NHS England releases guidance to CCGs concerning legal rights to personal wheelchair budgets
Following the extension of personal wheelchair budget (PWB) eligibility in December 2019, new guidance has been published by NHS England and NHS Improvement to CCGs regarding the rollout of the new personal health model.
What are PHBs and PWBs?
Personal health budgets are funds provided to individuals with long-term health and care needs to help empower people to manage and take more control over their specific needs in an aim to foster more independent living in the community.
The budget is agreed between the person, their representative, or, in the case of children, their families or carers, as well as the local NHS team.
People eligible for continuing NHS healthcare have had a legal right to a personal health budget since the 1st October 2014, however, in December 2019, the right was extended to people in receipt of NHS wheelchairs, with personal wheelchair budgets are another form of personal health budget.
The reason for the personal health budget rollout
Personal health is a key aspect of the NHS Long Term Plan to enhance personalisation of healthcare to better meet individuals’ needs, with the Government outlining its ambition to increase the uptake of personal health budgets to 200,000 people by 2023/24.
Personal wheelchair eligibility
People who are referred and meet the eligibility criteria of their local NHS wheelchair service, as well as people who are already registered with the wheelchair service, are eligible for a personal wheelchair budget when they require a new wheelchair.
This could occur through a change in a person’s clinical needs or if the condition of the current chair requires replacing.
Different means of managing personal wheelchair budgets
People eligible for PWBs have four different options available to them for how they manage their personal budget:
Notional personal wheelchair budget
A notional personal health budget enables an individual to use their PWB within an NHS commissioned service. The service sources and supplies the chair, with budget holders having the option to contribute additional funding to upgrade their selection.
This top up money – previously known as a ‘partnership voucher’ – can come from an integrated package with other agencies, such as education, social care or third sector organisations, or from budget holders’ own money.
Third party PWB
Third party wheelchair budgets allow people to spend their budget outside of NHS commissioned services, with the company or organisation receiving the personal budget by invoicing the NHS.
Again, this option allows people to also top up their budget. In the past, this would have been referred to as an ‘independent voucher’.
Traditional third-party PHB
An organisation legally independent of both the NHS and the person is responsible for holding and managing the budget, which may have the allocation of funds for the provision of a wheelchair as part of the person’s overall health and care plan.
Direct payments hold their budget in their own bank account and are responsible for arranging the care and support they need, as well as sourcing any equipment as agreed in their personalised care and support plan.
These payments must cover the entre cost of the equipment and cannot be topped up with contributions.
How personal wheelchair budgets are costed
According to the document, CCGs need to be open and transparent with people about what elements of their care can be included in a personal health budget and how this budget has been calculated.
The amount of budget for a person should be based upon what it would cost the NHS to meet the person’s assessed postural and mobility needs via the wheelchair service currently commissioned by a CCG.
For those with a range of health and social care needs, PWBs can be combined with other funding from statutory services to fund care solutions that could be more cost-effective in helping meet the person’s care needs.
As PWBs will encompass manual, powered chairs and specialist buggies, CCGs will also be required to address the chair’s repair and maintenance, considering how this will be supported by existing commissioned services or made available as part of a personal wheelchair budget.
In addition, CCGs will also need to take into account specialist seating and pressure-relieving equipment as it remains a statutory duty to provide these postural and seating requirements.
Again, the guidance highlights that it is up to the CCG to either cost for these in the person’s PWB or provide it through existing commissioned services, with decisions made on a case-by-case basis off the back of clinical assessments.
CCGs’ obligations to facilitate the rollout of personal wheelchair budgets
CCGs “must publicise and promote the availability of personal health budgets and personal wheelchair budgets,” states the NHS England guidance, as well as “provide information, advice and support to those eligible, their representatives, families and carers, to help them decide if a budget is right for them.”
Additionally, CCGs should ensure they have the “necessary processes, support and information in place so all options for receiving and managing the money can be made available to people.”
Who receives personal health and wheelchair budget
Working towards the government’s goals of 200,000 people have PHB and PWB within the next three to four years, the document points out that “if a person comes within the scope of the right to have a personal health budget, then the expectation is that one will be provided.”
Blanket refusals are not permitted, instructs the guidance, with no CCGs allowed to make sweeping assumptions about people’s abilities to manage their own personal health budgets.
If a CCG refuses to allocate a PHB or PWB…
If a PHB or PWB is refused to a person that is eligible, the CCG is required to give that individual a written explanation detailing why the request has been denied, with the individual having the right to ask the CCG to reconsider – along with submitting additional, relevant information to help their case.
The NHS England advice proposes that CCGs provide written acknowledgement of receipt of the request within 10 working days, as well as information regarding how the review will be conducted and timeframes for when it should be completed.
A final decision should be sent in writing within 28 working days of acknowledgement of the original request to the person, however, NHS England does note that some complex cases could take longer.
Once this review is complete, CCGs should inform the person and/or their representative of its decision in writing, identifying the reasons for the decision.
PWBs for people in nursing and residential care
The guidance outlines that any commission for nursing or residential care settings allows for the prevision of equipment including basic, non-complex wheelchairs used for general activities such as short outings. These do not qualify for PWBs.
For individuals in nursing and residential homes that require a personal, bespoke wheelchair to meet independent needs, these people would have a right to PWBs