Personal Health Budgets Summary of Main Points

Transcription

1 Personal Health Budgets Summary of Main Points A personal health budget is an amount of money to help a person meet their identified healthcare and wellbeing needs. The budget is planned and decided by the person who needs support, their representative, and their local NHS team. A personal health budget will meet people s needs in different ways, for example it can: 1. be managed by the NHS and they arrange and pay for the support and services the person needs; 2. be held by another organisation and they arrange and pay for the support and services the person needs; 3. be paid to the person getting support or their representative. This means you take the money yourself as a direct payment and arrange the support and services you need; 4. be a mixture of these options. Direct payments The law about direct payments for health services (The National Health Service (Direct Payment) Regulations) started from 1st August It says that anyone who is or should be provided with support or services from a health body can have a direct payment if: it is appropriate for their health condition and the impact it has on their life; it is good value for money. Page 1 of 8

2 A direct payment can be made directly to the person if they are over the age of 16, if they have the capacity to say they want a direct payment and if they are not excluded under the law. A direct payment can be made for a child if they have a representative who can manage the payment for them in the best way. The person has to be responsible for using the money correctly and for any legal arrangements. When a young person gets to the age of 16, they have a choice whether they want their representative to continue getting the direct payment, if they want to apply for a direct payment themselves or if they want the direct payment to stop. Mental capacity Capacity means being able to make a decision about something, like getting a direct payment. The rules about direct payments are different for adults who do not have the capacity to ask for a direct payment. Adults without capacity to ask for a direct payment A direct payment can be made to a representative of an adult who does not have capacity, if: it is appropriate for their health condition and the impact it has on their life; it is good value for money. Page 2 of 8

3 If the person does not have a representative who can manage the direct payment, the health body can appoint someone appropriate (an appointed representative). A representative must agree: to act on the person s behalf to manage the direct payment; to act in their best interests; to take responsibility for any legal arrangements; to use the money correctly. A person can be nominated (a nominee) to manage a direct payment on behalf of a person with the health needs by: 1. the person with the health needs - if they have capacity; 2. that person s representative; 3. a health body. The person with the health needs can also say, in advance, who they want to be nominated if they lose the capacity to make a decision in the future. A nominee must agree: to take responsibility for any legal arrangements; to use the money correctly. Page 3 of 8

4 Deciding to make a direct payment Before deciding whether to make a direct payment, the health body may talk to any of these people: a) someone that the person with health needs suggests; b) the parent of a young person aged 16 to 18; c) the person s carer; d) an independent mental capacity or mental health advocate (IMCA or IMHA) e) any health professional; f) any social care professional; g) anyone else suitable. If the direct payment is going to be paid to the person s representative then the health body may talk to: a) the person with the health condition; b) a Court of Protection deputy; c) anyone with power of attorney; d) the person s carer; e) an independent mental capacity or mental health advocate (IMCA or IMHA) f) any health professional; g) any social care professional; h) anyone else suitable, including someone named by the person with the health needs to talk to about a direct payment at a time when they had capacity. Page 4 of 8

5 The health body needs to make sure that they have a suitable bank account to pay the direct payment into and the person or their representative is able to manage the direct payment (with support if needed). If the direct payment is going to a nominee, the health body may talk to all the people named above. The nominee must have a suitable bank account and hold an enhanced criminal records check (including protection of vulnerable adults). (This does not apply if the person is a family member, lives in the same household or is a friend who helps with care and support.) Managing care and support Each person will have a care plan that shows how the direct payment will meet their health needs. It will include any risks and how these are managed. It will make sure that there is enough money to pay for the support and services the person gets. Each person will have a care co-ordinator in the health body who is responsible for: assessing the person s health needs; getting agreement that the support, services and money will meet the person s health needs; monitoring the direct payment; reviewing the direct payment arrangements; being first point of contact for the direct payment. Page 5 of 8

6 The care plan will include: a) the health needs and health outcomes the direct payment and the support and services will help achieve; b) what the support and services are; c) the amount of the direct payment and when it will be paid; d) who the care co-ordinator in the health body is; e) who will check the health condition of the person; f) how and when a review of the direct payment will happen; g) if the health body has to reduce or stop a direct payment - how long before doing it they have to tell the person There are some health services that cannot be paid for by a direct payment. Information, advice and support A health body has to give information, advice and support about direct payments to a person, their representative or nominee. It may provide accessible information and advice on: the amount of money in a direct payment and how this is decided; how a person, their representative or nominee can ask for a review of their care plan and direct payment; Page 6 of 8

7 when a direct payment can be stopped; how a care plan is written and agreed; what advocacy is available to help people with their care plan and direct payment; how a person can use their direct payment to buy support and services; support to be an employer if the direct payment is used to employ someone to provide support and services; how direct payments work together from a personal budget (for social care) and a personal health budget (for health care) Page 7 of 8

8 About this factsheet This factsheet was written by Uemploy. Uemploy supports children and adults with a learning disability to employ their own personal assistant. We have also written other factsheets about law like the Children and Families Act and Care Act. If you would like a copy of another factsheet or you would like this factsheet in another format, please contact us: Website: enquiries@uemploy.org.uk Tel: Post: Uemploy, The West House, Alpha Court, Swingbridge Road, Grantham, NG31 7XT Text: Uemploy 2014 Uemploy is part of the Thera Group of companies. Uemploy is a company limited by guarantee, company number Images: Widgit Literacy Symbols Widgit Software 2014 Please note, while we have tried to make sure this information is correct, it is not legal advice and we cannot guarantee its accuracy. Neither Uemploy Ltd nor any other member of the Thera Group accept any responsibility for liabilities arising if you use any of this information. Page 8 of 8