Wheelchair with man hand forPersonal Health Budgets

With eligibility of personal health budgets (PHBs) and personal wheelchair budgets (PWBs) being extended in December 2019, NHS England and NHS Improvement has issued new guidance regarding eligibility, people’s legal rights and CCGs’ obligations.

Created to assist CCGs to meet their duty to those eligible, the document also shines some light on how the new model will be rolled out and what options are available for individuals to use private retailers as an alternative to commissioned wheelchair services.

THIIS has highlighted the key points relating to PWBs, emphasising the potential opportunities available under the new system to mobility retailers, enabling dealers to help engage and navigate customers through the new personalised care model.

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What are PHBs and PWBs?

First piloted in 2009 and 2012 before being widely introduced in 2014, personal health budgets are an amount of money to support a person’s identified health and wellbeing needs, which is planned and agreed between the person, their representative, or, in the case of children, their families or carers and the local NHS team.

Personal wheelchair budgets are another form of personal health budget.

Why are PHBs and PWBs being rolled out?

People eligible for continuing NHS healthcare have had a legal right to a personal health budget since the 1st October 2014, however, in December 2019, the right was extended to people in receipt of NHS wheelchairs.

Personal health budgets aim to empower people experiencing some of the most significant long-term health conditions to exercise greater choice and control over their healthcare and to enhance independent living in the community.

The system forms a key element of the NHS Long Term Plan to increase personalisation of healthcare, with the Government outlining its ambition to increase the uptake of personal health budgets to 200,000 people by 2023/24.

Who is eligible for a PWB?

People who are referred and meet the eligibility criteria of their local NHS wheelchair service, as well as people who are already registered with the wheelchair service, will be eligible for a personal wheelchair budget when they require a new wheelchair.

This could be either through a change in the person’s clinical needs or in the condition of the current chair.

What are the different ways people can manage their PWB?

There are four ways in which individuals opting for a personal wheelchair budget can manage how they use their budget: notional, third-third-party PWB, traditional third-party PHB and direct payment.

Notional personal wheelchair budget

A notional personal health budget allows the person to choose to their PWB within NHS commissioned services, where the service purchases and provides the chair. Budget holders can also contribute to their PWB to upgrade their wheelchair.

This contribution, which would previously have been known as a ‘partnership voucher’, can come from budget holders’ own funds or from an integrated package with other agencies, such as education, social care or third sector organisations.

Third party PWB

This is where those in receipt of a PWB can use their budget outside of NHS commissioned services and with private retailers. The mobility retailer in question would receive the personal budget by invoicing the NHS and, as aforementioned in the option before, can be topped up with additional funds.

Previously, this would have been known as an ‘independent voucher’.

Traditional third-party personal health budget

This is where an organisation that is legally independent of both the NHS and the person holds and manages the budget, which could include provision of a wheelchair as part of a wider package of health and care support.

Direct payments

This is where the budget holder takes responsibility for arranging the care, support and support of any equipment as agreed in their personalised care and support plan, with the person holding the money in a bank account.

Importantly, direct payments cannot be currently topped up as the NHS and Department of Health and Social Care are reviewing regulations to establish whether additional contributions are permissible. Where a person does want to use a direct payment, the payment would need to meet the whole cost of the wheelchair, states the guidance.

How should CCGs calculate the amount of the PWB?

According to the document, CCGs need to be open and transparent with people about what elements of their care can be included in a personal health budget and how this budget has been calculated.

As PWBs are not new money but a reallocation of existing funds, according to the guidance, then the amount in the PWB should be based upon what it would cost the NHS to meet the person’s assessed postural and mobility needs via the wheelchair service currently commissioned by their CCG.

For people who have additional health and social care needs, the PWB can be pooled with funding from other statutory services as part of a more holistic care package where an investment in a wheelchair could be a more cost-effective option – for example, allocating budget to fund an elevating powerchair in place of adapting a kitchen.

PWBs cover manual, powered chairs and specialist buggies, with the NHS informing CCGs of the need to “consider repair and maintenance and how this will either be supported by existing services or made available as part of a personal wheelchair budget.”

Additionally, CCGs will also need to consider specialist seating and pressure-relieving equipment as it remains a statutory duty to provide these. It is up to the CCG to either budget for these in the PWB or via existing commissioned services, with decisions made on a case-by-case basis locally, based on clinical assessments.

What are CCGs required to do to facilitate the rollout of PWBs?

The document emphasises that CCGs “must publicise and promote the availability of personal health budgets and personal wheelchair budgets, and provide information, advice and support to those eligible, their representatives, families and carers, to help them decide if a budget is right for them.”

CCGs are also required to ensure that they have the “necessary processes, support and information in place so all options for receiving and managing the money can be made available to people.”

How should CCGs decide who receives a PHB and PWB?

In line with the government’s ambitions to expand the rollout of PHBs to 200,000 by 2023/24, the guidance highlights that “if a person comes within the scope of the right to have a personal health budget, then the expectation is that one will be provided.”

CCGs will not be allowed to make blanket refusals of PHBs and PWBs to groups based on assumptions that certain people, such as those with learning difficulties, will or will not be capable of managing a personal health budget.

Instead, all decisions to refuse a PHB or PWB must be made on a case-by-case basis.

What is the process if a CCG refuses to allocate a PHB or PWB?

If an eligible person and/or their representative requests a PHB and is turned down, the CCG must set out in writing the reasons why the request has been refused.

After this refusal has been received, the person can request the CCG reconsiders its decision, along with sending additional information to the CCG that may be relevant.

According to the guidance, a good practice timeframe for CCGs processing reconsideration requests is acknowledgement of receipt of the request in writing within 10 working days, detailing how the review will be conducted and timeframes for when it should be completed.

Then, a final decision should be sent in writing within 28 working days of acknowledgement of the original request to the person, although there can be complex situations where this could take longer. Once again, once this review is complete, CCGs should inform the person and/or their representative of its decision in writing, setting out the reasons for its decision.

What about PWBs for people in nursing and residential care?

The guidance notes that any commission for nursing or residential care settings generally allow for the provision of equipment including basis wheelchair for general use, such as portering. As these are not bespoke, NHS England says these would not qualify for PWBs.

For individuals in nursing and residential homes that require a personal, bespoke wheelchair to meet independent needs, these people would have a right to PWBs.

What should mobility retailers do to benefit from the new model?

Whilst many mobility retailers will be knowledgeable on the former voucher system, it will be essential for private companies to have a clear and in-depth understanding of PHBs and PWBs in order to help advise and support customers who are eligible and would like to purchase privately.

This is particularly important at the moment, as the new guidance sees CCGs mandated to promote, publicise and educate more people about the availability of PHBs and PWBs.

It may also prove prudent for retailers to have an understanding of the different non-statutory grants and funding available which customers can access to help top up their budgets in order to purchase higher-end and higher spec wheelchair models.

Read the full NHS guidance document here

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