Amendment 70, in clause 29, page 37, line 20, after services, insert
, unless such exclusion would prevent P from achieving the matters set out in subsection (2).
Amendment 49, in clause 29, page 37, line 21, leave out paragraph (a).
Amendment 70 seeks to deal with the situation in which all the services are not totally devolved. In the case that I quoted of someone going to university, it obviously made great sense for direct payments from the health authority, the local authority and the university to be put in one pot to provide a service. That worked out cheaper in the end, and also meant that only one group of people was looking after his needs. I welcome what the Government are planning.
The hon. Gentleman outlined a particular constituency case of his in which a great deal of effort was taken to get organisations working together. One of my concerns stems from a point that was raised during an evidence session in which Paul Davies specifically talked about the difficulties that his organisation had had in integrating Access to Work funding. He said that the officials that he works with in the Department for Work and Pensions
worked their socks off to make it work.[Official Report, Welfare Reform Public Bill Committee, 10 February 2009; c. 8, Q4.]
Therefore, there was no lack of desire to make it work. It was simply that within the rules and regulations, it could not be done. That is why I want to ensure that the Bill gives Ministers the power to set the regulations so that officials, despite wanting to make it work, are not hamstrung by rules and regulations.
I agree with the hon. Gentleman. There are two scenarios. In the previous clause, we dealt with a situation in which an authority is not willing to allow direct payments to be introduced. When it comes to clause 29, where we are talking about relevant services, the question is how we ensure that the various packages are available. As I have said, the process will not be appropriate for everyonenot everyone will want to access direct paymentsbut we must ensure that where there are circumstances in which someone needs to do something, the Minister, through the pilots and hopefully on to the general, has the wherewithal to ensure that that happens. I look forward to the Ministers response.
I thank the hon. Members for Forest of Dean and for Rochdale for raising these issues. There is a consensual spirit on the right to control. By talking about his constituent going to university, the hon. Member for Rochdale gave us a helpful illustration of the benefits that people could derive from such a scheme. He advised me in the margins that his constituent is now in his second year, and we wish him every success. The hon. Gentleman showed us how the measure can be practically applied, and the difference that it can make. His constituent is now in the driving seat; he is the one with the power. That may have been inconceivable only a few years ago, when we focused on what the producer provided. Public policy has shifted, and now there is a consensus that we want to empower the individual.
The hon. Gentleman talked why social care was not on the face of the Bill. I will come to that point later, but it is important to note that he talked about the primary care trust, which is about the health budget, rather than the social care budget that goes to the local authorities. I will explain later what we are doing about that. One can envisage its being easy to identify particular parts of a health budget that an individual is receiving. For example, one can see how chiropody services could be personalised. Dialysis, on the other hand, might be more difficult. I am talking here about providing that service to a particular community. The hon. Gentleman and I had a discussion about that outside the Committee. If a dialysis operation is to be economic, the number of people receiving the operation must be sufficient to allow expertise to be built up. I think people can understand the practical differences. That is why the Health Bill, which is now passing through the House of Lords, will provide opportunities for those pilots. In comparison with social care, it is a little less tangible and a bit more difficult to identify particular funding streams within the PCT budgets that one can put into a right to control individualised budgets.
We have experience in relation to social care. The hon. Member for Forest of Dean mentioned the pilots that we have already undertaken and we have had some evaluation of those, which in the main has been positive. It is not the promised land for everyone and we should not get too heady and think that this is the solution for every single one of our constituents, because it is not. In the pilots, a number of elderly people in particular found it difficult to manage such budgets. We perhaps need to find other ways to ensure that they are still in the vanguard in terms of shaping services. Again, there is a consensus in terms of public policy that that is what we want to do. So there is provision within existing legislation that allows us to direct for personal social care budgets. It is important for me to get some points on the record. Those were the immediate issues that arose from the hon. Gentlemans contribution, but I will make some further detailed remarks. Of course, I would welcome any interventions from hon. Members.
As I mentioned in the evidence that I gave on 12 February, to which the hon. Member for Forest of Dean referred, the exclusion of community care in the Bill is to ensure that we do not duplicate or cause confusion with existing powers. The Bill makes provision for disabled adults and therefore excludes community care and other care services that apply to people under the age of 18, as we discussed this morning. Disabled children have different needs.
Legislation relating to community care services is defined in the National Health Service and Community Care Act 1990, which is an Act that I remember well because I was completing my training as a social worker at that time. Indeed, an interesting parallel between that piece of legislation and the Bill is that there is a political consensus. That bodes well for the people who are recipients of services. However, although we celebrate some consensus in terms of ensuring that the services are better delivered and of a higher quality for our constituents, it is important to remember that the Bill does not suit everyone. One of the criticisms of the 1990 Act was that there was perhaps too much of a consensus and not enough questions were askedthe hon. Gentlemen may consider that an invitation.
The Government set out their vision of the personalisation of public services generally in the cross-government concordat, Putting People First. Local Authority Circular DH/2008/1 set out what that would mean specifically for adult social care. It states:
Everyone, with support if necessary, will be able to design services around their own needs, within a clear personal financial allocation.
The circular recognises that
With self-directed support, people are able to design the support or care arrangements that best suit their specific needs.
The circular also sets out the system of personal budgets that will deliver choice and, importantly, control. The changes detailed in that local authority circular mirror the changes that the Bill sets out in order to achieve better public services. The right to control and the current changes to the delivery of adult social care will together enable the implementation of the Governments commitment to empower disabled people, and ensure that choice and control are recognised as a right.
The Minister refers rightly to the steps that were taken in the adult social care area in relation to personal budgets and direct payments. One of the striking factsI know he is aware of thisthat came through in the evidence that we had from Paul Davies from Oldham metropolitan borough council was that of the 1.75 million people across the country who use adult care services, only 10,000 have a personal budget. The Minister is quite right: a personal budget, and the direct payments that may or may not go with it, is not the solution for everyone. However, only 10,000 people out of that 1.75 million have a personal budget, the evidence shows the benefit to many people of having one, and fully one fifth of those 10,000 people were in Oldham. So, with the legislation that is already in place and the welcome concordat that he discussed, does he think that we are going at the pace whereby, although those disabled people may never want to use the right, they will have the rightthat those who want to use it will genuinely be able to exercise it under the current legislative arrangements?
The hon. Gentleman makes an entirely reasonable point. My constituents have individualised budgets, and I was speaking to a constituent recently. He fired his carers and got some new ones, whom he has had for the past 18 months and for whom he is full of praise. That is inconceivable for the majority of people who will not be in that advantageous position, so I say to all local authorities that if they can get on with such work, they should. A balance must always be struck, because there is a consensus around devolving power, and around authorities making those decisions for the people whom they represent, while the Government work in partnership with them.
The hon. Member for Rochdale talked about the PCT and health budgets, and the hon. Member for Forest of Dean referred to the Access to Work budgets and to the budgets for disabled children, so there is quite a lot going on. By finding out what works best, we shall be in a strong position to show the overall picture. If we do not play our part and adopt the approach that we have advocated, things will happen more slowly. We do not want example after example of the cases to which the hon. Member for Rochdale referred; we want everyonenot just local authorities, but disabled people and their organisationsto be very clear about the situation. I shall talk more about the health budgets in a minute.
The Minister referred to the balance between directing local authorities to do things and giving them the powers, and we touched on it during the evidence-taking sessions. He is quite right that there is an emerging consensus around the importance of localism, but that is not an end in itself; it is a means to an end. It is about whether we believe that if central Government give local authorities more control, individuals will receive better services, because that is the end goal. It is all very well giving local authorities the powers to do things, but if disabled people want something to happen but the local authority is not very keen to get on with it, we must ensure that the disabled person gets the powers and the local authority does not stand in the way. How does the Minister think that the balance will be best achieved, remembering that the goal is to benefit the citizen, not necessarily the local authority?
I agree with the hon. Gentleman that it is the consumers interests not the producers that I have at heart, but we believe that instituting pilots for the different funding streams will give us a better picture, so that all the arrangements that one can envisage being available to everyone in a few years time will be available more completely and readily. I do not go to the Department every morning thinking, How can I stop this measure? and I am sure that the hon. Gentleman knows that; I go to the Department to work with my colleagues across Government to deliver it as quickly and speedily as possible, but with the complete picture, so that we do not experience the frustrations that the hon. Member for Rochdale mentioned.
It is important to talk about health budgets, but they are separate from social care budgets. We should also accept that the way that we organise society and the institutions that provide such services are not really the preoccupation of our constituents: the consumer, the individual, the citizencall them whatever you want. Their preoccupation is how they live their lives, the care and support that they receive and access to employment or college, for example; they rely on a number of different services.
So we want flexibility to be available through a range of services, and that means exploring options available in many areas. The Department of Health is currently introducing legislation to pilot health budgets that will allow people to take direct payments, with patients being given a budget to manage themselves, with regulations providing clear guidelines. That is important. Personal health budget money may be spent, for example, on social care where it is likely to improve health or well-being. I think that all Committee members would support that.
With the right-to-control trailblazers we will be exploring the more flexible use of funding streams, too. People will be able to have more choice and control over how they achieve their outcomes. We will be looking for alignment or collocation with other similar pilots, such as on individual budgets for children and health budgets. We hope to present as seamless a provision of services as possible for peoplefor the customerreceiving social care direct payments, personal health budgets and a right to control services.
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 relativeI 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. Gentlemans 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.
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.