Health Bill [HL]

We continue to talk about the review of the pilots, which again is one of the most important things that we will talk about today. All afternoon I have been explaining why, just in the field of social care, there has been a great deal of reservation about the way in which the pilots have been conducted. I agree with the noble Lord, Lord Darzi, that the IBSEN review is thorough and commendable research. However, it is telling that as thorough and detailed as it is, even today it has been interpreted in very different ways. On an earlier group of amendments, the noble Baroness, Lady Cumberlege, said that it had demonstrated that direct payments were cost-effective. However, it does not quite say that. It says that measures of cost-effectiveness vary across client groups. On page 240, the review says that in social care the market may change and the impacts on costs may play out. Direct payments may in future be less cost-effective than they are now. Even with such thorough research, an awful lot is left open to question and a lot of issues are left dangling even by the researchers, because they were unable to answer them. With that in mind, a number of these amendments have been put forward. Amendment 62 probes a part of the Bill that has caused interest across social care. The Secretary of State seems to be being given a power to revoke the pilot without reference to other people. Amendment 65 asks not only that there should be an independent review, but that there should be an independent review of all pilots. Amendment 66A reiterates the point made by various Members of the Committee today on the need to look at the impact on different client groups and to ensure that what is rolled out is applicable to all. Amendment 67 says that the pilots cannot be moved on to further status before all of them, not just one, have been reviewed. To a certain extent, that reflects the surprise at the department’s announcement in December 2007 that individual budgets would be the way forward for social care, even before the reviews of the pilots had been completed. Amendment 68 asks that there be a report to Parliament. Amendments 68A and 68B would address something that was raised in IBSEN research: that people should have been in receipt of direct payments for a year. There is a reason for that. In some client groups, a person’s health can change dramatically over the course of a year. One of the shortcomings, which is admitted by the researchers from the University of York, was that, in the report of the IBSEN pilot, some people had had a direct payment for only a matter of few weeks or a couple of months, and some of them had not even actually had it. When looking at the impact on people’s health, and given that older people are the majority users of the health service and that the majority of those users have multiple health conditions, we need to see how this works out over a period of time, during which a proper health assessment can be made. These amendments are tantamount to some quite severe reservations about the pilot programmes. I beg to move.