Woman with an arm around elderly womanThe UK Government has published guidance about one-off personal health budgets (PHBs) which are available to provide people with the support they need to leave hospital safely.

According to data from NHS England last year the number of patients who cannot be discharged from hospital because there is no support package for them at home has risen by 80 per cent.

‘Stranded patients’ refers to those who have been in hospital for seven days or longer, placing them at greater risk of picking up infections, such as COVID-19.

Older people in particular lose strength and mobility very quickly, so they are less well able to manage independently at home when they do get there.

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In the document, One-off personal health budgets within hospital discharge pathway, it is advised that PHBs can be considered where:

  • Payment for a good or service would enable early and safe discharge
  • The good or service cannot be provided via existing commissioned services or cannot be provided in a timely manner
  • The good or service cannot be provided through unpaid care or the voluntary sector or cannot be provided by them without this additional support

It is advised that the cost of the PHB should not exceed £200, though exceptions can be considered up to £400.

Clinical commissioning group (CCGs) must ensure that the proposed spend represents value for money: ie the PHB should not be more expensive than the cost of saved bed days or services commissioned by another means.

The good or service must meet a need that has been identified in planning the individual’s personalised care and support, and it should enable discharge discharge at least two days earlier than would otherwise be the case.

Because it is intended to be deployed rapidly, the document states that a one-off PHB is not suitable for funding the employment of a personal assistant.

Instead, the document states that the PHB must “enable care and support by family or other unpaid carers to facilitate discharge for up to two weeks.”

A personalised care plan that has been agreed with the patient and/or carers, and a case manager to keep arrangements under review, are regarded as minimum requirements for a one-off personal health budget.

One of the main reasons for delay in discharge is ensuring an appropriate home environment, with the necessary care and support, is in place. The Hospital Discharge Service Policy & Operating Model highlighted that many people only need support for some six weeks.

Peter Wingrave, Director of assistive technology provider AAT GB last year stated that its S-Max stairclimber provides a solution that can assist with hospital discharge as these accommodate any flight of stairs, and can be hired from local authorities or stores.

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