Personal health budgets (PHBs) allow individuals to have greater control over the health care they receive by allowing them to choose how the money on managing their needs is spent. The 10-year plan aims to double the number of people offered a PHB by 2028/29, offer 1 million people a PHB by 2030, and ensure it is a universal offer for all who would benefit by 2035.
People eligible for NHS continuing health care (CHC) have had a legal right to a PHB since 2014. CHC is a package of care arranged and funded by the NHS – often including social care too – but provided outside of hospital, for example in a person’s own home. There are two streams, standard and fast-track – the latter for people whose condition is rapidly deteriorating, many of whom may be approaching the end of life. An evaluation of the early PHB pilots found they were associated with improved care-related quality of life and wellbeing, with increased choice, flexibility and control over how the money was spent, and suggested they were most cost-effective for people eligible for CHC.
Despite the ambitions in the 10-year plan, current data suggests that – while PHBs will not be appropriate for everyone – uptake for people eligible for CHC is low and varies widely across the country.
The chart below shows the proportion of people eligible for CHC (both standard and fast-track) in receipt of a PHB in each integrated care board (ICB). In the year to the end of March 2026, only 17.8% of adults eligible for CHC were receiving a PHB (29,818). Uptake of PHBs for those eligible for CHC varied widely between ICBs, ranging from just 2.2% in NHS Bristol, North Somerset and South Gloucestershire to 56.4% in neighbouring NHS Somerset. In over half of ICBs, fewer than 25% of people eligible for CHC were receiving a PHB.
While we can’t know from this data whether this variation is warranted or not, the extent of it raises some important questions about how PHBs are currently being used, and whether the ambitions for them are achievable.
It is important to understand more about what drives this variation, and previous research could give some insight. The pilot evaluation found that the way PHBs were offered and managed varied in between areas, with differences in the level of choice and flexibility available. Higher-value PHBs were considered most effective, with the evaluation recommending that PHBs would be best offered to people with “greater need”, but it’s unclear at present whether this reflects current practice.
Our own research also showed that the approach to commissioning care for people eligible for CHC varies, and this could be reflected in the variation in PHB uptake. The level of variation is also likely to be influenced by how PHBs are used differently in each ICB for standard and fast-track CHC, which are combined in this chart.
Perhaps the biggest challenge is a lack of information on who is eligible for CHC and receiving a PHB by, for example, age group, diagnosis or the type of care they receive. Improving the quality of the data is a key next step, given the importance of this issue.
Learning more about what sits behind these figures – and in particular how PHBs are used by people eligible for standard and fast-track CHC – would help our understanding of who benefits most from a PHB, who is or is not getting access to that support, and how the ambitions in the 10-year plan are going to be achieved.
Notes on the data
Source: Nuffield Trust analysis of NHS England personal health budgets data (Quarter 4 2025/2026) and NHS England NHS CHC and NHS-funded nursing care (quarter 4 2025/2026) data.
We used CHC year to date figures for number eligible for NHS CHC (January to March 2026).
The percentage of people eligible for CHC (standard and fast-track) receiving a PHB is calculated as the number of adults receiving a CHC with a personal health budget divided by the total number of people eligible for CHC in each ICB in the same period.
The total number of people eligible for CHC includes those in receipt of standard or fast-track CHC though from our previous work, we note that fast-track numbers are likely to be influenced by local availability and commissioning of end-of-life care services.
NHS England has recently reclassified CHC data as management information rather than official statistics so calculations may not completely reflect the numbers of people eligible for CHC and receiving a PHB in the time period studied.
Suggested citation
Hutchings R (2026) “What proportion of people eligible for NHS continuing health care have a personal health budget?”, Nuffield Trust blog