House of Commons
|Session 2008 - 09|
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General Committee Debates
Health Bill [Lords]
Health Bill [Lords]
The Committee consisted of the following Members:
Chris Stanton, Committee Clerk
attended the Committee
Public Bill Committee
Tuesday 23 June 2009
[Robert Key in the Chair]
Written evidence to be reported to the House
H 10 Japan Tobacco International
H 11 British Medical Association
H 12 Sinclair Collis
H 13 National Federation of Retail Newsagents
Direct payments for health care
Mr. Stephen O'Brien (Eddisbury) (Con): I beg to move amendment 16 , in clause 11, page 8, line 29, after Trust, insert
and may also provide for an appeals process.
The Chairman: With this it will be convenient to discuss the following: amendment 190, in clause 11, page 8, line 29, at end insert
(4A) Any overpayment made by the Secretary of State shall not be recoverable under subsection (4)..
Amendment 191, in clause 11, page 8, line 29, at end insert
(4A) The regulations may make provision for the use of any surplus arising from the direct payment by
(a) the patient; and
(b) the Secretary of State.
Mr. O'Brien: Good morning, Mr. Key. Somewhat to our surprise, but great pleasure, we find ourselves serving under your chairmanship. Thank you for stepping into the breach to ensure that we have a continuing, uninterrupted consideration of the Bill. We look forward to making good progress.
Amendment 16 aims to protect individuals from the unwarranted removal of money from them by the Secretary of State. We have seen how the Government are not beneath top-slicing PCTs to bring them into line, both financially and politically, to generate a central war chest. I am concerned that this provision could be used to do the same to those with direct payments, and I hope that the Minister will reassure us on that.
Amendment 190 comes in the light of the Governments tax credit and other fiascos. Will the Minister confirm that if overpayments are accidentally made, the Government
Amendment 191 questions what plans the Government have for surpluses in the direct payment. Will the patient be able to transfer some of it for personal use? That might reward and incentivise the efficient use of resources. Would it roll over to the next year, or would it be clawed back by the PCT or the Department? If so, how would efficiency be incentivised? The Minister half covered that, somewhat affirmatively, in the reply he gave last week. So I look forward to his confirming and amplifying that.
I am concerned by paragraph 136 in the explanatory notes, which states that new section 12B(2)(h) means that the Secretary of State
may or must require all or part of direct payments to be repaid, for example, when a significant surplus has accumulated.
No cause is given for that, just the fact of accumulation. What does the Minister classify as significant? Surely the circumstances in which the surplus accumulated should be taken into account. The reverse is, of course, when there is not enough money in the tin; in the other place, Baroness Masham pointed out that it had happened to her in social care. I hope the Minister bears that in mind when he responds.
The Minister of State, Department of Health (Mr. Mike O'Brien): May I welcome you to your post, Mr. Key? It is a great pleasure to serve under your chairmanship and I hope that we make speedy progress under your tutelage.
Amendment 16 provides for creating an appeals process where money given in direct payment needs to be reclaimed by the NHS, such as in the event of fraud or abuse. I support the principle that if money given through a direct payment is to be reclaimed, then the process for doing so should be fair and transparent, and the individual shouldand doeshave the right to redress. That right is clearly set out in the NHS constitution. Any complaint about NHS services should be dealt with efficiently and investigated properly. The NHS complaints procedure has recently been reformed to make it more efficient and robust.
A complaints procedure would apply to any decision to reclaim a direct payment. Moreover, if not satisfied by that procedure, a patient may ask the health service ombudsman to look into the case. Clause 12 expands the role of the ombudsman to cover services delivered through direct payments precisely to ensure that people are suitably protected. It is worth reiterating that PCTs providing direct payments are still providing NHS services, and patients are still covered by all safeguards protecting them and their dealings with PCTs.
Amendment 190 would exclude repayment of a direct payment where the Secretary of State has made an overpayment. We think that if a certain amount of money has been applied, it is for achievement of a particular purpose. If that purpose is achieved, a review will need to be taken into the surplus. This case is different from care cases in that an amount of money has been agreed for a person with a prolonged illness or condition and they would be expected to use that money to manage their condition. If they are able to do that
There is broad agreement that that is the outcome that we want. With regard to the Secretary of State recovering money to build up a war chest, we are not talking about amounts that would make a big difference to the national health budget one way or the other. Initially we are looking at 70 or so projects, which would assess whether the process of direct payments can be refined and expanded or whether we want to change it in some other way. Building up a war chest is unlikely and I assure the hon. Gentleman that the Government would not contemplate that. Frankly, it would be pointless given the sums involved.
Regular monitoring will ensure that any surpluses or shortfalls in budget are identified quickly. It is important that we not only deal with surpluses but also budgets that are underfunded, where the money is insufficient to remedy that; it needs to work both ways. That is the objective and I hope with those assurances that amendments 16 can be withdrawn by the Opposition.
Mr. Stephen O'Brien: I have listened to the assurances and I am glad to say that my concerns are somewhat assuaged. I still have a concern about the building up of a war chest, which the Minister sought to dismiss. Clearly, while we are in the pilot stage, what he says in terms of the sums of money must be right, but if the pilot is to mean anythingwe are about to come on to thiswhen it is rolled out throughout the country, the cumulative amounts of money will be potentially significant. We need to get the principle and the ideas right now; that is the purpose of this scrutiny.
If there is a surplus that can be applied effectively in support of the purpose for which it is given, it is in effect one of the motivators to efficient procurement and the necessary contestability for getting higher quality services. I think that we are at one on that. My remaining concern, which might need to explore on Report, is how one defines purpose, given that at the moment the word significant is used. As part of his answer, the Minister sought to distinguish purpose from miscalculation. In practice this could be important because there will be residual worry for people in receipt of payments that they could suddenly be clawed back. People make their dispositions on the understanding that they have the amounts that they have been granted.
Mr. Mike O'Brien: Just to reassure the hon. Gentleman, it is not our intention to claw back funding where people have made dispositions and, as a result, created a surplus through efficiency. This is provided that the
Mr. Stephen O'Brien: That added assurance is helpful, and I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
(4A) The maximum period permissible in regulations made under subsection (3) is three years..
This deals with limiting pilot length. New section 12C subsection (3) reads:
A pilot scheme must, in accordance with the regulations, specify the period for which it has effect, subject to the extension of that period by the Secretary of State in accordance with the regulations.
This is a far-reaching power that would enable the Secretary of State to prolong the pilot, even indefinitely, if he wanted to. The noble Lord Darzi in the other place said:
We intend the personal health budgets pilot programme to run for at least three years, with direct payments being used for at least two years.[Official Report, House of Lords, 2 March 2009; Vol. 708, c. GC251.]
This was in response to a reverse point by Baroness Barker about the individual budget pilots. In some places the Government organised thosewe would argueso badly that people had been using them for only a few weeks or months before they came to be assessed. This was admitted by researchers in the IBSEN report. If Lord Darzi is content that three years is the time taken to run a pilot, it seems sensible that it should be on the face of the Bill at least as a benchmark expectation, if nothing else.
Mr. Mike O'Brien: The hon. Gentleman is right, but my noble Friend Lord Darzi had suggested in the other place that it is our intention to pilot health care payments. The maximum limit will be a period of three years. Most projects with direct payments will take around two. The system will take some time to set up, so we will have a set-up time, the running time and then an evaluation period. The aim is that we should be able to have a three-year block area where about 70 projects can be properly evaluated. They will have slightly different start-up and finish times.
The drafted provisions require the period for which a pilot would run to be defined and we expect most sites to be authorised within two or three years. However, it may be the case that a site takes longer to report than anticipated, either due to local circumstances or an unforeseen complication. We would therefore need flexibility to extend the period of the pilot to more than three years if necessary, in order properly to evaluate that site. The Bill allows for this but the amendment would prevent that from happening, so I hope the hon. Gentleman will feel able to withdraw it.
Essentially, in terms of getting this done, we need to have a block of time where we can set it up, ask for the various bids to be examined and allocate the funding. Then, we can start to run the projects, provide the level
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