Health Bill [HL]

The noble Lord, Lord Campbell-Savours, mentioned the National Audit Office. I think he will find that it is perhaps preoccupied with contemplating Armageddon at the moment; I refer to the article in last week’s Times by Mr Steve Bundred, in which he talked about the prospects for the future of funding public services—an issue that is not unrelated to the debates that we are having now. We have taken a great deal of time over things this afternoon. I simply wish to move Amendment 52A and speak to Amendment 60, for two simple reasons; nowhere does it say that someone can refuse to have a direct payment, and I want to establish that you do not have to have lost mental capacity to exercise the choice not to have a direct payment. That is a very important thing to do, not least because, it is fair to say, there is a degree of enthusiasm that sometimes borders on overestimating the appropriateness of direct payments for people. It is important that we have on record the fact that it is a legitimate thing for people to say, "No, I don’t want this. I just want a service, thank you very much. That will sort out my needs". That is a very good marker, which we should put down. Amendment 60 has a different purpose. It would do two things. First, it calls into question and seeks to probe the part of the Bill that says that the Secretary of State has the power to recover a due debt that is paid in a direct payment. It also seeks to flag up to noble Lords the fact that you cannot read directly across from social care to health. Issues arise in health that do not arise in social care. One is misdiagnosis. It is possible in social care to have different views about what people’s needs might be, but that does not arise from misdiagnosis. I shall give a quick example. Noble Lords might remember a case a few years of an older gentleman who was treated for mental illness, including being subjected to ECT. It transpired after about three years, during which time he was sectioned and subject to compulsory medication, that he was not suffering from mental illness; he had Lewy disease, a degenerative brain condition—a form of dementia. That is just one small example of diagnoses going wrong. What happens if a set of direct payments have been put in place on the basis of a misdiagnosis?