Health Bill [HL]

There are many amendments so I may take a little time to go through them. Most of them are concerned with the review of the pilot scheme for healthcare direct payments. I re-emphasise that we intend to carry out a thorough and rigorous evaluation of the personal health budget in general and of direct payments pilots in particular. We acknowledge that there are many unknowns and uncertainties, which we have debated today. That is precisely why we need to pilot them. On that same note, I made it clear in High Quality Care for All that a number of policies in that document need to be evaluated. We debated the quality accounts last Thursday. On personal health budgets, the department should and will be heading to evaluate policy as academically rigorously and independently as possible. That research will be commissioned independently by an external research group, which I hope will happen some time after the tender has gone out in March. Amendment 62, moved by the noble Baroness, Lady Barker, would omit our current clauses which provide explicit powers to use regulations to enable us to revoke or amend a pilot scheme. Our general intention is that the pilots should be clearly defined from the start, like any other study, and should be properly evaluated as they run. We hope that there will be little need to change the scope fundamentally once the pilots are up and running. However, and I say this as an academic, there will need to be a degree of flexibility. For example, the power in regulations would allow us to adapt pilots in response to emerging lessons. We will learn a lot of lessons as the pilots are launched. We would be able to extend the scope of a pilot midway if it became clear that there were benefits for other services or for patients, or perhaps if the full effect of the pilot could be measured only if more patients were recruited. In the last resort, we will be able to cancel a pilot scheme if the model being tested is obviously not working as intended. Being able to have the power in regulations to adapt or stop a pilot scheme is a sensible precaution, but that should not impact the academic evaluation. Even a failed pilot would tell us a lot that we needed to learn, if those rare circumstances arose. Amendments 65 and 67, tabled by the noble Baronesses, Lady Barker and Lady Tonge, and the noble Lord, Lord Rea, require an independent review of all pilots. Amendment 68B ensures that the pilots run for a year before any decision about national roll-out. At this stage, I can put on record our intention to evaluate all the direct payment pilot schemes, not just some of them. We will probably learn more from those that fail about how we can address the issues that caused that failure. We intend the personal health budgets pilot programme to run for at least three years, with direct payments being used for at least two years. The one-year requirement is surpassed by our policy. However, it would be unnecessarily prescriptive to put these details in the Bill. For example, the current drafting requires a review of "one or more" rather than "all" pilot schemes. This wording does not signal any intention to cut corners on evaluation, but it provides a degree of flexibility. There may be circumstances where it is not appropriate to review all pilots together before a decision on national roll-out is made. If one pilot took significantly longer than others to produce results relating to certain demographic groups or a certain condition, but the evidence from other pilot sites for or against direct payments was overwhelming, I would not wish to create unnecessary delay before making a decision. These pilots will deal with different conditions and different demographics. Noble Lords will also appreciate that there may be a range of pilot programmes running covering a range of services. The legislation allows us sufficient flexibility to allow direct payments for one service, while continuing to pilot others. Amendment 66, tabled by the noble Earl, Lord Howe, requires the department to carry out a formal consultation before any review takes place. As an integral part of the review, I envisage that the evaluation team will gather the views of individuals and organisations. My noble friend Lord Campbell-Savours raised a point in relation to the overview and scrutiny committee. It will be one of the stakeholders, and I have no doubt that that academic evaluation will include it as part of its stakeholder team. I am confident that the review of the pilots will draw on a far wider and richer range of evidence than would be produced by a conventional consultation exercise. Amendment 66A ensures that regulations require that the review evaluates the impact of direct payments on specific patient groups. At this stage, as I explained earlier, we do not intend to define the types of patients or services that would be eligible for a personal health budget, and we are awaiting the different and, we hope, innovative bids that will come in following the call. Amendment 68 requires the Secretary of State to present Parliament with the findings of the review of the pilots before making any decision to roll out direct payments for health care nationally. I emphasise that before the Government can extend direct payments more widely, both Houses of Parliament must give their express approval through the affirmative resolution procedure. That is an important safeguard; it is a stronger safeguard than these amendments provide. At that stage, we will need to lay out our evidence, so that your Lordships may make an informed decision. It is not necessary to add an explicit requirement to present Parliament with the findings from the evaluation. I turn finally to Amendment 68A. New Section 12C provides a power to extend direct payments nationally by allowing the Secretary of State to make an order repealing the limitation that direct payments may be made within pilot schemes only. New Section 12C also provides a power, at subsection (6)(b), for an order to amend, repeal or modify any provision of the 2006 NHS Act. This amendment would remove that provision. I can understand that, on first glance, this may seem a sweeping power for the Bill to contain. However, it simply provides the power to make any consequential amendments to the NHS Act that may be necessary to facilitate the wider rollout of direct payments. It is tightly constrained by subsection (7), which makes it clear that the power may be used only for the specific purpose of making changes relating to direct payments and not for any wider reason. We believe that this is a balanced and proportionate approach, which was endorsed by the Delegated Powers and Regulatory Reform Committee in its report on the Bill. The need to retain flexibility for the pilots inevitably means that we cannot prescribe every detail in the Bill. However, I hope that Members of the Committee will be reassured by my answers, particularly by the use of the affirmative procedure as a safeguard before any future extension of direct payments. Therefore, I hope the noble Baroness is able to withdraw her amendment.