MPs backed legislation to extend direct payments to health services, but called for greater clarity on how the system would work, in a House of Commons debate yesterday.
The Health Bill would permit the use of direct payments for NHS care, enabling the government to pilot the use of personal budgets for healthcare users.
High Court continuing care ruling
Disability and human rights campaigners are hoping that the legislation will mean that people assessed as eligible for NHS continuing care are no longer barred from receiving direct payments, as was confirmed in a High Court ruling this March concerning two disabled people.
In his first Commons appearance as health secretary, Andy Burnham said that 70 pilots will begin next year to test the viability of applying direct payments and personal budgets to health.
He said that direct payments would only be rolled out nationally in NHS care with the approval of Parliament, through secondary legislation.
‘Health must follow social care’
However, he said it was time for health “to proceed in the same direction” as social care in giving users more control over services, “especially when we can bring the two budgets together for people with particularly complex health and social care needs”.
Many of the primary care trust-led pilots will be focused on people with long-term conditions or mental health needs, but Burnham said he would not be prescriptive about how and where personal health budgets should be used.
Shadow health secretary Andrew Lansley supported the proposal, but said he was “seriously worried” about some PCT commissioning practices, which he said could deny choice to personal budget users. These included the use of reverse online auctions, under which care contracts are awarded to the lowest bidder.
Conservative MP George Young called for clarity on whether direct health payments could be used to top-up personal social care budgets. “When a patient is also a social services client, will the PCT simply put the direct payment into that pot, or will it set up a separate one with its own NHS rules?” he said.
Young pointed to a briefing by think-tank the King’s Fund, which said top-ups would not be allowed under direct health payments, whereas they are in social care.
Running out of money
Liberal Democrat shadow health minister Sandra Gidley questioned what would happen if patients with long-term conditions, who may deteriorate, ran out of money from their direct payment.
She also asked whether people with multiple conditions would have to go separate assessments, with each contributing to a direct payment pot, or “be treated as a single patient”.
Concluding the debate, care services minister Phil Hope promised the pilots would explore all the issues raised, alongside an independent evaluation. “We will roll out direct payments for healthcare only after a review of information gathered from the pilots,” he said.
Other measures in the bill include allowing self-funding social care users to make complaints about provision to the local government ombudsman, a route currently open to publicly-funded care users. Self-funders currently have no independent recourse for complaints.
Direct payments: ‘Law change needed to protect human rights’