National Health Service (Direct Payments) Regulations 2013 – sets out how direct payments for healthcare (a form of PHB) must be managed.

• The guidance on understanding the Regulations is much easier to understand. Consult here.

National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2022, revised 2023) – sets out the principles and process for CHC eligibility and delivery. Consult here.

NHS England – Personal Health Budgets – overarching guidance on PHBs, including the three budget management options. Consult here.

Advice:
Beacon – NHS England Free Information & Advice Service for CHC
Care to be Different – Guides, blogs, and template letters for CHC appeals and funding challenges.
Contact – Specialist support for families of disabled children (including PHB advice).
National Autistic Society – Information on PHBs, CHC, and challenging decisions for autistic people.

National Health Service (Direct Payments) Regulations 2013 – sets out how direct payments for healthcare (a form of PHB) must be managed. The guidance on understanding the Regulations is much easier to understand. Consult here.

National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2022, revised 2023) – sets out the principles and process for CHC eligibility and delivery. Consult here.

NHS England – Personal Health Budgets – overarching guidance on PHBs, including the three budget management options. Consult here.

Yes, in many cases, a named social worker is no longer involved when full CHC is
in place, because care becomes the responsibility of the NHS. However, the ICB
will assign a care coordinator — this could be a CHC nurse, case manager, or PHB
support nurse — to ensure the person’s needs are reviewed and supported. Where
appropriate, joint working with adult social care may still occur.

You can request a copy of the completed checklist and ask for clarification on how it was scored. The checklist is a screening tool, not a final decision. If you believe it was applied incorrectly, or if the person’s needs have changed, you can request a new checklist or ask for a full assessment.
You have a right to understand how decisions are made, and checklists should be applied consistently in line with national guidance.

No — the dispute is between the local authority and the ICB about who should fund care. Regardless of the outcome, the individual or their representative can still request a Local Resolution Meeting and, if needed, an Independent Review via NHS England. You can find more information here.

If someone is receiving joint funding or partial CHC and their needs increase, they can request a reassessment. This may involve a new CHC checklist and a full assessment using the Decision Support Tool (DST). A multidisciplinary team will consider whether the individual now meets the criteria for full CHC.

For standard CHC reviews (typically at 3 months, then annually), the Framework indicates that:

• Reviews are to assess whether the care package continues to meet the assessed needs.
• It notes that if needs have changed, a full reassessment (Checklist + Decision Support Tool) may be required.

This is self-explanatory by simply adding the framework wordings here:

NHS Continuing Healthcare Reviews (at three and 12 months) (page 61)

Purpose and frequency of reviews

201. Where an individual has been found eligible for NHS Continuing Healthcare, a review should be undertaken within three months of the eligibility decision being made. After this, further reviews should be undertaken on at least an annual basis, although some individuals will require more frequent review in line with clinical judgement and changing needs.

202. Bearing in mind the minimum standards set out above, a guiding principle is that the frequency, format and attendance at reviews should be proportionate to the situation in question in order to ensure that time and resources are used effectively.

203. These reviews should primarily focus on whether the care plan or arrangements remain appropriate to meet the individual’s needs. It is expected that in the majority of cases there will be no need to reassess for eligibility.

204. It is expected that the most recently completed Decision Support Tool (DST) will normally be available at the review and should be used as a point of reference to identify any potential change in needs. Where there is clear evidence of a change in needs to such an extent that it may impact on the individual’s eligibility for NHS Continuing Healthcare, then the ICB should arrange a full reassessment of eligibility for NHS Continuing Healthcare.

A Notional Personal Health Budget (PHB) is where the ICB retains and manages the budget on the individual’s behalf. The money is not paid directly to the person, but the person (or their representative) is involved in agreeing how it will be spent to meet their assessed health and wellbeing needs. The ICB arranges and pays for the agreed services directly with providers.

The main differences are listed here:

While therapies can be included in a PHB if they are needed to meet assessed outcomes, in some cases these needs may already be met through existing NHS services. In those situations, the ICB may arrange the therapy directly through core NHS provision rather than funding it separately through the PHB. The approach will depend on individual circumstances, clinical appropriateness, and
agreement within the Care and Support Plan.

In principle, no—if the person’s assessed needs have not changed and the item/service in question is still necessary to meet those needs, the ICB should not simply withdraw it. Any change must be linked to a reassessment of needs and an updated Care and Support Plan agreed with the individual.

If suitable services are offered and the individual chooses to decline them, the ICB will have fulfilled its legal responsibility. If the person’s needs haven’t changed, stopping or reducing the services or funding needed to meet them could mean the ICB isn’t meeting its duty.

While therapies can be included in a PHB if they are needed to meet assessed outcomes, in some cases these needs may already be met through existing NHS services. In those situations, the ICB may arrange the therapy directly through core NHS provision rather than funding it separately through the PHB. The approach will depend on individual circumstances, clinical appropriateness, and
agreement within the Care and Support Plan

These scenarios aren’t commonly funded but sometimes can be as a one-off Personal Health Budget (PHB).

This is a type of NHS funding provided to individuals to help them achieve specific goals, particularly in the context of hospital discharge. These budgets are typically used to fund services or support that are not readily available through standard NHS care, enabling a more personalised and flexible approach to healthcare.

Each request needs to be discussed with the relevant professional in
its area and firstly go through NHS available services.

There is no single definition in legislation — the term Primary Health Need is established through the National Framework for NHS Continuing Healthcare (CHC).

A Primary Health Need exists when the main aspects or majority part of a person’s care are focused on addressing and/or preventing health needs, rather than on social care needs. This is determined by looking at:

• Nature – the type of needs and their impact on overall health and
wellbeing.
• Intensity – quantity and continuity of care needed.
• Complexity – how needs interact, making care more difficult to manage.
• Unpredictability – how needs may change suddenly, requiring urgent
intervention.

If the totality of a person’s needs, when considered against these characteristics, goes beyond the scope of local authority provision, they are likely to have a Primary Health Need and be eligible for CHC.

This definition applies equally to people with different conditions — the key factor is the nature, intensity, complexity, and unpredictability of their needs, not the diagnosis itself.

A person can use a virtual online account to manage their direct payment, or a pre-paid card to buy goods and services. These options avoid the need for people to set up a separate bank account, simplifying review and monitoring of the spend. It also reduces massively the administrative burden for both the individual and the ICB. However, people should always have the choice to receive a direct payment into a separate bank account if this is what they prefer.

This can be requested during a conversation with the healthcare professional to be discussed with the ICB.

You can see more info here.