How to Use a Personal Health Budget to Choose Your Own Carer

How to Use a Personal Health Budget to Choose Your Own Carer 

If you've recently been told you're eligible for a Personal Health Budget, there's probably one question sitting at the top of your mind: does this actually mean I get to pick who looks after me? For a lot of families, honestly, that's the whole reason they started asking about it in the first place. Maybe you want your daughter to finally get paid for the care she's already been quietly giving. Maybe you've found a support worker you trust completely, and the idea of starting over with a stranger every few weeks just doesn't sit right. Whatever your reason, here's the short answer: yes, in many cases, you can choose your own carer with a PHB. The longer answer — the one that actually matters — is how. 

What Is a Personal Health Budget, Really? 

A Personal Health Budget is a pot of NHS money set aside to meet your assessed health and wellbeing needs. Instead of the NHS deciding exactly what services you get and who turns up to deliver them, you sit down with your NHS team, talk through what “good care” actually looks like for you, and agree a plan for how that budget gets spent to make it happen. 

It isn't extra money on top of what you'd normally get, by the way. It's the same funding, just used in a way that fits your life instead of a standard service template. For some people, that means booking physiotherapy sessions at a time that actually works for them. For others — and this is where it gets interesting — it means employing or arranging their own carer. 

It's worth getting clear on the difference between a Personal Health Budget and a social care personal budget, because the two get mixed up all the time. A Personal Health Budget is funded entirely by the NHS through your Integrated Care Board and covers your health and wellbeing needs. A social care personal budget, on the other hand, is funded by your local council, is means-tested, and covers social care needs. They're separate pots — though, as we'll get to, they can sometimes be joined together. 

Who Actually Qualifies? 

Not everyone can request one, but the list of people with a legal “right to have” a PHB is bigger than most people realise. It covers: 

• Adults receiving NHS Continuing Healthcare 

• Children and young people eligible for continuing care 

• People eligible for aftercare under Section 117 of the Mental Health Act  

• People eligible for wheelchair services through a personal wheelchair budget  

Outside those groups, plenty of Integrated Care Boards will still offer a PHB where it's judged to be the best way to meet someone's needs. So it's always worth asking, even if you don't tick one of the boxes above. Every ICB has to make information publicly available about who can access a PHB locally. 

If you've been told you don't qualify, push a little. Ask your ICB to explain why, and to confirm whether a PHB might still be on the table given your specific circumstances. A no isn't always the final word. 

How the Money Actually Works 

Here's the part that trips people up: a PHB isn't one single thing. It comes in three forms, and which one you have changes how much control you actually have day to day. 

Notional budget — the NHS still holds and manages the money and arranges the care on your behalf, but the plan is built around your choices. Most PHBs in England work this way. 

Direct payment — the money goes into a separate bank account in your name, or on behalf of someone acting for you, and you arrange and pay for the care yourself. This is the route that makes hiring a specific person — including a friend or family member — genuinely possible. Worth knowing: in most cases you'll need a separate bank account just for the PHB money, used only for buying care. 

Third-party budget — an independent organisation holds the money for you and manages the arrangements according to your wishes, taking the admin off your plate without you having to become the direct employer. 

If choosing your own carer is the priority, a direct payment or a third-party arrangement is where you want to land. A purely notional budget still gives you a say in your care plan, but at the end of the day, it's the NHS commissioning the provider — not you picking a specific person. 

What About an Integrated Personal Budget?

If you're getting funding from both the NHS and your local council — which happens a lot for people with complex needs — you might be able to combine the two into what's called an Integrated Personal Budget. This joins your health and social care funding into a single plan with one set of agreed outcomes. The whole point is to give you a seamless experience of care, no matter which organisation is footing the bill for which bit. 

For a lot of HomeCareDirect's clients who have both NHS and local authority funded care needs, an Integrated Personal Budget ends up being the most practical, most empowering option. It's worth asking your NHS team and your local council whether this could apply to you. 

How Much Money Will You Receive? 

This is the question almost everyone has, and it almost never gets a straight answer. 

What you receive depends on an assessment of your health and wellbeing needs and what it actually costs to meet them. There's no standard figure — no “typical” amount you can point to. Once your needs 

have been assessed, a personalised care and support plan gets built in partnership with your NHS team. This is the document that lays out your outcomes and how the budget will be used to meet them. The final budget is confirmed once that plan is agreed. 

You should be told your estimated budget before the plan is finalised, so you've got something to plan around. And if the final figure comes in lower than you were expecting, or it just doesn't stretch to cover what you had in mind, you can ask your NHS team to review it. 

Can You Really Choose a Friend or Family Member? 

Yes — and honestly, it's one of the most valued parts of the whole system. Though it does need to be agreed as part of your care and support plan, not just assumed. Continuity matters more than people realise. Someone who already knows your routines, your preferences, all the small details that never quite make it onto a care plan, tends to deliver better care than a rotating cast of unfamiliar faces ever 

could. For a lot of families, being able to formally employ a relative who was already providing informal, unpaid care is a genuine turning point — financially and emotionally both. 

That said, employing someone yourself, even a relative, brings real responsibility with it: payroll, tax, National Insurance, DBS checks, insurance, training, and keeping the whole arrangement compliant with NHS rules. That's exactly the gap a specialist provider like HomeCareDirect is built to close. 

What Can a Personal Health Budget Not Be Spent On?

Knowing the restrictions matters just as much as knowing the possibilities. A Personal Health Budget can't be used to pay for: 

• Alcohol, tobacco, gambling or debt repayment • 

• Anything illegal 

• A&E treatment or emergency care 

• GP appointments, medication or primary care services • 

• Hospital stays 

Those things stay accessed through the NHS in the usual way. And if you spend your PHB on something that wasn't agreed in your care and support plan, you might be asked to pay the money back to the ICB. 

Does the Evidence Support Personal Health Budgets? 

Yes — and it's worth knowing this if you're on the fence about pursuing one. 

The NHS piloted Personal Health Budgets between 2009 and 2012, across roughly 70 primary care trusts, with over 2,000 people taking part in a controlled trial. The independent evaluation found that quality of life and wellbeing improved for people with PHBs. People with high levels of need — the group HomeCareDirect most often supports — benefited the most. Total care spending actually fell for people with high levels of need, and people receiving NHS Continuing Healthcare or living with mental health needs spent less time in hospital once they had a Personal Health Budget in place. 

That's not a small thing. PHBs aren't just about preference and choice for its own sake — they tend to produce genuinely better outcomes for the people who need them most. 

How HomeCareDirect Makes This Work in Practice?

This is where HomeCareDirect's model really earns its keep. Rather than leaving you to become an accidental employer overnight, HomeCareDirect sits alongside your PHB and handles the parts that usually put people off going down this road in the first place. You choose who cares for you — a trusted friend, a family member, someone you've found independently — and HomeCareDirect takes care of the scaffolding around them. 

That means training your chosen carer to the right clinical standard, running payroll so wages, tax and National Insurance are sorted correctly and on time, and keeping the whole arrangement compliant with what your ICB expects to see. In effect, you get the freedom of a direct payment PHB without carrying the full weight of being a sole employer. It's the difference between choosing your carer and choosing your carer while also becoming a part-time payroll administrator. 

Getting Started: What the Process Actually Looks Like

The starting point is always the same conversation, whichever route you end up taking. 

1. Ask about eligibility. Talk to your NHS team, GP or ICB about whether a PHB is right for your situation — even if you're not sure you qualify. You can raise it with your care manager or whoever you deal with most regularly. 

2. Build your care and support plan. This is the document that sets out your health and wellbeing needs, what outcomes you want, and how the budget will be used to meet them. Be specific here — this is where your preference for a named carer actually gets recorded. A good care and support plan captures what matters to you as a person, not just a clinical rundown of your needs, and it should focus on the outcomes and goals you want to achieve, not just a checklist of tasks. 

3. Choose your budget type. Decide, with your NHS team, whether a notional budget, direct payment or third-party arrangement fits what you're trying to do. Want to choose a specific person? A direct payment or third-party arrangement is your route. 

4. Bring in support for the admin. Going down the direct payment route? Arrange for a provider like HomeCareDirect to manage training, payroll and compliance, so the employment side runs smoothly from day one instead of becoming a headache. 

5. Review regularly, and ask for a review when things change. Your plan isn't set in stone. You can ask for a review any time — when your needs change, if the current arrangement stops working, or if the budget just doesn't feel like enough. If you think your budget might be running out, tell your NHS team as soon as possible. And if you end up underspending, your ICB should talk you through what happens to whatever's left. 

A Note on One-Off PHBs for Hospital Discharge 

Worth knowing: one-off Personal Health Budgets are also available specifically to help people leave hospital. NHS England has confirmed these can enable earlier discharge — by at least two days in many cases — by giving people access to personalised care and support when their needs can't be met through standard commissioned services. If your loved one is in hospital and discharge has stalled, a PHB might be one of the tools that gets things moving again. 

This ties directly into NHS Continuing Healthcare funding, which you can read more about in our guide to bringing your loved one home from hospital. 

The Bottom Line 

A Personal Health Budget puts a genuine decision back in your hands — not just what your care looks like, but who actually delivers it. For a lot of people, that means keeping a familiar face involved in their care instead of handing that role over to whoever a rota happens to assign. The financial and administrative side can feel like a lot, and honestly, that's usually the bit people quietly worry about before they even ask the question. 

That's exactly why services like HomeCareDirect exist — to take on the training, payroll and compliance, so the choice you fought for actually works day to day, instead of turning into another job on your to-do list. 

If you'd like to talk through how a Personal Health Budget could work for your specific situation, or find out more about how HomeCareDirect supports PHB clients across England and Wales, call us on 0345 061 9000 or book a free consultation at homecaredirect.co.uk. 

About HomeCareDirect 

HomeCareDirectis a CQC-regulated nurse-led complex care provider with 23 years of experience supporting people with complex health needs to live at home. We are an Aspiring NHS Lifestyle Medicine Provider and specialists in