Health Bill [HL]

I thank all noble Lords who not only took part in this debate but proved my point. There is a great deal of support for this policy and a great many misgivings about how it will work in practice. I begin by thanking the noble Lord, Lord Darzi, for answering the question that I posed in Amendment 50. I understood him to say that even if someone did not have a lasting power of attorney, it may still be deemed possible for them to have someone who could act as a recipient for a direct payment. I want to pick up two or three key points that have run through this debate. I begin with those made by the noble Baroness, Lady Campbell. I am talking about direct payments. She made a very telling point when she said that direct payments are a mechanism not a service. That is true, but they are a mechanism that has a distinct effect on the health and social care economy. I listened to the noble Lord, Lord Warner, very carefully. One does not have to be some kind of luddite supporter of existing provider arrangements—I am not—to have concerns about the potential impact of direct payments on provision. We will return to that at greater length in our debates on other amendments, but I simply contrast the point made by the noble Baroness, Lady Cumberlege, who said that if providers were no good they should be allowed to disappear, with some of the points raised by other noble Lords about the viability of services. As ever, I am grateful to the noble Lord, Lord Walton, for raising a point that I wanted to raise. Far be it from me to wander into the age old, perennial argument about alternative therapies, but I want to raise a potential scenario. Let us say that, in a given geographical area, people are given direct payments and choose to have osteopathy or chiropractic rather than physiotherapy because they find it good for them. I do not think that even the noble Baroness, Lady Finlay, would get upset about that, but what if the consequence of that is that the physiotherapy unit, which also serves the needs of acute patients, becomes unviable? That is the issue of concern to some of us, and we have not answered it this afternoon. We will have to return to it in later debates. There are other things that I could say, but I do not want to say them at the moment. I am in favour of transforming services to make them more effective for users, but I return to some of the misgivings that, I hate to say, I do not think the Minister answered. I do not think that he can answer them at the moment. Therefore, I thank him for the spirit in which he answered our questions, but the lack of detail serves to underline the problems that some of us still have. Amendment 50 withdrawn Amendment 51 not moved.