Health Bill [HL]

I thank the noble Lord, Lord Darzi, for that very full response to the large number of issues raised in this group of amendments. When I moved the amendment, I should have said that I took considerable care to look at the material provided by the department, for which I am very grateful to the noble Lord. The other week, his department gave Members of the Committee a briefing on direct payments, specifically about the evaluation. This may be known in the business as the curse of PowerPoint, because there are some very brief headings, about which I meant to inquire. What the evaluation that the department is about to commission will cover is set out and includes financial impacts. What do the financial impacts concern? Does the evaluation refer to the financial impact on patients, providers or commissioning? That is not clear. Analysing innovation and responsiveness in the provider market is also referred to. What about market failure? We know that when market mechanisms are introduced, that can bring about market failure. Part of this is designed to do that. We have not had extensive market failure in the social care world, because the pilots have been running alongside the existing system of commissioning block contract services. That might be the case for the pilot phase, but I imagine that, ultimately, it will not be further down the line. I should say to the noble Baroness, Lady Cumberlege, that I did not seek to imply that she had not done her homework or that she was misquoting. She was reading from the summary and it is right to say that that is part of the report. It is a bit like going to the theatre and seeing the Reduced Shakespeare Company do the "To be or not to be, that is the question" soliloquy, and then not hear the rest of it. In the full report, the points made by the noble Baroness are put into more detail and more context. The researchers are more tentative about what their findings may mean for the future: for example, when there is a more fully developed supplier market in social care, individual budgets have been running for a considerable time and no longer is block contract tendering going on by local authorities. It talks about how, if the price of an individual care service goes up, it may have an impact on the cost-effectiveness of that service, particularly if it is being provided for only one user as opposed to a large number of users, and there are no economies of scale. I am not accusing the noble Baroness of misquoting: it is just that there is a more detailed picture in the fuller report. Perhaps the noble Lord, Lord Darzi, will answer my points.