Continuing Healthcare & the NHS funding options for 18 year olds
From the age of 14, children’s services can notify the Integrated Care Board (ICB) of the young people for whom it is likely that NHS Continuing Healthcare Funding (CHC) will be appropriate at age 18.
For young people who have been assessed as being eligible for CHC, the ICB determines the health budget for the young person, and this is known as a personal health budget, and there are 3 options on how this can be managed:
• Notional budget: The local authority or the NHS manages the budget and arranges care and support.
• Third party budget: An organisation such as Partner2Care (P2C) who are independent of the person, the local authority and the NHS commissioners, manages the budget. P2C are responsible for ensuring the right care is put in place through working in partnership with the person and their family to ensure the agreed outcomes can be achieved.
Third party budgets are particularly helpful when a person:
- Does not want to manage a direct payment
- Does not wish to take on employer responsibilities for personal assistants
- Lacks capacity or is otherwise not able to manage their own budget
- Needs specialist or very tailored support that most providers are not able to deliver
The arrangement should enable the person and their family to have as much input into the delivery of their personalised care and support plan as they choose. This can include playing a role in:
- Recruitment and training
- Planning of rotas
- The day-to-day management of a personal assistant team
• Direct payment: The budget holder has the money paid into a bank account or an equivalent account and takes responsibility for purchasing care and support.
The service and support we provide
Partner2Care (P2C) is the Sirona service for people with an NHS Personal Health Budget, who choose to have a managed account.
We support people in Bristol, North Somerset, South Gloucestershire and elsewhere in the Southwest.
P2C is comprised of registered nurse assessors, payroll, brokerage and support officers and our nurse trainers.
You can find more detailed information on our service here
What a managed account can offer a young person
Firstly, for someone who lacks capacity, we ensure they continue to be as involved as possible in all processes along with their Lasting Power of Attorney, Deputy, or Representative. At all times the young person will be central in developing their personalised health budget care plan.
The P2C nurse assessors support the planning conversations to create an individualised support plan.
A managed account with P2C aims to reflect what is important for the individual regarding their health and wellbeing outcomes. This is achieved through shared decision making and collaborative processes that respect that an individual knows best, regarding their preferences, personal circumstances, goals, values, and beliefs.
The nurse assessor identifies what is important to the young person and their family and discusses what they want to achieve and then documents how this has been agreed and who is to be involved.
The P2C PHB care plan details how the care provided supports the young person and their family to achieve the outcomes agreed, this is achieved by using the available budget in a tailored and flexible way.
To ensure health needs are met as assessed by CHC, the ICB must approve the personalised care and support plan before it can start.
Why a managed account as an option for transition and beyond!
Young people or their representative may feel that they are dependent on services and are not always in control on how their care is delivered, this can create a sense of being disempowered and not being in control.
Families and the young person can worry as they can feel powerless, as it can feel that decisions over day-to-day care are often made by other people. For example, they may have to fit in with set times when care is being provided, this may mean being at home or going to bed and getting up at set times outside of their preferred choice.
Families supporting a young person with complex health needs can struggle to leave their loved one in the care of an agency or new services. They may have been the main carers throughout childhood and can feel a sense of helplessness and experience deep anxieties for the safety of the person when they are trusting other carers.
Families can often become very competent to perform high-tech procedures that are normally the preserve of qualified nurses.
A managed account enables a young person (PHB holder) to be more empowered and in control of how their support needs are met by the people that they employ or who they have chosen to be part of their care provision.
P2C together with the ICB ensure that personal assistants have all the required skills and are trained to meet all the individual's healthcare needs.
Young people coming through transitions are individual, diverse and being young they often have more creative ideas on how they want to live their lives, and they require a package of care that is flexible and able to support their health and wellbeing goals.
For young people who lack capacity, families cannot always find reassurance in the more traditional models of support available. P2C assist and support the process of recruiting personal assistants, who families feel they can trust. Personal assistants who are able to develop the confidence and expertise and personal specialist knowledge of all aspects of caring for their family member.
Adolescence can be a difficult time for any young person but even more so for those who have ongoing health needs.
Families often identify that personal assistant (carers) becoming proficient in every aspect of their loved ones health needs is crucial to ensuring their safety and wellbeing.
Further reading
https://www.england.nhs.uk/wp-content/uploads/2017/06/516_IPC-QG-Children-and-young-people_S7.pdf
www.thinklocalactpersonal.org.uk