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Clinical Commissioning Groups and Commissioning Support Units

HomeCareDirect work in partnership with continuing healthcare and personal health budget teams to roll out self-directed, truly personalised healthcare at home.

HomeCareDirect began working in health care over five years ago, as a solution for people who would benefit from a personalised, self-directed support package at home yet were either not suitable for a personal health budget or were not in a personal health budget pilot area.

Once the personal health budget pilot scheme began we were proud to be a part of this pilot and as of 2014 over a third of all the people we support receive healthcare funding.

We are now proactively looking to help all the people we support who are funded through traditional continuing heath care to transition on to a personal health budget.

But why do we think this is a good idea for individuals, their loved ones and the NHS?

There are proven benefits for people who direct their own care and support at home via a personal health budget.

Personal health budgets were piloted in 20 in-depth areas and an independent evaluation afterwards found that:

  • 70% of people with a personal health budget felt improvements in their care related quality of life, health and psychological wellbeing
  • 56% of carers of people with personal health budgets felt it had a positive effect on their own personal wellbeing
  • The cost of inpatient care was significantly lower for the personal health budget group
  • If half of the people eligible for NHS Continuing Healthcare chose to take the offer of a budget, this could imply a potential saving of around £90 million
  • The study concluded that personal health budgets were cost-effective and thus supports a wider roll out

However, personal health budgets come with a range of responsibilities that can prove daunting to individuals and their families. Responsibilities including ensuring personal assistants are employed legally, paid correctly, trained appropriately and that the whole package of support is to CQC standards and fully insured are challenging prospects for people to take on. For commissioners it can be difficult to ensure that all legal requirements are being taken care of by the individual.

So how can we help everyone realise these benefits?

With the HomeCareDirect third party approach we take on all these responsibilities on people’s behalf, leaving all the choice and control that a personal health budget can afford, yet providing the peace of mind for all that a specialised personal budget and self-directed support service is ensuring everything is up to standard.

Our local presence is provided by our national network of independent living nurses and, since personal assistants only work with the person who has chosen them, we only train in their specific needs. This means we don’t have the overheads of a traditional agency with local offices or the cost of having to train all personal assistants in all requirements – keeping our charge to a minimum, whilst paying personal assistants a higher than average wage which promotes stability of support.

For complex health care tasks, such as Use of Ventilators, Tracheostomy care or Percutaneous Endoscopic Gastrostomy (PEG) management, we work closely with the clinical commissioning group or commissioning support unit to arrange gold standard training for personal assistants from either the local hospital specialist teams or local specialist providers.

Choice and Control – as part of the HomeCareDirect service people will:

  • Choose their own personal assistants, be it either family members or someone from their local community. If necessary personal assistants will be found via advertising and interview, which the individual and their family will be fully involved with
  • Be relieved of the employer responsibilities associated with doing everything themselves
  • Have the peace of mind that their personal assistants are trained in both their health and social care needs – to CQC standards. The individual/family is involved at every step of the training process and training takes place in the home – where possible
  • Count on a dedicated independent living nurse to carry out supervisions and update training when required
  • Have a dedicated independent living advisor who will support the individual and the personal assistants on a daily basis
  • Have the safety net of a 24 hour, 365 day a year out of hours telephone support service

Peace Of Mind – for commissioners

  • A separate managed bank account to receive the direct payment which can receive funding from both social and health care is all part of the service. Funds are deemed to belong to the funding authority until spent appropriately, and any concerns around potential inappropriate use of funds would be reported back to the funder for evaluation prior to funds release
  • Quarterly financial returns and bank account balances on request for any external audit purposes, combined with monitoring of actual hours used against budgeted hours
  • Monitoring of the minimum number of personal assistants required in each support package to ensure individuals are keep safe in the event of sickness and holidays. Personal assistants visits for 3 weeks ahead are monitored to help ensure the safety of the client
  • On-going monitoring of training competency of the personal assistants supporting individuals with systems to automatically identify the need to update training
  • CQC registration. HomeCareDirect has a duty of care to the client and any incidents, accidents and injuries are reported to the CQC and any suspected abuse will be reported to the social services/health authority safeguarding teams and the police
  • Fully insured. Packages of care supported by HomeCareDirect are fully insured, with employers liability, public/products liability and professional liability. Packages are also insured against abuse, injury or damage arising from a negligent action by HomeCareDirect employed PAs


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