§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Humphrey Atkins.]
§ 10.16 p.m.
§ Mr. Christopher Woodhouse (Oxford)
The Minister will be aware that, like other Members, I have long been concerned about the provision, under the National Health Service, of suitable vehicles for disabled drivers—and by "suitable vehicles" I mean, for reasons which I will elaborate, four-wheeled mini-cars rather than the three-wheeled vehicles which are at present provided for them.
I first raised this matter in 1963 with the present Chancellor of the Exchequer when he was Minister of Health, and I was about to raise it again when I was temporarily interrupted by the 1966 General Election. I am glad to say that during my absence a number of Members kept this subject very much alive, including my hon. Friend the Member for Banbury (Mr. Marten), the hon. Member for Manchester, Wythenshaw (Mr. Alfred Morris), and my immediate predecessor as Member for Oxford.
I am glad that in the intervening years the right to the four-wheeler mini-car has been slightly extended. There was a small extension to two new categories of disabled people in July, 1964, which brought in 300 eligible drivers and there was an extension to three more new categories in February, 1967. The latter extension was expected to bring in about 1,600 new eligible drivers, but, according to information available at the end of last year, it brought in only 200. That discrepancy is very significant because, according to the Haemophilia Society, there are only 3,000 haemophiliacs in the United Kingdom of whom only about 100 would be eligible to qualify for a vehicle. I initiate this debate on their behalf in particular.
There is no danger of opening the way to a flood of additional applications by extending, under the National Health Service, the right to mini-cars to disabled haemophiliacs. Moreover, the extra cost of supplying a mini-car instead of a three-wheeler, according to information 754 brought out by a Parliamentary Question in December last year, would be under £30 per annum, covering the capital and running costs, so that the total cost of the extension which I and some of my hon. Friends ask for would be only about £3,000 a year.
This concession would not lead to demands in similar cases which could not logically be rejected, because there are no similar cases. Haemophiliacs are a unique and easily identifiable small group among the disabled. For many reasons they deserve to be, and have to be, treated as special cases. The principal reason for this is that they are peculiarly vulnerable to any kind of physical shock. If a haemorrhage occurs while they are driving, very expensive treatment may be needed which, over the lifetime of a vehicle, would probably cost more than the difference between the annual costs of a three-wheeler and a four-wheeler. I am told that in some cases they would need blood transfusions which would cost as much as £15 a time.
Since haemophiliacs cannot be accompanied by a passenger in a three-wheeled vehicle, because it is both illegal and physically impossible to carry a passenger, they are in a desperate position if a mishap occurs. That such mishaps may occur is shown by evidence from many doctors and sufferers. I have the latest list which was published by the Haemophilia Society in August of this year, a copy of which I will send to the Minister tomorrow. Within the last 24 hours, since it became known that I was initiating this debate. I have had a number of telephone calls and letters bringing to my attention more cases, including the case of a disabled driver who was recently stuck on the roadside for several hours in his three-wheeler because nobody observed him or thought he was in trouble. He was unable to get out or summon help.
None of these cases will be surprising to anyone who has actually driven a three-wheeled vehicle, as I have, and as I know my hon. Friend the Member for Banbury has. To anyone used to driving an ordinary car, the gears are extremely clumsy, the steering is very unsteady, the three wheels are inherently unstable and the machine is grossly under-powered for even the slightest incline. I recently drove one round the grounds of the 755 Churchill Hospital, and my mind boggles at the thought of what might have heppened had I tried to take it out on Headington Hill.
I understand that a new improved three-wheeler is planned. It was announced in October, 1968, but is not yet in production. Even if it comes into production, its components will have to be imported from abroad—from Austria, Italy and the United States. Representing as I do a motor manufacturing constituency, I can assure the Minister that that would never be necessary in the case of the mini-car. The reports of those who have tried this prototype, including one of my disabled constituents, are far from encouraging.
The advice of haemotologists who have special experience of these problems is, I am sorry to say, still being ignored. A clear preference for a four-wheeler rather than a three-wheeled vehicle, even an improved three-wheeled vehicle, has been strongly expressed by, among others, Dr. Rosemary Biggs, the director of the Haemophilia Centre at Oxford, Dr. Rizza, her consulting physician, Mr. J. W. Goodfellow and Dr. P. J. R. Nichols, both of the Orthopaedic Centre in Oxford. The consensus of their views is not only that a comfortably upholstered mini-car is greatly preferable to the present three-wheeler, but also that the mini-car has two advantages which cannot be matched even by the new improved three-wheeled vehicle. The first is the greater stability of four wheels over three wheels—and anyone who has tried driving three-wheeled vehicles in even the mildest wind will know how serious that is. The second is that the mini-car can carry a passenger and this may be necessary in the case of many disabled drivers.
Since I have mentioned four Oxford doctors the first two of whom I have consulted personally it will be obvious that I have regarded it as my personal duty to raise this subject in the House. I have an additional reason for raising this subject which is that one of the most active figures in the Haemophiliac Society is also one of my constituents, Mr. Peter Macbray, who is himself a haemophiliac and has lost both his legs. Apart from paying tribute to his courage and tenacity 756 and inexhaustible good humour, I wish to stress that he has no personal benefit to gain because he has already bought himself a mini-car and adapted it with the help of a National Health Service grant. But of course before a disabled driver can benefit from such a grant he or she must first buy their own car and many cannot afford to do so. I am told that the adaptation grant will not be paid on second-hand cars, which again is a handicap for those who cannot afford a new one. But it is surely better to provide them with reliable means to go out and earn their living rather than to force them to stay at home permanently dependent on the State.
I wish to end with one question and three brief requests. The question is whether I am right in believing that the Minister now has power which his predecessors had not, without fresh legislation, to extend the right of obtaining a mini-car from the N.H.S. to this small group of about a hundred people without more aid. I understand that this is the effect of Section 31 of the Health Services and Public Health Act, 1968. If this is so, my first request is that the Minister should do so. My second request is that, if for any reason he cannot do so, he should provide adequate financial help towards the purchase of a mini-car rather than simply give a grant for adaptation. My third request is that as the Prime Minister is due to meet a deputation of the disabled driver in his constituency the day after tomorrow the Minister should arrange for a record of tonight's debate to be included in his brief.
I have seldom known an Adjournment debate at this hour in which so many hon. Members have wanted to support me and perhaps to join in. Therefore, I will conclude so as to give them an opportunity to take part.
§ 10.27 p.m.
§ Mr. John Wilkinson (Bradford, West)
I wish briefly to raise a few matters mainly concerning quadraplegics who have suffered badly in recent years. In fact, up to five years ago no vehicular transport at all was provided for them. Now they are able to get electrical vehicles, but they are very inadequate for their purpose. They have been unjustly discriminated against and yet they are the worst disabled category of all. They also receive no tax relief and their motor 757 vehicle costs a fair amount to maintain. This should be taken into account in regard to the poorer-off disabled.
It is clear from Section 20(1,a) of the Chronically Sick and Disabled Persons Act, 1970, that there was to be no statutory provision prohibiting or restricting the use of footways by disabled people. Yet in practice this has not occurred. I will quote a letter from the Department of Health and Social Security to one of my constituents who is totally incapacitated. It reads:I am writing about the powered indoor chair provided for use by this Department. The passing of the Chronically Sick and Disabled Persons Bill has led to some publicity about the use of powered chairs on the pavement. Although it is no longer illegal to drive certain powered chairs on the pavement, I would like to remind you that the powered chair issued for your use by this Department was supplied for indoor use only.In other words, these people are not provided under the National Health Service with a proper outdoor vehicle and are not able to get around at all outside their own homes, unless they are rich enough to afford special transport.
Lastly, in regard to the design of these vehicles, it is interesting to note a fascinating letter that appeared in the British Medical Journal on 31st October, 1970:Why in this age of space travel can we not design a reasonably efficient wheelchair?The writer goes on to describe the faults in a number of vehicles for seriously disabled people, and I should like to draw the attention of the House to some of them. First, none of the contemporary vehicles is ergonomically sound, and a lot of research has to go into this. Second, footrests are insufficiently adjustable. Third, the electric chair has no brakes at all. Fourth, bicycle wheels are totally unsuitable. There are many other faults, and all these should be looked into, because these are matters to which we should all be addressing ourselves.
§ 10.30 p.m.
§ Mr. Alfred Morris (Manchester, Wythenshawe)
I congratulate the hon. Member for Oxford (Mr. Woodhouse). It will be appreciated that what is now the Chronically Sick and Disabled Persons Act was preceded by lengthy discussions about the problems of severe haemophiliacs. This is an extremely 758 sensitive problem. I am pleased to see present the hon. Member for Banbury (Mr. Marten), who has a most distinguished record in this matter.
As the hon. Member for Oxford said, the position of the severe haemophiliac is desperate if he meets a difficulty. I commend to the Minister what has been said by the Haemophilia Society, that there is increasing concern at the injuries that have been caused largely from the use of tricycles, at a cost of many thousands of pounds to the National Health Service. Hon. Members will recall the disabled driver who spent the night in a ditch. Fortunately he was only a disabled person paralysed from the waist down. Had he been a haemophiliac, he could have died. I ask the Minister to consider the case presented by the hon. Member for Oxford against the background of that possibility.
Mr. Graham Hill, a distinguished user of motor cars, has been in touch with the hon. Member for Banbury and myself, as have motor manufacturers, to say that we could have a four-wheeled vehicle as cheaply per unit as a three-wheeled one. I ask the Minister to do what we were hoping would be done during the proceedings on the Chronically Sick and Disabled Persons Bill; namely, to give four-wheeled vehicles to severe haemophiliacs who desperately need them, as has been shown by the excellent speech of the hon. Member for Oxford.
§ 10.33 p.m.
§ Mr. Neil Marten (Banbury)
I congratulate my hon. Friend the Member for Oxford (Mr. Woodhouse) on initiating this Adjournment debate and also on what he said. It is interesting that he, for Oxford, and my hon. Friend the Member for Abingdon (Mr. Neave) and I are here for this debate. I think that this is largely due to Mr. Peter Macbray, and also the fact that we have the Churchill and Radcliffe Hospital in Oxford and we have become interested in this matter.
I hope that the Minister will not for one moment fear extending the category to the hundred or so haemophiliacs whom my hon. Friend mentioned, because his Ministry has been rather wide of the correct figure in the past. My hon. Friend ought not to pay over-much attention to the estimates that it makes, because it has been wrong in the past.
759 I hope, too, that my hon. Friend will not forget about the disabled passenger, the person who is so badly disabled that he cannot drive himself. I hope that my hon. Friend will undertake to speak to his right hon. Friend the Chancellor of the Exchequer to try to get some relief for these people, because they are one of the top priority groups of people whom we ought to be looking after.
§ 10.34 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
I begin by saying how agreeable it is to have my hon. Friend the Member for Oxford (Mr. Woodhouse) back in the House and speaking on this subject again. He says that it is seven years ago that he first raised this subject: it seems but a moment. I am grateful to him for choosing this subject.
There is little doubt that for many of those who cannot walk or whose walking is very limited the invalid vehicle service is vital to their wellbeing and we give a good deal of care and attention to this. It is right and proper that from time to time we should consider whether the service should be improved or extended, and, if so, in what ways; and whether its benefits should be more widely shared.
Let me say a few words about the vehicle we supply because there has been some criticism of it here and outside. Some of the criticism has come from non-disabled drivers, accustomed to handling ordinary cars, who find it difficult to appreciate the particular advantages it provides for invalids especially compared with the vehicles with which the service started at the time of the Great War. It is easy to get into—something we cannot say about small modern cars—it has an uncluttered floor space, it can easily accommodate a wheelchair. Perhaps of most importance, it is suceptible to very many custom-built variations to cater for a wide range of individual needs. No wonder there are many who can use an invalid three-wheeler without adaptation which would be beyond the scope of the service but could not drive a car, and others who would find driving a car much more fatiguing.
§ Mr. Ernle Money (Ipswich)
Would my hon. Friend bear in mind the very strong feeling among the disabled as a whole 760 that this places them in a special category of driver, who cannot, unlike any other driver, carry their families with them? This means that if they are going up to London, their families and their luggage generally have to travel by train, thus making second-class citizens of this group?
§ Mr. Alison
I register my hon. Friend's point. I shall have something to say about this. If I do not satisfy him, perhaps he will have another go at me.
§ Mrs. Elaine Kellett (Lancaster)
Would my hon. Friend please remember that paralysed women with small children find it difficult to do their shopping because they have to leave them behind or in the care of a neighbour?
§ Mr. Alison
Mothers who are themselves disabled and would be eligible for a three-wheeler but who have children of school age would be eligible for four-wheelers, motor cars.
§ Mr. Alison
But children of school age at any rate. I will look into the point about babies.
I do not want to sound complacent. We are not satisfied with the given vehicle at any moment and we think that there is scope for improvement. The House knows that we expect next year to have in production a much improved version, with a bigger engine and automatic transmission and a number of other improvements. I have tried one, as has my hon. Friend the Member for Banbury (Mr. Marten); there is no doubt that it is greatly improved and more powerful.
I accept that many people would still prefer a car. I should try to explain why cars cannot be made more readily available. We do supply cars to some users—war pensioners for example—and it is still the House's view, I think, that we should continue to acknowledge the special position of war pensioners in this way. We also make cars available to some National Health Service patients; for example, disabled parents who have been left alone to care for small children—not babies.
Nevertheless, thousands of others who would prefer and could use a car cannot, under the realities of the parameters within which we work, have a car as 761 such from public funds. The inescapable fact is that it would cost much more to make cars generally available instead of three-wheelers.
This is not because of such a difference in the unit cost. In fact, there is not much difference in the price of a car to my Department and one of our three-wheelers. It is the total consequential difference that is important. There are more than 5,000 disabled persons eligible for a three-wheeler who at the moment content themselves with a five-yearly grant for the conversion of the controls of their own car; their vehicle is also exempted from excise duty. We expect that almost all of these would want a car from us if one were available free of charge and this would increase the cost very considerably. Then again, we believe that the availability of cars would in itself attract more applicants.
§ Mr. Alfred Morris
Is the hon. Gentleman aware that the demand is so great because the vehicle is so unsatisfactory?
§ Mr. Alison
I assure the hon. Gentleman that, as the custodians of the invalid vehicle, we are never satisfied that we have the perfect model and that we are always aiming to improve what we have.
§ Mr. Alison
I must not give way much more. My hon. Friend the Member for Oxford is anxious to raise a point with me. As this is his Adjournment, I trust that my hon. Friend the Member for Ipswich (Mr. Money) will forgive me if I do not give way to him.
§ Mr. Woodhouse
Is my hon. Friend aware that my request was made on behalf of only 100 easily identified disabled drivers and that to allow this request would not open the flood gates to all sorts of new applications?
§ Mr. Alison
Nevertheless, my hon. Friend will appreciate, as my hon. Friend the Member for Bradford, West (Mr. Wilkinson) pointed out, that there are a number of other special categories—paraplegics, quadruplegics and others—who would come forward, and it would be difficult to know where to draw the line.
762 Nobody is talking about flood gates being opened in this matter. The suggestion is that cars should be made available simply on the ground that a particular category is not capable of using the standard invalid three-wheeler. However, as soon as one admits that principle, one must open the flood gates to many more, both in total numbers and in particular categories.
This does not mean that we should stay as we are and make no changes. We have been examining the vehicle service in detail in the past months; studies are still continuing, so the House will understand that it would be premature to anticipate any conclusions. I hope that it will be possible to refashion it so as to enable us to be more flexible in the manner in which our help is given. This I believe is right.
My hon. Friend the Member for Oxford stressed in particular the special need of haemophiliac patients for cars. Let me make one point clear to avoid any misunderstanding. Persons suffering from haemophilia are not, as such, eligible for a vehicle. They qualify if they are disabled—often as a result of the haemophilia—in such a way that their walking ability is very limited. In this they are no different from any other disabled person; and, in fact, because of this their need in the way of a vehicle is in general the same as other disabled.
The advantages of an invalid three-wheeler are as real for the eligible haemophiliac as for any other user. It is true that some special facilities may also be of help, and I would like to pay due recognition to the way in which the Haemophilia Society has presented its case in support of this. But I am afraid we are not persuaded that the haemophiliac user has a greater claim for a car than other groups.
It has been asked why we ignore the advice of eminent consultants in haemophilia. We do not ignore it. We are grateful for it and take much notice of it. So, too, do we take notice of doctors in the Department who have a vast experience of invalids with mobility difficulties and their vehicle needs. Eligible haemophiliacs need a form of steering control that avoids, as far as possible, the risk of bleeds in the upper limbs; generally this is achieved with a steering wheel. They benefit from automatic transmission.
763 Because their disablement varies from time to time they find advantageous an alternative for accelerator or brake, either hand or foot, which they can use according to the circumstances that exist at any time. All these advantages are available on the new three-wheeler which will be in production next year, and haemophiliacs will have priority for supply. Beyond that I do not think we ought to go.
The haemophiliacs are suggesting that because they claim that some of them cannot safely drive the vehicle we issue they should be given cars. This introduces an entirely new concept into the National Health Service arrangements for providing vehicles. The rule is that if a person cannot safely drive the vehicle we issue, he is not issued with a vehicle at 764 all. According to this rule a haemophiliac who genuinely believes he cannot drive in a three-wheeler, or is medically adjudged incapable, must join the regrettably large ranks of people suffering in other ways who are similar deprived.
I am delighted that many haemophiliacs have hitherto managed in three-wheelers and hope that they will so continue, assisted by the new design of vehicle, for a long time. Our resources do not, however, permit us—
§ The Question having been proposed after Ten o'clock, and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at fourteen minutes to Eleven o'clock.