Paul
Rowen: I am grateful for what the Minister just said. Will
he seek to ensure that some of these pilots are coterminous with the
health
pilots?
Jonathan
Shaw: Yes, we will, most certainly. We will be piloting
personal health budgets at the end of 2009 until 2012 and the aim is to
build on the success of the social care individual budgets to give
people greater choice and control over the money
spent. Personal
health budgets could work in many ways, which could include having a
notional budget held by the commissioner or a budget managed on behalf
of the patient or by a third party. That is an interesting point in
respect of children and those people who need a power of attorney, such
as someone who has dementia, in which case the budget could be run by
the family rather than the state. Safeguards are needed there, too,
because there are advocacy issues to consider. It does not always
follow that a family will act in the best interests of their
relative—I am sure that we are all aware of such cases. In the
vast majority of cases, of course, that is not so, but we have to
safeguard against such
eventualities. Primary
care trusts already have extensive powers to offer such provisions, but
we will be seeking powers in the Health Bill to allow the pilot for
direct payments for
health care. To date, PCTs have used existing powers to create personal
health budgets in relatively few cases, which bears out the comments
made by the hon. Gentleman. Those that have done so have demonstrated
that they can be
successful. Finally,
on how the pilots for personal health budgets link with the
right-to-control trailblazers, we will be exploring whether at least
some of the right-to-control trailblazer sites can be collocated, as
the hon. Gentleman asks, in selected pilot areas. It would be folly to
miss that opportunity and the hon. Gentleman would be correct to say so
if we did. We will certainly do
that. Can
social care and other direct payments be pooled with personal health
budgets? We hope to present as seamless a provision of services as
possible for people receiving social care and other direct payments and
personal health budgets, and those things should be pooled as far as is
practical and legally possible. Doing so may require some level of
auditing. I
hope that I have answered the hon. Gentleman’s points. I welcome
the opportunity to put what I have said on the record. I invite the
hon. Gentleman to ask leave to withdraw his
amendment.
Mr.
Harper: This has been a useful debate. I am grateful to
the Minister for his assurances about the pilots. I urge him to do more
than just commit to looking into this, and to ensure that at least some
of the pilots use all the different funding streams, not just personal
health budgets, and that we wrap in the pilots that the Department for
Children, Schools and Families is conducting, and try to get them all
working together.
The key point
is seamlessness. In response to a question from the hon. Member for
Sheffield, Heeley, Mr. Davies gave a very good response when
he said that, in the experience of the metropolitan borough
council,
“where one is
able to integrate those funding streams into that single delivery
vehicle, wrapped around the individual, with that individual having
choice and control, it works. What does not work is a load of
bureaucratic jiggery-pokery at the back as organisations try to sort
things out, and not always
seamlessly.”——[Official Report, Welfare
Reform Public Bill Committee, 10 February 2009; c. 8-9,
Q6.] The most
important thing, in running the pilots with all the different funding
streams, is to make things seamless for individuals, so that they can
live their lives in the way that they want to live them, rather than
trying to fit them into departmental silos. However, the test is
whether that can be done without making the system so complex that it
either costs an extraordinary amount of money to manage, and we have to
put lots of money into administration instead of service delivery, or
simply breaks down and does not work. If it is too complicated, all the
organisations that have the power to deliver what is required might
find that so hard that none of them will do it, in which case millions
of the people who could benefit from the system might be in a similar
position to those in adult social care, relatively few of whom have had
the chance to access such opportunities.
The Minister
has made it clear that his plan is to work closely with other
Departments on the pilots and to ensure that there is proper
integration and that lessons are learned. With that in mind, my final
comment to him is that if it becomes clear, shortly after the pilots
have started running, that things work, we should not necessarily run
them to full length before rolling out the
system. In those circumstances, it would be useful to take stock and see
whether we can move earlier than that. Given those assurances, I beg to
ask leave to withdraw the
amendment. Amendment,
by leave,
withdrawn. Clause
29 ordered to stand part of the
Bill. Clause
30 ordered to stand part of the
Bill.
Clause
31Power
to make provision enabling exercise of greater choice and
control
Mr.
Harper: I beg to move amendment 79, in
clause 31, page 38, line 21, at
end insert ‘including, in
particular, making arrangements with voluntary organisations to provide
disabled persons with assistance in connection with direct
payments.’. The
clause gives Ministers the power to make provision enabling the
exercise of greater choice and control, so it is one of the excellent
clauses that relates to the very thick book containing all the
regulation-making powers that was produced by the Minister for
Employment and Welfare during Tuesday’s sitting. The amendment
responds to the concern that has been expressed about people receiving
direct payment to spend themselves, and whether they are receiving
appropriate advice and support on how to manage that money correctly.
That concern was expressed by Liz Sayce, the chief executive of the
Royal Association for Disability and Rehabilitation, during an evidence
sitting, and by RADAR in its brief to the Committee.
The
Government have recognised the need for peer support and advice on
managing direct payments, and there are other options if people do not
want to receive their individual budgets as direct payments. The report
of the Prime Minister’s strategy unit, “Improving the
life chances of disabled people”, included a commitment to
having a user-led organisation in every local area by 2010. I
understand that we are quite a long way off that target and, given that
2010 is not a long time away, it might help if the Under-Secretary of
State for Scotland, the hon. Member for Glasgow, North, updated us on
progress towards getting those user-led organisations in every local
area. The Department of Health has carried out some capacity-building
programmes, but it would be very helpful if the Minister gave us an
idea of how many local authorities have a good user-led organisation
that people can access for advice on how to use their direct
payments. I
understand from the briefing material supplied by RADAR that the
availability of support and information can make a huge difference in
the take-up of direct payments. There is a direct correlation between
take-up and the availability of
support. As
Ministers have suggested, people who have not used an individual budget
and a direct payment before may have many questions about how to spend
the money, and whether they really want to take on the responsibility,
perhaps of employing people directly. Actually, learning from people
who have done that successfully about creativity and the different
solutions that one can come up with is helpful. As RADAR has
stated:
“Being
able to access quality support services—be they to broker
services or manage payroll—will in many cases make the
difference between someone feeling able to take a direct payment and
just feeling it could all be too much
hassle.” Will
the Under-Secretary outline where we are in respect of user-led
organisations in local areas? What further steps will the Government
take to roll out such services, specifically as part of the pilot, and
will Ministers ensure that peer support and advice are there to help
people to make the best use of their individual budget and direct
payments? If she could reassure the Committee on those issues, it would
be
helpful.
Paul
Rowen: I support the amendment. We have talked a great
deal about the provision of quality services and how some things are
not appropriate for everyone, which will always remain the case.
However, pilots provide the Government with a unique opportunity to
trial various models of operation, which, in our view, might include
some independent support to enable the transition. I very much hope
that the Government will look at different models when they design the
pilots. There
is an officer in Rochdale who is employed by Manchester and Rochdale
councils jointly. His job is to get direct payments out to people, and
he spends a great deal of his time advising and supporting individuals.
An alternative appropriate model might involve voluntary organisations.
In some towns, there are many groups that might take on such work
collectively. If something like that could be included in the pilots,
it would go a long way towards ensuring that this initiative will be
the success that we all want it to
be.
The
Parliamentary Under-Secretary of State for Scotland (Ann
McKechin): I welcome the debate on the amendment, which
has raised important points about engagement with the voluntary
organisations that have been central to moving the right-to-control
agenda forward over the past few
years. Clause
31 contains powers that will deliver real choice and control for
disabled people. It enables regulations to be brought forward that will
allow disabled people to require an assessment of the amount used to
provide a service, and to require that the authority consults them on
how that money is used. This is intended to deliver our White Paper
commitment to increase choice and control for disabled people in
decisions about how public money is spent to meet their needs and
aspirations. The
commitment was informed by responses to consultation and by advice
received from disabled people and their associated voluntary
organisations, which made it clear that the right to take a direct
payment, which currently exists for those eligible for adult social
care services in England, is not, by itself, sufficient to give people
more choice and
control. Although
the amendment is permissive, it would signal a firm intention to make
such regulations with regard to voluntary organisations. We believe
that the right to control should be widely accessible, and, as has been
mentioned in Committee, that means that there has to be the provision
of adequate advice and brokerage services. That will be an important
consideration during the trailblazer project. Such services are also an
important part of the implementation of Putting People First, our
policy in England, and that will support the transformation of adult
social care.
I understand
the important role that the voluntary sector can play. The report,
“Improving the life chances of disabled people”, which
was published in 2005, clearly recommended improving the availability
of advice and advocacy services, and it put an emphasis on the role of
organisations that are led and controlled by disabled
people. I
can confirm that the report set out a commitment that, by 2010, there
should be a user-led organisation in every locality in
England—locality being defined as an area covered by a council
with social services responsibility. My understanding is that that
timetable remains in
place 1.30
pm User-led
organisations are key both to delivering personalisation and achieving
independent living. The Health Department in England is investing
£1.65 million in ULO development funds to support the
development of up to 25 action and learning sites. Such sites will
share best practice with organisations interested in becoming a ULO, or
in supporting the development of one in another local authority
area. The
action and learning sites will focus on developing ways of becoming
organisations that meet the life chances recommendation, and they will
share that learning with other groups across the country.
The hon. Member for Rochdale
made the important point that it is not a case of one size fits all,
and that it is important to consider different models. Moreover, we
have to remember that disabled people will not always wish to look to a
voluntary organisation to support their use of direct payments. In the
evaluation of the Department of Health-led individual budgets, it was
found that many participants took the opportunity to involve their
family and friends in deciding how to spend their budget to meet their
outcomes. As we develop the personal health budgets pilots, we are
placing an emphasis on avoiding prescription with regard to how
information and support service are provided. We will be following that
model for these particular
provisions. Key
principles in developing the right to control are consultation and
co-production. We want public authorities to take the initiative in
provision. We want to engage with local expertise to apply as much of
that as possible to the provision of advice and information that we
give. That is why I am keen for legislation to avoid setting out
prescription.
Mr.
Harper: Before the Minister concludes her speech, may I
take her back to the point from the Prime Minister’s strategy
unit report? She mentioned that the timetable to have a user-led
organisation in each area, which she clarified as one that is served by
a council with a social services function, is still on course to
achieve its target of 2010. I did not hear the update on how many areas
there are and how many have user-led organisations. How many milestones
have we passed on the way to 2010? Alternatively, will everything
happen at the back end of the process?
Ann
McKechin: I will provide the hon. Gentleman with an update
on that before the end of the Bill’s consideration in Committee.
I do not have the information with me today, but I will make
arrangements to ensure that we can provide it for
him.
Mr.
Harper: I am grateful to the Minister for that assurance.
It would be very acceptable to receive the information before the
Committee rises.
I am very
happy with what I heard. Part of the reason for tabling this amendment
was to get a sense of how Ministers envisaged voluntary organisations
providing such advice and support. The Minister said that the
Government believed that voluntary organisations had a clear role, but
she said that there should not be a prescription that people should
have to use them. I just wanted to ensure that the provision was in
place. As she said—and I know that this has been the case with a
number of people to whom I have spoken—some people decide things
for themselves, some talk to friends and family, some take advice from
the local authority, some use voluntary organisations, and some have
used all those sources to put together a package. We must ensure that
such flexibility remains. None the less, if people want to take
advantage of advice, there should be an organisation in place to
provide it. Given the Minister’s assurances, I beg to ask leave
to withdraw the
amendment. Amendment,
by leave,
withdrawn.
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