Integrated personal budgets

Integrated personal budgets provide a mechanism to give people with health, social care and/or education needs a more personalised and integrated experience of care and support by receiving a single budget to pay for assessed needs and agreed outcomes.

Ensuring more people can benefit from personalised care is one of the key practical changes set out in the NHS Long Term Plan, which sets the ambition to increase the uptake of PHBs (which includes integrated personal budgets) to 200,000 people by 2023/24 by exploring expansion beyond the current right to have groups.

The government’s Integration White Paper sets out that people of all ages should receive better, more joined-up health and care services, supported by integrated planning and commissioning. It reaffirmed a commitment to personal budgets, personal health budgets and integrated personal budgets as a means for supporting integration around people who draw on health and care services. This means that organisations and services must work in partnership to remove barriers and offer more holistic care and support to meet people’s needs, improve their outcomes and experience, and reduce health inequalities – driving the integration of services at an individual level.

Who can benefit?

People and families

People in receipt of joint-funded services from health, social care and/or education can benefit from receiving their care and support via an integrated personal budget, giving them greater flexibility, choice and control over their health and care needs, increasing self-management, and reducing the administrative burden of receiving different funding streams as separate personal budgets. Key groups who could benefit include:

  • Children and young people with Education, Health and Care plans
  • Children and young people eligible for continuing care
  • Adults below the threshold for NHS Continuing Healthcare with identified health and social care needs who are receiving care at home
  • People in receipt of learning disability and autism services
  • People in receipt of Mental Health s117 aftercare services

The extent to which people and families are likely to benefit from an integrated personal budget will depend on:

  • the process for receiving and using an integrated personal budget being clear and easy to access, and
  • people having meaningful choice in how they spend the budget allocated to meet their assessed needs.

Systems

Benefits for systems include reduced reliance on staff as people self-manage their care and support, and reduced administration for service commissioners.

Statutory duties

The following groups currently have a legal right to have a personal health budget:

  • Adults eligible for NHS Continuing Healthcare
  • Children and young people eligible for continuing care
  • People eligible for aftercare services under s117 of the Mental Health Act
  • People eligible for an NHS wheelchair

Currently, there is no legal right to an integrated personal budget as there is for personal health budgets and personal budgets.

However, local authorities and the NHS already have statutory duties in relation to integration as set out in the SEND code of practice: 0 to 25 years and the Care Act 2014 which also encourage a joined-up approach for personal budgets. In addition, the legislative framework underpinning the Health and Care Act 2022 supports collaboration and partnership working to integrate services for people and families through the formalisation of integrated care systems.

Six-step process

Where local authorities and the NHS are working together to deliver integrated personal budgets, the six key features of a personal health budget must be met.

This means that the person with an integrated personal budget (or their representative) should:

  1. Be central in developing their personalised care and support plan and agree who is involved.
  2. Be able to agree the health and wellbeing outcomes* they want to achieve, together with relevant health, education, and social care professionals.
  3. Get an upfront indication of how much money they have available for healthcare and support**.
  4. Have enough money in the budget to meet the health and wellbeing needs and outcomes* agreed in their personalised care and support plan.
  5. Have the option to manage the money as a direct payment, a notional budget, a third-party budget, or a mix of these approaches.
  6. Be able to use the money to meet their outcomes in ways and at times that make sense to them, as agreed in their personalised care and support plan.

* And learning outcomes for children and young people with education, health, and care plans.

**There may be flexibility when an indicative budget is discussed as part of a one-off budget.

Making integrated personal budgets work

To ensure the benefits are realised, systems will need to:

  • prioritise the development of a local integrated personal budget offer
  • co-produce the model with people with lived experience and those who utilise care and support services, including carers
  • ensure a strong focus on developing local providers of services so that people have a range of options to choose from to spend their integrated personal budget
  • move away from traditional and risk averse commissioning and invest in developing integrated personal budget processes that support people to make good choices and best use of the resources available
  • build capacity and capability to deliver personalised care and support plans with people and families
  • ensure the quality standards set out in the Personal health budget quality framework are embedded in the local offer.

Integrated personal budgets in practice

Integrated personal budgets for children and young people in Bedfordshire, Luton and Milton Keynes (BLMK)

In BLMK, integrated personal budgets have been successfully offered to children and young people eligible for Special Education Needs and Disability (SEND) support. One young person (aged 11 years) with learning disability and complex epilepsy received a small budget, jointly funded by health, education and social care, to buy a wrist sensor watch to support timely medication administration and self-management of their condition. This avoids the need for more expensive 1:1 support in school from a care worker. The young person is able to attend the same school as their friends and be age-appropriately independent (sleepovers / playing in the park with friends and not only when mum is present). In addition to improved quality of life for the young person, mum is also sleeping better, less stressed and better able to meet the needs of the whole family.

More information on this case study, and others, is available on the Future NHS collaborative platform (log-in required).