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Direct payments for healthcare
Changes to the rules about direct payments forhealthcare -
Tell us what you think
This is an Easy Read version of:Direct payments for healthcare -A consultation on updated policyfor regulations
What is in this booklet
page
About this booklet 1
How to tell us what you think 2
Personal health budgets 3
What we learnt 9
What we are asking people 12
Our ideas and questions 14
The questions we are asking 29
How to tell us what you think 32
About this consultation 33
1
The Department of Health has written thisbooklet.
It is about personal health budgets andtells you:
· what has been happening withpersonal health budgets
· what we learnt from trying out directpayments for healthcare
· how we want to change some rulesabout direct payments for healthcare
· how to tell us what you think aboutthese changes
You can tell us what you think over 8weeks between 1 March and 26 April2013.
February
April
About this booklet
2
We will use what people tell us when wethink about the changes we want to tellParliament about in summer 2013.
If they agree, the changes will start laterin 2013.
You can email your answers to:
Or you can post your answers to:
Personal Health Budgets TeamDepartment of HealthRoom 162Richmond House79 WhitehallLondonSW1A 2NS
2013
How to tell us what you think
3
The story of personal health budgets
In the last 30 years health and social careservices have been getting morepersonalised.
This means they think about the best wayto meet each person’s needs.
Lots of government plans and ideas areabout giving people more choice andcontrol and better public services.
One of these ideas is to give people apersonal health budget and choice abouthow the money is spent on theirhealthcare and support.
Personal health budgets
4
You can already get a personal budget topay for social care.
A personal health budget is to pay forhealthcare:
· you must spend the money on thingsin your care plan that keep you safeand healthy
· you agree the best way to spend themoney with your local NHS team inyour care plan
· a personal health budget gives youmore choice about your healthcare, itdoes not give you more money
· you can use the budget for most typesof healthcare and support, but youcannot usually use the budget to payfor things like care in hospital,medicines or services from your localdoctor (GP).
Care plan
5
Using personal health budgets
We think personal health budgets will helppeople who have disabilities or have beenill for a long time.
They will have more choice over theirhealthcare and:
· agree their health goals with their localNHS team
· be involved in their care plan
· know how much money there is fortheir healthcare
· choose who looks after the money andhow it is spent to help them meet theirhealthcare needs
6
The NHS will always be free for people whoneed it - whether you have a personalhealth budget or not.
We will not force people to have apersonal health budget but anyone whoneeds one and wants one can ask for one.
Between 2009 and 2012 we tried personalhealth budgets in 60 different places inEngland.
The people who tried them had differenthealth problems and used different healthservices.
The University of Kent looked at howthings went and wrote a report.
The government is using this informationto plan what happens next.
7
Direct payments for healthcare
At the moment there are 3 ways you canget a personal health budget:
· a notional budget
We tell you how much money there isfor your healthcare, you say how youwant us to spend it and the NHS looksafter the money.
· a real budget held by a third party
An organisation like a charity looksafter the money for you and helps youdecide how to spend it.
· a direct payment means we give youthe money to buy and manage yourown healthcare and support.
At the moment you cannot get directpayments for healthcare in all parts ofEngland.
8
Parliament changed the rules so somepeople could try direct payments forhealthcare.
We now want to give everyone the choiceto have a direct payment for healthcare.Parliament must agree this.
We want to change some of the rulesabout direct payments to make thingsclearer.
This paper tells you about these changesand asks what you think about them.
9
Trying things out
The University of Kent looked at howpersonal health budgets worked for morethan 2 thousand people.
This helped us understand how to usepersonal health budgets.
There is still a lot to learn but we knowthat they:
· use money well and give patients realcontrol
· generally make people’s lives betterbut do not usually make people morehealthy
· work better for people who need a lotof healthcare support
What we learnt
10
· work best when there are not toomany rules about what people canspend them on
· work best when people can choosehow they have the budget. Thisincludes having a direct payment forhealthcare
· can mean people use less NHS servicesand do not go into hospital as often.
What the government wants tohappen:
· we will give more people the choice ofa direct payment for healthcare, notjust people in places where we triedthem out
· the new board running NHS serviceswill look at this but it might take a longtime to have it everywhere in the NHS
11
Local Authority
· places that tried out direct paymentsfor healthcare will still be able to givethese to people
· from April 2014 anyone who gets NHSContinuing Healthcare (when the NHSpay for healthcare outside hospital forpeople who need a lot of support withtheir health) will be able to ask for apersonal health budget
· GP groups will be able to offer apersonal health budget to some otherpeople
· we will look at ways to give peoplejoint health and social care personalbudgets.
There is more information about personalhealth budgets on the NHS Choiceswebsite.
12
We want to know what you think aboutchanges to rules about direct paymentsfor healthcare.
We think these things need to change:
· how we decide who can have a directpayment for healthcare
· make it easier to understand whichhealthcare services you cannot use adirect payment to pay for
· explain what information, advice andsupport the NHS should give people
What we are asking people
13
· change the rule that says people needa separate bank account if they onlyget one lot of money as a directpayment for healthcare.
We think most other rules should stay thesame.
We might need to make some smallchanges when the new NHS board and GPgroups start in 2013.
In the next pages we tell you about theserules and ask what you think about ourideas.
14
Deciding who can have a directpayment for healthcare
We think local areas should still decidewho can have a direct payment forhealthcare.
The government says anyone who getsNHS Continuing Healthcare will be able toask for a direct payment for healthcare.
We think GP groups should offer a directpayment to other people who:
· they think this would be good for
· would normally use NHS services fortheir healthcare
Our ideas and questions
15
We want the NHS to think about thingslike:
· whether this is good for the person
· if this is worth the money it costs
· if the same money that would havebeen spent on someone’s healthcarecan be used for a direct payment
· if this fits with how your local NHSprovides services
· how this will affect other services inthe area.
16
Question 1.
Do you think these are the right things tothink about to decide if someone can havea direct payment for healthcare?
Should this be written in the law?
Direct payments for healthcare forchildren and people who cannotdecide for themselves
The rules say how someone shouldmanage a direct payment for healthcarefor a child or for an adult who cannotdecide for themselves.
We think the rules should stay the samebut we should have separate informationfor each group.
Question 2.
Do you agree with this?
Is there anything else we need to thinkabout for people who cannot decide forthemselves?
17
Care planning
The rules talk about care planning withsomeone who wants a direct payment forhealthcare.
There is a list of things you cannot spend adirect payment on and we would like toinclude other things:
· your GP has already been paid toprovide you with healthcare, so youcannot pay him or her again from yourdirect payment.
The list of things you cannot pay yourGP for is in the long version of thisinformation
· dentist charges
18
· paying for things like prescriptions andmedicines
· wigs or fabric supports
· health checks or injections like flu jabsthat stop you getting ill
· accident and Emergency services oremergency care and operations.
You could still use a direct payment to payfor things that are not on this list, forexample, gym membership to help youlose weight.
19
Question 3.
Do you agree that people should not beable to use a direct payment to buyhealthcare on this list?
Is there anything else you think youshould not spend a direct payment forhealthcare on?
Information, advice and othersupport
The list of information your local NHSshould give you includes:
· advocacy
· help with buying healthcare services
· information about paying your ownstaff
20
People who tried out direct payments forhealthcare said it was really important toget lots of good information to help themdecide about and manage the money.
We think this should also includeinformation about:
· how much money is in your personalhealth budget and how this is workedout
· whether you can ask your local NHSteam to look at your care plan andbudget again if you do not think itmeets your health needs
· if or when the NHS could take awayyour direct payment for healthcare
21
· rules about how you can spend themoney
· how your local NHS team agree yourcare plan
· what happens if you also have apersonal budget for social care.
Question 4.
Do you agree that we should add thesethings to the list of information, supportand advice?
Care plan
22
Having a separate bank account fordirect payments for healthcare
At the moment you must have a separatebank account just for your directpayments, even if you only get 1 paymenta year.
It can be difficult to set up a bank accountand take longer to get the money forservices or equipment you need.
We want to change the rules so peoplewho just get 1 direct payment forhealthcare can have this paid into theirown bank account.
They will need receipts to prove how theyspend the money.
Question 5.
Do you agree that people can use theirown bank account if they just get 1 directpayment for healthcare?
23
New rules about local councils
In April 2013 there will be changes to howthe local NHS is run.
GP groups will take over from PCTs(Primary Care Trusts) and local councilswill take on some PCT work.
Local councils can already give people adirect payment to pay for social care.
We think they should also be able to givepeople a direct payment for things to helppeople get and stay healthy. For examplelosing weight or stopping smoking.
Question 6.
Do you agree that local councils shouldgive direct payments for some healthcareas well as social care?
April
24
Managing a direct payment forhealthcare for another person
The rules say you cannot use a directpayment for healthcare to pay for carefrom a friend or from a family member(who lives in the same house).
We think this is right.
A lot of people who tried out directpayments for healthcare said their familyor friends spent a lot of time helping themmanage the money.
This included things like:
· helping them choose staff
· sorting out when staff will work
· making sure the person has support ifone of the staff they employ is ill or onholiday
25
· paying their staff.
Some people think you should be able touse some of your direct payment to pay afriend or family member for this type ofsupport.
Other people think family and friendsshould not be paid because this is not ajob.
Before we decide, we would like to knowwhat you think about this.
Question 7.
Do you think people should be able to paytheir friends or family to help themmanage a large or difficult healthcarebudget?
How should we decide when people cando this?
Should it depend on how big the directpayment is?
26
We do not want to change the rules aboutthese things:
· what a Nominated person (someonewho looks after a direct payment onyour behalf) must do when they lookafter your direct payment forhealthcare and buy the services orequipment you need
· who the NHS board or GP group cantalk to and the information they canask for to help decide whether to givesomeone a direct payment forhealthcare
· what should be in your care plan andwhat the care co-ordinator (personwho leads your healthcare) must do
· the GP group or NHS Board must beable to read any information you givethem and make copies of it
Care plan
27
· a direct payment for healthcare mustbe enough to pay for all the services inyour care plan. If your health needschange then the budget should alsochange
· rules about how GP groups or the NHSBoard check whether direct paymentsare working for people and being spenton the things in their care plans
· rules about when you have to pay backsome or all of your direct payment. Forexample, if your needs change or youspend money on things that are not inyour care plan.
· rules that say the NHS can stop thedirect payment if you do not want itany more or if they think you are notspending it properly.
Question 8.
Do you think all these rules should staythe same?
If not, what do you think should change?
Care plan
Care plan
28
Question 9.
Are there any other things you want to seein the rules? If so, please tell us what theyare.
You can tell us what you think over 8weeks between 1 March and 26 April2013.
Question 10.
A law called the Equality Act makes surepeople from protected groups are nottreated unfairly.
For example, people should not be treatedunfairly because they are disabled,because of the country they come from ortheir religion.
Do you think our ideas will mean anyone istreated unfairly?
29
Question 1.
Do you think these are the things to thinkabout to decide is someone can have adirect payment for healthcare?
Do we need rules that say what to thinkabout?
Question 2.
Do you agree the rules should stay thesame but we should have separateinformation for children and for peoplewho cannot decide for themselves?
Is there anything else we need to thinkabout for people who cannot decide forthemselves?
Question 3.
Do you agree that people should not beable to use a direct payment forhealthcare to buy things on the list?
Is there anything else you think youshould not spend a direct payment forhealthcare on?
The questions we are asking
30
Question 4.
Do you agree that we should add thethings we suggest to the list ofinformation, support and advice?
Question 5.
Do you agree that people can use theirown bank account if they just get 1 directpayment for healthcare?
Question 6.
Do you agree that local councils shouldgive direct payments for some healthcare?
Question 7.
Do you think people should be able to paytheir friends or family to help themmanage a large or difficult healthcarebudget?
How should we decide when people cando this?
Should it depend on how big the directpayment is?
31
Question 8.
Do you think the other rules should staythe same?
If not, what do you think should change?
Question 9.
Are there any other things you want to seein the rules? If so, please tell us what theyare.
Question 10.
Do you think our ideas will mean anyonewho is protected by the Equality Act istreated unfairly?
32
We will use what people tell us when wethink about the changes we want to tellParliament about in summer 2013.
If they agree, the changes will start laterin 2013.
You can email your answers to:
You can tell us what you think over 8weeks between 1 March and 26 April2013.
Or you can post your answers to:
Personal Health Budgets TeamDepartment of HealthRoom 162Richmond House79 WhitehallLondonSW1A 2NS
February
April
2013
How to tell us what you think
33
We are sticking to the government’s rulesabout consultations (asking people whatthey think).
We will:
· ask what you think while there is stilltime to change things
· tell you what we want to do, why wewant to do things and how we will useyour ideas
· try to make it easy for people whomight be affected by the changes toget involved
About this consultation
34
· look at what you tell us and tell youwhat we decide to do
· make sure people who run theconsultation know what they are doingand learn from it.
Personal information
We will stick to the law and our rulesabout using personal information andsharing it with other people.
People can ask to see public information.Please let us know if anything you tell us isprivate so we can try to keep it safe.
What happens next
At the end of the consultation we will puta paper with the main things people toldus on the Consultations part of ourwebsite:
www.dh.gov.uk
If you want to say something about theway we are doing this consultation:
Write to:
Consultations CoordinatorDepartment of Health3E48 Quarry HouseLeeds LS2 7UE
Email:
Please do not send your answers tothis address.
36
