| Reference | FOI 2025/1203 |
|---|---|
| Description | PHB and Children’s Continuing Care |
| Date Requested | 22/04/2025 |
| Date Replied | 09/05/2025 |
| Category | Continuing Health Care (CHC) |
Please could I ask for the following information related to Personal Health Budgets that you are responsible for under NHS GREATER MANCHESTER INTEGRATED CARE BOARD?
This includes:
2. Can you confirm whether Clinical Oversight/Supervision of PA/carers is included in your Direct Payments PHB Offer? If yes, please could you confirm how this is achieved (i.e. via Community Nurse, Registered Nurse as part of PHB budget, centralised ICB Nurse, etc.) on:
If so,
4. What pay scale/process is used for PAs / Carers employed under Direct Payment PHBs (and can you share) for NHS GREATER MANCHESTER INTEGRATED CARE BOARD
5. Who is responsible for ensuring training for the PAs / Carers is provided/undertaken for Direct Payment PHBs (Parents / NHS / ICB / CCN, etc).
6. Who is Lead Commissioner for the Direct Payment PHB Budgets – Local Authority or ICB (or another)?
7. What is the current structure of your ‘PHB’ team (internal to ICB and those who liaise/support parents directly)?
The responsibility for delivering PHBs for those who are eligible for Children’s Continuing Care lies with each Greater Manchester locality.
NHS Greater Manchester ICB (NHS GM) acknowledges its responsibilities to ensure that those citizens who have a “right to have a PHB” can access one.
We have contacted each locality for their response to each of the question in the FOI and have collated the responses below.
1.
| Locality | Response |
| Bolton | Please see Bolton local offer for personal budgets – https://www.bolton.gov.uk/sendlocaloffer/homepage/24/personal-budgets |
| Bury | SEN Personal Budget – Bury Council
** An attachment was sent to the requester with this response. If you require a copy of the full response, together with the attachments, please contact NHS GM’s FOI team – nhsgm.foi@nhs.net.** |
| Heywood Middleton & Rochdale (HMR) | ** An attachment was sent to the requester with this response. If you require a copy of the full response, together with the attachments, please contact NHS GM’s FOI team – nhsgm.foi@nhs.net.**
This is our PHB Information Leaflet that is sent to all patients and their relatives informing them of their options. |
| Manchester | SEND and Alternative Provision Change Programme Partnership | Help & Support Manchester
The Children’s and Young People’s Complex Care Team is part of the Manchester Children’s Specialist Services Community Nursing Team. The nursing team complete a health needs assessment for children with complex needs who require continuing care. Following assessment, the team will contact the Manchester Continuing Health Care if the child meets Continuing Care criteria. If they are interested in having a personal health budget (PHB) they are referred to our brokerage service for support with their plans including exploring all 3 options for PHB |
| Oldham | Oldham locality has a contract in place with Northern Care Alliance NHS Foundation Trust ventilation team who provides support to all young people and children who are eligible for children’s continuing care funding.
|
| Salford | Personal budgets•Salford City Council
All Children and Young People in Salford locality found eligible for NHS Continuing Care have the right to request a PHB. The offer is in line with our local authority offer as outlined in the link above. |
| Stockport | Link to local authorities online SEND personal budget offer:
Personal budgets – Stockport Council As per the National Framework for Children and Young People’s Continuing Care 2016 |
| Tameside | Personal Health Budgets | Tameside Send Local Offer |
| Trafford | Trafford Directory | Personal budgets |
| Wigan | Wigan Locality offer Notional and Direct Payments to children that are eligible for Children Continuing Care (CCC) in line with the agreed support plan. NHS GM Wigan do not currently have any 3rd Party PHBs in CCC.
This is a link to the local offer site where all of the information sits. Personalised education, personal budgets and direct payments |
2.
| Locality | Response |
| Bolton | a. During the PHB annual review, we would look at current training needs, including those training needs that need updating annually. This would be arranged by a broker service with the family.
b. If needs changed before an annual review, then any training request would be put but in through the personal budget and the training would be arranged. |
| Bury | a. Clinical oversight is provided via annual reviews undertaken by the Continuing Care Nurses, with more frequent input if required. Brokers keep a log of who has had training and when refreshers are due.
b. Please refer to the response above. |
| HMR | When a PHB is established, the case manager determines the aspects of care that are delegated healthcare tasks and therefore require additional training/ competency sign off. All PHB PAs carry out Foundations of Care training offered by our local hospice which covers all aspects of basic care. Any delegated healthcare task training is indicated on our training matrix which is sent to the broker when establishing the PHB. Training providers are then commissioned with an upfront payment into the PHB to deliver the training and devise care plans for the PAs to follow. This is then checked at the PHB review and financial audit to ensure training has been provided and competencies maintained. |
| Manchester | Yes. All PAs supporting families who have a PHB access our training programme and complete the training modules as recommended by our clinicians. This programme of training is delivered by a specialist training provider who monitor each PAs training and the need for refresher training. They will notify us if there are any instances of non-compliance. |
| Oldham | Not Applicable. Currently no young person or child has a direct payment |
| Salford | a. Yes, all PHBs will have clinical oversight from CCNT and an ICB Nurse as part of the usual offer.
b. Oversight will be provided yearly or sooner as the needs of the PHB require e.g. new staff joining the package. |
| Stockport | Personal Health Budgets are overseen by brokerage services. Clinical oversight is gained through training provided by nurse trainers, and assessment of competencies. Records of competencies are retained by the brokerage service and cross-checked during CC Clinical reviews.
PHB’s are initially reviewed after 3months, followed by annual reviews to ensure that the PHB continues to meet clinically assessed needs. This is undertaken by an ICB Children’s Nurse. Costings provided by brokerage services include initial training, annual mandatory training, and re-assessment of competencies. Any additional training needs are highlighted and discussed during continuing care reviews. |
| Tameside | a. This is done by the training provider which has been arranged at set up who also offer yearly competency. This may be a community nurse, private training provider or an NHS service providing the training.
b. The Individual Commissioning Nurse also gain assurance of clinical competency and effectiveness |
| Trafford | Clinical Case Manager assesses need for delegated healthcare task training and commissions a training company to deliver training and undertake competency checks on a yearly, or more frequently based on training type/subject, basis. Training and competency checks must be completed by a reg. Nurse trainer. Those with DP budgets – families submit shift notes to the CCC clinical case manager monthly for oversight of what is happening during their shifts.
Those with notional budgets – the CCC Clinical Case Manager meets monthly with all agencies providing care to discuss each child they deliver support to. This includes conversation on oversight of what occurs during shifts, any incidents, accidents or safeguarding concerns, checking on any training required for each of the staff in each package – when annual refreshers are required, checking that acre plans devised by the agencies are regularly updated. All shifts’ notes are sent across to the CCC case manager monthly for each child for additional oversight and uploading to each child records.
|
| Wigan | The local Children’s Community Nursing Team offer the clinical training (for delegated healthcare tasks) to include refresher training and ongoing clinical advice and support for Personal Assistants for those with continuing care needs. There is no cost for this included in the individual’s support plan, instead the cost is absorbed through the block contract with the NHS provider organisation.
It is the responsibility of the employer (typically parents) to monitor the performance of Personal Assistants. If there are any concerns in relation to clinical practice, then employers know to contact the Children’s Community Nursing Team to request further training.
The Children’s Continuing Care Nurse will complete an overview and monitor the training requirements at the annual review and signpost them to the appropriate resource, if required. |
3.
| Locality | Response |
| Bolton | a. All families (where the child / young person is living at home) are offered a direct payment form of personal health budget unless there is a good reason to refuse one as outlined in the direct payments for healthcare guidance. In these cases, a notional or 3rd party budget would be considered.
b. Some children are eligible for children’s continuing care, but are for within a residential home, in which cases we would not usually offer PHB. Some families choose not to have a personal health budget and receive commissioned children’s continuing care services from the local foundation trust. c. 0% of people who are eligible for a PHB i.e. those living at home |
| Bury | a. No. We offer PHB’s to all children however not all offers are accepted. In exceptional circumstances, there may be the need for a third party PHB to be implemented.
b. N/A c. 42% |
| HMR | All HMR children are offered a direct payment PHB, but some parents do not want the responsibility of a direct payment and choose a notional budget instead.
74% of patients currently have a direct payment PHB in place, the remainder have needs that require them to be managed in 24hr care settings or choose a notional PHB with service from a domiciliary care provider |
| Manchester | All continuing care eligible patients (living at home) are entitled to PHBs but there might be specific reasons why a PHBs might not be put in place:
· The family of the child / young person doesn’t want to have any kind PHB · A young person over the age of 16 doesn’t want to have any kind of PHB · The child / young person is living in a 24-hour care facility where we would not generally consider an offer of a PHB. In these instances, a commissioned care arrangement would be put in place with an appropriate care provider following discussion with the family / young person. There may be times when a direct payment PHB option is refused as follows: · that the person (or their representative) would not be able to manage them · that it is inappropriate for that person given their condition or the impact on that person of their condition · that the benefit to that person of having a direct payment for healthcare does not represent value for money · that providing services in this way will not provide the same or improved outcomes · that the direct payment will not be used for the agreed purposes. In these instances, family would be offered the option of a 3rd party or notional PHB |
| Oldham | No |
| Salford | No – where a direct payment is felt to not be appropriate a notional or 3rd party budget will be considered. |
| Stockport | No – all children and young people assessed eligible for continuing care are eligible for a PHB. PHB’s are discussed at annual reviews, and offered when setting up a package of care |
| Tameside | No |
| Trafford | No |
| Wigan | No, only Looked After Children in residential placements who aren’t included in the PHB offer. All other children eligible for Continuing Care have a PHB in place, either Notional or Direct Payments. |
4.
| Locality | Response |
| Bolton | The current rate is £12.60 per hour unless in exceptional circumstances where care is complex sure as ventilated child. |
| Bury | PHB PAs are agreed at a standard or complex hourly rate dependent of assessed level of need.
24/25 Standard £12.00, Complex £14.20 25/26 Standard £12.70, Complex £15.02 |
| HMR | Our standard rates are agreed in line with Real Living Wage, and we do have a complex rate for those individuals with more complex needs |
| Manchester | We do not have a standard rate for PAs / carers but recommend no lower than £12.50 per hour from 01.04.2024. Each individual employer determines their own PA rate within their allocated budget.
There will be an uplift to the rate for 2024-25 |
| Oldham | Oldham locality aligns with the local authority pay scale for PAs. This is currently £12.60 per hour set and agreed by the LA/ICB. As mentioned before no child or young person currently has a direct payment PHB. |
| Salford | PAs are paid the National Living Wage rate. This will be uplifted annually. |
| Stockport | I have been advised from the LA that the uplift is £16.82 p/h from 01.04.2025, the current hourly rate is £12.97, the ICB uplift is yet to be agreed. |
| Tameside | We don’t have set pay scales as it will depend on the level of complex tasks and the skill set required. |
| Trafford | Personal Assistants are paid according to a local standard tariff rate (based on training completed/time employed/level of responsibility/unsociable hours) which is increased according to annual uplift %. For joint funded packages of care the rate is set at the Local Authority rate. Higher rates for PAs are considered on an exceptional case by case basis according to level of complexity of care. |
| Wigan | The current rates are: –
Agenda for Change Band Hourly Rate (without oncosts) Band 2 (Standard) £12.08 Band 3 (Complex) £13.13 Band 4 (Specialist) £14.89 Band 5 £18.66 |
5.
| Locality | Response |
| Bolton | The ICB is responsible for identifying training needs and advising the family of where they can access training from. The employer
is responsible for ensuring their PAs are trained. |
| Bury | CCNT and Training Consultant who is a registered children nurse. Some tasks delegated from physio and overseen by the physio with care plans and liaison with RMCH. |
| HMR | All patients are referred for training at the commencement of a PHB which is to be renewed annually / commencement of new PAs. This is the responsibility of the person who is managing the direct payment. Before the PHB commences, the ICB receive confirmation from the brokerage provider, assisting with the set-up of the direct payment, that all training has been completed. This is reviewed at both the annual review and audit |
| Manchester | The person who has signed the direct payment agreement is responsible for ensuring that PAs are trained appropriately. |
| Oldham | If the family of a child or young person chooses a direct payment the ICB (Oldham) would ensure that there is training available for PAs to access. Where the PHB is being taken as a direct payment the person who is managing the direct payment arrangement (i.e. the cared for person or representative / nominee is responsible for ensuring any staff they employ are adequately trained. The ICB will carry out a check of whether PAs have or will be trained before approving a Personalised Care and Support Plan. |
| Salford | The individual who is managing the direct payment care arrangement (usually the family member for those with Continuing Care) will be responsible for ensuring that PAs are trained with support from the ICB and CCN. |
| Stockport | The individual who is managing the direct payment care arrangement (usually the family member for those with Continuing Care) will be responsible for ensuring that PAs are trained with support from the ICB and CC nurse.
Potential training needs are identified in collaboration with the nurse assessor and parent/carer. Training is provided by nurse trainers sourced by brokerage services and funding for such training is supported by the ICB. The CC nurse assessor also liaises with specialist trainers and training providers to ensure that any necessary training is delivered. Any additional training needs are highlighted and discussed during continuing care reviews. |
| Tameside | The employer is responsible; however, they do have support services to assist them from the initial set up. The Individual Commissioning Nurse also has a responsibility to complete our PHB quality assurance document which includes appropriate training |
| Trafford | The direct payment employer or Third-party management service are responsible to ensure that all PA / staff training is completed. Details of completed training are considered at the review stage by the Clinical Case Manager via Personalised Care and Support Plan review document. |
| Wigan | The employer of the PAs / Carers is responsible for the provision of training. This is typically parents for PAs. The ICB checks with employers as part of the review process whether PAs/Carers have accessed all appropriate training. |
6.
| Locality | Response |
| Bolton | ICB |
| Bury | ICB |
| HMR | ICB |
| Manchester | ICB |
| Oldham | ICB |
| Salford | Local Authority and ICB are the Lead Commissioners. |
| Stockport | Within the ICB nurse assessors set up and commission PHBs. |
| Tameside | ICB |
| Trafford | ICB |
| Wigan | The Local Authority tends to be Lead Commissioner for those with Direct Payments, but the ICB is typically the Lead Commissioner for Notional PHBs, when support is accessed via Nurse Led Provider Organisations. |
7.
| Locality | Response |
| Bolton | There is no PHB team in place. PHB are supported through children continuing care team, finance and broker support |
| Bury | There is no “PHB Team”. Case manager nurses liaise with family. We have a PHB nurse who also supports the case managers. |
| HMR | Managed in house by all members of staff in HMR CHC team, from case management, co-ordination and financial management. |
| Manchester | There isn’t one person with responsibility for leading on PHBs. PHBs are a core responsibility of each case manager including our children’s continuing care professionals. |
| Oldham | There is no dedicated or separate PHB team. Providing support to people who wish to have a PHB is a core duty of each case manager. |
| Salford | There is no “PHB Team”. All Clinical Staff on the NHS Funded Care Team (Salford) receive training regarding the provision and oversight of PHBs. |
| Stockport | There is no PHB team. Lead Children’s Complex Care Nurse Assessor support with PHBs and has also received in house training in relation to Personal Health Budgets. |
| Tameside | There is no PHB team, it is part of all the team’s core responsibilities. |
| Trafford | Children’s Continuing Care Nurse.
Head of Individualised Care/Personalisation Lead – Programme Lead for system wide PHB delivery. No Project support or administrative support within current structure. PHB Support Providers outsourced to VCSE and registered companies. Payment and Audit for PHBs commissioned to Local Authority DP Team. Head of Personalised Care – Senior Lead responsible for CHC/CCC/LD/MH operational delivery, including PHB offers. |
| Wigan | There is no PHB team within Wigan Locality, the PHB offer, and support is delivered in collaboration with the Local Authority. |
