Health Bill [HL]

I fully appreciate my noble friend’s concerns when it comes to the impact of this, and that is exactly what we need to learn from the pilots and the evaluation. What is the impact not only on the individual but on the local health economy? That is all based on the types of services, the demand and the supply at the local level. Once we know the impact of that, we can address these issues and we will have a greater evidence base that we can debate at a local level with the local public and patients who are the users of such a service. As I said earlier, it would be premature to have such services in the Bill. I also have concerns about having a list, which could be misleading. The approach taken in the Bill provides the overarching framework but at the same time the flexibility to prescribe specific details in regulation where necessary. This mirrors the legislation for direct payments in social care. I turn to the detail of how we intend to use regulation-making powers, set out in the department’s briefing notes on direct payments, which I hope noble Lords have seen, and the department’s memorandum to the Delegated Powers and Regulatory Reform Committee, which the committee has endorsed. A few other issues have been raised by this informative debate. First, the noble Earl, Lord Howe, and the noble Baroness, Lady Finlay, asked about where to buy such services. If agreed by the care manager and the care plan, such services could be bought from the private or voluntary sector. That is exactly the ethos of the policy. Patients will be empowered to make those decisions based on the quality of the services that they receive. Secondly, what can they buy? A number of noble Lords referred to crystal therapy, which is not my area of expertise, but hydrotherapy would probably be a better example. Any intervention that will improve the health and well-being of the patient that is signed off by the care manager within the care plan would be implemented. The noble Earl raised the issue of the transaction costs. We have said that personal health budgets, including direct payments, should be used only when the likely benefits outweigh the transaction costs. I recognise that this will not be suitable for all patients, or certainly all services, which is why we are piloting them. He also raised the issue of the BMA and I declare an interest as I am still a member, despite my interactions over the past 18 months. It is important always to recognise the concerns of continuity of care, which is the issue that has come up. The patient must always remain the continuum. The patient is always challenging us as professionals about integration of care, rather than fragmentation of care. The more we shift power to the patient from the professional, the more we will see a better response to healthcare in the future.