Once you are assessed as eligible for continuing healthcare the NHS become responsible for the management of your care. It is their responsibility to ensure that the care provision meets your assessed health and social needs, whether they be psychological, emotional, physical or mental health needs.

The CCG should consult with you regarding your preferences and commission care services which maximise personalisation and offer individual control. If your preferred care arrangement is more expensive than the CCG wants to commission and if they can demonstrate that your needs could be met in a less expensive care setting, they do have the right to commission the less expensive care service. The CCG have a responsibility to take into account your preferences and to ensure that moving you to a new care setting or selecting a different care agency will not have a detrimental effect on your health. The CCG should also demonstrate that they have investigated all available options (such as negotiating a reduced rate) for keeping you in your current environment before deciding to change your care.

Because continuing healthcare is based upon your needs and not your ability to pay, the CCG cannot set arbitrary caps on funding, nor can they ask you to ‘top up’ your own care. To do so would be unlawful because it breaks one of the founding principles of the NHS. The only situation in which top-ups would be permissible is if you chose to pay for extra support that is not intended to meet your assessed health and social care needs, and which could be clearly separated from your current care provision.

CCGs cannot impose a charge on you or your family because they feel that your care home is more expensive than they would like to pay, even if they believe that it provides you with non-essential services because those services could not be clearly separated from the rest of the care you receive in your care home.

If you are eligible for continuing healthcare then the NHS are responsible for the delivery and management of your care. This means that the Clinical Commissioning Group (CCG) have final say as to where that care is delivered although the CCG should consult with you as to your preferences. The CCG should ensure that their preferred care setting meets your assessed health and social care needs, including psychological and emotional needs. The CCG must also demonstrate that they have fully considered the wishes of your representative if you have one before making a decision, and should commission care services that maximise personalisation and individual control.

The CCG has an obligation to ensure that any care provided whilst you are eligible for continuing healthcare meets your assessed needs. If either you or your CCG are unhappy with the quality of care being delivered in your current setting, then it may be possible for you to move as long as the CCG deem the alternative care setting suitable to meet your assessed needs. The CCG should not make changes to your care setting just because responsibility has shifted from the Local Authority (i.e. social services) to the NHS, due to the potential disruption to the management of your care.

As of October 2014 every person who is eligible for continuing healthcare should be offered a personal health budget. The aim of giving individuals (or their representatives) their own budgets to manage is to promote genuine choice and control over how your assessed care needs are met by providing you with the flexibility to choose your own care provision, within certain boundaries.

If you decide that you would like a personal health budget your Clinical Commissioning Group (CCG) should work with you to set personalised care and wellbeing goals based upon the assessed needs detailed in your care plan. The CCG will offer you an indicative budget based upon these goals. CCGs may also offer free and independent brokerage services to help you create a support plan and to find appropriate services.

Personal health budgets can be managed in different ways. For example, you may decide that you wish to receive the cash so that you can buy in and manage the care and support services that have been agreed upon in your support plan. However, you do not actually have to handle the money or manage the care yourself if you don’t want that responsibility. Opting for a ‘notional budget’ gives you choice and control whilst leaving the complexity of employing and managing care services to the NHS.

Between 2009 and 2012 the Department of Health ran a pilot programme for personal health budgets. Oxfordshire was chosen to be one of the in-depth pilot sites. Our team at Beacon were heavily involved in the pilot through Age UK Oxfordshire from the outset which gave us the opportunity to influence key strategic decisions from an independent perspective, on behalf of our clients.

For more information we recommend that you visit NHS Choices’ personal health budgets webpage here.