What is the difference between a personal health budget, a personal budget, an individual budget and a direct payment?

• A personal health budget is for your NHS healthcare and support needs.
• A personal budget is for your social care and support needs.
• An individual budget includes your social care and support needs plus other funding, such as independent living.
• A direct payment is one way of managing these budgets, where you get the cash to buy the agreed care and support you need.

What is a personal health budget

A personal health budget is an amount of money to support your identified health and wellbeing needs, planned and agreed between you and your local NHS team. The aim is to give people with long-term conditions and disabilities greater choice and control over the healthcare and support they receive.

Personal health budgets are being introduced by the NHS to help people manage their care in a way that suits them. Anyone in England receiving NHS continuing healthcare has the right to have a personal health budget.

Personal health budgets work in a similar way to the personal budgets that many people are already using to manage and pay for their social care, but they are not available in Wales and Northern Ireland yet. In Scotland they have a system called self-directed support.

People in Wales have the choice of either directly employing carers through their social services – but for some people this may not give enough hours of care or receive 24 hour care through the NHS which means that they have no control at all on who comes to give the care.

You can develop a care plan together with your NHS team (such as a GP). The plan sets out your personal health and wellbeing needs, the health outcomes you want to achieve, the amount of money in the budget and how you are going to spend it. You can use a personal health budget to pay for a wide range of items and services, including therapies, personal care and equipment. This will allow you more choice and control over the health services and care you receive.

You don’t have to change any healthcare or support that is working well for you just because you get a personal health budget, but if something isn’t working, you can. Read more on the NHS’s page about personal health budgets.

What is a personal budget

A personal budget is the amount of money you need to pay for your support and has been allocated to you because, following an assessment of your needs, the authority consider you are eligible for support. You can receive this support as a direct payment or it can also be allocated to a trust fund and managed by friends, family or your social worker.

There are regional differences. The availability of a personal budget is mandatory in England and Scotland for those who qualify for it. However in Scotland they call their system self-directed support.

In Northern Ireland they are available in some areas and the others will be available in due course whereas, in Wales, personal budgets are not used currently, but direct payments known as self-directed support are used instead.

What is an individual budget

An individual budget is similar to a personal budget but can include other sources of funding ie funds for a holiday if this will meet your social care needs, and is a very flexible arrangement to meet individual needs.

What is a direct payment

A direct payment is money that is given to you directly to pay for the services you need, putting you in control of your budget. It is compulsory for Local Authorities to offer Direct Payments in almost all circumstances to anyone over 16 assessed to need them.

Direct payments are means tested payments to individuals who have been assessed as needing help from social services which they can then use to arrange and pay for their own care and support services instead of receiving them directly from the local authority. Using the direct payments system, you can use some of the services provided by the local authority and arrange the rest yourself.

The aim of this system is to give people more control and choice in how their care needs are met. You must be able to consent to and willing to have direct payments, you cannot be forced to have them. You must also be able to manage the payments, either alone or with assistance.

You can use direct payments to:

• Pay for the services and/or equipment which will meet your assessed needs.

Generally, authorities should leave the choices of how to meet your assessed needs to you, as long as they are satisfied that all agreed support arrangements made, continue to be met.

You can't use direct payments to:

• Pay for permanent residential accommodation - but you may be able to use direct payments to secure occasional short periods in residential accommodation( a maximum of 4 weeks or 120 days for children in any one year), if your local authority agrees that is what is needed.
• Secure a service from your spouse or civil partner, close relatives or anyone who lives in the same household as you, unless that person is someone who you have specifically recruited to be a live-in employee (other than in exceptional circumstances, which your authority may agree with you)

Eligibility

Social services - and therefore direct payments - are normally available if you are:

• Anyone assessed as requiring support aged 16 and over
• People with parental responsibility for a disabled child - however, you cannot use direct payments to buy services for the person you care for. The payments can only be spent on getting the support you, as a carer, have been assessed as needing.

You will need to contact your local authority and ask them to carry out an assessment of your needs.

In England the scheme has been extended to those who lack the capacity to agree to and manage the payments themselves. They can now have access to direct payments with the funds paid to an appropriate person who takes on the responsibility of managing the direct payments on their behalf. A similar scheme is planned for Wales.

If you are applying for services for the first time, your social worker should discuss the direct payments option with you when they assess your care needs.

Regional Differences

Wales

More information specific to Wales is available from Dewis Cymru.

Scotland

You can also use direct payments to purchase services from your local authority in Scotland, whereas in England, Northern Ireland and Wales, you cannot.

Although the rules in Scotland are similar to those in the rest of the UK, in exceptional circumstances a local authority can make direct payments to employ relatives living in the same household, where securing the services of this person is necessary to meet the care recipient's need for the service.

Northern Ireland

If you are over 16 and have been assessed as needing personal social services, you are eligible to receive direct payments and this includes carers. More information can be obtained from the Centre for Independent Living.

Already receiving social services?

If you are already receiving social services, your local authority is obliged to offer you the option of direct payments in place of the services you currently receive. However, some people have circumstances which don't permit this option and, if this applies, you will be advised of the reasons by your local authority.

Refused social services?

You will not be offered direct payments if the local authority has decided that you do not need social care services. You will also not be offered direct payments is your are subject to the criminal justice system. In any case, if there have been changes in your needs or circumstances, you should contact them and ask for a new assessment.

How much do you get?

The amount you receive will depend on the result of the assessment of your needs carried out by the local authority. However direct payments must be made by local authorities at a rate equal to their estimate of a reasonable cost of the service which will meet your assessed needs. The payment must also be sufficient to enable you to meet your legal obligations as an employer for example, holiday and sick pay, national insurance contributions and employer's liability insurance. The whole point of the direct payments system is to give people more control and choice in their care but, you will have to pay the extra cost yourself if, your choice of provider is more expensive than the 'reasonable' amount allowed by the local authority.

Will it affect my other benefits?

Payment of direct payments will not affect other benefits as they are not a replacement of income.

Methods of payment

Payment of Direct payments is usually made directly into your bank, building society, Post Office or National Savings account. However, If you need someone who cares for you to collect your money, or you are registered blind, payment can also be made by sending a cheque which can be cashed at the Post office.

How to apply for direct payments locally

If you already get services, ask your local authority about direct payments.

The Government’s page on applying for direct payments will let you enter details of where you live and then take you to your local authority website where you can find out more and/or apply online.

Record keeping

If you receive direct payments you will need to keep records to account for the money you spend. Your local authority will tell you what information you'll be expected to provide: such as timesheets signed by personal assistants, or receipts for services from agencies as it will have to satisfy itself that the needs for which it is giving you direct payments are being met. The local authority should tell you how they will go about this and may involve a visit to your home.

What to do if your circumstances change

You should contact your local council as soon as possible if your needs change so that they can reassess the level of benefits you require. It doesn't matter whether the changes are long- or short-term.

For example, if you don't need to spend the full amount because your condition improves temporarily, or you go into hospital, they may need to adjust your payments.

If you don't want to continue with direct payments

If you decide you don't want to continue, the local council will arrange services instead.

If you cannot manage with direct payments

If the council decides you cannot manage with direct payments, it might decide to stop making direct payments and provide services instead.