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Making personal health budgets work for all – Colin Royle

Speaking yesterday at a Westminster Briefing on the next steps for implementation of personal health budgets, Colin Royle, Director of Peoplehub CIC, reflected on how personal health budgets can offer more flexibility even for those who don’t feel confident in taking more control of their care.

When people first hear about the option of having a personal health budget, it’s not uncommon for questions to be raised. Many aspects sound appealing to individuals, including the ability to have more choice over who provides your care and support, and the opportunity to look at what may work outside of standardised NHS services. But the prospect of managing a budget and managing your long-term health condition, may feel somewhat daunting and overwhelming.

What people might not realise is that personal health budgets aren’t just for people who want to take on significantly more control over their health and care, but are a way to have more flexible, personalised care packages, informed by discussions about the amount of control that someone wants to have, and how much support they might require to manage the care package.

Personal health budgets are about looking at the bigger picture for each individual, and this means that there should always be a range of options for managing the money and the level of support that is provided, enabling people to benefit from a personal health budget regardless of their skills, confidence or financial acumen.

Receiving a personal health budget as a direct payment is one option, where people receive the money directly to buy their care and support, but it’s not the only way ofmanaging the budget. Personal health budgets can also be held and managed through a third party organisation, a “third party budget”, or as a notional budget, where no money changes hands and remains held by the NHS team.

Take for example someone with very complex needs. The costs to ensure they are well cared for are substantial, and can involve managing a team of personal carers around the clock. In these situations a CQC registered third party organisation, often a charity or social enterprise, can be the best solution.

The third party organisation will receive the money, and manage it on behalf of the family. This allows the family to still have the flexibility they need, with the organisation taking responsibility for tasks that can often feel overwhelming to individuals, such as payroll, help with recruitment and sourcing appropriate staff training.

Importantly, third party organisations are not simply there to provide a direct payment support service or managed account, or to simply move the money around. Their role can be much more in-depth and involve a range of services that people need in order to co-ordinate complicated care needs.

Dawn Krueger’s profoundly disabled son Spencer has had a personal health budget for three years:

“Our third party provider manages Spencer’s care package on our behalf for the same cost as a traditional care agency, with the only additional costs related to paying for the clinical trainer who ensures that personal assistants are skilled in essential medical tasks. However, this needs to be balanced against the cost of reduced hospital admissions and money that goes to agencies for uncovered shifts”.

“Spencer was in hospital for four years and it was the personal health budget that meant he could be discharged and cared for at home. We had two failed care packages and 15 staff through a care agency…who all left. Managing care on this scale is not easy, but the third party have been able to manage this in a way that’s more cost effective than employing agency staff and ensures continuity of care. He’s been living at home for three years now”.

Speaking as someone who used a third party to manage the care of my late father who had dementia, Dawn’s experience echoes my own. Traditional models of providing care for people with complex needs aren’t working and personal health budgets offer an approach to help deliver safe, high quality care that represents good value for money. Third party arrangements can help facilitate this where direct payments aren’t possible or don’t feel manageable.

Dave Johnson’s son Thomas has profound and multiple learning disabilities. A personal health budget is used to fund 24/7 care and support for Thomas at an independent annex adjacent to his parents’ home:

“It’s important to understand the spectrum of support services that can be needed by families wanting to manage a personal health budget…Our third party enables us as family carers to have the time to focus on what is important to us and our CCG – delivering safe quality care for our son and embracing new, effective and innovative ways of doing this”.

Health and care systems across the country are now being asked to explain how “a major expansion of integrated personal health budgets and implementation of choice” will be an integral part of handing more power to patients in the future, as part of local Sustainability and Transformation Plans (STPs).

In order to deliver personal health budgets at this scale, we need to ensure that there is more understanding, both at a system level and amongst the public, about what personal health budgets can offer, and the ways in which they can be managed.

Allowing individuals to take responsibility through greater choice and control can lead to better targeted use of limited resources, more effective partnerships between clinicians and service users, and greater efficiency in the NHS.

Colin is a co-founder of Peoplehub CIC – a not for profit organisation made up of people with lived experience of receiving a personal health budget. Peoplehub are a strategic partner to NHS England in the implementation of personal health budgets and Integrated Personal Commissioning and also work with Clinical Commissioning Groups in setting up local peer networks that enable genuine collaborative working.

Colin was previously a carer for his father Malcolm for seven years until he passed away in April last year. Malcolm suffered from a rare form of dementia and started receiving a personal health budget in 2009.


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