Health Bill [HL]

I have hesitated over whether to speak now or later, but this debate has gone on for some time so I thought that I might chuck my questions for the Minister in now. How will evidence-based care be monitored? The term "complementary therapy" has been bandied about but we should be clear about whether we are talking about complementary or alternative therapy. Indeed, if we are talking about complementary therapy, how will that be assessed? To comment on what was said by the noble Baroness, Lady Cumberlege, I should say that one of the difficulties is that many patients like certain things, but the trial of benefit—comparing some of these therapies against things such as going to the hairdresser—has never been done. All those things make patients feel better, but should NHS money pay for them? There may be no evidence of harm, but we need evidence of benefit if we are going to spend NHS money on something. I am not sure that anyone has died for lack of complementary therapy, but I think that patients have suffered for lack of complementary therapy given in conjunction with their mainstream therapy to support them through it. That is different from alternative therapies, and it must be sorted out. Will the Minister say how commissioning from the voluntary sector will be worked out? How will the tariffs be worked out? How will patients who want to go to direct payments be affected if they wish to buy a service from across one of the borders—either into Scotland or into Wales? It is very unlikely that they would want to buy a service in Northern Ireland, but certainly patients who live just on the English side of Offa’s Dyke may well wish to purchase from Wales. Another issue is the speed of allocation. If someone has been assessed as eligible for direct payment but decides not to go for it, the service is too slow and they purchase something, will they be able to claim retrospectively? Indeed, will they have some sort of appeal mechanism for the way in which they are assessed for payments? Will there be a requirement that patients must buy an indemnity for any service that they buy, as they must for midwifery services, for example? Certainly, trust indemnity is a requirement and is part of the services that an NHS trust provides, but what if patients go outside that? What happens if the budget is overspent? If a patient buys more or suddenly has to go back into the NHS, which has been covered already, how is that worked out? How will the tariffs be determined? The Motor Neurone Disease Association has evolved a year of care and has broken down the care requirements of patients with motor neurone disease into discrete packages, which it has also costed. It is a fantastic piece of work and a great service for anyone who is trying to provide end-of-life care. Will patients be able to mix and match? If they are, how much will they be able to mix and match, dip in and out and top up? It strikes me that the devil will be in the detail and that it will work well if it is well managed, as the noble Lord, Lord Warner, said. If it is not very carefully managed and defined, it may well fall apart and run into big problems.