An adult eligible for NHS Continuing Healthcare has a legal right to have a personal health budget, but that statement is often oversimplified for people living in care homes. NHS England’s expectation that a personal health budget is the default operating model applies particularly to CHC packages delivered in a person’s own home; a care-home placement involves an existing provider contract, regulated accommodation and care, and less scope to separate every element. The right is still meaningful: the integrated care board should explain the available budget, personalised planning, how it will be managed, what flexibility is possible, and why a requested arrangement is accepted or refused. It is not automatically a cash payment to the family.
Confirm CHC eligibility and commissioning responsibility
Obtain the written CHC eligibility decision, effective date, responsible integrated care board, named case manager and current review date. Separate full CHC from NHS-funded Nursing Care, joint funding, section 117 aftercare or a local-authority package. The source of funding affects what can be placed in the personal health budget.
The guide to NHS Continuing Healthcare eligibility provides background. Do not let a personal health budget discussion delay urgent implementation of an approved package. Ask the ICB to arrange safe care while personalised planning and management options are developed.
Ask for the indicative and final budget
A personal health budget should make the resources for agreed outcomes transparent. Ask for the indicative amount used during planning, how it was calculated and the final approved amount. Request a breakdown between the core care-home placement, additional health support, equipment, therapies or one-to-one input where relevant.
A home’s weekly fee is not necessarily identical to the personal health budget. The ICB may commission a package directly and retain a notional budget. Ask which costs are fixed by the placement contract, which are flexible and which remain outside the budget. This prevents expectations that ordinary accommodation charges can be redirected freely.
Choose a management method deliberately
Personal health budgets can be managed as a notional budget held by the NHS, through a third party, or in some circumstances as a direct payment. Ask which options the ICB offers for a care-home resident and the reasons for any restriction. A direct payment carries employment, payroll, safeguarding, record-keeping and contingency responsibilities if it funds personal assistants or services.
No one should be pressured to take more control than they want. Compare flexibility, administration, risk and continuity. Identify who purchases services, signs contracts, handles invoices, covers absence and returns unspent money. Put the chosen arrangement in the plan rather than relying on the phrase “family-managed.”
Create an outcomes-based support plan
Start with assessed health and wellbeing outcomes: safe respiratory care, communication, meaningful activity, symptom control, community access or reduced distress, for example. Then identify the support, evidence, provider, frequency, cost, monitoring and contingency. The budget cannot be used for excluded items such as alcohol, tobacco, gambling, debt repayment, illegal purchases, emergency care, ordinary GP access or routine medication.
Check that proposed extras do not duplicate services the care home is already contracted and paid to provide. Ask the home to agree operational details, staff access, insurance, safeguarding and records. A creative purchase that cannot be delivered safely in the home is not a workable plan.
Protect choice when the ICB refuses an element
Ask for the decision, reasons, policy, evidence considered and alternative offered. The ICB may refuse a proposed use if it is unsafe, unlawful, poor value, not linked to assessed outcomes or incompatible with commissioning arrangements, but it should engage in personalised planning rather than issue a blanket statement that care-home residents cannot have budgets.
If the dispute concerns CHC eligibility or package sufficiency, use the appropriate review or complaints route. The CHC disagreement and appeal guide helps distinguish a funding decision from a personal-budget implementation complaint. Seek advocacy or specialist advice when essential care is at risk.
Review changes in needs, home or provider
Set a clinical and financial review schedule based on the person’s condition. Trigger earlier review after hospital admission, deterioration, safeguarding concern, provider fee change, failed service, move or evidence that outcomes are not being met. Track expenditure and results without reducing the person to receipts.
If another placement is considered, compare services through the UK care-home directory and guidance hub, then involve the ICB before committing. A budget is tied to an agreed plan, not automatically portable at the same amount to any provider. Obtain written continuity arrangements and avoid a gap while contracts are renegotiated.
Before approval, run a failure scenario. If the additional worker is absent, specialist equipment breaks or a third-party service withdraws, identify who provides essential support and who pays for replacement. The care home must know which tasks remain within its core duty and which depend on the budget. Direct-payment or third-party arrangements need sufficient reserve, insurance and notice terms. Put contingency funding and decision authority in writing; otherwise a flexible plan can become fragile precisely when the resident’s condition changes.
Confirm who owns equipment and information purchased through the arrangement and what happens at death, discharge or loss of eligibility. Exit terms should protect continuity and prevent unexpected recovery demands.
Does a CHC personal health budget mean cash in hand?
No. It may be a notional budget managed by the NHS, a third-party arrangement or, where agreed and lawful, a direct payment. All forms require an approved personalised care and support plan and clear accountability for spending and outcomes.
Can the budget pay the care home’s entire fee?
The ICB may commission and fund an eligible person’s assessed CHC package, but how the placement cost appears within a personal health budget varies. Accommodation, core contracted care and flexible health support may not be separable. Ask for the written breakdown and management method.
Can the ICB refuse a direct payment in a care home?
A right to have a personal health budget is not an unconditional right to receive it as a direct payment or spend it on any item. The ICB must apply current regulations, safety and suitability considerations, explain its decision and work through feasible alternatives.
Personal health budget arrangements are individual and locally administered; obtain the ICB’s current written decision and specialist help for disputes.
