Health Bill [HL]

I shall speak to Amendments 63A, 69A and 69B in my name and that of my noble friend Lady Campbell. I hope that this group of amendments will help to provide a solution to the various points that have been made. I hope that it is clear that I support Amendment 69, but I believe that more than advocacy services and advice is needed because managing the direct payment is important. I was pleased to hear the strong case made by the noble Baroness, Lady Barker, in her introduction to the first group of amendments, on the vital need for support services for people receiving direct payments, and I look forward to the further point that she wishes to make on this group. The purpose of these amendments is to ensure that the importance of effective support is recognised and built into the pilot schemes on direct payments. My noble friend’s reply on Second Reading was somewhat tentative, when he said: ""We would expect the PCTs to work with local authorities and third sector organisations to provide guidance and support".—[Official Report, 4/4/09; col. 752.]" He said that "independent or peer advocates" may also have a role in supporting people through the process. I urge the Minister to make it clear that effective support is an essential element in establishing successful direct payment schemes, and in doing so I again declare my interest as vice-chairman of HAFAD, which is a user-led organisation that runs a support scheme for direct payments users in social care. The social care model in direct payments has clearly demonstrated the benefits of peer support from user-led organisations. The benefits of taking control over one’s services are considerable, as the famous speech of my noble friend Lady Campbell, spelt out so well on Second Reading. The transition of being a passive recipient of services to take control is not a simple one. As any employer knows, there are many pitfalls to be avoided, which can be serious if people do not have the right advice, advocacy and support. Managing support is crucial. HAFAD’s support scheme has numerous examples of people who have been put on direct payments by the local authority without any reference to support but who are left to negotiate the transition on their own. Last summer, a woman faced huge bills because she had not paid any national insurance for her personal assistance or paid tax, assuming that that would be dealt with by the council. Others have faced the trauma of a threatened employment tribunal because they advertised wrongly and were totally unaware of their legal responsibilities as an employer. Our experience at HAFAD shows that the professionals—social workers, in this case—are not aware of employment obligations and are not equipped to give this time-to-time support. The most successful direct payment scheme is in social care, where new users are put in touch with a local body of expertise that is built up by their peers who have gone through the same process as themselves. User-led organisations give people the confidence to take up the direct payment, as too often people are put off by the notion that they will be cast adrift to do everything themselves. The National Centre for Independent Living, which has long experience in this area, supports the pilots but warns that the schemes could be ineffective if support is not available. The health pilot schemes will benefit considerably if the Minister ensures that we learn from the social care precedent and establish effective support arrangements. The right support will mean that people can maximise the use of their direct payments, greater numbers will be attracted to take part, which will help in the analysis of the pilots, and most important, there will be higher user satisfaction and the increased likelihood of people’s health aspirations being met. It is a false economy not to ensure that people have the backing of such user-led support, advocacy and advice in the pilot schemes. I hope that my noble friend will support the amendments.