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Health Bill [Lords] |
The Committee consisted of the following Members:Chris Stanton, Committee
Clerk † attended the
Committee Public Bill CommitteeTuesday 23 June 2009(Morning)[Robert Key in the Chair]Health Bill [Lords]Written evidence to be reported to the HouseH
10 Japan Tobacco
International H
11 British Medical
Association H
12 Sinclair
Collis H
13 National Federation of Retail Newsagents
10.30
am
Clause 11Direct
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 Government’s tax credit and other
fiascos. Will the Minister confirm that if overpayments are
accidentally made, the Government
will bear responsibility and not the individual, and, above all, that
the individual will not be at risk of the cost for such error,
inadvertency, incompetence or plain
negligence? 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 should—and
does—have 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
more efficiently, effectively and cheaply than the PCT, that is
fine—the money should be deployed in maintaining and improving
that condition. Provided it is for that purpose, it should be possible
to negotiate and agree to it. However, it may be that the amount of
funding initially agreed is in excess of that required and a mistake
has been made, and it is right that a review should take place at that
stage and that a determination should be made about whether the
appropriate figure was or was not calculated at the beginning. We want
to ensure that those who use their funding efficiently are able to
retain it for a similar purpose within the context of their care and
budget. We do not want a situation where, should there be a
miscalculation or an issue arises that should not have arisen, somebody
ends up not deploying money for their
care. 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
anything—we are about to come on to this—when 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
surplus is to be deployed for the purpose of the health budget. If, for
example, the person’s condition had ceased, that might be a
factor that would need to be reviewed. The aim is not to claw back
moneys that, because of efficiency, had arisen as a
surplus.
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
those—we would argue—so 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
of support that they need, get to the end, evaluate it and have an
outturn date which is within approximately three years of the start of
the pilot schemes. That is why there is a difference in terms of two to
three years.
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