| Reference | FOI 2025/1463 |
|---|---|
| Description | CHC Budget Calculation, Natural Support, Cost Disclosure & Shortfalls |
| Date Requested | 13/11/2025 |
| Date Replied | 11/12/2025 |
| Category | Continuing Health Care (CHC) |
Please treat this as a request under the Freedom of Information Act 2000.
This request concerns organisational policy and methodology only and contains no personal data. It must therefore be processed under FOIA, not SAR.
Please provide the following information:
1.1 The ICB’s current policy for calculating Continuing Healthcare (CHC) or Personal Health Budget (PHB) costs.
1.2 The methodology used to determine the weekly and annual cost of a CHC package.
1.3 Any internal guidance, instructions, or manuals issued to CHC staff on budget-setting.
1.4 Any assessment tool, spreadsheet, calculator, or resource allocation model used to convert assessed need into a budget value.
1.5 Any documents describing how staff must apply these tools.
2.1 A list of all document types used when calculating CHC budgets (e.g., CHC care plan, DST, MDT reports, OT/SALT/Psychology reports, PBS documentation, behaviour/sensory assessments, risk assessments, provider costings, internal costing templates).
2.2 Any hierarchy or weighting system determining which documents carry most influence.
3.1 The ICB’s policy on including weekly and annual costings in CHC care plans.
3.2 The ICB’s policy on disclosing costed CHC care plans to families and patients.
3.3 Any guidance on preparing a costed CHC care plan before a CHC review.
3.4 Any documents authorising the omission or withholding of costings from CHC care plans.
4.1 Whether unpaid family support may be considered in CHC budget-setting.
4.2 Any policy allowing natural support to reduce the funded package.
4.3 Any guidance on using natural support to fill gaps (e.g., travel, driver support, community access, behaviour/sensory needs, rota gaps).
4.4 Any policy prohibiting the use of natural support in CHC budgeting.
4.5 Any governance or audit documents addressing inappropriate reliance on family natural support.
4.6 Whether the ICB applies the same natural-support approach to all CHC patients.
5.1 Whether the ICB funds driver support, travel supervision, escorting, or mileage where community access or vehicle safety forms part of assessed need.
5.2 Any criteria or guidance defining when driver or travel support must be included.
5.3 Any standard costing assumptions (driver rate, mileage rate, travel time, etc.).
5.4 Whether family-provided transport may be used to cover an unfunded or underfunded component of care.
6.1 The ICB’s policy on disclosing the following to families and patients:
6.2 Any policy or internal rationale permitting the withholding or redaction of CHC costings.
6.3 Any governance/audit documents relating to CHC Framework (2022) paragraphs 333–339.
7.1 Whether the above budget-setting process applies to all CHC patients.
7.2 Any exceptions (autism, learning disability, cost threshold, PHB vs provider-commissioned packages, etc.).
8.1 Any policy describing how the ICB identifies shortfalls between assessed need and funded provision.
8.2 Any documents confirming how often CHC packages are:
8.3 Any instructions to staff on:
8.4 Any templates or reporting used to record shortfalls or natural-support substitution.
8.5 Whether this process applies equally to all CHC patients.
1.1 In respect of how NHS Greater Manchester ICB (NHS GM) calculate budgets, this is based on the care needed for the individual, as per their primary health need. The process in followed in line with the National Framework, as issued by the Department of Health and Social Care (DHSC). A copy of the framework is published on the DHSC website, as provided below:
The oversight of budgetary spend is managed locally, within each of the ten localities of Greater Manchester (GM). The budget delegation is for localities to manage and oversee, in line with the NHS GM Operating Model. The Heads of CHC / Individualised Packages of Care (IPOC), under the line management of each of the 10 Associate Directors of Quality, Nursing and Safeguarding (ADQs), manage the day-to-day financial management in accordance with the Scheme Reservation and Delegation (SORD), as detailed on the NHS GM website:
NHS Greater Manchester Integrated Care Governance Handbook
1.2 As explained within the answer to question 1.1, NHS GM determines the package of care based on an individual’s primary health need. As part of the determination of the weekly costs, the ten CHC Teams use various software tools to support in setting the cost, as well as the internal financial sign off processes, as detailed in the response to questions 7 and 8. Two pieces of software which are used within NHS GM are Imosphere and Carecubed. For completeness, NHS GM have provided links to both respective companies below:
CareCubed – The National Care Costing Tool
1.3 In addition to compliance with the National Framework, as detailed in response to Question 1.1, as well as working towards the locally agreed policies, as provided below:
**PDF documents were 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 **
1.4 Please refer to the responses provided to Questions 1.1 and 1.3.
1.5 Please refer to the GM Operational Policy provided to Question 1.3.
2.1 Although not an exhaustive list, the ten CHC Teams utilise the Decision Support Tool (DST), a CHC Care plan, in addition to any Multidisciplinary Team (MDT) assessments, and / or reports. Moreover, Positive Behaviour Support (PBS) documentation, as well as risk assessments and any other support with identifying needs to be met. Based on the consideration of such documentation, NHS GM ICB commissioning the necessary package of care.
2.2 As detailed in the National framework, as provided in the answer to question 1.1, the National Framework does not determine the weighting, nor influence of any documentation when determining eligibility for CHC, and / or a Personal Health Budget (PHB).
3.1 to 3.4 Please refer to the responses provided to questions 1 and 2.
There are no policies which exist within NHS GM ICB to answer questions 4.1 to 4.6
5.1 NHS GM ICB will fund the support required to meet the primary heath need.
5.2 to 5.4 There are no criteria, nor guidance.
6.1 Please refer to the answers provided in responses above.
6.2 There are no criteria, nor guidance.
6.3 Paragraphs 333-339 are in relation to managing care for Section 117 (S117) applications. NHS GM ICB do not have any governance, nor audit documents available.
7.1 to 7.2 There are no exceptions – budget setting is applied consistently for all category of patient.
8.1 to 8.5 NHS GM does not have a policy. In respect of how NHS GM ICB calculate budgets, this is based on the care needed for the individual, as per their primary health need. The process in followed in line with the National Framework, as issued by the Department of Health and Social Care (DHSC).
