Health Bill [HL]

That is a particularly interesting question which my noble friend will know is being asked by a number of outside organisations. The very nature of the scheme invites circumstances in which top-up arrangements would take place. I will go back to the issue of the position of UNISON and say a few words on my Amendment 58. UNISON feels strongly on this issue. I wonder whether my noble friend might respond. As I have already said, the union is not absolutely opposed to the principle; its opposition is centred on the potential for service reductions arising out of the proposals as they are currently set out. It recognises and supports the need for health services to be more responsive and able to provide more tailored support to some patients, but it does not believe that direct payments will be either a long-term or a satisfactory solution as currently proposed. While it is wholly opposed to a policy that could easily lead in its view to means-testing patient top-up fees for services or greater barriers to services for those who most need them, it does not feel that at this stage it is a risk worth taking, particularly at a time of tightening economic conditions. I refer my noble friend to the words on page 26 of his document, where he refers to the fact that there are no additional resources to be made available and more money will not be injected into the system. If they cannot inject more money into the system and the budget runs out, what happens? Additional money has to come from somewhere. I presume that, in the circumstances of someone’s budget running out, additional money will have to be injected into the system, which is in breach of the principle set out on page 10 of the document. Will my noble friend explain the contradiction which is built into that statement and the assurances that we have been given from the Dispatch Box on Second Reading?