Health Bill [HL]

I will speak briefly in support of the amendment, because we have gone over all the arguments on the importance of a support scheme quite well. There is an awful lot to learn from the 28 years of experience of setting up support to help people to become independent and to self-manage. I hope that we will truly draw on that experience in the pilot and not reinvent any wheels. The one important thing that we have not spoken about much is advocacy in these support schemes. I do not mean advocacy simply to get the care package that you want, but advocacy to enable the organisation and the development of this different culture of self-operated care to be discussed and understood by the providers, local authorities and PCTs in the future. There is still very little knowledge about what direct payments are. You go to a PCT and talk about direct payments, and they kind of look at you, a little blurry, and say, "Ooh, isn’t that something they do in social care?". There is resistance, which we have already heard about, from the social care workforce. It took us probably about 28 years to persuade social workers that we were the experts in our own situation, and that this could actually be a shared approach to the development of social care in this country. I spoke to an older person, who was 70 and using direct payments, last week. She said, "Fundamentally, it comes down to doing things with people, not to them or for them". She emphasised the "with". We do not do this on our own; it has got to be a contract. It is important to look at support services not only in terms of the information and advice on the nuts and bolts of employment, contracts or pay and conditions. That is all very important and has been vital. Resistance from the local social services has also been looked at, people have been talked to who have said that the people down at their day centre could not manage, and truly believed it. Those people said, "It is all right for you. You’re articulate, you’re okay, but not my people". An element of cultural shift still has to be made. In the IBSEN analysis, I was particularly struck by the statement that most pilot sites report major challenges in the changing attitudes and culture of care managers and other staff. That resistance was reported among the team working with mental health users and older people, which shows that we still have a long way to go. In supporting the amendment proposed by the noble Baroness, Lady Wilkins, I would say that it is not possible to take pilots forward without support services and that it is not possible to have support services without good funding, about which we have not talked. One of the best support services for direct payments in this country is the Bristol centre for independent living. Hundreds of disabled people became effective direct payments users. The centre did not have a single issue for about six years. Then its funding was cut, and I know of two ongoing tribunals, simply because it did not recruit properly and people are floundering. I am a big supporter of the proposal and I do not think that we should look at pilots without also looking at support services, as proposed by the noble Baroness, Lady Wilkins.