Since 1 April 2014, personal health budgets have come into full force and effect. What do CCGs need to do to ensure patients understand their responsibilities?

Personal health budgets (PHBs) may be accessed in one of three ways: by direct payment, i.e. paying the cash to the patient; a notional budget, where the cash is held by the CCG but the patient directs how it is spent; and a nominee budget, where the cash is paid to a third party (such as a care agency) who then administers payments on the patients’ behalf.

The policy behind PHBs is to empower patients to commission the care they feel works best for them. Before receiving a PHB, the patient is reviewed and assessed for eligibility, then, once it is decided a patient is eligible, a care plan is agreed which details required care and support and expected health outcomes, against which the success of the PHB can be judged on a regular basis. A decision is also made as to which of the three options for accessing the budget will be applied.

In the case of direct payments, there is a need to ensure the money is used and managed appropriately. The ability to call for a direct payment to pay for care has been around for a while in social care, but it is a relatively new concept in healthcare and a degree of nervousness is to be expected. The NHS (Direct Payments) Regulations 2013 set out legal requirements on both CCGs and patients to ensure that the money is used and managed appropriately and to ensure the patient’s health outcomes are achieved.

The Regulations are quite detailed as to what the patient must do and CCGs are advised to prepare legal agreements which set out, in clear and concise terms, what the patient’s responsibilities are and in what circumstances the PHB can be terminated. Creating a contract between the NHS and an individual patient is an unusual idea but it is vital in this context to ensure accountability for the spending of NHS resources.

The contract should be concise, written in plain English and avoiding, where possible, legalistic terms or jargon. But it must also contain certain information required by the Regulations, for example, it should list items which the money cannot be spent on e.g. cigarettes, alcohol or gambling.