Personal budgets and personal health budgets

Everyone whose needs the council has agreed to meet gets one, including people who will pay for all of their own care because their savings are over the limit. That is worth knowing, because the personal budget is the council's own statement of what the care should cost. How to get local authority funding for care at home covers the assessment that comes before this point, and the means test in full goes through the financial assessment line by line.

A carer can have a personal budget of their own after a carer's assessment, for the support the carer needs rather than a share of the cared-for person's budget.

Those four groups have a legal right to have a personal health budget, so the integrated care board has to provide one when it is asked, unless it can say in writing why it would be impracticable or inappropriate in that case. Adults on NHS Continuing Healthcare and children on continuing care have had that right since October 2014, and it was extended in December 2019 to section 117 after-care and to NHS wheelchairs. Anybody else can still ask their board, but there is no right behind the request.

For a family arranging care at home, the route that matters is almost always Continuing Healthcare. NHS Continuing Healthcare explained sets out the primary health need test, the twelve care domains assessors score, and how to challenge a refusal. If your relative is found eligible the care is free whatever their savings, and a personal health budget is the way to have a say in who delivers it. What fully funded care means covers the rest of the bills.

The plan behind a personal health budget is called a personalised care and support plan. NHS England says it should set out the health and wellbeing needs the budget is there to address, the outcomes your relative wants, the amount of money in the budget, and how that money is going to be used. Ask to see all four written down before the plan is signed off, because a plan that names the outcomes rather than only the tasks gives a family room to arrange care around a life.

The means test is the difference families feel first. A council personal budget is split by a financial assessment, so a contribution letter follows, and for some households the council's share is nothing at all. A personal health budget is not split, because NHS care is free at the point of use. That is one reason a Continuing Healthcare assessment is worth asking for even when it feels like a long shot.

Neither budget stops your relative claiming benefits. Attendance Allowance is not means-tested and is paid on top, and it is worth claiming early. The different types of care funding shows how the routes fit together across a whole arrangement.

The third column is the one families ask about most, because it is the only one where your family chooses the individual carer rather than a provider. It also carries the most administration. Hiring a carer with a direct payment is the page to read next if that is the route you want: it covers the four conditions the council has to check, what the money will and will not buy, paying a relative, and what to do if the council says no.

You are not locked in. The statutory guidance allows a mixed package, so part of a personal budget can be a direct payment while the rest stays with the council, and it says these arrangements should be adjustable later with the minimum of procedure. The NHS guidance says the same about its three options. Starting with a mixture gives a family time to get used to the account before everything depends on it.

One refusal is worth separating from the other. If the NHS decides a direct payment is not appropriate for your relative, that is not the same as refusing a personal health budget. NHS England's guidance says a person turned down for a direct payment may still have the budget as a notional or third-party budget, and asks boards to consider how else the care could be personalised.

1. 1

   Ask for the figure in writing, and for the assumptions behind it

   First

   The council has to be transparent about how it calculated a personal budget, including any points system it used, and it should share its cost assumptions with you. The NHS board has to be open about which parts of the care sit inside the budget and how the amount was reached. Ask in writing rather than over the phone.
2. 2

   Read the assessment before you argue about the money

   The usual cause

   A budget can only be enough to meet the needs that were written down. If a need was missed at the assessment, the thing to ask for is a reassessment rather than a bigger figure. Get a copy of the assessment and the plan and read them against each other.
3. 3

   Point at the sufficiency duty

   The legal test

   The guidance says a council personal budget must always be an amount sufficient to meet the needs it has agreed to meet, taking reasonable preferences into account, and that it should reflect what quality care costs locally rather than what the council pays in bulk. An NHS budget has to be enough to meet the outcomes in the plan.
4. 4

   Ask for written reasons, then use the complaints route

   Free

   For a council, that is the local complaints procedure and then the Local Government and Social Care Ombudsman, which costs nothing. For the NHS, ask the board in writing to reconsider and send it anything it has not seen. NHS England suggests boards acknowledge such a request within ten working days and answer within twenty-eight.
5. 5

   Ask about a funding panel if the number dropped

   Worth checking

   Some councils send a draft plan to a panel. If your relative's budget came back smaller than the one the social worker discussed, ask for written reasons. A panel must not be used to cut a budget below what the agreed needs cost.

Councils buy agency hours in bulk at rates a family cannot get, so a budget calculated from council prices can look thin. What a family can do instead is buy an hour of care from a self-employed carer for less than an agency charges. Carers on PrimeCarers charge £18 to £25 an hour with our fee included, typically about £20, against £28 to £35 an hour through an agency. On a fixed weekly budget that difference is extra visits rather than extra money.

When you are ready to see who is available, you can search for carers near your relative and compare their rates, experience and reviews. It is worth doing while the budget is still being argued about, because it tells you what an hour of care costs where your relative lives. How you pay a self-employed carer covers the mechanics, and writing a care plan together covers what goes into a care plan.

Some families end up with both budgets at once, where the NHS funds part of the care and the council the rest. A council personal budget is allowed to set out other public money your relative is receiving, including a personal health budget, and councils are told to consider a request to present it that way. Where both are in play, ask the two organisations who is leading, because two sets of accounts and two review cycles is a weight nobody intended a family to carry.

If your relative has just come out of hospital, the funding often changes twice in a few weeks, first through a short reablement period and then into whatever pays for the longer term. Funding care after a hospital stay covers that sequence, and what complex care means explains where the line between carer-led and nurse-led support falls.