, what it covers and how much it is are all NHS decisions, made by the relevant NHS body. No support organisation can grant one or change the answer.

How it differs from a Direct Payment

People use the terms interchangeably and then get confused when the rules do not match. They are different mechanisms from different parts of the system.

Some people have both, for different needs. Where that happens, the two need to work together rather than duplicate each other, and the plans should say who is funding what. If nobody has explained that split to you, it is a fair question to ask.

Three ways it can be held

A PHB does not have to arrive in your bank account. There are normally three arrangements, and they can be mixed:

A notional budget

The NHS holds the money. You discuss how you would like it used, and the NHS arranges that support. You get the say without the administration.

A third party budget

An organisation independent of the NHS holds the funds and arranges things on your behalf, following the agreed plan. Useful where you want choice without holding the money yourself.

A direct payment for healthcare

The money is paid to you, or to someone authorised to act for you, and you buy the agreed support yourself. This gives the most control — and, like a social care Direct Payment, the most responsibility. If you employ someone with it, you are their employer.

Which options are offered depends on your situation and on the NHS body involved. If you are unsure which you have been offered, ask directly: "Is this notional, third party, or a direct payment?" The answer changes what you need to do.

Who can have one

Availability is decided by the NHS, and it varies by circumstance. Some groups have a legal right to have a personal health budget considered, and others may be offered one depending on local arrangements. Rather than list categories that may not apply to you, the useful advice is narrower: ask.

Reasonable people to ask include the NHS professional coordinating your care, a continuing healthcare team if one is involved, a hospital discharge team, or your GP practice. The phrase that gets a straight answer is: "Is a personal health budget available for my situation, and if so which type?"

Oakline cannot answer that question for you. We are not an NHS body and we have no role in deciding whether a PHB is available or what it should cover.

How the process usually runs

1. A conversation about your needs. With the NHS professional or team responsible for your care.
2. An indicative amount. A sense of what might be available, so planning is realistic rather than theoretical.
3. A personalised care and support plan. Written with you: what matters to you, what the support is intended to achieve, what will be bought and what the risks are. This is the document everything else hangs off.
4. Agreement by the NHS. The plan is signed off, or sent back with questions. The NHS has to be satisfied the plan meets the agreed needs safely.
5. Setting it up. The budget is put in place in whichever of the three forms has been agreed. If it is a direct payment and you are employing someone, this is where recruitment, contracts, payroll and insurance need to be arranged.
6. Review. Normally at least annually, and sooner if your needs change. Expect to show that the money went where the plan said it would.

Step three is where people either get a genuinely personalised arrangement or an off-the-shelf one with their name on it. It is worth taking time over, and worth having someone with you if that helps you think.

What it can and cannot cover

A PHB covers what the plan says it covers, which must relate to the agreed health and wellbeing needs. Depending on the plan, that might include personal care and support at home, employing a Personal Assistant, equipment, therapies, or support that helps you manage a condition and stay well.

There are firm limits. A PHB cannot normally be used for emergency care, for care you would receive from a GP as part of primary medical services, for anything unlawful, or for anything the NHS has not agreed as part of the plan. It cannot be used as general income.

The practical rule is the same as for Direct Payments: if you are unsure whether something is within the plan, ask before you buy it. A question in advance is free.

Questions worth asking

• Which type of budget is this — notional, third party or a direct payment for healthcare?
• What exactly is it intended to cover, and what is explicitly outside it?
• If I employ someone, am I the employer, and has the budget accounted for employment costs such as National Insurance, pension contributions, insurance and cover for holidays?
• What records will I need to keep, and who reviews them?
• How often will the plan be reviewed, and what happens if my needs change before then?
• Who do I contact if something goes wrong or the arrangement stops working?

The third question is the one most often skipped. An amount that covers a PA's hourly pay but not the cost of employing them is not a workable budget, and it is much easier to raise at the planning stage than a year later.

Where Oakline fits

Once a Personal Health Budget is agreed and is being used to employ someone, the practical work looks much like any other employment arrangement — and that is where we help.

We can recruit and check a Personal Assistant, prepare employment documentation, run payroll including PAYE, National Insurance, statutory pay and pension duties, coordinate training, and keep records ready for review.

We cannot decide whether you can have a PHB, tell you what it will contain, influence the amount, or negotiate with the NHS on your behalf. Those are NHS decisions and we are not part of them. We are also not registered with the Care Quality Commission and do not provide regulated personal care.

If you have a budget agreed, or you have been told one is being considered and you want to understand the employment side before it lands, talk to us.

General information, not advice.Personal Health Budget arrangements are decided by the relevant NHS body and differ between areas and circumstances. Confirm the current position for your situation with your NHS contact before acting on anything here.