Continuing health care and personal health budgets

Continuing health care and personal health budgets

NHS Continuing Healthcare (NHS CHC) is a package of care for adults aged 18 or over which is arranged and funded solely by the NHS. In order to receive NHS CHC funding individuals have to be assessed by Clinical Commissioning Groups (CCGs) according to a legally prescribed decision making process to determine whether the individual has a ‘primary health need’.

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A primary health need

Primary Health Need is a concept developed by the Secretary of State for Health to assist in deciding when an individual’s primary need is for healthcare (which it is appropriate for the NHS to provide under the 2006 Act) rather than social care (which the Local Authority may provide under the Care Act 2014). To determine whether an individual has a primary health need, there is an assessment process, which is detailed in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, October 2018 (Revised). Where an individual has a primary health need and is therefore eligible for NHS Continuing Healthcare, the NHS is responsible for providing for all of that individual’s assessed health and associated social care needs, including accommodation, if that is part of the overall need.

The National Framework provides guidance to CCGs about how assessments are carried out. A Checklist is initially completed to decide whether a full assessment is required.

If the outcome of the Checklist tool indicates that an individual is eligible to receive a full assessment then a multidisciplinary (MDT) process is commenced. In order to determine whether an individual has a primary health need, an assessment of eligibility process must be undertaken by the MDT which must use the national Decision Support Tool (DST).

The DST is designed to ensure that the full range of factors that have a bearing on an individual’s eligibility are taken into account in reaching the decision, irrespective of client group or diagnosis. The tool provides practitioners with a method of bringing together and recording the various needs in 12 ‘care domains’. The care domains are:

  1. Breathing
  2. Nutrition
  3. Continence
  4. Skin Integrity
  5. Mobility
  6. Communication
  7. Psychological & Emotional needs
  8. Cognition
  9. Behaviour
  10. Drug therapies and medication
  11. Altered states of consciousness
  12. Other significant care needs

Each domain is broken down into a number of levels. The levels represent a hierarchy from the lowest to the highest possible level of need (and support required) such that, whatever the extent of the need within a given domain, it should be possible to locate this within the descriptors provided. The levels are:

  • Priority
  • Severe
  • High
  • Moderate
  • Low
  • No needs

Determining whether an individual has a primary health need involves the MDT looking at the totality of the relevant needs. Eligibility is the same for all individuals, whether their needs are being met in their own home or in care home accommodation. Certain characteristics of need – and their impact on the care required to manage them – may help determine whether the ‘quality’ or ‘quantity’ of care required is more than the limits of a local authority’s responsibilities, as set out in section 22(1) of the Care Act 2014:

  • Nature: This describes the particular characteristics of an individual’s needs (which can include physical, mental health or psychological needs) and the type of those needs. This also describes the overall effect of those needs on the individual, including the type (‘quality’) of interventions required to manage them.
  • Intensity: This relates both to the extent (‘quantity’) and severity (‘degree’) of the needs and to the support required to meet them, including the need for sustained/ongoing care (‘continuity’).
  • Complexity: This is concerned with how the needs present and interact to increase the skill required to monitor the symptoms, treat the condition(s) and/or manage the care. This may arise with a single condition, or it could include the presence of multiple conditions or the interaction between two or more conditions. It may also include situations where an individual’s response to their own condition has an impact on their overall needs, such as where a physical health need results in the individual developing a mental health need.
  • Unpredictability: This describes the degree to which needs fluctuate and thereby create challenges in managing them. It also relates to the level of risk to the person’s health if adequate and timely care is not provided. An individual with an unpredictable healthcare need is likely to have either a fluctuating, unstable or rapidly deteriorating condition.

The outcome of the MDT meeting is communicated to the assessed individual and/or their representatives on completion of the DST meeting. Once the MDT decision has been ratified by the CCG a letter outlining the outcome will also be sent.

  • Consent Form
  • CHC Patient Information Leaflet
  • NHS CHC Needs Checklist
  • NHS CHC DST
  • National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, October 2018 (Revised)

What is a personal health budget?

A Personal Health Budget (PHB) is an amount of money from the NHS to spend on the support you require to meet your health and wellbeing needs. PHBs were introduced to give people with long-term health conditions and disabilities more choice and control over arranging and paying for their support.

Before we give you a PHB, a nurse will talk to you and any friends or family about your health and wellbeing needs and together you will plan the best way to meet those needs. We (Blackpool Clinical Commissioning Group and Blackpool Council in partnership) will then work out the cost of the care and support.

A PHB can be managed in three ways, or a combination of these:

  • Notional budget

We will tell you how much it costs to meet the needs in your plan, but we will arrange and pay for your care and support.

  • Direct payment for healthcare

You or your representative receives the money from us into a bank account and arrange and pay for the care and support in your plan. We will help you to do this as independently as possible, but will need to see how the money has been spent so will ask you for information on a regular basis

  • Third party budget

Again, we will tell you how much it costs to meet your needs, but you then ask an independent organisation to arrange and pay for your care on your behalf, which we fund. This could be a voluntary trust or charitable organisation. If you chose this option, we would help you to find an independent organisation.

We encourage people to think of different ways to meet their needs, but when you decide how you want to arrange care and support, we will talk to you about this to check it meets your plan and can be funded. We will agree this with you in advance of you needing to put the plan into action.

What support can I receive?

The level of support that you receive will depend on which PHB option you choose. Everyone will have the support of a Nurse Advisor, and a specialist PHB Officer will help you to decide which option is best for you and provide ongoing support.

If you decide to have a Direct Payment for healthcare and become an employer of Personal Assistants, we can help you find a payroll company, managed account company or both, and pay for them to provide these services.

Who can have a PHB

Anyone eligible for NHS Continuing Healthcare who lives at home has the right to have a PHB, and in most cases can choose from any of the 3 options. Others who have some or all of their needs funded by the NHS can ask to be considered for a PHB, and we will try our best to support you to make this work.

What can a PHB be used for?

A PHB may be used for a range of things that will meet the needs identified on your care and support plan, such as personal care from an assistant or agency, therapies or equipment.

There are a small number of things PHBs cannot be used for, for example to pay for alcohol, tobacco, gambling or debt repayment, or anything that is illegal. A PHB also cannot be used to buy emergency care, for prescriptions or primary care services such as a GP.

Specific information for Blackpool residents

For more information about PHBs contact your Continuing Healthcare Nurse Advisor on:
Tel: 01253 951230
Email: c.careteam@nhs.net

For more information regarding Direct Payments in Healthcare, please click here.

Specific information for Fylde and Wyre residents

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Last updated on 20 June 2019 at 12:33 by communications and engagement manager