Health Bill [Lords]

I am grateful to the Chairman of the Select Committee for his kind congratulations. This is an issue on which I have not yet taken a firm view. I have seen the list of pilot projects; I believe that they exist in every SHA region and in many primary care trust areas. I hear what my right hon. Friend says and I believe that there should be careful analysis of what the pilots tell us before there is any rush in this direction. It is also important to acknowledge at this point that different issues arise in respect of health care and of social care. Health care can often involve more specialised or complex services that might require a critical mass of patients to support their continuation, for example. These are precisely the kind of issues that the pilots will test, and I give him a commitment that we will proceed with caution and, wherever possible, publish information as we go along. In the case of direct payments, the Bill and subsequent regulations will provide explicit safeguards. There will also be evaluation. The Bill will ensure that direct payments could be extended more widely only in the light of evaluation and with the active approval of Parliament. I hope that that will give my right hon. Friend further reassurance; Parliament would have to endorse any further development of direct payments. The second part of the Bill establishes a new regime for NHS providers that have been performing badly despite interventions by primary care trusts, the strategic health authority or the appropriate regulatory body. The vast majority of trusts perform well, but in the rare instances where that is not the case, there must be transparent processes in place to deal with poor performance. The Bill outlines the following measures, which would be taken only as a last resort and when other measures have failed. In such circumstances, the trust board would be immediately suspended and the Secretary of State would appoint an independent trust specialist administrator to review and consult patients, public and staff on the organisation's future. Recommendations would be made to the Secretary of State, who would report to Parliament the final decision about the organisation's future. These measures will provide protection against the possibility of allowing NHS providers that have consistently failed patients to continue indefinitely.