Education related budget

This may vary depending on school preference. For example, as part of their core provision, special schools and colleges make specialist provision available that is not normally available. The particular choice of a special school, with integrated specialist provision, may reduce the scope for a Personal Budget.

Personal Health Budgets

Personal Health Budgets for healthcare are not appropriate for all of the aspects of NHS care.

• Since April 2014, everyone receiving NHS Continuing Healthcare (Adults -18 years of age and over) has had the right to ask for a Personal Health Budget.
• From October 2014 this group have 'a right to have' a Personal Health Budget and is available in city.
• From April 2015 Personal Health Budgets including direct payments should be an option for people with long-term health needs. This includes people who use NHS services outside NHS Continuing Healthcare.

This is usually a budget for children/young people who are assessed by the NHS as having continuing care needs. These children/young people usually have complex, long-term or life limiting conditions and may require an additional package of health support to meet their needs, which is assessed using the National Framework for Children and Young People’s Continuing Care.

There are also options for wheelchair users who have long term postural and mobility needs that have had an assessment completed by wheelchair services to have a personal health budget.

A personal Social Care budget

Under the Care Act 2014 people over 18 with eligible care and support needs have a right to request a direct payment to meet some or all of their care and support needs (this covers people with and without capacity to request a direct payment). 

This is a budget for people assessed as needing extra support at home or in the community, or for social activities.

Your Personal Budget can be spent on anything that meets the goals that have been agreed between you and relevant professionals who are supporting you. These goals will be set out in your support/care plan or EHCP. It is a good idea to think about how you would like to use the budget to meet your health and wellbeing needs and how to manage it.

Examples of how a personal budget can be used include:

• Employing carers or Personal Assistants (Pas) to support children & young people receiving a Budget.
• Paying for activities that help children & young people have access in the community.
• Equipment to help at home
• Those accessing targeted short breaks funding

As part of an EHCP we could offer Personal Budgets for aspects of:

• Special Educational Needs Funding for children and young people with an EHC Plan
• Continuing Health Care Funding
• Home to School Transport Funding

Personal budgets cannot be used to pay for universal services that all children and young people can access but can help with individual support that needs to be put in place for a child or young person with SEND. Additionally personal Budgets cannot be spent on:

• Paying off debts and household bills
• Primary care services - General practitioner, dentistry, prescriptions, and vaccinations
• Urgent and emergency care, surgery.
• Anything that NICE (National Institute for Health and Care Excellence) has said cannot be prescribed on the NHS (for example homeopathy and herbal treatments)
• Funding a school place or post-16 institution.

There are four ways in which the child's parent and/or the young person can be involved in securing provision:

Direct payments to the child's parent and/or the young person

Where a child's parent and/or the young person receive the cash to contract, purchase and manage services themselves. If a person gets a Direct Payment, then they will get the money that has been agreed for the care and support paid either into a separate bank account, or onto a pre-paid card issued by the Local Authority.

An arrangement

Whereby the local authority, school or college holds the funds and commissions the support specified in the plan (these are sometimes called notional budgets or an Individual Service Fund - ISF)

Third party arrangements with direct payment

Where funds (direct payments) are paid to and managed by an individual or organisation on behalf of a child's parent or the young person, but they will still have control over what their support looks like and how the money is spent.

Or a combination of the above.

Direct payments for health require the agreement of a Care Plan between the NHS Black Country ICB and the recipient. (This requirement can be fulfilled by sections G and J of the EHC Plan as long as it includes the stipulated information).

Personal Budgets are linked to an assessment of need. The assessment will look at the holistic needs of the child and their family. From the assessment, it may be decided that support is needed from one or more teams/agencies.

Before a Personal Budget can be agreed, the Council and/or ICB must agree that additional funding is required to support a young person over and above what is already available through universal services.

A child's parent or the young person has a right to request a Personal Budget, when:

• The local authority has completed an Education, Health and Care needs assessment and confirmed that it will prepare an EHC Plan. You can also inform the SENSTART team who is involved in the EHCP process, that you would like a personal budget for your child/young person’s education.
• Personal budgets can be requested during a statutory review of an existing EHC Plan.
• A young person with an EHCP can ask for their own Personal Budget after the end of the school year in which they become 16 years of age.
• If you are eligible for Children and young people’s continuing care visit Continuing Healthcare Black Country ICB for more information.
• For any other queries related to health and social care needs please speak to someone who is already involved in your care needs - such as a social worker, strengthening families worker, community nurse.

How will the decision be made?

Each request for a Personal Budget will be considered on its own individual merits.

• Where the local authority is unable to identify a sum of money, a child's parent or young person will be informed of the reasons. For example, the local authority might agree that the provision is needed but may be unable, at this point in time, to disaggregate funding that is currently supporting provision of services to a number of children and young people.
• Where a Personal Budget is able to be offered, a written notice of the conditions for receipt of any direct payment will be made. However, where a direct payment is proposed for special educational provision, local authorities must secure the agreement of the early years setting, school or college, if any of the provision is to be delivered on that institution's premises. Where agreement cannot be reached with the early years setting, school or college, the local authority must not go ahead with the direct payment.
• Details of the proposed Personal Budget will be set out in Section J of the EHC Plan and, where the proposed budget includes direct payments for special educational provision, this section will include the special educational needs and outcomes to be met by the payment.

What will happen if the request is refused?

If the local authority refuses a request for a direct payment for special educational provision, the local authority must set out their reasons in writing and inform the child's parent or the young person of their right to request a formal review of the decision. The local authority will consider any subsequent representation made by the child's parent or the young person and notify them of the outcome, in writing, setting out the reasons for their decision.

Where the disagreement relates to the special educational provision to be secured through a Personal Budget, the child's parent or the young person can appeal to the First-tier Tribunal (SEN and Disability), as with any other disagreement about provision to be specified in an EHC Plan.

Decisions in relation to the health element (Personal Health Budget) remain the responsibility of the NHS Black Country ICB or other health commissioning bodies and where they decline a request for a direct payment, they must set out the reasons in writing and provide the opportunity for a formal review.

A personal health budget (PHB) 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. At the centre of the PHB is a care and support plan. This sets out the agreed health and wellbeing outcomes that the individual wants to achieve, and how the budget will be spent to help them.

Who can access a Personal Health Budget?

• If your child/young person is under 18 and in receipt of continuing care, or over 18 and is eligible for Continuing Healthcare (CHC) funding, they can access a personal health budget (PHB). This enables you to manage and control how they receive their care and support. 
• Young people under 25 who do not have continuing care or CHC funding but have an Education Health and Care Plan (EHCP), can also access a PHB.
• Those who are under 25 with special educational needs or disabilities (SEND) can also access a PHB if there is a gap in the services they are receiving, because their needs are outside of what can be commissioned by the Integrated Care Board (ICB)

How do Personal Health Budgets work?

Personal Health Budgets (PHBs) are a tool to support personalised care and may be offered as part of the ICBs (Integrated Care Board) focus on meeting a child/young person’s individual needs. It is important to note that these budgets will not be available to all patients, and that Personal Health Budgets are targeted at those with complex health needs.

Personal Health Budgets have been shown to help children/young people’s health and wellbeing. They are just one way of providing more personalised support and have been found to be of particular benefit for those with complex needs, helping to reduce time in hospital and maintain independence.

The amount in someone’s personal health budget is based upon their personalised care and support plan. This plan helps people to identify their health and wellbeing outcomes, together with their local NHS team, and sets out how the budget will be spent to enable them to reach their goals and keep them healthy and safe.
Personal health budgets and personal budgets in social care both aim to give people more choice and control to meet their health or care and wellbeing needs. If someone receives a personal health budget and a personal budget for social care, then it may be possible to join the two budgets together to form a joint or pooled budget.

Managing a Personal Health Budget

There are three ways you can manage your PHB:

• Notional budget: No money changes hands. A budget is determined and, together with your NHS team, you decide on how best to spend it. They will then arrange the agreed care and support. Regular reviews will take place to ensure your personalised care and support plan is working well for you.
• 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 and pays for the care and support agreed in your personalised care and support plan.
• Direct payment: The budget is transferred directly to you to buy the care and support you and your NHS team agree will meet your needs. You, or your representative, buy and manage services directly yourself. A regular review will take place to ensure that your personal health budget is meeting your needs and goals.

What can a Personal Health Budget be spent on?

A PHB can be spent on any care or services that are set out in the care and support plan that has been put together with the NHS Team. The plan then needs to be agreed by the ICB.

It is important to think through how you would like to use the budget to meet your health and wellbeing needs or your child/young person’s needs.

Examples of how a PHB can be used include:

• Employing carers or personal assistants (PAs) to support children & young people receiving a PHB.
• Paying for activities that help children & young people in the community.
• Equipment – such as wheelchairs.

What a Personal Health Budget can’t be used for?

It cannot be spent on anything that is illegal, alcohol, tobacco, gambling, or debt repayment.

It cannot be used to buy Emergency Care - for example if someone in receipt of a personal health budget had an accident, they would go to A&E like everyone else - they would not use their personal health budget to arrange for example an x-ray or plaster a broken arm.

It also cannot buy Primary Care Services such as seeing a GP or Dental Treatment.

How do I find out more information?

If you would like to find out more or talk to someone about personal health budgets, please contact the Children and Young People’s Continuing Care Team by calling 0121 612 4110.

For continuing care personal health budgets email bcicb.cccteam@nhs.net

For personal health budgets related to EHCP’s and health email bcicb.send@nhs.net

• Factsheets & Booklets | Wolverhampton Information, Advice & Support Service
• Personal budgets and direct payments guide - NHS
• What is a personal health budget? - NHS
• Personal budgets and direct payments | (IPSEA) Independent Provider of Special Education Advice