Health Bill [HL]

I agree entirely with what has been said about supporting the idea in principle of direct payments in the National Health Service, following on the model, to which reference has been made, of the efficient way in which such payments could be used in relation to social care. As is plain from the implications of Amendment 60A in the name of the noble Baroness, Lady Greengross, the main purpose of such direct payments will largely be at the interface between medical and social care, I hope. Nevertheless, I appreciate the reservations expressed by the British Medical Association. I suppose I have to declare an interest as a past president, although that was 27 years ago, and I am not in any way involved any more with the policies of the organisation. My anxieties are largely dispelled by the content of the regulations, which, if properly applied, should protect against potential abuse. However, if direct payments are to be used to cover the costs of specific items of medical care, I am somewhat concerned about the extent to which that will be based on evidence. That is rather important. For instance, can someone who is receiving direct payments from a primary care trust use those to pay top-up costs of drugs not approved by NICE? I have another anxiety on the situation for complementary and alternative medicine. I again have to declare an interest: I chaired the House of Lords Select Committee inquiry into complementary and alternative medicine that reported a few years ago. We recommended and accepted that those forms of complementary medicine regulated by law, such as osteopathy and chiropractic, might reasonably be paid for by the NHS if the general practitioner recommended that the individual in question needed to have the services of a chiropractor or an osteopath. However, if such direct payments were held by a patient, I would be concerned if they were to be spent on so-called disciplines such as crystal therapy, iridology and radionics for which there is no evidence at all. What control and monitoring would be undertaken of the use of direct payments in specific areas of medical care by the individual? I would like the Minister to give me some reassurance about that.