Managing a Personal Health Budget (UK)

Zak provides us with his experience of managing his home care with an Personal Health Budget (NHS Continuing Healthcare)

I have a personal health budget which is a way of self-managing your care under NHS Continuing Healthcare (UK). I have opted for a version where I manage the whole budget that has been allocated to me for my care, which includes having all the control in recruiting and managing the employment of my personal assistants (PAs).

You can opt for other ways for your care to be managed, for example, by still choosing your own PAs but getting a not-for-profit organisation (recommended by your CCG) to manage all the administrative aspects regard the budget/payments etc. If that’s still too much, you might just have everything arranged through a care agency and they will allocate you some PA’s who are managed and employed directly by them.

Having the full control of a Personal Health Budget works well in my situation – I think that is partly because I have parents to fall back on, as they will help me to manage it. My parents tend to step in at short notice if carers fail to come in due to sickness, or there are gaps in care due to someone leaving. For someone who didn’t have this type of back-up, it might be more challenging. However, for me it works well, and my PA staff have liked working for me directly, rather than for an agency. They have been so happy at work, showing loyalty and working with me for a number of years now meaning I have good continuity of care from people who really understand my health condition and how to manage it.

Also I have the ability to manage my PAs by myself, and for a lot of people this wouldn’t be feasible.

Employing and managing everything can be quite intensive – it includes things like arranging the rota of care; calculating staff hours worked from timesheets and organising holidays and holiday pay via a payroll company; day-to-day managing staff and making sure they perform all their tasks; general HR such as making sure contracts are up to date and they are managed in line with employment law; doing risk assessments; arranging insurance; recruiting new staff and arranging all the annual competency training which is specific to my needs. The payroll company is great to support me for any usual situations such as if someone is off sick and qualifies for sick pay, or goes on maternity leave, etc. All of this extra administration to manage a care team might feel daunting and this is where it is sometimes better to use a care agency or intermediary agency to manage everything for you.

Since having a personal health budget, I have managed to find some useful tools to help me manage it more efficiently and more easily. Rotacloud – a rota management online system, for example , takes away some of the need for direct management. This is because it allows you to set up ‘rules’. For example, you might select that staff have to request holiday with notice. You can prevent staff from requesting time off at the same time as colleague/s. If you wanted no carers to take any time off during a particular week, it allows you to put in an ’embargo’. Carers are able to see their shifts on their smartphone, and once published agree to their shifts, pick up ‘open’ shifts, sets reminders and tells them how many hours they have worked. It calculates things like weekly pay and holiday allowances. As an employer, it provides somewhere for you to keep a log of all conversations with your team, share information and upload important HR files like communications and contracts or personal notes. It even has a clever clocking in and out system which automatically logs when your carer arrives at work and leaves, to help promote good time management.

Skills for Care is another great website which provides practicalities and training to help you manage your personal health budget and staff. They do provide funding to help you cover the cost of training up on managing a team, or for specific staff training. Competency training for your specific care needs is something that needs to be covered by the NHS (either your specialist doctors, or by the PHB).

Fish Insurance, is an insurance company which provides employers insurance for carers and personal assistants. They can provide HR and Health and Safety at Work advice free of charge (this is included in your PHB budget so you are not out of pocket).

In terms of buying training, your CCG can provide advise about where to go locally for care training that is tailored to your specific needs. Sometime the NHS will even provide their own training. We do not have this, so instead have used our local Hospice Education Centre to train up staff annually in things such as :-

First Aid; Basic Life Support; Choking Protocols; Observation taking and MEWS charts (Modified Early Warning Score to identify when illness is escalating); Pressure Management and Tissue Viability; Personal Hygiene; Suctioning; Moving & Handling; Person Centred Care that is specific to me.

We employ a private physiotherapist to train the staff in Airways Clearance because the hospital is limited about the time they can provide to train or competency check this.

For me, I like to have full control of my own care, because only I know what I need and am going to be doing day-to-day. It means I have more flexibility and freedom to choose how I want my care done and who I want it done by. I did have a care agency in the past but found that really limiting because they didn’t necessarily choose people to work on my package who I got on with, nor did they work flexibly around my specific needs.

For me too, because we manage the Personal Health Budget ourselves, this also means that a care agency isn’t being paid a lot of money to do it. It gives us peace of mind that we are managing it really efficiently and it that it costs the NHS a little less – hopefully allowing someone else to benefit from our savings.