This document provides information about personal health budgets and continuing healthcare. It begins with an overview of personal health budgets, including findings from a national pilot that showed benefits for quality of life, wellbeing and cost effectiveness. The document then discusses the case of "Dave", who has multiple sclerosis and received a personal health budget, and how it improved his independence, care consistency, social activities, pain control and more. It also provides details on the process for personal health budgets and continuing healthcare assessments and eligibility. Breakout session examples discuss cases and whether individuals would qualify for continuing healthcare assessments.

1. Personal Health Budgets and Continuing
Healthcare
Gill Ruecroft, Commissioning Manager PHB/CHC
gill.ruecroft@neneccg.nhs.uk 01604 651121
Debbie Quinn QN, MS Specialist Nurse
Northamptonshire Healthcare NHS foundation Trust
Follow this link for the Northamptonshire PHB DVD, patients and staff describing their
experience and the benefits of PHBs www.neneccg.nhs.uk/personal-health-budgets

2. Aims and Objectives
• To provide attendees with an overview of
PHB’s
• To demonstrate effectiveness of PHB’s
through case studies
• To provide attendees with an overview of CHC
funding
• To provide attendees with an opportunity to
discuss cases and share ideas

3. Plan for the session
• Gill - Overview of PHBs, national and local
implementation, learning from pilot
• Debbie – clinicians experience of a patient
with a PHB
• Gill & Debbie – All about CHC, eligibility,
process
• Break out sessions – how could this work in
practice?

4. What is a Personal Health Budget (PHB)?
A personal health budget makes it
clear to a person and the people who
support them how much money is
available for their health care so they
can discuss and agree the best way
to spend it.

5. PHB Pilot – National Evaluation Findings
• PHBs improved people’s quality of life and wellbeing
• Benefits more marked where;
o There were higher levels of need
o Higher value budgets
o People had most choice and control, least restrictions
• PHBs are cost effective, particularly for CHC and MH
• Reduction in inpatient costs
• Reported positive impacts for carers and family members
• Reported changes in relationships with health
professionals

6. National Policy for PHB roll out
In November 2012 the government announced that from April
2014, people receiving NHS Continuing Healthcare and families
of children receiving continuing care, will have the right to ask
for a personal health budget.
On 9 October 2013 Care and Support Minister Norman Lamb
announced that from October 2014 this right will be
strengthened and will become a right to have a personal health
budget.
Norman Lamb has also described that from 2015 the
government want to see PHBs available for more people with
LTCs

7. Meet Dave
Dave has MS and is eligible for CHC funding. He lives with his partner who,
with his mother, provide him with quite a lot informal care. He has a supra
pubic catheter and a voice amplifier
Measurable Outcomes from the Dave’s PHB plan:
• To improve my independence
• To improve the consistency and quality of my care
• To increase my opportunities for social interaction/activity
• To have better control of my bladder spasms
• To reduce my pain

8. Is Dave making progress?
• I feel better cared for, better looked after
• I don’t think we have completely eradicated all my pain but it is
much easier to control now
• I have definitely got more independence, definitely, I have got
more control
• Having Paul coming in every morning makes a huge difference
than waiting for carers to come from Kettering or Northampton
• This PHB has had a knock on effect on my kids, I am less angry
and they are here quite a bit
• Now I am a lot more chilled and relaxed

9. PHB High Level Process
1. Patient Identification 2. Assessment
3. Indicative Budget
4. Personal Planning
7.Monitor/recalibration
5. Agreement 6.Managing the money – ‘contract’

10. Things we learnt from the PHB pilot
• Most patients/representatives do understand PHBs
• Hard to identify and release indicative budgets
• Most people are very responsible with the money
• It is easier than we thought to identify measurable outcomes
• Important to focus on outcomes not on what they are buying
• The personal plan is the key to the best results
• Patients must be involved in the design of the processes/systems to
get them right
• Tension – current provision/decommissioning to release savings
• This is much more complex and much harder to implement than we
envisaged!

11. Clinicians Experience Case Study
• Daisy, 46 years old with progressive MS
• Nursed in bed
• Severe ataxia
• Parents carry out a lot of care with agency
support
• Frustrated with limitations of agency and
changing staff
• 2 weeks holiday a year from 25% SC&H funding

12. Parents feelings

13. The CHC PHB option
• Changed to 100% CHC funding
• Parents wishing to employ own team of carers with
their support to have consistency for daughter
• Could incorporate well being – hair, nails
• Allow freedom for parents and respite at home
• Care provided around needs and wishes

14. Options for clinicians
• Smaller packages – look at shared carer
options
• Flexibility with arrangements
• More hours to attract future carers
• Enhanced care provided by carers who know
clients
• Choice

15. Choice and tailoring individual
needs

16. PHB
Questions?

17. What is Continuing Healthcare (CHC)?
NHS Continuing Healthcare is an ongoing
package of health and social care that is
arranged and funded solely by the NHS where
an individual is found to have a ‘primary health
need’. Such care is provided to an individual
aged 18 or over, to meet needs that have arisen
as a result of disability, accident or illness.

18. Some facts
• Northamptonshire has a population of around
700,000
• At any one time there will be approx. 650
people eligible
• 150 of these will be fast track – i.e. end of life
• This equates to in the region of 0.1% of the
population being eligible for CHC funding

19. Primary Health Need
• A primary health need is not about the reason
why someone requires care or support, nor is it
based on their diagnosis; it is about their overall
actual day-to-day care needs taken in their
totality
• It is the level and type of needs themselves that
have to be considered when determining
eligibility for NHS continuing healthcare

20. Assessment and decision making
To determine that the care required is more than the limits of
the Local Authority’s responsibilities:
•Nature – characteristics and type of need
•Intensity – extent, severity and continuity (ongoing needs)
•Complexity - skills required to monitor, treat and/or manage
the care
•Unpredictability - the degree to which needs fluctuate or
deteriorate and the challenges in managing them

21. Delivery of NHS CHC
National Framework for NHS Continuing
Healthcare and NHS-funded Nursing Care
November 2012 (Revised)
National tools:
•CHC checklist (screening tool)
•Decision Support Tool (DST)
•Fast track pathway tool (End of life)
https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-

22. Decision Support Tool (DST)
• Supports/facilitates a full assessment for eligibility NHS
continuing healthcare
• A comprehensive multidisciplinary assessment of a person’s
health and social care needs and their desired outcomes
• The person is given every opportunity to participate in the
assessment, plus the option of being supported by an advocate
• Existing specialist assessments are used and/or referrals made
for other specialist assessments where appropriate
• Unless there are valid or unavoidable reasons, time from
checklist to funding decision will not exceed 28 days
• 12 domains/areas of need + nature, intensity, complexity,
unpredictability

23. CHC – a clinicians guide
• ‘Specialist care’
• Primary health needs
• Intense, complex and unpredictable
• Utilise Community services –
Communicate
• Family/home situation
• Checklist

24. Examples
• Pressure sores – due to severe spasticity,
requiring regular monitoring and position
changes
• Swallowing – choking, monitoring, cough
assist
• Mood – high levels of changes, loss of
consciousness, awareness

25. Examples
• If only one of the example domains is met
then CHC may fund some of a care package
jointly with Social Care and Health (i.e. 50/50)
• If more of the domains are met this could lead
to a package being offered by CHC

26. Process – clinicians guide
• Checklist
• Assessment - invitation can take 3 hours
• Involvement of all MDT – evidence
• Decision making – outcome
• Reviews

27. CHC
Questions?

28. Break out session 1
• John is 65 years old, he has progressive MS
and is cared for by his wife. He is a wheelchair
user. His wife assists with his personal care.
He has mild spasticity, occasionally chokes on
dry foods and all pressure areas are in tact.
• Does John require a CHC assessment and if so,
why?

29. Break out session 2
• Diane is 40 years old, has secondary
progressive MS and is cared for by her
family members with a small social care
package. She has a PEG insitu, is cared for
in bed and has contractures. She has a
grade 3 sacral sore, has frequent UTI’s and
aspiration pneumonia.
• Does Diane require a CHC assessment and
if so on what grounds?

30. Other options!
Think of both the cases discussed and discuss
how a personal budget (PB) from either social
care or health could benefit each person