1. Payment types

How much money someone is given in their personal health budget is determined by what they need to achieve their recovery goals. This includes both notional budget purchases and direct payment purchases.

Notional budget purchase

In City & Hackney some services are already funded by NEL ICB, and no extra payment is needed for the person to take part. The service will be included in the person’s recovery plan, and we need to take into account the notional value of what the person is receiving. This currently includes the services run by Core Arts (Recovery Alliance clinical referral), Hackney Centre for Better Health and Hackney Volunteer Centre.

There are currently no notional budgets in Tower Hamlets and Newham.

Direct payment purchase

If what a person needs to work towards their mental health recovery goal isn’t already funded by NEL ICB or available through community services, we’ll set up a direct payment. The person will use their direct payment to purchase the planned item or service that will support their recovery goal.

There are no set criteria for the amount of money we can allocate, but the referral must explain in detail why the item or service is the best way for the person to achieve their recovery goals. This is always reviewed on an individual basis.

Our finance team set up an account for the person with Prepaid Financial Services (PFS) and deposit the agreed funds into the account for the requested item/ activity. The person has a choice of accessing the online PFS account to make the purchase or receive a prepaid  card (see below).

Before the funds are organised, a Direct Payment Agreement (DPA) is completed with the person. This agreement outlines how the PHB must be used. The referrer will need to ensure a DPA is completed before the Brokerage service can set up the account for direct payments.

2. Ways to pay for direct payment purchases

• Direct online payment – for one-off or multiple payments.
  The PFS account has online card details that can be used to make a purchase or set up regular payments.
• Prepaid card – one-off or multiple payments.
  The person receives a prepaid card in the post that they can use to make purchases in person. There are some restrictions on the card, for example it cannot be used at ATM machines. This option is best suited to those who would prefer to make a purchase in-person.
• Third-party provider – for one-off or multiple payments.
  Also referred to as a ‘managed account’. A PFS account is set up in the person’s name but the purchase is made on behalf of the person by a PHB advisor. This option should only be selected if there is a reason the person cannot make the purchase themselves or with support.

3. What can’t be funded by a PHB in NEL?

Here are some examples of things that can’t be funded by a PHB.

• Specialist Psychological therapies: this is sometimes funded under individual funding request
• Something that will benefit someone connected to the budget holder, but not the budget holder directly – for example using a PHB to buy an item for a family member or friend
• Support for de-cluttering: Refer to local safeguarding protocols for self neglect
• Travel costs for a journey out of the UK
• Driving lessons for people without a driving license
• Fast food delivery services e.g. Uber Eats or Deliveroo.

This is not a complete list and NEL ICB reserves the right to refuse any PHB request that does not clearly relate to a person’s mental health recovery goal. We recommend PHB requests are discussed with a PHB advisor before making a referral.

4. Requesting specialist items or equipment

When a person is selecting an item or piece of equipment to support them to work towards a mental health recovery goal, it must be clear in the referral how the item will support the person’s goal. If a specialist model or piece of equipment is chosen, it is important to include details of why this particular model is needed (e.g. Mac laptop) to achieve the goal and why other models are not suitable.

When this information is not clear, the PHB advisor will contact the referrer for more information which could result in delays to the process. We recommend discussing any specialist requests with a PHB advisor ahead of making a referral.

5. Approval limits

Direct payments need to be approved as follows:

• assessing clinician: £0 – £250
• team manager: £250 – £750
• team manager and e-approval (representative from ELFT, lived experience rep and NEL ICB): £750 – £1000+

6. Clinical recommendation

The referral must include details of how the proposed purchases are clinically important for the person to improve their mental health. We need to know:

• How the PHB request will support the person’s mental health recovery goal
• The reason for the overall budget size
• How direct payments have been chosen
• Other options that were considered.

7. Long term sustainability

A PHB can fund support for up to a year; however, the length of time should be based on the time required to make progress with the identified mental health recovery goal. It’s unlikely a PHB would be available as a long-term source of funding. Clinicians need to  consider long-term sustainability, for example stepping down PHB-funded support over time as confidence grows, or the possibility of social care direct payments to continue support in the future.

8. One PHB at a time

A person should only have one direct payment request open at one time. If a person is working with multiple staff within ELFT or has recently been referred to you from a different member of staff or team, please check their Rio notes for details of a PHB. You can also contact the PHB team to check this information.  If the information you equire is historic you can contact the ELFT PHB Lead Bonnie who may be able to give you some details of previous PHBs the person has received.

If the person has a ‘live’ PHB, the new request will be put on hold until the original PHB has been reviewed and closed. If the first PHB is not yet live, the person will be asked which goal and PHB request they would prefer to focus on first. The person can receive a second PHB to support the next stage of their mental health recovery journey once their original PHB request has been reviewed and closed (minimum 12 weeks).

A person can receive a ‘stay connected’ PHB for a smart-phone/data or notional PHB alongside a direct payment.

9. Considering risks

PHBs are about enabling people to take positive risks. However, it’s still important for the team to consider any risks that might arise, and agree with the person how to manage these. This might include trying a new type of support for a short period then reviewing it with the clinician. For more information on this, see our guidance on using a PHB safely.

10. A PHB is part of the person’s mental health support

A PHB is not a grant. A PHB is one of the options available to help someone to work towards their identified mental health recovery goals and is therefore part of the support they receive from ELFT. People should be supported by ELFT throughout the duration of their PHB: personalised care and support planning, setting up the request, reviewing the PHB.

The PHB is reviewed to:

• Discuss how the PHB is supporting the person’s goal
• Make changes to the PHB, where necessary
• Collect impact by completing a quality-of-life questionnaire (ReQol 10) or DIALOG+ plan
• Discuss the next stage of the person’s mental health recovery journey.

The PHB is reviewed at 6 weeks from the budget going live unless otherwise specified and can be reviewed again at 12 weeks if more time is needed, when the PHB is closed. Payments may continue after the PHB has been closed, depending on the request. This timeframe should be considered when discussing the appropriate type of support for the person. If the person is being discharged to a different team within ELFT, the PHB should be part of the handover.

11. Patients Know Best

Patients Know Best (PKB) is an online platform that people can use to access their health information. In NEL, PKB is being used to support people living with a SMI to self-manage their mental health. People can register on PKB to access details of their PHB including their PHB plan and any reviews captured as part of the PHB outcome. This will be available to view by those who have registered.

People can register on PKB through the NHS app to view their health records, you can see more information about PKB here.