Where do I start?

Personalisation, personal budgets and direct payments

Personalisation is the term used to describe the way councils provide services to adults and carers who are considered eligible to receive them. It covers the variety of ways people can receive a mixture of local authority and government money that can be used to pay for care services.

People receive assessments of their care needs and finances by social workers who will also involve any carer you may have. There is also a carer’s assessment which they can have independently of the person being cared for. This means that, if eligible, both you and your carer may be allocated a Personal Budget.

A Personal Budget is the amount of money that will fund your care and support costs. It is calculated by assessing your needs and is spent in line with a support plan that has been agreed by both you and your council. You may also choose to pay for additional support on top of the budget. Any eventual contract for services is between the individual and their care provider, not the council.

A Personal Budget may be taken by an eligible person:

  • direct payment, held directly by the person or, where they lack capacity, by a ‘suitable person’;
  • by way of an ‘account’ held and managed by the council in line with the person’s wishes or as an account placed with a care or support provider and accessed by the user in direct negotiation with the provider; or
  • as a mixture of the above.

Personal Budgets cannot currently be used to pay for care homes but some areas are piloting this. The council will tell you if this is an option in your area. The way you are offered a Personal Budget may depend on local policies in your area too. The key to accessing this begins with an assessment of your care needs and financial circumstances.

Your assessment

You have a legal right to a care assessment (sometimes called a community care assessment) and a financial assessment whether or not you access council services. This free assessment will look at your personal circumstances such as:

  • how you can best be supported to live as independently as possible;
  • your home and how you are coping in it;
  • your emotional wellbeing;
  • your diet;
  • any health and medical treatments you need; and
  • your financial status and any benefits you may be claiming.

Your local Adult Social Care team is responsible for this process. Once the team has an understanding of your needs, the next stage is to determine what services and financial assistance you may be eligible for.

Assessments from hospital

If you have been in hospital and either you, your family, your carers or the ward staff think you need social care on discharge they may refer you to the discharge team for an assessment. The hospital assessment team can be made up of many different professionals.

The assessment will consider your needs and your carer’s needs if you have one. If it is decided that you have care or support needs, they will work with you, your family or carer to develop a suitable support plan. Services may be required from adult social care or the NHS, or private organisations and the team will work to either restart any existing services you may have had or help to arrange the appropriate services to aid your timely discharge.

If you come out of hospital and need more support whilst you recover, you may be eligible for a period of enablement, reablement or intermediate care (depending on local policy). Some people may be discharged without any support needs or just a little help from family or friends until they’re back on their feet.

Enablement or reablement

Enablement (sometimes known as reablement) is intensive short-term support that helps people regain skills and confidence, for example, after a fall or hospital stay. You will need to have a care assessment to decide if you are eligible for enablement. If eligible, an enablement worker will support you, usually for a limited period.

Enablement can help people to learn or re-learn daily living skills. Enablement is not about doing things for you, it’s about giving you the skills and confidence to do things for yourself. It can also mean that you do not start to depend on support that could cost you money. For example, an enablement worker could provide support that helps you to prepare a meal if there has been a change in circumstances that means you need to cook. Through enablement they may also identify equipment or home aids that could support you to regain or maintain your independence for a long as you can.

Some local areas may also offer a Mental Health Reablement Service. The support will focus on coping techniques, promoting social inclusion, building self-esteem, goal setting and can refer to other support services. You may be referred to these services following an assessment by a social care or health professional.

Intermediate care

This aims to give recovery and rehabilitation support to help people regain their independence when they come out of hospital or, just as importantly, prevent them having to go into hospital.

Intermediate care can be provided in your own home or in a care home depending on local policy and your needs. It can be provided by care staff, occupational therapists and physiotherapists, with additional support provided by your local GP surgery, social workers and community nurses. This combined resource helps older people to regain their independence and feel confident in their ability to manage with any additional support.

NHS Continuing Healthcare

NHS Continuing Healthcare, also known as NHS Continuing Care, is a package of care arranged and funded solely by the NHS. It is for people who are not in hospital but who have complex, ongoing healthcare needs.

Eligibility is based on having a ‘primary health need’ which means that your main, or primary, need for care must be health-related. To find out if you are eligible you will need to have an initial assessment with a health or social care professional.

As with the assessments mentioned above, you will be fully involved in the process. The initial assessment will then decide if you need to be referred for a full assessment. If, after a full continuing healthcare assessment, you are deemed eligible, NHS Continuing Health Care is free and will cover your health care and personal care needs. If eligible, it can be delivered in your own home or in a care home depending on need and local policy.

Personal health budgets

A personal health budget is an amount of money to support a person’s identified health and wellbeing needs, planned and agreed between the person and their local NHS team. The aim is to enable people with long-term conditions and disabilities to have greater choice, flexibility and control over the health care and support they receive.