Personal support plan
Name: John Smith
Sam
My background :
Continuing Care Number:
Tom
NHS Number:
Timmy
Justin
John was born in XXX 2010.
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John was born five weeks early because he had transposition of the great arteries, which needed two open heart surgery to
be corrected. After the second open heart surgery, John required a tracheostomy due to where his heart was beating
incorrectly. John also has a gastrectomy and voice cord palsy. John does not have a voice or create a noise so we are
using part sign and part Go Talk 4 to understand what John wants or needs. John also had a stroke which resulted in right
sided Hemiplegic Cerebral Palsy with Epilepsy (focal motor).
Breakdown of Medical history:
Born:
First emergency Heart surgery:
Home for the first time:
ENT exploratory
Admitted into Halifax
Transferred to LGI
Second emergency Heart surgery:
MRI scan
Stroke confirmed
Trackyostme fitted
Gastrectomy fitted
Tracky Training for Mum, Dad
Transferred to Halifax
Home for Christmas
August 2010
August 2010
September 2010
January 2011
April 2011
April 2011
May 2011
June 2011
June 2011
June 2011
July 2011
July 2011
September 2011
December 2011
John has been in and out of hospital many times up until now.
John needs constant physio to keep him mobile. Daily routines are
by parents and staff to make sure John can be independent as
possible and live a normal life.
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1 My life and what is important to me
People who are important in my life – family & friends:
Mum, Dad, brother, dogs, Granma (Linda), grandparents and aunties. All my staff, school friends.
Places I like to go & and things I like to do:
Going to school is fun, going to the park, riding in my toy car at home. I like going to see the cows, chickens and birds. I
like to play with Hex-bugs, spinning small balls, car garage and balloons.
My routines:
05:00 – 06:00 Wake up
06:30 Get bath, get dressed and play
07:00 Have breakfast and play
08:00 Night staff leave, day staff start.
08:30 Go to school
12:00 Go home or meetings
13:00 Eat lunch, play. Day staff go
14:40 Go to get my brothers from school
15:30 Get home and play
16:30 Have dinner with family
18:00 Time for bed
How you like people to help you:
John needs support from very well trained experienced cares with knowledge of LTV. He needs consistent reliable staff
and the family need to be able to rely and trust them. John needs consistency all the time.
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2 Things that work well for me now that I would like to keep the same
Home:
John now has a family which has been adapted to his needs. He loves his Fireman Sam room which is also equipped
with all his equipment for LTV , oxygen and resuscitation. John has 7 x 12 hour periods of care overnight. He is gradually
being weaned to have lower ventilated levels. The house works well, except a lack of space for a walker and other large
items.
John is signing really well with modified BSL. He has just got a GO Talk4 with the aim that he will use AAC. He loves
looking at Mum and Dad’s phone which he already knows how to use them.
He has 5x 5 hours carers during school. Carers are employed by local agencies and they manage the service.
John currently travels in the family car but a wheelchair accessible vehicle has been ordered.
He has a wheelchair from Wheelchair services and a walker from Physo to keep him mobile.
Johns Daily Routine:
This daily routine mostly works well. Having cares arrive at 8 am really helps with the school routine. Having overnight
cares allow the family to get some rest and this is working well.
School and Community:
Nursery school is going very well with making new friends and progressing well in class. John now has a new walker
which allows him to walk freely in class not just outside.
John is getting to school but not really getting out and about much beyond this into his local community either with cares
or his family
Food and Drinking:
John had a Gastrectomy which is not being used now as John is eating well and drinking well.. John does not chew food
; he really enjoys pureed food. Parents think Johns reluctance to chew is a sensory issue, e.g. he really dislikes getting
messy things on his hands. John loves his Tea and Apple Fruit Shoot.
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3 How I want to make my life better and my goals for the future
Everyday things that you would like to be easier or do more of – going to the shops, visiting
friends, getting out and about:
 John would like to have space and opportunity to practise using his walking frame (which is currently only used at
school)
 The family would like the allocated hours to be available to be used more flexibly; e.g to allow John to access
community activities, such as the park, going swimming, out on family outings , practising walking/kicking a ball
with his walking frame in the park
 Morning routines work well. Lunchtime routines are rushed, the carer gets back with John at 12.30 , has 30 mins to
handover, put John on potty, cook lunch and do notes and has to leaves at 1pm. If carer stay til 2pm , would allow a
good handover, an allow carer to also clean the suction machine, put stock away and clean Johns room. In turn this
means a less rushed mealtime for John and parents, time for potty training, physo et. before the parents leave to
pick up Johns brothers from school.
 Johns’ family would like flexibility to take all the family out together, which John, his brothers and parents really want
to do in order to be as “ordinary” family as they can at times. This will help ensure all the family remain
psychologically healthy, resilient and therefore better placed to meet Johns needs long term. Instead there is a risk
that they feel socially isolated
 John would like to go swimming; this would require 2:1 support
 John has had to turn down invitations from a friend at school who has a horse. Extended PA /more flexible hours
would enable John to meet social and emotional and community needs and be part of his mainstream peer group.
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 At present, if a carer does not turn up, the parents carry out John’s overnight or day care which has a big impact on
them. They also are unable to “bank” the unused hours and would like to bank any unused hours for longer days
during the holidays when needs are greater and to support community activities e.g swimming which will be 2:1
 When John is ill , the parents pick up the extra support and stress; ideally more flexible hours would enable carers
to cover for ill health
 Johns carers would ideally be able to tailor their support to meet and adapt to the family changes.
 Johns family would like to ensure carers have more specialised training to meet Johns additional support and
communication needs; Manual handling, BSL, basic life support skills.
 The family want to explore options to manage the PHB, recruit PAs/carers.
 John no longer needs the Gastrectomy and the site is sore. Hope this can be reversed at some point soon.
 Johns larynx to be checked re vocal palsy and possible speech valve suitability in Feb 2014
 Plan to introduce John and get him eating lumpier foods.
 Sensory integration will be addressed.
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Johns Goals by the age of 5:
 To reduce and stop LTV by early 2015
 By the age of 5, hope that Johns tracheotomy can be reversed and that he no longer needs any ventilating
 Johns parents will hear him speak : he may be able to communicate using a speech valve (this has not been
possible so far)
 John will be communicating well ; using a range of AAC; possibly an iPad (some anxiety that AAC will take away
likelihood of John using his voice)
 John’s health needs will be well managed including epilepsy.
 John will be independently mobile and using splints and walking frame if required.
 John will be using the toilet independently.
 John will play independently and with others and will also be able to switch on TV.
 John will be eating food of more normal consistency.
 John will be settled in at mainstream school.
 John will be accessing inclusive community play activities after school, weekends and during holidays.
 John will have friends at school he can visit and have home
 His care needs at home will have reduced and be met by a stable well trained team.
How close are you to achieving your goals now? Please give a score out of 10 (1 meaning not close at all): ___/10
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4 How I can stay safe and well
The training my supporter / carer will need
All training is given by parents and lead carer. Any extra training will be provided by external person/company.
The skills needed for supporting John is:
Manual handing
Trackyostme training
Personal care training
administering medication
Epilepsy training
Good communication and written Skills
Ventilator training
NVQ Level 2 and above.
administering oxygen therapy
What will I do if my supporter / carer doesn’t come
If a support worker does not turn up for a night shift we would see if another support worker could do the shift
otherwise Mum and Dad would split the night, and get the support worker in earlier the following morning.
For a school shift John would have to miss out on School. Once John is full time we could get someone else to cover
the afternoon in School so the whole day is not wasted.
What specialist support I need
John need BSL trained workers to support his communication. Also some who can work with life saving equipment to
monitor John while he sleeps. John also needs a support worker who will enable and encourage his independent
mobility on a daily basis.
John requires daily physio that must be maintained.
My support hours including all night time support I need
John needs full night support so his mum and dad can rest due to John needing awake support workers to monitor
him and attend to his cares. When John is sleep this is a more likely time for a fit to happen and needs action quick
when this happens.
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What equipment I use/need to keep me safe
The equipment John needs is:
Ventilator x2
Nebulizer
Humidifier
Stair Lift
Suction machine x2
Oxygen condenser
Emergency Bag
Raised seating
Suction catheters
Wireless monitor
Pedro boots
Wheelchair
Saturations machine
Trackyostme 5.0, 4.5 x2
Leg splints
W.A.V
Profiling Bed
Thermometer
Potty Chair
Walking Frame
5 How decisions are made
John’s mum and dad will be the sole ones for making all the decisions on John’s behalf.
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6 My Personal Budget and how the money and my support will be managed
You can choose to organise your money in different ways. Please tell us using the table below, how you have chosen to
manage your money and support.
Direct Payment
I would like to receive my Personal Budget as a direct payment and I will
be responsible for paying for and organising my support.

Notional Budget
You will have a personal health budget but the NHS will management
the payments
Managed Account through a Third Party
A third party agency will manage the account for you
7 How I will use my Personal Budget
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Support need and what you will Outcome – what will the
put in place to meet this need. support help you to
achieve?
Need : Carry out personal care
Provide support with personal
hygiene needs and washing and
showering. John’s Mum and Dad
will support and encourage John
with all his personal care needs. At
the moment is being encouraged to
use his potty.
John will carry on being
supported by his family as
all under 5’s are but with
the added support of his
carers that will be
employed directly by his
father.
Who will
arrange this
(please tick)
Cost: Included in the total weekly
My
representative care package of £1,355.12

CCG

Support I will put in place:
Informally John’s family will carry on
offering support and encouragement
to him.
Formally the carers will provide this
support during the night and when
John is at school.
Who will provide this:
Informally – Family and Friends
Formally – Carers
Need : Preparing and having food John will continue to have
and drink. John needs all his food
a nutritional diet supported
to be prepared and pureed for him,
by family and carers.
He also needs to be fed
Support I will put in place:
John will be supported by his family
and carers
Who will provide this:
Informally – Family and Friends
Formally – Carers
Personalisation Support Plan
Cost, and how often payment
will need to be made
(please tick as appropriate)
Total cost
per year
£70,466.24
25 hours a week school term
24 hours a week school holidays
12 hours a night x 7 days a week
 One off payment on ……………
 Weekly  4 weekly
 Other, please explain
…………………………………………
…………………………………………
………………………………………….
Cost: Included in the total weekly
My
representative care package

CCG

 One off payment on ……………
 Weekly  4 weekly
 Other, please explain
…………………………………………
………………………………………….
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Support need and what you will Outcome – what will the
put in place to meet this need. support help you to
achieve?
Need : Keeping in touch with
John will be supported
family and friends
with his independence and
John requires support when he is
to build up friendships
attending school and during school
holidays to maintain his relationship
with his friends
Support I will put in place:
John will be supported by his family
and carers to keep in touch with his
family and to assist him to become
more independent
Who will provide this:
Informally – Family and Friends
Formally – Carers
Need : Being part of the
community
As with every other under 5 John
needs support to access the
community
Support I will put in place:
John will be supported at all times
by his family. His carers will support
him to access school and during the
school holidays they will accompany
John and his family to access the
community
Who will provide this:
Informally – Family and Friends
Formally – Carers
Personalisation Support Plan
Who will
arrange this
(please tick)
Cost, and how often payment
will need to be made
(please tick as appropriate)
Total cost
per year
Cost: Included in the total weekly
My
representative costing.

CCG

 One off payment on ……………
 Weekly  4 weekly
 Other, please explain
…………………………………………
…………………………………………
John will be supported at all
times by his family to be a part
of the community. His carers
will support John to access
school and during the school
holidays they will accompany
John and his family to access
the larger community
Cost: Included in the total weekly
My
representative costing.

CCG

 One off payment on ……………
 Weekly  4 weekly
 Other, please explain
…………………………………………
…………………………………………
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Support need and what you will Outcome – what will the
put in place to meet this need. support help you to
achieve?
Need : Communication
John cannot verbalise at the
moment but it is hoped that in the
future he will be able to. At the
moment he relies on some BSL and
GO talk
Support I will put in place:
John will be supported by people
that he is familiar with and who know
and are familiar with his ways of
communicating.
Who will provide this:
Informally – Family and Friends
Formally – Carers
Support need and what you
will put in place to meet this
need.
Need : In and out of house
John uses a walker and wheelchair
but due to the lack of space in the
family home he isn’t able to use at
home. He also requires splints,
Pedro boots, hand splints and a
walking stick to support him when
he is using his walker.
Support I will put in place:
John will be supported to access
his home safely
Who will provide this:
Informally – Family and Friends
Formally – Carers
Personalisation Support Plan
John can be supported by
people that understand his
differing ways of
communicating. This could
include carers that he already
knows or new carers that have
knowledge of BSL.
Specifically employed Personal
Assistants will be more able to
anticipate John’s needs by
their in depth knowledge of
him.
Who will
arrange this
(please tick)
Cost, and how often payment
will need to be made
(please tick as appropriate)
Total cost
per year
Cost: Included in the total weekly
My
representative costing.

CCG

 One off payment on ……………
 Weekly  4 weekly
 Other, please explain
…………………………………………
…………………………………………
………………………………………….
Outcome – what will the
support help you to
achieve?
Who will
arrange this
(please tick)
Cost, and how often payment
will need to be made
(please tick as appropriate)
John will be supported to
mobilise so that he is able to
access all areas within his
home and outside with the
support of his family, friends
and carers. They will support
John with all the equipment
that he is able to use to assist
him with his mobility.
My
representative
X
Cost: : Included in the total weekly
costing
CCG

Total cost
per year
 One off payment on ……………
 Weekly  4 weekly
 Other, please explain
…………………………………………
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Need : Complex Health Needs
John requires suctioning to keep
his airways clear. He needs to be
ventilated at night.
John needs monitoring at all times
due to his epilepsy which is more
frequent at night.
John requires support with his
physiotherapy exercises.
John requires the correct
medication to be administered.
Gastrostomy care also needs to be
provided to John
Support I will put in place:
John will be supported at school
and at night by qualified Carers.
They will be able to suction John,
provide Tracheotomy care,
administer medication, monitor his
oxygen saturation levels and have
knowledge of the development of a
child with Cerebral Palsy.
Who will provide this:
Informally – Family and Friends
Formally – Carers
John will be on life support at
night, suction will be carried
out day and night to keep
airways clear He will be on a
saturation machine which will
monitor his oxygen levels and
heart rate. The carers will
also be able to monitor his
heart rate, breathing and
oxygen levels to pre-empt any
epilepsy seizures or illness.
All the procedures and
monitoring will be provided by
family and Carers who have
received training and regular
updates. If any issues are
identified with his ventilation.
My
representative

CCG

Cost: Included in the total weekly
costing.
 One off payment on ……………
 Weekly  4 weekly
 Other, please explain
…………………………………………
…………………………………………
………………………………………….
Tracheotomy and suctioning
they will be brought to the
attention of John’s Mum and
Dad.
John will receive support to
complete his physiotherapy
exercises within the guidelines
given by his physiotherapist.
John will be monitored at all
times so that support can be
offered when he has an
epileptic episode by family
and Carers who are trained in
the correct procedures.
John’s medication will be
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given by trained Carers at the
correct time and administered
in the correct way following
the guidelines given.
Although John is no longer fed
using his Gastrostomy it is still
in situ and requires flushing
and cleaning daily. He also
has skin integrity issues at the
sight of his Gastrostomy
Support need and what you
will put in place to meet this
need.
Outcome – what will the
support help you to
achieve?
Who will
arrange this
(please tick)
Cost, and how often payment
will need to be made
(please tick as appropriate)
Other Needs:
John will be supported by
carers that have the
necessary checks undertaken
My
representative

Cost: 5 x £54 = £270.00
John needs to be support by
suitable carers
Support I will put in place:
Purchase 5 DBS
Who will provide this:
John’s representative – via CSU
CCG

 One off payment on ……………
 Weekly  4 weekly
 Other, please explain
Total cost
per year
£270 one
off
…………………………………………
…………………………………………
………………………………………….
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Other Needs:
A suitable venue for the training to
take place at.
Support I will put in place:
I will have a suitable place for the
carers to undertake training
Who will provide this:
John’s representative – Matt will
find a place for this to take place.
Johns’ carers will be able to
undertake the training that
they are required to undertake
so that they are fully skilled to
support John and his family.
The training will take place in
a suitable venue.
My
representative

CCG

Cost:
 One off payment on ……………
 Weekly  4 weekly
 Other, please explain
…………………………………………
…………………………………………
………………………………………….
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Support need and what you will Outcome – what will the
put in place to meet this need. support help you to
achieve?
Other Needs:
John, his representative and Carers
require to be insured against
liability. His representative will also
have access to employment advice.
Support I will put in place:
Employers Liability Insurance will be
purchased by my representative.
Who will
arrange this
(please tick)
Cost, and how often payment
will need to be made
(please tick as appropriate)
John, his representative and
Cost: one off cost of £99
My
Carers will be insured against
representative
liability. John’s representative
One off payment on ……………
will also have access to an
Weekly
4 weekly
employment advice service this
will assist him with any issues
CCG
Other, please explain
he encounters surrounding
employment of Carers for
…………………………………………
John.





Total cost
per year
£99 one
off

…………………………………………
Who will provide this:
John’s representative – Dad
Other Needs:
John’s carers will require liability
insurance in case they are found
liable of causing injury to John.
Support I will put in place:
I will ensure that the cost of the
insurance is made paid from the
direct payment funding
Who will provide this:
Premier Care Insurance
…………………………………………
The carers that are employed
to provide John with support
will have the appropriate level
of cover in case they cause
injury to John. This could occur
when they are administering
medication, suctioning and
performing physiotherapy
exercised and monitoring his
epilepsy and life support.. This
is due to the complex health
needs that John has.
. Cost: 5 carers x £85 = £425.00 per
My
year
representative

CCG

One off payment on ……………
 Weekly  4 weekly
 Other, please explain
£425.00
per year
A yearly payment of £425
Planning for the unexpected (contingency)
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Sometimes things happen unexpectedly that means that you require extra care or support. To make sure you plan for
this, you might need to set some of your budget aside and/or make alternative care arrangements.
Consider these questions:
 How your care is organised, for example: does CCG manage your support and budget for you? In this case
your plan may be to contact the CCG again to get alternative support.
 How stable are your needs? If your needs vary, you could think about how you need to increase your support
during those periods. E.g. have an arrangement with a relative to assist or organise more paid help.
 Do you receive informal care, free of charge, from a friend or relative? What if your informal carer was
temporarily unavailable? What would you do in this situation?
Please tell us how much you need to set aside;
I would like to set aside £1,467.01 of my Personal Budget as a contingency.
Below, please explain why you think that is a suitable amount and what you will do with this money.
If you are not receiving your budget in the form of a direct cash payment from CCG. please say what you will do to
ensure you have the care and support you need should the unexpected happen.
The contingency for John will cover 14 days of 24 hour cover this will be used it John’s becomes unwell or his
parents are unable, due to illness, to look after John’s health needs. As John receives 84 hours a week to cover
the night time support and 25 hours to cover the day time support the contingency has been calculated thus:
84hours + 25hours = 109 hours. The total cost of weekly care calculated by John’s dad is £1,355.12/ 109 hours =
£12.43. 24 hours x 14 days = 336 hours – 218 hours support already funded = 118 hours x £12.43 = £1,467.01
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My agreed annual Personal Budget
Now you have decided how you will use your Personal Budget to meet your needs and this has been agreed by your
Personalisation worker.
Please indicate below the total annual cost for your budget, (the actual amount you are spending in this plan)
Arranging services and goods to meet my needs
£70,565.24
Contingency (if relevant)
£ 1,467.01
Other funding (i.e. continuing care)
My agreed total agreed annual Personal Budget is
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£72,032.25
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Risk
We want you to use your Personal Budget to make sure your needs are supported. This will help you get the most out
of life and live as independently as possible. But, we must also make sure you are safe.
Is there anything in your Support Plan that could put you, or someone else, at risk? If so, tell us in the grid below.
Your social care worker also might fill this in if they think there is a risk.
If you and your Personalisation worker disagree about any risks, they will talk to you to reach an agreement about
how the risk should be reduced.
Who thinks it is a risk?
What is the risk?
How will it be minimised?
Representativ Persone
alisation
worker
John’s Carers will require
updates to their training so
that they are fully aware of
the processes that they
need to undertake to
maintain John’s health and
wellbeing.
x
x
A training provider needs to be identified
who is able to offer the correct training
for Johns’s medical needs. This is
being investigated by parents and CHC
clinical lead and the cost will be
included in the 6 week review.
Boxes for worker
to complete:
Risk
Risk not
resolved resolved
x
If a risk is not resolved between you and your Personalisation worker, they will talk to you about next steps. The main
aim will be to make sure you are happy with your plan, and that both you and the Personalisation worker are
confident that the plan keeps you safe.
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What you would have chosen, if it was available?
Is there anything you would like to have done using your Personal Budget that is not available locally?
Please tell us using the space below.
7. Anything else you would like to tell us.
Please use the space below to tell us anything further that you haven’t already included.
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Date of completion of support plan:
Personal Health Budget holder
signature:
Please print name
Date of signature:
Personalisation Advisor signature:
Please print name
Date of signature:
CCG Representative signature
Job Title:
Please print name
Date of signature:
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