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The NHS Long Term Plan recognises personalised care as one of five major practical changes to the NHS to ensure we have a service that is fit for the future. This means people will get more control over their health, and more personalised care when they need it – including access to personal health budgets (PHBs).
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This PHB Quality Framework will support collaboration across integrated care systems (ICSs) to build on best practice and realise the improved outcomes and experience of NHS care and support that PHBs can offer for people. Integrated care boards (ICBs) will play a vital role in supporting partners to deliver high quality PHBs, offering strategic support to ensure PHBs are part of the solution to improve outcomes, tackle inequalities and make best use of resources.
When we really focus on what matters to people rather than what is the matter with them, we see a shift – PHBs support people to build on their strengths and develop their existing support networks, and empower staff to offer care and support that is flexible and innovative.
We continue our national commitment to deliver on the mandate expectation for 200, 000 people to have a PHB by 2023/24 and hope that this framework supports ICBs and partner organisations to make this a reality.
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The PHB Quality Framework supports ICBs to create the conditions to meet PHB performance expectations, with a focus on improving operational delivery to:
Both the ICS Design Framework and Thriving places: Guidance on the development of place-based partnerships as part of statutory integrated care systems outline the expectation for ICSs to work at place level, integrating and co-ordinating the delivery of health, social care and public health services around the needs of the population – including the use of PHBs.
The PHB Quality Framework focuses on PHBs, however, the principles and requirements can be applied to integration of health, social care and education needs around the individual through the provision of integrated personal budgets (IPBs). The potential to offer IPBs should be considered in all PHB offers – the key requirements for health within these remain as detailed in this document.
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The PHB Quality Framework is intended to support integrated care partnerships meet the requirements for quality improvement and personalised care within integrated care strategies, and develop ICB PHB strategy, governance and processes. It can be used to self-assure quality and progress against key NHS Long Term Plan commitments and annual operational and planning guidance requirements.
The PHB Quality Framework may also be particularly helpful where PHB offers are coming together in a single ICS and best practice approaches and areas requiring further development and/or improvement need to be identified. It is not intended to be used as an external assurance tool.
ICBs must retain overall responsibility, including legal responsibility, for all decisions made under The National Health Service (Direct Payments) Regulations 2013, even where functions have been delegated to other statutory providers and organisations.
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They have a broad range of responsibilities that empower them to better join up health, social care and education, improve population health and reduce health inequalities.
The PHB Quality Framework should be read in conjunction with the Guidance on direct payments for healthcare: understanding the regulations which explains the regulatory requirements relating to direct payments.
Direct payments for healthcare are one way of managing a PHB. Although the regulations only apply to direct payments, the guidance provides useful information for all types of PHBs and information on implementing PHBs not included in the PHB Quality Framework.
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A PHB uses NHS funding to create an individually agreed personalised care and support plan that offers people of all ages greater choice and flexibility over how their assessed health and wellbeing needs are met.
The personalised care and support planning conversation identifies the care, support and services the PHB will be spent on. This can include a range of things to give people access to care, support and services that are holistic, innovative and build on their strengths.
The following groups have a legal right to have a PHB – adults in receipt of NHS Continuing Healthcare, children and young people eligible for continuing care, people eligible for aftercare services under section 117 of the Mental Health Act and people eligible for an NHS wheelchair.
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The rollout of PHBs is not confined to these ‘right to have’ groups. Ensuring more people can benefit from personalised care is one of the key practical changes set out in the NHS Long Term Plan, which sets the ambition to increase the uptake of PHBs to 200, 000 people by 2023/24.
1. Notional budget: The money is held by the NHS and services are commissioned by the NHS according to the agreed personalised care and support plan.
2. Third party budget (also known as an individual service fund, ISF): An organisation independent of the person, the local authority and NHS commissioners manage the budget and are responsible for ensuring the right care is put in place, working in partnership with the person and their family to ensure the agreed outcomes can be achieved. A third party budget is not a form of direct payment. They are particularly helpful when a person:
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3. Direct payment: A monetary payment to a person (or their representative or nominee) funded by the NHS, to allow them to purchase the services that are agreed in the personalised care and support plan. ‘Managed account’ is the term used when a direct payment is held in an account on behalf of the budget holder, by a direct payment support service, solicitor, accountant or other provider. Unlike a third party budget, the managed account provider does not take on responsibility for arranging care and support, but co-ordinates the financial elements of the budget. The budget holder is still the person who signs the direct payment agreement and retains responsibility for decisions about how the budget is spent, and in most instances is also the registered employer for any personal assistants.
Universal Personalised Care outlines the expectation that at least 40% of PHBs in a local area are managed as a direct payment or third party budget (this excludes personal wheelchair budgets).
Several core principles and enablers should underpin all aspects of the PHB process. This will ensure people have a good experience and are supported to achieve the outcomes that are important to them and agreed in their personalised care and support plan. Principles and enablers for PHBs are outlined in the next section.
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Matthew’s PHB allowed us to plan his life beyond school. He spends time doing things that matter to him like hydrotherapy, rolling on his in-ground trampoline and being outside – especially in the wind, snow and rain!
Matthew has a lie-in if he is unwell overnight, instead of having to fit in with transport or college schedules. He has a more comfortable wheelchair. He is calmer and sleeps better so his epilepsy and previous poor weight gain have improved dramatically, avoiding hospital appointments and intervention. This has also had huge benefits for me and his sisters as we’re less exhausted.
Developed by people with lived experience of PHBs, the I statements represent what good care and support through PHBs looks like at each step. They provide a framework for systems to continually review and improve their PHB offer, alongside the quality standards.
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The NHS Personalised Care Strategic Co-production Group and the City and Hackney Place Based Partnership co-production group have been instrumental in supporting the development of these I statements. Their experience crosses a broad range of services and support through which PHBs can be accessed, including those for adults and children and young people, and physical and mental health services.
The PHB I statements complement the Think Local Act Personal (TLAP) Making it Real resources which aim to support change and improvement by setting out what good personalised and community-centred care and support looks like, and National Voices: A narrative for person-centred co-ordinated care.
The first step in the PHB process aims to ensure that both staff delivering PHBs and people who have requested or are offered a PHB receive appropriate information about them, including what a PHB is, how PHBs can be used and the support available to receive and manage one. People need the right information and support throughout the process to achieve good outcomes.
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As set out in Responsibilities and Standing Rules Amendment (2013) and Amendment No.2 (2019), for those groups who have the right to have a PHB, responsible health bodies have a legal duty to:
Where another organisation provides information and support, the relevant health body should work in partnership with that organisation to ensure messaging is comprehensive, relevant, up-to-date and accessible.
This step involves a detailed discussion with the person about their specific health and wellbeing needs. These needs should be determined before the indicative budget setting process which calculates the
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