§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Bryan.]
§ 10.0 p.m.
§ Miss Joan Vickers (Plymouth, Devonport)
I am very grateful to you for allowing me to raise this matter so early in this Session, Mr. Speaker, because it is one of very great importance. For a crippled person, it can make all the difference between really enjoying life and being put on one side. The possession of a motor vehicle provides him with the opportunity of being independent and self-supporting, despite his disabilities. It means the difference between living and existing. To a person who has an active and fit mind, a crippled body must be a very frustrating factor in life.
In putting forward the suggestions I wish to make, I hope that the Parliamentary Secretary will not attempt to answer at the points. It is essential that the matter should be looked into thoroughly. I am not asking for a final decision to be given now, but I want the whole policy re-examined.
The Conservative manifesto stated that the position with regard to certain vehicles—I believe those relating to ex-Service men who were crippled—was to be looked into. I hope this means that in future there will be a two-seater vehicle. When the war disabled have been given them I hope that we can look into the question of providing them for civilians.
When a disabled person, especially a paraplegic, goes on a journey in such a vehicle, although he has been helped into it by his friends or relations, he has little chance of getting out at the other end unless there is somebody to help him do so. It is therefore difficult for him to take part in social or even business activities unless he has a companion with him.
I want to consider the conditions under which these vehicles are allocated. I went to the Library to find out, and I was astonished to learn what a long time it took. I found that the librarians had 937 to get in touch with Blackpool in order to obtain the details.
It appears that chairs are allocated for two reasons: firstly, when the invalid has had both legs amputated, at least one above the knee, and is, therefore, regarded as being totally disabled; and secondly, when his injuries are slightly less serious and he needs a vehicle as personal transport to and from work.
I understand that the Ministry of Health wants to allocate all the vehicles as it considers that all types of vehicles should be regarded as an extension of the medical treatment already afforded to a patient. That is why the Ministry of Health is the issuing authority. If a disabled person is at work, however, he has been probably placed in work by an officer attached to the Ministry of Labour—an officer known as a disabled resettlement officer. This officer, in my opinion, should have the final say in the question whether the individual should be allocated a vehicle.
I understand, however, that all the final decisions in this respect are made in Blackpool. I admit that the officials there obviously have the relevant papers, but they cannot have the personal contact which is necessary in order to make their decisions, and the decision whether an allocation should be made is very important to the individual concerned. The present conditions are too rigid, and allocation is done from such a distant place that the person making it can have no real knowledge of the details of the case, except on paper. He does not know what the applicant really needs.
In paragraph 311 (iii) the Piercy Committee urged:Closer collaboration between the various Government Departments concerned, and perhaps a clearer definition of each Department's responsibilities.At the moment, the Ministry of Health, the Ministry of Pensions and the Ministry of Labour are all connected with the allocation of these vehicles. The Ministry of Labour, according to the Piercy Report, paragraph 88, advocate that they should have extra medical sessions for dealing with these particular types of case. Paragraph 311 (iv) goes on to stress that a single Government Department should take responsibility for issuing aids in order that there should 938 be no delay. It says that it is absolutely essential that there are no delays in the progressive conduct of the disabled person's treatment. I think that is very important.
The present time, according to my information, is anything between six and nine months' delay in the allocation of these vehicles. Furthermore, the Piercy Report talks about work aids and says that these should be issued by the Ministry of Labour. In the case of blind people, special Braille aids, special shorthand typewriters and so on are issued through the Ministry of Labour. The provision of hand controls for vehicles is also by the Ministry of Labour. Therefore, I think that anyone who is in work and who requires these vehicles should be able to come under the jurisdiction of the Ministry of Labour.
There is not enough liaison at the present time between the medical practitioner, that is, the patient's own doctor, the specialist and the Ministry. I know of cases where both the medical practitioner and the specialist said that it would be a very good thing if an individual had a tricycle, but nothing has happened and the application has been turned down by the Ministry of Health.
When these vehicles are allocated, I think it is absolutely essential to know something of the district in which they are to be run. I know that some people find difficulty in managing anything but an electric chair, but I suggest that, if possible, electric chairs should not be used in hilly districts. When vehicles are fitted with batteries, particularly in hilly country, such as the West Country, it is not possible to get more than 40 miles from one battery and there is always the difficulty of the battery running out.
There are a considerable number of accidents in connection with these vehicles. I think that many accidents occur because too little tuition is given to the individual when taking over a vehicle. I know that as little as half an hour's instruction is given to a person who has never had any previous driving lessons.
I also suggest that if the people who have these vehicles were given maintenance allowances they would be able to look after them even better. Service men get a maintenance allowance for their vehicles, but civilians do not. This gives 939 a far more independent feeling and people take far greater care of their vehicles when they have an allowance for them.
I know that nowadays some people can afford to buy their own cars, but to have hand controls fixed costs approximately £80 and the car has to be taken to special garages for this to be done. In Plymouth, if one wants to have hand controls put on a car one has to go to Bristol. I should like the Ministry to agree that the person who buys a car has the controls already fixed. I know of an ex-Service man who has travelled 90,000 miles in his car and the hand controls are re-fixed every five years. A similar provision would give great pleasure to civilians who would be able to take their families with them in their cars.
When a vehicle is allocated there is often a hold-up over the question of building a garage. The Ministry of Labour, which often has closer contacts with the local authority housing manager than has a Department situated at Blackpool, could get in touch with local authorities and arrange for garages to be built more quickly. I wish to quote one or two cases to illustrate my point about the difficulties over the allocation of these cars. I will not mention individual names. I do not want to do so because it is disappointing to people if their difficulties are mentioned and no action is taken, but I am prepared to give full details regarding names and addresses to my hon. Friend.
Mr. B. is aged 51 and suffers from the effects of polyomelitis. Both his legs are affected and he walks with crutches. He works in a Remploy factory. He has applied previously for a car, but his application was turned down and it has been suggested by his doctor that he should apply again. To get to the factory he has to leave home at 6.30 a.m. and travel on two buses. He does not arrive back home until 6.30 p.m., when he has to do all his own housework, including the cooking, as he lives alone.
Mr. P. is aged 53 and has been working at a bus depot. He was a driver. He had bad circulation in both legs and underwent a double amputation below the knees and so, under the present conditions, he does not qualify. His job is still open, and he wishes to know whether 940 he can make another appeal for a chair and does not want to have to wait six months or nine months before a decision is made.
Miss B. is a girl aged 18 who had polyomelitis which affected both legs. She has a job with Smith's Crisps. This happens to be a Plymouth case, and as we have in Plymouth an unemployment figure of 3.4 per cent., it is not easy to obtain jobs for people. She is able to walk with the aid of two sticks and she lives a good way from a bus stop. She must get up at 5 a.m. and leave home for work at 6 a.m. She works six days a week with a short day on Saturdays. She will not be able to carry on work unless she can get some form of transport.
Mr. P is in his thirties and crippled in both legs. He walks with the aid of crutches. He has a job in a British Railways inquiry office and unless he can obtain some form of transport he will not be able to carry on. His wife is disabled and he has two small children, so it would make a great difference to him if he has to give up his job.
Mr. V. was also a bus driver. He is aged 57. He suffers from a spinal disease affecting both legs and has to wear callipers. He has to travel nine miles to get to work. He works on a shift system from 6 a.m. to 1.20 p.m.; from 1.20 p.m. to 8.40 p.m.; from 9.40 p.m. to 5 a.m. and from 10.40 p.m. to 6 a.m. On 9th October, 1959, his application was refused. I have here a petition signed by nearly 400 of his fellow workmen, asking that his case be reconsidered.
Finally, I wish to bring to the attention of my hon. Friend the case of Mr. P.S.B., who is aged 37. He is crippled in both feet. He was allocated a tricycle for which application was made in January, 1955. He waited until November, 1955, by which time nothing had been heard, so I wrote to the Ministry on his behalf and the tricycle was finally delivered on 16th December, 1955. In January, 1958, the tricycle was taken away for repair. At the time this man had a part-time job. On 8th August, as the tricycle had still not been returned, I made further inquiries and was told that it had been decided not to return it although up to the time when I wrote the man was still waiting for it. On 30th September, 1958, it was suggested that he should have 941 another medical examination and, on 13th October, his application was turned down. There was further correspondence on 1st January, 6th March and in June of this year. Only yesterday, I received a note from this man saying that he had been called for another medical examination on Friday, 13th November, which I hope will prove a luckier date for him than were the previous examinations. That was a case of a man who was allocated a tricycle and it was taken away for repairs. Only through my writing to the Department could we find what had happened. I consider this "cat-and-mouse treatment" and not good enough for these people suffering from disabilities.
I realise that the Piercy Committee's Report said in paragraph 136 that the whole question of helping the disabled to use public transport needs further study. This may be one of the replies I shall receive tonight. The Committee recommended that this should be done, but unfortunately I have seen no report that any help is being given to these crippled people to get public transport.
I hope I have said enough this evening to convince my hon. Friend that all is not well. I hope she will look into the points I have raised and bring some necessary improvement into the services which I think could be of even greater benefit to the disabled.
§ 10.16 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)
My hon. Friend the Member for Devon-port (Miss Vickers) began by saying that this debate was of great importance, and I agree. The fact that my two colleagues, the Parliamentary Secretary to the Ministry of Labour and the Joint Parliamentary Secretary to the Ministry of Pensions and National Insurance, have also made time to be present for it shows my hon. Friend, I hope, the importance that we all attach to this subject. I know that she feels that it is a matter of concern, and that concern is shared by hon. Members on both sides of the House. I say at once that it is shared by my Ministry, too. We regard this as an important part of our work and one which needs sympathy and understanding in the problems of the disabled.
942 Where need is proved and supported by medical evidence, and it is in the interest of the patient, we are concerned to provide the right kind of transport. The power-propelled invalid tricycle, either petrol-engined or electric, is one part of the very extensive service the Ministry provides for giving means of transport of one kind or another for the badly disabled. Under the National Health Service Act the Minister has power to provide to such extent as he considers necessary to meet all reasonable requirements, medical, nursing, and other services required at or for the purposes of hospitals.
It is under this power that he provides tricycles for National Health Service patients to give some mobility to those who have lost, or nearly lost, the use of their legs. This means that no one has an automatic right to receive a tricycle, because it depends on the medical and other factors, although, as I have said, the service is administered with the utmost sympathy. In passing, I should explain that war pensioner cases are slightly different, because those pensioners get their tricycles under the wider discretionary powers of the Royal Warrant.
The procedure in National Health Service cases begins with the general practitioner who refers the applicant to a consultant. The consultant has been given advice by my Ministry and knows the criteria we employ. He, in turn, sends a recommendation to the local appliance centre. The consultant may, of course, decide not to recommend, even if he considers that the patient falls within the medical category. He may think that the patient is not fit to control the tricycle, he may judge that one is not necessary, or that reliance on a tricycle might militate against the patient's improvement.
As I think my hon. Friend has implicitly agreed, there must be criteria for eligibility. Those criteria are not twofold. I am sorry to say that my hon. Friend must have been wrongly informed for there are four tests in considering eligibility. They are: double leg amputations with one above the knee, or paraplegia, the patient being virtually unable to walk, some other disability which results in total or almost total loss of both legs, or patients similarly but 943 slightly less severely disabled with very limited walking ability who, because of the disability, need a machine to get to and from work. Those criteria are the same as for war pensioners, but in borderline cases the fact that an applicant is a war pensioner creates a bias in his favour and I think that hon. Members will agree that is as it should be, because successive Governments have undertaken to take special care of war pensioners.
When a recommendation is received, the patient is examined by our doctors at the appliance centre, and I wish to stress the fact that our doctors are experienced in this kind of work. The case is then sent to the Ministry at Norcross, to approve or reject it, and I can say that the people at Norcross, both medical and lay, have long experience in the work. There certainly is the liaison for which my hon. Friend asks both between our local doctors and the consultants, because difficult cases are discussed, and our doctors go back to the consultant if there is any point which needs clarification, and if the consultant's case is rejected, our doctor explains the reasons to him.
The number of tricycles on issue is increasing and the service is expanding. I should like to give the House some comparative figures, because they confirm my point that the service is administered with sympathy and understanding. For England and Wales, in 1951, the number on issue to war pensioners was 1,378 and to National Health Service cases, 4,860, giving a total of 6,238. In 1955, the respective figures were 1,768 and 8,720, a total of 10,488. In 1957, they were 1,794 and 10,265, a total of 12,059. In 1959, they were 1,733 and 11,285, a total of 13,018. In addition, we have a substantial number of machines held as spares in the regions for replacements or temporary service.
The service is very expensive. We have to meet the capital costs of machines for approved new applications—about 1,600 a year. We have to provide replacements of older machines, about 1,300 in the last twelve months, and we have to meet expenditure on sheds to house the machines and on maintenance and repair, which we pay for. Sometimes the machines which we supply are not used as carefully as they 944 might be. Excluding expenditure on salaries of staff, the annual cost in England and Wales is about £1½ million a year.
If we gave machines to all who would like to have them, the cost would certainly increase enormously. There must be some kind of control, as my hon. Friend will appreciate, and, to ensure general fairness and common standards all round, we are sure, as was the Ministry of Pensions which administered the scheme before 1953, that the approval of all applications must be made centrally. At one time, the Ministry of Pensions approved applications at its regional centres, but that resulted in a general unevenness in standards.
To go back to a purely local decision in the case of those whose machines are required for employment, as my hon. Friend suggested, would, I think, have the reverse effect to what she has in mind. Indeed, the interpretation of the criteria by local people might vary in different areas, and would breach this principle of fair and equal treatment between the disabled.
I want to stress and reassure my hon. Friend that we do receive full reports from the centres about all the applications they submit, and we take full account of local conditions. My hon. Friend knows that we do take advantage of local information, and, in particular, we certainly know the local geography in some towns. I can support my hon. Friend's point about Plymouth being hilly, because I have toured that district many time myself. We take all these local circumstances into account.
To go back to the criteria, the first three categories are clear enough, and those are the patients to whom we think our first attention should be given. It is the fourth category—the not quite so serious disablement with need for a machine to get to work—which is the difficult one, and this is the one in which my hon. Friend is most interested. A large number of disappointed applicants claim to fall under it, and they are the source of many letters from hon. Members, including my hon. Friend. We go into these cases with the greatest care and we examine all the factors, both medical—that is, the degree of disablement and the walking disability—and 945 lay—that is, the walking distance involved in getting to work. About 3,000 tricycles are on issue in England and Wales to patients in this category.
This fourth category, which we call the employment category—though many who get tricycles in the other categories are employed—is, in a sense, a concession. Our first duty under the National Health Service Act must be towards those who have lost or virtually lost the use of their legs, and these people in the employment category can get about a bit.
The important point is that the applicant must be seriously disabled. I think it natural that some of the disabled should feel that they need or would like a tricycle to get to and from employment, but we have to consider the degree of disability and the extent to which such a person can walk. We look at each case on its merits, examining the walking distances involved in their journey, the public transport facilities and other factors, which are contained in the instructions which we issue both to the consultant and to our own people.
In many instances the type of case which hon. Members take up is that in which a patient claims that he cannot look for work without a tricycle. We say that we cannot give a machine for this reason alone unless a patient qualifies automatically because he is virtually unable to walk. There are two reasons for this. First, it is not easy for us to withdraw a machine, once it is issued, in those cases where a person does not take up employment. The second and more important reason is that until we know where the job is and the difficulties of getting to it, we do not know whether there is a need for the machine.
Nevertheless, the patient is not left stranded in a search for a job, because this is where the Ministry of Labour comes in, and the appliance officer at the Ministry works closely with the disablement resettlement officer of the Ministry of Labour. Furthermore, the Ministry of Labour can and does help patients to get interviews, and, once we hear of a firm offer, where the patient is medically eligible and in our opinion cannot get to it without a tricycle, we give him one quickly, possibly one of the spare machines which I have mentioned. 946 This arrangement works. I have no evidence, nor has the Ministry of Labour, of anyone losing opportunities of work.
Turning to the need to speed up allocations, we have never been able to supply tricycles generally with great speed because it takes time to go through this procedure, but those who need machines for employment are given priority.
We pay a fee of three guineas for tuition, and it is laid down in the instructions that people who teach applicants must give at least three hours tuition. I am surprised to hear about the half-hour tuition mentioned by my hon. Friend. I will show her the circular and discuss that point with her.
My hon. Friend also asked about the conversion of private cars to hand control for the disabled. I am happy to reassure her, because this facility is already available for both the National Health Service patient and the war pensioner. If a patient is eligible for a tricycle but prefers to drive his own car, we pay towards the cost of conversion from foot controls up to a limit of £70, which covers the cost of most conversions.
My hon. Friend referred to two-seater vehicles. The passage referring to war pensioners in the election manifesto issued by the Conservative Party reads:Particular attention will be given to providing more suitable vehicles for the badly disabled.I answered a Parliamentary Question on the subject by saying that my right hon. Friend is considering this matter.
I wanted to answer the points made about the Piercy Report, because. although they did not have much bearing on the provision of tricycles, they had a bearing on the work for the disabled, but since there is no more time I will write to my hon. Friend on the subject as well as on any other points which I have not been able to include in my answer.
In a service like this we must have standards. While we all know of hard cases, a line must be drawn somewhere. Nevertheless, I should like to feel that this part of our job is administered with 947 sympathy. My hon. Friend concluded by saying that she wished to enlist my support in studying the matter. She has already done so by the work which I have done in order to be able to answer 948 her tonight, and I promise her that that study will continue.
§ Question put and agreed to.
§ Adjourned accordingly at half-past Ten o'clock.