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Description
Personal Health Budgets are amounts of money allocated to a Patient/Service User to support their health and well-being needs and to enable them to purchase and manage their own treatments, equipment and personal care. Personal Health Budgets are available to Adults receiving NHS Continuing Healthcare and children receiving continuing care - for example, people with long-term physical or mental health issues. Requests outside this are considered on a case basis by the Patient/Service User's CCG.
A Personal Health Budget Capability will allow a Personal Health Budget to be defined, reviewed and updated. The Capability facilitates the link between the Personal Health Budget and the Patient/Service User's care plan to ensure spend is directed towards meeting the Patient/Service User's health goals. A Personal Health Budget Capability will allow purchases of a range of products and services to deliver the agreed health and well-being outcomes, for example therapies (e.g. counselling), personal care (e.g. a personal assistant), services (e.g. gym membership) and equipment (e.g. a wheelchair). CCGs will be able to assess Personal Health Budgets to ensure they are used appropriately.
A Personal Health Budget Capability may manage multiple budgets and the directory of equipment, treatments and therapies and give further reporting functionality. It may also link to the Patient record and Workflow tasks to further broaden its integration with other functions.
Outcomes
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- Able to understand, upfront, the amount of money available to them for healthcare and track spend against this
- Able to choose an individual who can manage the Personal Health Budget on their behalf
- Able to identify and then purchase the equipment, treatment or services they feel will best deliver the outcomes defined in their care plan
- Able to use a Directory of Services to identify potential equipment, treatment or services that might be of benefit and compare costs
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- Facilitates a conversation between the Patient/Service User and their Care Coordinator, local NHS team or Health Broker
- Use of eligibility criteria makes it easier to identify Patients/Service Users who are eligible for a Personal Health Budget
- Use of eligibility criteria makes it easier to identify products and services that can be purchased using a Personal Health Budget
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- Able to audit spend against Budgets and identify inappropriate spend
- Able to plan effectively and track spend by monitoring across all Personal Health Budgets within the CCG
- Able to utilise different models for the management of Personal Health Budgets - notional, 3rd party and direct payment
- Able to pay for equipment, treatment or services direct to the Service Provider or via a 3rd party or the Patient/Service User
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- Directory of services allows them to share information on their services
- Able to understand the take-up of their services by Patients/Service Users
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| title | MUST Epics - Epics and acceptance criteria will be evaluated during the Capability Assessment Stage of Onboarding |
C32E1 - manage Personal Health Budget
As a Patient/Service User
I want to manage my Personal Health Budget
So that I can use my budget to deliver my desired health outcomes
Acceptance criterion 1: create Personal Health Budget
Given the Health or Care Professional has requested a Personal Health Budget
When they choose to create the Personal Health Budget
Then the Personal Health Budget is created for the Patient/Service User
Acceptance criterion 2: choose an individual to manage Personal Health Budget
Given the Patient/Service User has been allocated a Personal Health Budget
When the Patient/Service User chooses an individual to manage their Personal Health Budget on their behalf
Then the individual can access the Personal Health Budget
And can make purchases on behalf of the Patient/Service User
Acceptance criterion 3: view Personal Health Budget
Given that the Patient/Service User has a Personal Health Budget
And purchases have been entered
When the Patient/Service User chooses to view the Personal Health budget
Then the Personal Health Budget is displayed
Acceptance criterion 4: review Personal Health Budget
Given a Personal Health Budget and care plan has been set up for a Patient/Service User
When the Personal Health Budget is reviewed
Then a record of the review can be recorded against the Personal Health Budget
Acceptance criterion 5: amend Personal Health Budget
Given a Personal Health Budget and care plan have been set up for a Patient/Service User
When the Personal Health Budget is reviewed
Then the Personal Health Budget can be amended
Acceptance criterion 6: close Personal Health Budget
Given a Personal Health Budget and care plan have been set up for a Patient/Service User
When the Personal Health Budget is reviewed
Then a record of the review can be captured against the Personal Health Budget
And the Personal Health Budget can be closed or made inactive
C32E2 - record Personal Health Budget purchases
As a Patient/Service User
I want to be able to record Personal Health Budget purchases
So that I can evidence where my Personal Health Budget has been spent
Acceptance criterion 1: record Personal Health Budget purchase
Given that the Patient/Service User can access the Personal Health Budget Solution
When payment is made for products or services (by the NHS team, a Third party or the Patient/Service User)
Then evidence of how and on what the money has been spent (e.g. receipts, invoices, bank statements) can be captured
And this is recorded against the Personal Health Budget for the Patient/Service User
C32E3 - assess Personal Health Budgets
As a representative of the CCG
I want to be able to assess Personal Health Budgets
So that I can ensure that Budgets are only spent on appropriate products and services
Acceptance criterion 1: view purchase trail against the budget
Given the user has been permitted access to the Personal Health Budget
And the Personal Health Budget purchase has been recorded
When the user chooses to view the purchase trail against the budget
Then purchase trail against the budget is displayed
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| title | MAY Epics - All May Epics and Acceptance Criteria will be evaluated during the Capability Assessment Stage of On-boarding. However, these Epics are not mandatory and will not be used as part of the overall assessment of whether the Capability is fully met. Any May Epics that are assessed as met will be available to buyers via the Buying Catalogue. |
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Enables a Patient/Service User to set up and manage a Personal Health Budget giving them more choice and control over the management of their identified healthcare and well-being needs.
Enables Health or Care Professionals to manage Personal Health Budgets for Patient/Service Users. |
Outcomes
For a Health or Care Professional: | Able to manage Patient/Service Users' Personal Health Budgets. |
MUST Epics - Describes the minimum functionality required to deliver a Capability. Solutions MUST be successfully evaluated against each Epic and Acceptance Criteria via Capability Assessment in order to be associated with this Capability | ||
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E00649 - manage Personal Health Budgets for a Patient/Service UserAs a Health or Care Professional I want to manage Personal Health Budgets for Patient/Service Users So that Personal Health Budgets can be managed Acceptance criterion 1: create Personal Health Budgets for a Patient/Service UserGiven the Health or Care Professional is permitted to manage Personal Health Budgets for Patients/Service Users When the Health or Care Professional selects to create a Personal Health Budget for a Patient/Service User Then the Personal Health Budget is created Acceptance criterion 2: view Personal Health Budgets for a Patient/Service UserGiven the Health or Care Professional is permitted to manage Personal Health Budgets for Patients/Service Users When the Health or Care Professional selects to view a Personal Health Budget for a Patient/Service User Then the Personal Health Budget is displayed Acceptance criterion 3: amend Personal Health Budgets for a Patient/Service UserGiven the Health or Care Professional is permitted to manage Personal Health Budgets for Patients/Service Users When the Health or Care Professional selects to amend a Personal Health Budget for a Patient/Service User Then the Personal Health Budget is amended Acceptance criterion 4: close Personal Health Budgets for a Patient/Service UserGiven the Health or Care Professional is permitted to manage Personal Health Budgets for Patients/Service Users When the Health or Care Professional selects to close a Personal Health Budget for a Patient/Service User Then the Personal Health Budget is closed
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MAY Epics - Describes additional functionality associated with the Capability. Suppliers should consider all MAY Epics as part of their User Research. Suppliers can choose to map their Solutions to these Epics and they will be evaluated via Capability Assessment. Contracting Authorities or purchasing organisations may require these Epics as product qualification or requirements criteria | ||||||||||
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E00650 - record reviews of Personal Health BudgetsAs a Health or Care Professional I want to record reviews of Personal Health Budgets So that reviews of Personal Health Budgets are recorded Acceptance criterion 1: record reviews of Personal Health BudgetsGiven the Health or Care Professional is permitted to manage Personal Health Budgets When the Health or Care Professional selects to record a review of a Personal Health Budget Then the review is recorded E00651 - Health or Care Professionals recording purchases made using Personal Health BudgetsAs a Health or Care Professional I want to record purchases made using Personal Health Budgets So that there is a record of the products and services purchased for the treatment and care of Patient/Service Users Acceptance criterion 1: Health or Care Professionals recording purchases using Personal Health BudgetsGiven the Health or Care Professional is permitted to manage Personal Health Budgets When the Health or Care Professional selects to record a purchase made using a Personal Health Budget Then the purchase is recorded And evidence of the purchase is attached
E00652 - make payments for products or servicesAs a Health or Care Professional I want to make payments for products or services relating to Personal Health Budgets So that payments are made for products or services Acceptance criterion 1: make payments for products or servicesGiven the Health or Care Professional is permitted to manage Personal Health Budgets When the Health or Care Professional selects to make a payment for a product or service Then the payment is made And the purchase is recorded to the Patient/Service User’s Personal Health Budget E00653 - Patient/Service Users viewing Personal Health BudgetsAs a Patient/Service User I want to view my Personal Health Budget So that I can view my Personal Health Budget Acceptance criterion 1: Patient/Service Users viewing Personal Health BudgetsGiven the Patient/Service User is permitted to view their Personal Health Budget When the Patient/Service User selects to view their Personal Health Budget Then the Personal Health Budget is displayed
E00654 - Patient/Service Users recording purchases made using Personal Health BudgetsAs a Patient/Service User I want to record purchases made using my Personal Health Budget So that there is a record of the products and services purchased for my treatment and care Acceptance criterion 1: Patient/Service Users recording purchases using Personal Health BudgetsGiven the Patient/Service User is permitted to record purchases using their Personal Health Budget When the Patient/Service User selects to record a purchase made using their Personal Health Budget Then the purchase is recorded And evidence of the purchase is attached
E00655 - Proxies viewing Personal Health BudgetsAs a Proxy I want to view a Personal Health Budget on behalf of the Patient/Service User So that the purchase of products and services can be viewed Acceptance criterion 1: Proxies viewing Personal Health BudgetsGiven the Proxy is permitted to view Personal Health Budgets When the Proxy selects to view the Personal Health Budget Then the Personal Health Budget is displayed
E00656 - Proxies recording purchases made using Personal Health BudgetsAs a Proxy I want to record purchases made using a Personal Health Budget on behalf of the Patient/Service User So that there is a record of the products and services purchased for the treatment and care of Patient/Service Users Acceptance criterion 1: Proxies recording purchases using Personal Health BudgetsGiven the Proxy is permitted to manage Personal Health Budgets When the Proxy selects to record a purchase made using a Personal Health Budget Then the purchase is recorded And evidence of the purchase is attached
E00657 - link Personal Health Budgets with Care PlansAs a Patient/Service User I want to link my |
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Personal Health |
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Budget with my Care Plan So that |
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my Personal Health Budget is |
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linked with my Care Plan Acceptance criterion 1: link Personal Health Budget with |
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Care PlanGiven the Patient/Service User is permitted to link their Personal Health Budget to their Care Plan When the Patient/Service User |
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selects to link their Personal Health Budget |
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to their Care Plan Then the Personal Health Budget and |
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the Care Plan are linked Acceptance criterion 2: link |
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Given a Personal Health Budget has been created for a Patient/Service User
And a care plan has been linked
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Personal Health Budget |
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purchases |
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to elements of the |
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C32E5 - support different models for management of Personal Health Budgets
As a Care Coordinator or Local NHS Team
I want to choose a model to manage a particular Personal Health Budget
So that I can select the model that will be most appropriate and effective for the Patient/Service User and their Care Team
Acceptance criterion 1: support different management models
Given a Personal Health Budget has been assigned to a Patient/Service User
When the model to manage Personal Health Budgets is chosen (e.g. via the NHS Care Team, Third Party, direct payment or a combination of these)
Then different elements of the Budget can be assigned to the relevant model
And the agreed equipment, treatments or services can be purchased by the relevant individual or Third Party
C32E6 - apply criteria for the use of Personal Health Budgets
As a representative of the CCG
I want to apply criteria for the use of Personal Health Budgets
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Care PlanGiven the Patient/Service User is permitted to link their Personal Health Budget to their Care Plan When the Patient/Service User selects to link a purchase on the Personal Health Budget to an element of their Care Plan Then the purchase on the Personal Health Budget and the element of the Care Plan are linked E00658 - apportion Personal Health BudgetsAs a Health or Care Professional I want to apportion Personal Health Budgets So that Personal Health Budgets are apportioned to meet the needs of Patient/Service Users Acceptance criterion 1: |
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Given the Personal Health Budget eligibility criteria has been defined for Patients/Service Users (e.g. Adults eligible for NHS Continuing Healthcare and children receiving continuing care)
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apportion Personal Health BudgetsGiven the Health or Care Professional is permitted to apportion Personal Health Budgets When the Health or Care Professional selects to apportion a Personal Health Budget |
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Then the Personal Health Budget |
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C32E7 - payments under Personal Health Budgets
As a Health or Care Professional
I want to make payments relating to Personal Health Budgets
So that I can enable Patient/Service Users to access appropriate products and services
Acceptance criterion 1: pay for products or services
Given a Personal Health Budget is being managed with a model (e.g. via the NHS Care Team, Third Party, direct payment or a combination of these)
When the user chooses to make a payment for a product or service
Then a payment can be made
And the payment can be recorded against the relevant Personal Health Budget
C32E8 - maintain directory of equipment, treatments and services
As a Personal Health Budget Manager or Health or Care Professional
I want to be able to maintain a directory of equipment, treatments or services
So that I can use the directory to find relevant equipment, treatments or services
Acceptance criterion 1: create directory of equipment, treatments and services
Given that the user is permitted to create a directory of equipment, treatments and services in the Personal Health Budget Solution
When the user chooses to create the directory of equipment, treatments and services in the Personal Health Budget Solution
Then the directory is created
Acceptance criterion 2: view directory of equipment, treatments and services
Given that the user is permitted to view the directory of equipment, treatments and services in the Personal Health Budget Solution
And the directory of equipment, treatments and services has been created in the Personal Health Budget Solution
When the user chooses to view the directory of equipment, treatments and services in the Personal Health Budget Solution
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is apportioned
E00659 - manage products or services in a directoryAs a Health or Care Professional I want to manage products and services in a directory So that there are products and services to record purchases against Acceptance criterion 1: add products and services to a directoryGiven that the Health or Care Professional is permitted to manage products and services in a directory When the Health or Care Professional selects to add a product or service to a directory Then the product or service is added Acceptance criterion 2: view products and services in a directoryGiven that the Health or Care Professional is permitted to manage products and services in a directory When the Health or Care Professional selects to view a product or service in a directory Then the product or service is displayed Acceptance criterion 3: amend |
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products and services |
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Given that a directory of equipment, treatments and services has been created in the Personal Health Budget Solution
When the user chooses to update the directory of equipment, treatments and services in the Personal Health Budget Solution
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in a directoryGiven that the Health or Care Professional is permitted to manage products and services in a directory When the Health or Care Professional selects to amend a product or service in a directory Then the product or service is amended Acceptance criterion 4: remove |
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Given that a directory of equipment, treatments and services has been created in the Personal Health Budget Solution
When the user chooses to remove an item from the directory of equipment, treatments and services in the Personal Health Budget Solution
Then then the item in the directory is removed
C32E9 - search a directory of equipment, treatments and services
As a Personal Health Budget Manager or Health or Care Professional
I want to be able to search a directory of equipment, treatments or services
So that I can identify and select the equipment, treatments or services that will support delivery of the Patient/Service User's healthcare outcomes
Acceptance criterion 1: search directory of equipment, treatments and services
Given that a directory of equipment, treatments and services has been created in the Personal Health Budget Solution
And search criteria have been defined
When the user chooses to search for equipment, treatment or services
Then the list of equipment, treatments or services that match the search criteria are displayed
C32E10 - manage multiple budgets
As a Personal Health Budget Manager
I want to manage budgets from multiple sources (e.g. those relating to health, care, education or other needs) as a single, joint budget
So that I can more easily manage and co-ordinate across all my needs
Acceptance criterion 1: manage multiple health and care budgets
Given a Personal Health Budget has been set up for a Patient/Service User
And the Patient/Service User holds further budgets (e.g. a social care Personal Budget) relating to their needs
When the Patient/Service User identifies they want to manage these as a joint budget
Then the multiple budgets can be managed as a single budget within the Personal Health Budget tool or system
And the Patient/Service User can use the single, joint budget to pay for agreed equipment, treatments or services across their health, care, education or other needs
C32E11 - link to Patient Record
products and services from a directoryGiven that the Health or Care Professional is permitted to manage products and services in a directory When the Health or Care Professional selects to remove a product or service from a directory Then the product or service is removed
E00660 - view Personal Health Budget reportsAs a Health or Care Professional I want |
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to view Personal Health Budget reports So that reports relating to Personal Health Budgets can be viewed Acceptance criterion 1: |
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view Personal Health Budget reportsGiven a Health or Care Professional |
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is permitted |
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to |
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view |
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Then the Patient Record is displayed
C32E12 - link to Workflow
As a Health or Care Professional
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Personal Health Budget |
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So that I can send requests for information into the Patient/Service User's Practice (e.g. request for clinical information, request for confirmation of medical history)
Acceptance criterion 1: create Workflow task
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reports When the Health or Care Professional |
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When the user chooses to create a Workflow task
Then the Workflow task is created
And the task is directed into the workflow for the Practice
C32E13 - provider view
As a Service or Product Provider
I want to be able to view the purchases of my products or services
So that I can analyse and understand take-up of my products and services
Acceptance criterion 1: provider can view purchase information
Given a Provider's products or services are included in the Directory
And they are permitted to view information in the Personal Health Budget Solution
When they choose to view purchases of their products and services
Then purchase information relating to their products or services is displayed
C32E14 - Management Information
As a representative of the CCG
I want to analyse and report against data relating to Personal Health Budgets
So that I can use the results to plan and commission healthcare more effectively to meet the needs of Patients/Service Users
Acceptance criterion 1: Management Information reporting
Given the user is permitted to run Management Information reports
When the user chooses to run a Management Information report
Then the Management Information report is displayed
C32E15 - identify candidates for Personal Health Budgets
As a representative of the CCG
I want to identify potential candidates eligible for Personal Health Budgets
So that Patients/Service Users can be proactively identified
Acceptance criterion 1: identify Patients/Service Users that are candidates for a Personal Health Budget
Given the CCG has defined criteria for prioritising Patient/Service User need
When the CCG representative inputs the criteria to identify Personal Health Budget candidates
Then the results for Patients/Service Users meeting the criteria are displayed
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Suppliers will have to attain compliance with these Standards during the compliance stage before they can be live on a framework with this Capability: None |
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Suppliers will also have to attain compliance with these additional Standards during the compliance stage before they can be live on a framework with this Capability: |
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selects to view a Personal Health Budget report Then the report results are displayed
E00661 - view reports on Patient/Service Users eligible for Personal Health BudgetsAs a Health or Care Professional I want to view reports on Patients/Services Users who are eligible for Personal Health Budgets So that Patients/Services Users who are eligible for Personal Health Budgets can be identified Acceptance criterion 1: view reports on Patients/Service Users eligible for Personal Health BudgetsGiven a Health or Care Professional is permitted to view reports on Patient/Service Users who are eligible for Personal Health Budgets When the Health or Care Professional selects to view a report on Patient/Service Users who are eligible for Personal Health Budgets Then the report results are displayed |
Items on the Roadmap which impact or relate to this Capability |
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