Clause 11
Health Bill [Lords]
10:30 am
Mike O'Brien (Minister of State (Health Services), Department of Health; North Warwickshire, Labour)
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.