Health Bill [HL]

My Lords, I return to the subject of direct payments. Noble Lords who followed the Bill in Committee will remember that although this is a policy that has strong support around the House, a great many questions remain unanswered about how the policy will work in practice and, in particular, about the effects it will have on continuity of service for patients. Last week, the noble Lord, Lord Darzi, very helpfully shared with the Committee the range of submissions that have been received from primary health trusts and strategic health authorities for the sorts of services that might be provided to patients using individual budgets and direct payments. I thank him for sharing that information. I am moving Amendment 32 and speaking to Amendment 33 at the same time, which I hope will help the House move more speedily through our deliberations. When the noble Lord, Lord Darzi, revealed that there had been applications for services as disparate as maternity care and palliative care, I think that it became apparent that the potential scope of direct payments and individual budgets within the NHS was perhaps far wider than many had believed up to that point. Many who are strong advocates of the policy of giving people either a notional budget or an actual sum of money believed that we were talking about a very limited number of treatments for chronic conditions. From the information which the noble Lord has shared with us, it is now apparent that these pilots have the potential to bring about enormous change in the way in which health services are planned and delivered. Noble Lords who took part in our deliberations in Committee will have noted that I referred in great detail to the IBSEN report on research into the pilot projects for individual budgets in social care. That was an extensive piece of research: perhaps one of the biggest pieces of research into social care that the department has done in recent years. Yet that report, detailed though it was, still could not answer a great many fundamental questions about the effectiveness and cost-effectiveness of individual budgets. As I said in Committee, individual budgets in social care may well bring about provider failure. In fact, it is almost certain that they will do so, although provider failure may be less of a problem in social care than it would be in the NHS when we are talking about the potential for acute services to decline. I should inform the House that the noble Lord, Lord Darzi, was kind enough to enable me to meet the officials who will be responsible for commissioning the research into the pilots in health. I am most grateful to him for that. I understand that the department intends there to be extensive research and believes that particular attention should be paid to the different demographics of people who will have individual budgets and to different conditions, but I still maintain that this is a policy of such potentially profound impact that there is a need for these pilots to be thoroughly and completely researched. Moreover, they should not, as the social care pilots were, be the subject of an announcement well before the research is completed. I remind noble Lords that in December 2007, before the social care pilots had been finished, the then Care Services Minister, Ivan Lewis, announced that individual budgets would be the way forward for all social care. That was misguided. Amendments 32 and 33 should be viewed together. Amendment 33 would require PCTs taking part in these pilot projects in health to commission information, advice and support services. Noble Lords who took part in Committee will realise that the inclusion of the word "support" in the amendment is indicative of the fact that I took on board the comment made by the noble Baronesses, Lady Campbell and Lady Wilkins, that people who have individual budgets and direct payments often require more than information and advice. I also listened to the arguments made by the noble Lord, Lord Darzi, in Committee when he stressed that the department did not wish to be prescriptive in its requirements on PCTs, but I believe that it is important that the House lays down a marker that says that information, advice and support must be provided. Individual users of services are free to ignore such a service and not to use it, but we need to say at this stage that the success of individual pilots depends on people who have individual budgets, and their carers, being able to access support and guidance that will enable them to find their way around a very complex service. I have one final word to say in support of these two amendments. It is important to say again, as I did the other day, that the pilots in social care were introduced at a time when health and social care funding was being dramatically increased. These pilots will be introduced at a time when public services are facing unprecedented levels of demand. At such a time it would be perfectly understandable if commissioners and providers of services sought to make economies, some of which would be false. It is of the utmost importance for this policy, and for the service users, to include these two factors in the pilots at this stage. I therefore beg to move.