Personal Budgets Policy

London Borough of Sutton – Special Educational Needs and Disabilities

Personal Budgets Policy

Last Reviewed: 30th January 2025

Next Review Date: January 2026

Personal Budgets Policy

1. About this policy

1.1. This document explains the approach taken by the London Borough of Sutton (LBS) Council, Cognus Limited, and Integrated Care Board (ICB) to Personal Budgets across Education, Health and Social Care for children and young people aged 0-25 years with Special Education Educational Needs and/or Disabilities (SEND).

1.2. This policy relates to the duties of LBS Council in relation to Personal Budgets as outlined within Section 49 of the Children and Families Act 2014, and associated legislation.

2. What is a Personal Budget?

2.1. Personal budgets are an amount of money identified by the Council/Cognus or ICB in order to secure the provision, achieve outcomes and deliver aspects of support set out in an Education, Health and Care Plan (EHCP), Short Breaks support plan or Health plan. They are designed to give children, young people and their families more control over the services they receive and how they are organised. Throughout this document the Council and Cognus are considered as synonymous / the same entity. Personal Budgets are optional for the child’s parent or the young person.

2.2. Personal Budgets can vary in terms of how to apply for one, how the application from child and family is assessed, and the provision of support agreed based on the agency that is providing the support. There are different assessment routes for Health, Education and Social Care (see section 4).

2.3. There are key features of a Personal Budget that ensure children and young people experience the best outcomes possible. A child or young person should:

1. Be central in developing their personalised support plan and agree who is involved

2. Be able to agree the learning, health and wellbeing outcomes they want to achieve, in dialogue with relevant education, health and social care professionals

3. Know upfront an indication of how much money they have available for support

4. Have enough money in the Personal Budget to meet the education, health and wellbeing needs and outcomes agreed in the personalised support plan.

If there is an EHC plan, Personal Budgets: 

1. should reflect the holistic nature of an EHC plan and can include funding for special educational, health and social care provision. 

2. They should be focused to secure the provision agreed in the EHC plan 

3. and should be designed to secure the outcomes specified in the EHC plan.

2.4. The Personal Budget will not replace or replicate existing services and will only be used to create bespoke services where there is an identified need or gap in a child or young person’s Plan.

3. Requesting a Personal Budget

3.1. Educational Personal Budget: Young people who are 16 years and over and parents/carers of children below the age of 16 have a right to request a Personal Budget once the Council/Cognus has completed an EHC Needs Assessment and confirmed that it will prepare an EHC Plan. They may also request a Personal Budget during a review of an existing EHC Plan (commonly referred to as Annual Review).

3.2. Social Care Personal Budget: Under section 17 of the Children’s Act 1989 and The Breaks for Carers of Disabled Children Regulations 2011, Personal Budgets can be made available as part of an assessed short breaks provision. A child or young person does not require an EHC plan to access a short break but will need to be assessed and meet the short breaks eligibility criteria in order to be considered for support. 

3.3. Health Personal Budget: An individual can request a Personal Health Budget if they are eligible for:

1. Children’s Continuing Care

2. Adult’s Continuing Healthcare

3. Their local NHS wheelchair service

4. After-care services under section 117 (appendix 3.3a) of the Mental Health Act.

4. Assessment for a Personal Budget

4.1. Separate assessments will take place for Education, Health and Social Care.  The information below sets out how the Personal Budget assessments work for each of the three elements.

4.2. Education: 

Personal Budgets that relate to Education will be organised by the Council/Cognus. Details of the proposed Personal Budget will be included in section J of the EHC Plan and, where the proposed budget includes direct payments, this section will include the outcomes to be met by the payment.

1. The Council/Cognus will provide written notice of the conditions relating to the delivery of any direct payment and the provision associated with the Personal Budget.

2. The Council/Cognus will aim to develop a joint contractual agreement for the delivery of services provided through an EHC Plan in relation to direct payments. As a primary part of the conditions of a Personal Budget, the child's parent/carer or the young person will be required to confirm their decision and agreement to the provision and services agreed and the requirement to meet the identified outcome listed in the EHC Plan.

3. Where the child's parent or the young person has nominated a person to receive payments on their behalf, the agreement must come from the proposed recipient.

4. The Council/Cognus will seek assurance from the child's parent/carer, young person or nominee that any person employed by the child's parent/carer or young person, but working on early years, school or college premises, will conform to the policies and procedures of that institution and may write such an assurance into the conditions for receipt of the direct payment.

5. Where a direct payment has been agreed, the Council will seek evidence from the child’s parent/carer, the young person directly or the nominated person employed by the child’s parent/carer or by the young person that all relevant safeguarding checks have been conducted and the organisation or individual is safe to work with children and/or vulnerable adults. This will include providing evidence that any professional is fully qualified and registered to deliver any specialist service that requires registration to a professional body in order to practice.

4.3. Setting and agreeing the Personal Budget

4.3a. The child’s parent or the young person should be given an indication of the level of funding that is likely to be required to make the provision specified, or proposed to be specified in the EHC plan. An indicative figure can be identified through a resource allocation or banded funding system. As part of a person-centred approach to the development of the EHC plan, the Council should agree to the provision to be made in the plan and help the parent or young person to decide whether they want to take up a Personal Budget. Local authorities should be clear that any figure discussed at this stage is indicative and is a tool to support the planning process including the development of the draft EHC plan. The final allocation of the funding budget must be sufficient to secure the agreed provision specified in the EHC plan and must be set out as part of that provision.

4.3b. Details of the proposed Personal Budget should be included in section J of the draft EHC plan and, where the proposed budget includes direct payments for special educational provision, this section must include the SEN and outcomes to be met by the payment. Local authorities must also provide written notice of the conditions for receipt of any direct payment for special educational provision and can do this alongside the draft EHC plan. The child's parent or the young person should confirm their decision and agreement of the budget. Where appropriate, this must include their agreement, in writing, of the conditions for receipt of the direct payment, alongside any request for a particular school, college or other institution to be named in the EHC plan. Where the child's parent or the young person has nominated a person to receive payments on their behalf, the agreement must come from the proposed recipient.

4.3c. Where a direct payment is proposed for special educational provision, local authorities must secure the agreement of the early years setting, school or college, if any of the provision is to be delivered on that institution's premises. Local authorities should usually do this when they consult the institution about naming it on the child or young person's EHC plan. The Council should also seek assurance from the child's parent, young person or nominee that any person employed by the child's parent or young person, but working on early years, school or college premises, will conform to the policies and procedures of that institution and may write such an assurance into the conditions for receipt of the direct payment.

4.3d. The SEND service will consider each request for a Personal Budget on its own individual merits. If the SEND service is unable to identify a sum of money, or it is unable to offer a Personal Budget, it will inform the child's parent/carer or young person of the reasons for this decision in writing. For example, the Council might agree that the provision is needed but may be unable, at that point in time, to disaggregate funding that is currently supporting provision of services to a number of children and young people.

4.3e. Any refusal of a request for a Personal Budget for special educational provision on the grounds set out in regulations (SEND Code of Practice Paragraphs 9.119 to 9.124) will be set out in writing and the parent/carer or young person informed of their right to request a formal review of the decision. The SEND service will consider any subsequent representation made by the child’s parent/carer or the young person and will notify them of the outcome, in writing, setting out the reasons for their decision. Currently, decisions relating to Personal Budgets cannot be heard by a Special Educational Needs and Disability Tribunal.

4.3f. Where agreement cannot be reached with the early years setting, school or college, the Council must not go ahead with the direct payment. However, they should continue to work with the child's parent or the young person and the school, college or early years setting to explore other opportunities for the personalisation of provision in the EHC plan. Local authorities may wish to discuss the potential for arrangements whereby the Council, the early years setting, school or college, holds a notional budget with a view to involving the child's parent or the young person in securing the provision. The broader purpose of such arrangements is to increase the participation of children, their parents and young people in decision-making in relation to special educational provision

How to request a personal budget for education provision or to find out more information:

A personal budget to deliver educational provision can be requested through the review process (Annual review) or, for the first EHCP, when discussing the draft EHCP. Please contact your EHCP Coordinator or email sen.team@cognus.org.uk with your request.

For information, support and advice, please contact Sutton’s  Information, Advice and Support service - SIASS - which is impartial and free for families to access if they require Information, Advice or Support around any aspect of the  personal budget.  

4.4. Health:

A Personal Health Budget (PHB) is the amount of NHS money available to meet an individual’s health and wellbeing needs. Personal Health Budgets are agreed by the Integrated Care Board. PHBs are intended to enable people and families to exercise greater choice and control, ensuring support purchased with NHS resources is a “good fit” with day-to-day life and that the best possible outcomes are achieved. PHBs support the vision of a more personalised, patient-focused NHS and offer opportunities for people and their healthcare professionals to work together, to make shared decisions and actively co-design the services and support they require in a support plan. This combines their health professional’s vital clinical expertise and knowledge with the individual’s expertise in their health condition/s and their ideas for how their needs can be met. Personal wheelchair budgets are another form of PHBs.

The right to a PHB applies to the following:

• Children and young people receiving NHS Continuing Care (appendix 4.3a)

• Adults receiving NHS Continuing Healthcare

• Wheelchair users who are referred and meet the eligibility criteria of their local NHS wheelchair service and users who are already registered with the service, will be eligible for a personal wheelchair budget when they require a new wheelchair or specialist buggy, either through a change in clinical needs or the condition of the current chair

• Young People with mental health problems who are receiving after-care (appendix 4.3b) services under section 117 of the Mental Health Act

PHBs are not restricted to people in the four identified groups above, thus an Integrated Care Board (ICB)  can continue to offer services via a PHB on a voluntary basis. ICBs should work with their Council colleagues to ensure all PHB recipients can continue to access health, social care and education support that is personalised for their needs, regardless of their eligibility for Continuing Care, Continuing Healthcare, a wheelchair, or section 117 after-care.

If a child or young person comes within the scope of the right to have a PHB, then the expectation is that one will be provided. There may be some exceptional circumstances when an ICB considers a PHB to be an impracticable or inappropriate way of securing NHS care for an individual (please see 6.2).

Any decision not to provide a PHB should always be made on an individual, case-by-case basis. ICBs should not make blanket assumptions that certain individuals will or will not be capable of managing a PHB.

If an individual requests reconsideration of a decision not to provide a PHB, a suggested good practice timeframe would be:

• Acknowledge receipt of the request in writing within 10 working days. This acknowledgement should include details of how the review will be conducted and timeframes for when it should be completed, and;

• Any final decision should be sent in writing within 28 working days of acknowledgement of the original request. There may be instances where a complex situation requires a longer timeframe. In these instances, people should be kept informed of progress

Once the reconsideration is complete, ICBs should inform the child’s family or young person and/or their representative of its decision in writing, setting out the reasons for its decision. If the child’s family or young person and/or their representative is not satisfied they can pursue the matter via the local NHS complaints processes. Even if the individual is turned down for a PHB, the ICB should make every effort to work in partnership with the child’s family or young person and/or their representative to ensure their preferences for care and support are considered. ICBs should ensure individuals have a personalised care plan that clearly sets out their needs and wishes.

How to request a personal budget for healthcare provision or to find out more information:

To find out more information or apply for a health personal budget, please contact SENDSuttonICS@swlondon.nhs.uk

4.5. Social Care:

0-17 years

4.5a. Requests for Personal Budgets for Social care as they relate to children and young people aged 0-17 years, are  assessed by the Children and Young People’s Disability Service (CYPDS). To determine eligibility for a Personal Budget, the CYPDS Team will arrange for an assessment of need to be completed. This will usually be an Early Help assessment, although a Social Work assessment completed in the last 3 months will also suffice if there have been no changes in the family situation since the last assessment. 

4.5b. This assessment will highlight the level of need and determine the provision/resource required delivered as part of a short breaks package of support. The CYPDS Team will liaise directly with the family to identify what service would best suit their child or young person and the family as a whole. The Short Breaks Statement in Appendix X provides a detailed overview of short breaks. Consideration for approval of a personal budget will be through the CYPDS Resources Panel. 

4.5c. The CYPDS Resource Panel meets on a weekly basis and considers the request for a short break based on the assessment of need, Functional Needs Assessment and the impact of the child’s disability on both themselves and their family. The short break can include a request for a personal budget alongside other alternative support. 

How to request a personal budget for social care provision for children and young people 0-17 or to find out more information:

To make an application for a short breaks assessment where a personal budget may be considered as part of the support package, please complete the Children's First Contact Service referral form. 

18-25 years

4.5d. For young people aged 18-25, their eligibility will be identified using the Care Act 2014 which will assess the young person’s needs, the impact on their wellbeing and outcomes they want to achieve. Following the assessment, an indicative budget will be calculated. Funding will be agreed, where appropriate. Care plans will be reviewed to ensure they are as effective as possible, based on the needs of the individual.

4.5e. In order to request a Personal Budget, the young person making the request has to understand what a Personal Budget is, what the Personal Budget can be used for and must understand the agreement that they will need to sign. If necessary, a Mental Capacity Assessment will be carried out to decide whether the young person has the capacity to make these decisions.

4.6f. A social care Personal Budget can be delivered in 2 methods:

1. Direct Payments: If an individual receives a Personal Budget in the form of Direct Payments, this may be paid in installments.

2. Commissioned Services: If an individual’s Personal Budget is in the form of Commissioned Services, LBS Council will pay for the agreed services on their behalf.

How to request a personal budget for social care provision for young people 18-25 or to find out more information:

For more information on being assessed under the Care Act 2014 and for applying for a personal budget, please contact referralpoint@sutton.gov.uk or call 0208 770 6770.

5. Reviewing Personal Budgets

5.1. It is essential to check at appropriate intervals how the Personal Budget(s) are working and whether the EHCP is achieving the agreed outcomes. It is also important that Personal Budget holders know who to contact to discuss changes to their Personal Budget should their needs change (please use the relevant contacts listed above). Reviews should be ongoing and embedded in best practice and local processes around delivery support, if there is an ongoing package of support. Reviews that focus on outcomes can be the most effective way of identifying what works well and what does not. Depending on what is agreed at the review, changes can be made to the resources, support or conditions described in the support plan.

5.2. Reviews are a crucial part of Personal Budgets and support safeguarding, so they need to be carried out effectively. The primary aim of the review is to strengthen the child or young person’s ability to achieve the outcomes they want in a timely fashion. Each agency will carry out reviews accordingly but must occur at least annually. The outcome of the review will then feed back into the EHCP Annual Review. 

5.3. These reviews should include an appropriate level of financial review to give the relevant organisation confidence that the Personal Budget is being used as agreed and that the level of the Personal Budget remains appropriate to meet the person’s assessed needs. Where a one-off budget is provided, for example for the purchase of an item of equipment, then ongoing or annual reviews may not be appropriate. The relevant organisations must still review any provision to ensure it is appropriate and outcomes are being met, but the timings of these reviews will be on a case-by-case basis.

6. Types of services, which currently lend themselves to the use of Personal Budgets

6.1. Personal Budgets are appropriate for specific, tailored care and support services, which are:

• not services commissioned as standard for all children and young people; OR

• only commissioned for a limited time period

6.2 The following types of services are currently not considered for a Personal Budget:

Education :

• Any funding delegated directly to schools is not available as a Personal Budget. For example, Element 1 (standard placement funding) or the entire special school placement funding. 

• Funding available in Element 2 or Element 3 without the clear and express permission of a Head Teacher of college Principal if the provision needs to be delivered in their setting. 

• Funding for provision which has not been identified in Section F of the Child or Young Person's EHC Plan. 

Health:

• Primary medical services provided by GPs.

• Acute Hospital Services.

• Any provision that would destabilise existing services. 

Social Care:

• Any provision that would destabilise existing services. 

• Structural adaptions via a Disabled Facilities Grant (appendix 6.2a) that are reasonable and practicable in line with the grant guidelines to property.

• Large pieces of equipment, in some cases due to expense and maintenance plans. 

• Any provision provided for a health need under the National Health Service Act 2006 (unless it is merely ancillary or incidental). (appendix 6.2b)

7. Types of Personal Budget available

7.1 There are four ways of managing Personal Budgets:

1. A Direct Payment where individuals receive the money to contract, purchase and manage a service themselves

2. An arrangement (also known as a notional budget) whereby the LA or learning setting holds the funds and commissions the support specified in the Plan on your behalf

3. A third-party arrangement where funds are paid to and managed by an individual organisation on behalf of the young person or parents/carers

4. A combination of the above

7.2. If a young person and/or parents/carer take a Personal Budget as part of a Short Break via Direct Payments, the LBS Council will, as standard, assist in opening a Sutton Prepaid Card account. Direct Payments will go directly into this account, and monitoring will take place at regular  intervals to ensure that the Personal Budget is being used to support the outcomes identified in the child or young person’s Short Breaks support plan. It is not necessary to provide bank statements, but an individual may wish to keep receipts in case there are discrepancies with any transactions.

8. Payments

An agreement will be made as to whether: 

a) the applicant will require a first term's payment in advance and then subsequent payments will be released upon evidence of usage; 

or b) applicant will pay for the provision and be refunded on receipt of evidence of expenditure. 

Payments are normally made within 14 days of receipt of evidence being provided

9.Who can help me make informed decisions on Personal Budgets?

Sutton has an Information, Advice and Support service - SIASS - which is impartial and free for families to access if they require Information, Advice or Support around any aspect of the  personal budget.

8. When will the policy be reviewed?

8.1 This policy will be reviewed on an annual basis but may be adjusted more regularly than this (e.g. in response to parental feedback or service reviews).