Personal health budget records: what the NHS expects you to evidence

1. What a PHB is and who holds it

People eligible for NHS Continuing Healthcare have a right to a personal health budget, and integrated care boards offer them for some other groups too. The budget can be a direct payment into a dedicated account that the person or a nominated family member manages, a notional budget the NHS manages on their behalf, or a third-party arrangement. Most families reading this hold a direct payment and employ their own carers, often with higher hours and more clinical tasks than a council package.

2. The support plan and its outcomes

Every PHB rests on a personalised care and support plan agreed with the NHS. It sets out the person's health needs, the outcomes the budget should achieve, how the money will be spent, and what will happen if something goes wrong. The outcomes are the part families underestimate. "Remain at home safely", "pressure area care maintained", "medication taken as prescribed", "fewer emergency admissions": each one is something the review will ask you to evidence.

3. What the review expects to see

• Spend against the plan. Bank statements for the PHB account, payroll reports and payslips for each carer, invoices for agency cover, equipment or training the plan allows.
• Hours delivered. The plan funds a number of hours. The review asks whether they were delivered, by whom and when. Hours per carer from a record made at the time answer this.
• Outcomes. Evidence that the care is doing what the plan says. Visit notes written at the call are the natural evidence: what was done, how the person was, anything changing.
• Medication and health tasks. Where carers give medicines or carry out delegated health tasks, a dose-by-dose record and a note of each task.
• Safety. Falls, pressure concerns, missed calls, hospital visits, and what was done about them.
• Employer duties. As with any direct payment: contracts, right to work, DBS where obtained, employer's liability insurance, training for any delegated task.

4. Health tasks and the record they need

PHB carers often do more than personal care: medication by several routes, repositioning on a schedule, catheter or stoma care, feeding by tube, monitoring that a nurse has delegated and trained them for. Each of these needs a record that says it happened, at what time, by whom, and anything observed. Without it, a nurse reviewing the package has no way to know whether the plan is being followed, and a family has no way to show a hospital what the carers have been doing when things go wrong at 3am.

The medication record matters most. A PHB package can involve many medicines a day across several carers. The standard every care provider works to is a medication administration record: every medicine, every dose, every outcome, with the initials of the carer who recorded it.

5. Several carers, one record

Higher hours mean more carers: a team of four to eight people is common, with waking nights and double-ups. The failure mode is obvious. Each carer knows their shifts. Nobody knows the whole week. A dose is repeated because the morning carer did not know the night carer gave it. A pressure sore is found at a nurse visit because the notes were never shared. The fix is a single record that every carer writes into and reads from, on their own phone, with the next carer seeing what the last one wrote.

6. How Carelo's Personal plan does it

A rota for the whole team. Plan a week of calls, including double-ups, and each carer sees their own calls in the Carelo app. Up to fifteen carers on one household.

Hours that prove themselves. Check-in and check-out at the door with the time and the location. Hours per carer for any period come from those stamps and export as timesheets for your payroll service.

Notes every carer can read. Each carer writes what they did and saw before checking out. The next carer reads it before their call. The diary holds every note, by date and by carer.

Medication, dose by dose. Every medicine with its dose and times. At each call the carer records given, prompted, not required, refused, not given or other, with a reason where needed. The MAR chart with initials is there the same day and prints for any month.

The family sees it too. Today's visits as they happen, every note and the medication log in the family app. The first family login is included; extra logins are £10 a month each, up to five.

Export for the review. The record is your household's. Print the visits, the hours and the MAR chart for the period the review covers.

Carelo does not replace the nurse who delegates a task or the training that comes with it. It keeps the record that shows the task was done.