Health Bill [HL]

The amendments in this group are concerned with the design of the pilot schemes for healthcare direct payments. Amendment 61, tabled by the noble Baronesses, Lady Barker and Lady Tonge, is about the impact of the pilots on different demographic groups. Amendment 63 is about control schemes for the pilots, and Amendment 64, tabled by my noble friend Lord Campbell-Savours, would require at least one pilot scheme in each strategic health authority in England. I should start by assuring noble Lords that we will commission a rigorous scientific evaluation of the pilots, as outlined in our policy document. The pilot programme and evaluation will start later this year for models of personal budget that are allowed under current legislation: in other words, the notational budgets. Then, subject to parliamentary approval, the pilots will be extended next year to include pilot schemes for direct payments, to which the Bill relates. The department is currently in the process of tendering for a team of researchers to carry out the evaluation of the personal health budgets programme as a whole. Our aim in the tender is to specify the outcomes that we want to measure—we have already debated most of them—not to prescribe the evaluation method. However, I have no doubt that we can learn a lot from this debate. We will be looking for innovative and rigorous proposals from bidders. For that reason, I am unable at this stage to give noble Lords exact details of how the evaluation will work. However, I reassure them that we will be looking for the most innovative bids that try to address most of the questions that we have debated. The evaluation will be based on a wide range of qualitative and quantitative evidence, and we will draw on the lessons of the IBSEN review in social care. That examined in detail the effect of individual budgets on a range of people, conditions and social groups. As the noble Baroness, Lady Barker, pointed out, a lot has been learnt from it and we could probably do better and make our evaluation more rigorous. We are also now seeking expressions of interest from PCTs to become part of the pilot programme. Applications are due by the end of March. The department is currently running a series of regional events. I reassure my noble friend Lord Campbell-Savours that we are going through all 10 strategic health authorities trying to engage as many PCTs as possible and encouraging them in order to get applications from across the country. I anticipate a positive response from the NHS. I saw the excitement in one of the deliberative events. We hope that pilot proposals will cover a range of services and conditions. I would be very pleased if we received applications from PCTs in every strategic health authority. However, where PCTs do not wish or are unable to apply to be pilot sites, I do not want to force them to do so. We are looking to harness existing enthusiasm in the NHS for personalisation, rather than to impose pilots on PCTs by selection by the Department of Health. I would be reluctant for the Bill to specify a precise geographical spread, but I reassure the noble Lord that we will do all we can to encourage innovative bids from across the country. On demographic groups, I agree that it is important to examine the effect of personal health budgets on different groups of people. Personal Health Budgets: First Steps made it clear that the evaluation would look at the impact across different groups by condition and background. This is particularly relevant because the IBSEN review of social care individual budgets revealed that not every group benefited equally. In particular, older people were less satisfied with the use of individual budgets. It will be important for the evaluation to look closely at these issues to help to understand how personal health budgets can be introduced in a way that benefits all groups. One of the challenges that we have in the next 10 years, as highlighted in High Quality Care for All, will be caring for more older people. I sympathise, but I do not want legislation to restrict individual pilot sites to looking at a particular demographic group. The current clause would allow that flexibility if necessary, but it is more likely that pilot sites would cover a range of different groups of people. It would be for the evaluation team to synthesise information from all the pilots and draw conclusions about the impact on different groups. Finally, on of control sites, I assure noble Lords that we expect the evaluation team to gather evidence from control or comparison groups. There are various ways of doing this. For example, there could be separate control sites outside the pilots from different PCTs with similar characteristics. There might be control areas within the pilot sites: for example, GP practices that do not participate in the pilot. In principle, although we believe this to be less likely, the evaluation could use a randomised approach, as in the IBSEN study. We are leaving that open, depending on the bids that we receive. Again, our aim is to prescribe the outcomes that we want to measure, not the evaluation method. I hope that I have reassured the Committee about that. We are committed to commissioning a high quality and rigorous evaluation for the pilot programme. That assurance is backed up by the safeguard in the Bill, which we will discuss in our debate on the next group of amendments. Parliament will have to give explicit approval, through the affirmative procedure, for any future decision to roll out direct payments more widely. I am sure that noble Lords will wish to see robust and persuasive evidence at that point before any national rollout. I hope that I have convinced the Committee of the evidence and the way in which we plan the rollout, and that noble Lords will not press their amendments.