Personal health budgets, CHC and paying for therapies — Easy Read

Understand the different budgets

A council personal budget concerns social care needs and may include an assessed personal contribution. An NHS personal health budget, called a PHB, concerns agreed health and wellbeing support. NHS Continuing Healthcare, called CHC, is a funding arrangement for eligible adults; it can be organised using a PHB. These terms do not mean the same thing. Ask who is responsible for each part of your care.

Your right to a personal health budget

Adults eligible for CHC, including through the fast-track route, have a right to a PHB, subject to whether it is appropriate in their individual circumstances. Living in a care home does not automatically exclude you. The arrangement should give meaningful choice about care. If the ICB refuses, ask for its reasons in writing and a review. You do not have to employ staff or manage money yourself. Discuss the NHS arranging the budget, an independent organisation managing it, a direct payment, or a mixture. Direct payments have extra conditions and are not an automatic entitlement. Ask for support choosing an arrangement that works for you.

Therapy and training when the NHS arranges care

You can ask about assessed therapies and necessary staff training when the NHS buys and arranges your CHC care directly. You do not have to receive a direct payment or employ PAs to raise these needs. The ICB is responsible for planning and arranging a package that meets your assessed needs. Ask your named contact, care provider and relevant clinician to agree who will arrange treatment, train workers, check skills and review care. Existing NHS services may provide some support. Providers must meet their own staffing and training duties. Avoid paying twice for support already funded.

Start with your needs and goals

Explain what you want support to make possible. This might be communicating choices, moving more comfortably or taking part in everyday life. Ask the relevant clinician to assess the difficulty and discuss options with you. Record what is being recommended and why, the intended benefit, any risks and how you will know whether it helps. Your preferences belong in that discussion.

Can the budget fund therapy?

A PHB can be used for agreed therapies as well as personal care and equipment. This does not guarantee any therapy you request. Ask the team to consider the clinical assessment, suitability, evidence, safety, expected benefit and cost. Ask whether treatment will be provided through an existing NHS service or included in your personalised plan. A blanket statement that a PHB can never fund therapies does not explain the national approach.

Make the proposal specific

Ask for a proposal showing the professional involved, number and length of sessions, location, equipment and review date. Explain communication and access needs, travel and support to attend. If an activity is mainly recreation or wellbeing support, describe its purpose honestly rather than calling it clinical treatment. Ask whether it can meet an agreed outcome and which funding route can consider it.

Separate professional therapy from daily practice

A therapist may recommend practice between appointments. Ask what workers can safely help with, how they will learn, and when the therapist must reassess. Training a PA does not turn them into a therapist or transfer every clinical responsibility. Agree any delegation, competence checks, supervision and stop rules with the responsible professional. Do not copy another person’s programme.

Include the costs of making the plan work

For an NHS direct payment, necessary employment costs include PA training, development and emergency cover. Discuss the cost of the agreed therapy alongside the support needed to use it. List items separately and check for costs already paid through another service. Ask the team to confirm the final budget and what it covers, rather than assuming the first estimate is final.

Know what stays outside the budget

Ordinary GP care, emergency care and medicines continue through their usual NHS routes. PHB money cannot be used for gambling, alcohol, tobacco, illegal purchases or personal debts unrelated to services agreed in the plan. The detailed direct-payment rules contain other exclusions. Ask about a particular proposal instead of assuming either that everything is allowed or that every unusual request is prohibited.

Agree spending before buying

Get the care and support plan, costs and purchase arrangements agreed before signing a contract or paying. Ask who is the named coordinator and who can approve a change. Keep the agreed records and receipts. Spending outside the plan may have to be repaid. Do not assume the NHS will reimburse a private course or therapy that you booked yourself.

When the budget is too small or needs change

Contact the NHS team promptly if agreed care cannot be delivered within the budget. Explain the shortfall and ask for a plan and budget review. NHS-funded care should not depend on routinely topping up an inadequate PHB from your own money. There are limited exceptions, such as some wheelchair arrangements. Separately purchased extras are different from the NHS meeting your assessed needs.

Ask for reasons and use the right challenge route

If a therapy, training cost or budget request is refused, ask for written reasons, the assessment and the policy used. Ask what alternative will meet the identified need. A complaint about a CHC care package or PHB is different from challenging CHC eligibility. Ask the ICB about review and complaints, and use the linked CHC challenge guide. An independent NHS complaints advocate can help you put your concerns forward.

NHS budgets and paying for therapy

What is a personal health budget?

Different funding

When the NHS arranges your care

How the money is managed

Say what you need

Ask about therapy

Help between appointments

Check the full cost

Agree before spending

Other NHS care continues

Review the plan

If you disagree

What you can do next

More useful links