Health Bill [HL]

I was not going to speak until the amendments tabled by the noble Baroness, Lady Wilkins—on which, of course, I have a lovingly crafted speech—but I felt compelled to speak now because of some of the interesting and important comments that Members of the Committee have made. I would like to add to the history lesson. Actually, the first direct payments in this country were in 1983. Four young disabled people in Hampshire decided that they wanted to use the money that was there to care for them in a residential home as their own and move out, get a home and design their own support arrangements. That was called the 1981 project. They started in 1981 and got out in 1986—it took them that long to persuade the local authority that they had the wherewithal to live the life that they chose and arrange their own care support. In those days, that was completely unheard of; we have come a long way. I did not want the Committee to feel that I was too much of a Pollyanna about direct payments. If the noble Baroness, Lady Barker, had not told her story, I too would have told a horror story, because there are horror stories, largely when people’s support arrangements fall apart because their impairment suddenly increases or a loved one leaves them and they do not have enough hours in the day to get support in. All those things can happen; life happens. When things fall apart, you need a good local support service to help you through it. You need somebody to assist you to find a new personal assistant or look for the support that you need. Often when direct payments fall down, it is because the local authority does not have support services and does not have people there to assist you—to know how to recruit, employ and maintain your personal assistance. Also, often the advocacy and extra support for people who have extra support needs—for example, people with learning difficulties and older people—simply is not there because it is not invested in. We will need to look at that investment. However, I am getting a little confused as to whether we are talking about direct payments or individual budgets. They are different. I use direct payments; I do not use an individual budget. We need clarification of what we are talking about. It is important that we understand that direct payments are simply a mechanism. They are not a service in themselves; that comes after the direct payment. You receive your direct payment, then you develop your service. Until you are assessed, your hours have been decided and the direct payment has gone into your bank account, you cannot begin to build your service. Again, it needs to be understood that direct payments are much more than simply handing over the cheque. That is when the real work begins, and again that is why we need decent support services, which I will talk about a little later when I support the amendment in the name of the noble Baroness, Lady Wilkins. Clarification from the Minister of what we are discussing here would help. I thought that we were discussing direct payments as a mechanism. I also remind the Committee that the noble Lord, Lord Darzi, assured us that this will simply be a pilot, through which we begin to look at what works and what does not. So far as I am concerned, everything is up for discussion.