The ME Association was recently contacted by a member of NHS England’s Lived Experience team, asking if we would help promote a survey on NHS Personal and Integrated Health Budgets.
We felt it provided a useful opportunity to review what we know of Personal Health Budgets to and ask whether people with M.E. are making use of what appears to be a very useful resource.
NHS Personal Budgets are likely to be most applicable to those who have severe/very-severe M.E. From the information we have reproduced below, eligibility is based on need, and not diagnosis, but it depends on whether you also have NHS Continuing Healthcare in place.
We would like to hear from anyone with M.E. – or carer of a person with M.E. – who has applied for a Personal Health Budget and succeeded, or failed, in their application.
We would also be interested in hearing from anyone who might like to write of their experience, for an article in ME Essential magazine.
If you are willing to share your experience or would like to know more about the proposed article, then please get in touch by email.
NHS England Survey
This survey is for people who have a Personal Health Budget/Integrated Personal Budget and requires only registration at this stage. The survey will go live on March 1st and runs until April 30th. Once you have registered you will be contacted again to take part.
NHS Personal Health Budget
A personal health budget allows you to manage your healthcare and support such as treatments, equipment and personal care, in a way that suits you. It works in a similar way to personal budgets, which allow people to manage and pay for their social care needs.
The right to have a personal health budget only applies to adults receiving NHS continuing healthcare – see below – (NHS-funded long-term health and personal care provided outside hospital) and children in receipt of continuing care.
If you do not fall into either of the eligible patient groups but you are interested in a personal health budget, then you should speak to your GP and/or local clinical commissioning group (CCG).
CCGs make the arrangements for personal health budgets and are all encouraged to offer them to other patient groups. Find your local CCG.
Can I have a personal health budget as well as a personal budget?
Yes. If you already have a personal budget for care and support from a social care services and your NHS team agrees, you can also have a personal health budget and ask for both to be paid into the same account.
What is the difference between a personal health budget, a personal budget, an integrated personal budget and a direct payment?
- A personal health budget is for your NHS healthcare and support needs.
- A personal budget is for your social care and support needs.
- An integrated personal budget is for both your healthcare and support needs and social care needs.
- A direct payment is one way of managing these budgets, where you get the money to buy the agreed care and support you need.
NHS Continuing Healthcare
Some people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS. This is known as NHS continuing healthcare.
There is an easy-read version available that explains continuing healthcare.
Where can NHS continuing healthcare be provided?
NHS continuing healthcare can be provided in a variety of settings outside hospital, such as in your home or in a registered care home.
Am I eligible for NHS continuing healthcare?
NHS continuing healthcare is for adults. Children and young people may receive a “continuing care package” if they have needs arising from disability, accident or illness that can’t be met by existing universal or specialist services alone. Find out more about the children and young people’s continuing care national framework.
To be eligible for NHS continuing healthcare, you must be assessed by a team of healthcare professionals (a “multidisciplinary team”). The team will look at all your care needs and relate them to:
- what help you need
- how complex your needs are
- how intense or severe your needs can be
- how unpredictable they are, including any risks to your health if the right care isn’t provided at the right time
Your eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition. If your needs change then your eligibility for NHS continuing healthcare may change.
You should be fully involved in the assessment process and kept informed and have your views about your needs and support taken into account. Carers and family members should also be consulted where appropriate.
A decision about eligibility should usually be made within 28 days of it being decided that the person needs a full assessment for NHS continuing healthcare.
If you aren’t eligible for NHS continuing healthcare, you can be referred to your local authority who can discuss with you whether you may be eligible for support from them. If you still have some health needs, then the NHS may pay for part of the package of support. This is sometimes known as a “joint package” of care.
NHS continuing healthcare assessments
Clinical commissioning groups, known as CCGs (the NHS organisations that commission local health services), must assess you for NHS continuing healthcare if it seems that you may need it.
For most people, there’s an initial checklist assessment, which is used to decide if you need a full assessment. However, if you need care urgently – for example, if you’re terminally ill – your assessment may be fast-tracked.
Initial assessment for NHS continuing healthcare
The initial checklist assessment can be completed by a nurse, doctor, other healthcare professional or social worker. You should be told that you’re being assessed and be asked for your consent.
Depending on the outcome of the checklist, you’ll either be told that you don’t meet the criteria for a full assessment of NHS continuing healthcare and are therefore not eligible, or you’ll be referred for a full assessment of eligibility.
Being referred for a full assessment doesn’t necessarily mean you’ll be eligible for NHS continuing healthcare. The purpose of the checklist is to enable anyone who might be eligible to have the opportunity for a full assessment.
The professional(s) completing the checklist should record in writing the reasons for their decision, and sign and date it. You should be given a copy of the completed checklist.
Full assessment for NHS continuing healthcare
Full assessments for NHS continuing healthcare are undertaken by a “multidisciplinary team” made up of a minimum of two health or care professionals who are already involved in your care.
You should be informed who is co-ordinating the NHS continuing healthcare assessment.
The team’s assessment will consider your needs under the following headings:
- cognition (understanding)
- psychological/emotional needs
- nutrition (food and drink)
- skin (including wounds and ulcers)
- symptom control through drug therapies and medication
- altered states of consciousness
- other significant needs
These needs are given a weighting marked “priority”, “severe”, “high”, “moderate”, “low” or “no needs”.
If you have at least one priority need, or severe needs in at least two areas, you should be eligible for NHS continuing healthcare.
You may also be eligible if you have a severe need in one area plus a number of other needs, or a number of high or moderate needs, depending on their nature, intensity, complexity or unpredictability.
In all cases, the overall need, and interactions between needs, will be taken into account, together with evidence from risk assessments, in deciding whether NHS continuing healthcare should be provided.
The assessment should take into account your views and the views of any carers you have. You should be given a copy of the decision documents, along with clear reasons for the decision.
You can download a blank copy of the checklist and other related materials.
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