Health Bill [HL]

I, too, have amendments in this group. The noble Earl, Lord Howe, is absolutely right to focus attention on support, which people who are contemplating the use of a direct payment need to have. I am absolutely sure that a number of patients will need very little help at all. There will be people who might have been through the expert patient programme and know as well as, if not better than, the people engaged in their treatment what they need, and they will know where to get it and what to do with it. However, there will be others who do not. It is quite telling that many of the amendments in this group have been put to us not by provider organisations but by representatives of quite widespread users. Amendments 53 and 54, I am afraid, reflect another failure on the part of the people responsible for setting up the pilots in social care. It was initially proposed that the pilots in social care should include people who had sensory disabilities, but when the pilots took place, lo and behold, those people had been missed off the list and never properly got a chance to have a role and a say in those pilots. We know that quite a number of people who have sensory disabilities are users of NHS services. People who have sensory disabilities have a type of vulnerability that is different from that of learning disabilities or people who are old. It is not that those disabilities are worthier of attention; they are simply different and need to be involved. I have not framed the amendments in terms of risk, and I have not chosen to speak about risk overall, because one of the great benefits of direct payments is that they enable people to take risks if they choose to do so. There are particular and potential risks of abuse that have not been investigated in the pilot programmes, and we need to look at them. Amendment 53 proposes that, where there is the potential for abuse, providers must be checked and vetted. Amendment 54 is about providing training and guidance to patients and their carers if they feel that they need it to be able to manage direct payments and to safeguard themselves against potential abuse. Amendment 69 is somewhat different. It would place a duty on PCTs that intend to make direct payments to commission advice and advocacy services. I accept some of the implicit criticism of this in some of the amendments tabled by the noble Baroness, Lady Campbell. I know that it is slightly deficient. None the less, it points up a significant issue. I do not know whether other noble Lords go to conferences at which people, particularly those in local authorities, tell people about the imminence of direct payments and self-directed support. There is usually a very informed, zealous and passionate analysis of the benefits of individual budgets, self-directed support and direct payments. Then when it comes to the practicalities of how the system will work, it becomes a little quiet. If someone in the audience then asks about support and advocacy, it becomes very quiet indeed and sometimes silent. Sometimes the person giving the presentation says, "Of course there will be advocacy", but when asked if they will pay for it, the answer is no. That is the key to this issue. This is one of the most essential amendments of the lot. If there is no readily available source of support, which people can use or not as required, the potential for this policy to fall rapidly and immediately into disrepute is extensive. I give notice to the noble Baroness, Lady Campbell, that I have a point to make on her amendments when she speaks to them.