---

Lord Campbell-Savours: My Lords, I will be very brief but I think this is quite an important amendment. I did not think it was so important as little as three or six months ago but it is particularly important now. This Bill was born in a time of relative affluence when the National Health Service saw huge increases in expenditure. We are going into a period which may be very different indeed. There are going to be all kinds of new pressures exerted on health service budgets with people crying out from every section of the health service for an increased share of the cake. A matter of only months ago we may not have thought that this would be a problem in the future. This needs regular review over and above pilots. Over the next couple of weeks before Third Reading additional consideration should be given to the principle behind this amendment. I know my noble friend will have to reject it now, but I appeal to him to ask his civil servants and his department to consider the period

28 Apr 2009 : Column 209

that we are going into and the new pressures which none of us, at this stage, is able to predict with any certainty.

Lord Darzi of Denham: My Lords, Amendment 30 tabled by the noble Baronesses, Lady Barker and Lady Tonge, would create an expectation that direct payments would continue to be independently reviewed every three years, even after the pilot phase has concluded. Let me try to convince noble Lords why I do not believe that is necessary. I would be the first to say that any innovation such as this has to be evaluated, and I could not agree more with the noble Baroness that it needs to be a rigorous evaluation. It could have a tremendously positive impact on the patient and also on the health service. We will be speaking later about how we are calling for bids for independent evaluation. The question here is how long we keep evaluating something once we have had an independent evaluation of the pilots. We do not evaluate anything else independently in the health service. It all comes under our normal evaluation of our commissioning structures. If these pilots are successful, direct payments will be evaluated through the performance management of PCTs and their commissioning function will be evaluated as part of the world-class commissioning programme.

Maybe I misunderstood what the noble Baroness, Lady Barker, was suggesting. I will take back the issue of the behavioural change that might arise from providers and patients in relation to direct payments. That should be considered by the independent evaluating committee. I will never accept the idea of an independent rigorous academic evaluation without taking into account the behavioural change that the noble Baroness referred to.

The area I do not agree with is the impact of direct budgets on healthcare funding. This is innovation and innovation can save money. If we look at the evidence base of small pilots run in the US and from talking to stakeholders, including patient groups and the voluntary sector, we are constantly reminded of the amount of waste in the system. If the patient is empowered to make these decisions and have control of the payment, what cost savings might arise from that? Remember the wonderful example told by the noble Baroness, Lady Campbell, about her mattress. Let us remember the mattress story. The PCT was encouraging her to spend £3,000 and she found the same brand on the internet for about a tenth of the price. Let us have an open mind about this, which is the purpose of the independent evaluation. I hope I have made the case for why the Government see independent evaluation as important. Once we evaluate this independently, we have to make a call. Are direct payments going to benefit patients or do we need to decide what suits who based on our evaluation of the pilots? I hope I have reassured the noble Baroness enough to allow her to withdraw the amendment.

Baroness Barker: My Lords, I thank the Minister for one of the politest and most thoroughly considered responses that I have ever had to an amendment. I thank the noble Lord, Lord Campbell-Savours for his response, too. I hope the Minister will accept that I

28 Apr 2009 : Column 210

accept that individual budgets can bring about cost savings and be more efficient. I am not as convinced as he is that they will automatically be more effective and efficient. Even the noble Baroness, Lady Campbell, who was a bit embarrassed about the example of her mattress, had the grace to concede that a physiotherapy service in which the physiotherapist goes to somebody’s work to provide physiotherapy at a point and place convenient to the person receiving the service might have a higher unit cost than one that is run for the benefit of several people from a traditional NHS facility. Let us not take one example and from it extrapolate savings that may or may not arise across the NHS.

I want individual budgets to succeed. A critical part of their success will be their being subject to full, rigorous and independent review. I suspect that the process will have to carry on way beyond pilots. Pilots are carried out by people who are enthusiastic and work extremely hard to make sure that they are a success. That may not be the case when they are rolled out, as I am sure that they will be, throughout the whole of the NHS. I thank the Minister and beg leave to withdraw the amendment.

Amendment 30 withdrawn.

Amendment 31 not moved.

Consideration on Report adjourned.

Beverley Freemen Bill [HL]

Committed to an Unopposed Bill Committee

The Examiner’s certificate that the further Standing Orders had been complied with was ordered to lie on the Table and the bill was committed to an Unopposed Bill Committee.

Bribery Bill

Message from the Commons

A message was brought from the Commons that they concur with the Lords that it is expedient that a Joint Committee of Lords and Commons be appointed to consider and report on any draft Bribery Bill presented to both Houses.

That a Select Committee of twelve Members be appointed to join with the Committee appointed by the Lords to consider the draft Bribery Bill (Cm 7570).

That the Committee should report by 21 July 2009.

That the Committee shall have power:

(i) to send for persons, papers and records;

(ii) to sit notwithstanding any adjournment of the House;

(iii) to report from time to time;

(iv) to appoint specialist advisers; and

(v) to adjourn from place to place within the United Kingdom.

House adjourned at 10.07 pm.

---