Clause 11
Health Bill [Lords]
10:45 pm
Mike O'Brien (Minister of State (Health Services), Department of Health; North Warwickshire, Labour)
It is our intention that we should properly evaluate all these trials. These pilots are enormously important for assessing the impact of direct payments and it is right that we should have a full and comprehensive evaluation of them. The Liberal Democrats’ amendment would mean that we could not move forward with direct payments until all of the pilots had been completed. Some of the pilots may be delayed for all sorts of reasons. They may go beyond three years. They may have to carry on because of the health condition of individuals. Therefore we want some flexibility in the way in which we deliver the evaluation. We also need to make sure, however, that this evaluation is comprehensive. This is why we have a spread of 70 projects across a range of types of income, area and condition, so that we can have a proper assessment of where these projects would bring benefits from direct payments and where they would not. The hon. Member for Romsey is right to say that we need fully to evaluate this and that therefore we cannot try to rush through the evaluation. The evaluation, however, will be going on alongside the pilot. We do not necessarily always have to wait until the end before much of the work on evaluation takes place. One of the things we have to evaluate is how we get applications in. How well is it done? Who gets them? This can be done early on therefore and it can be evaluated well within the initial year. Therefore, we have a process of evaluation that evaluates the different stages of the pilot and identifies what works and what does not work. The main evaluation, however, will have to wait until the end so that we can look at the impact it has had on individuals.
We want to ensure that we involve all the key stakeholders—the patients, the staff, the voluntary organisations, the representative bodies—in looking at how direct payments work. It will be important in evaluating the impact of direct payments on particular conditions how not only individuals react to the handling of funding for direct payments but also how the various patient groups see the implications of direct payments on that condition. We may end up with an outcome that says that for particular conditions direct payments are beneficial, while for other conditions they are not. That is probably where we will end up, but let us see where it goes. We need to have a broad spread of the various types of direct payment pilots. We then need to have a full and proper evaluation of them. We need to involve the various patient groups, and that is our intention—it is not necessary to spell it out in the Bill. This would not be an effective evaluation of an important step for the NHS unless we involved the patient groups. In our policy statement “Personal Health Budgets: First Steps” we have specified that one of the principles of personal health budgets is to tackle inequalities and protect equality. Our advertisement for the evaluation, which was published in April, specifically asked research teams, who are now being recruited to conduct those evaluations, to consider how the impact of personal health budgets differs between patient groups, looking not only at health conditions but also socio-economic groups and patient characteristics such as ethnicity. The advertisement also asked teams bidding for the evaluation to consider how easily individuals from different groups can access personal health budgets and the support that they would need to do so. We are in the process of selecting the evaluation teams to do that. They will be responsible for ensuring that the views of all relevant stakeholders are considered in the evaluation process and that the impact of direct payments on health inequalities is comprehensively reviewed.
In summary, we want a broad spread in the size and nature of the different pilots. We want to ensure that we are looking at the different characteristics of both income and condition and that we have a spread, where we are able to get that, of particular conditions.