§ Order for Second Reading read.4.21 pm
§ The Minister for Social Security and Disabled People (Mr. Nicholas Scott)
I beg to move, That the Bill be now read a Second time.
This is a short Bill for the House to consider, but it is an important one for severely disabled people. Before I deal with the contents of the Bill and the independent living fund in detail, I should like to place the concept of independent living within the wider context of care in the community. As we all know, policy on care in the community developed as a concept in the 1980s. Against the background, the aim was that, wherever feasible and sensible, people should be assisted to live as independently as possible in the community.
The final phase in the implementation of that concept will take place in April, when social security funds—that is to say, income support—hitherto used to pay independent sector home fees will be transferred to local authorities to enable them to purchase care from a range of providers, according to the needs that have been assessed for each individual. The future of the independent living fund, with which the Bill deals, has to be set in that context. The background against which ILF has hitherto been operating will be changed from April and I shall say something about that later.
The Bill fully meets our manifesto commitment to continue to support people with severe disabilities and consolidates the excellent work that the independent living fund has done over the past five years. It is the next step in the development of support to enable disabled people to live independently in the community.
§ Dame Elaine Kellett-Bowman (Lancaster)
What would be the position of somebody who was so severely disabled that he could not remain at home, even with the assistance of the council and the fund, admittedly at the large amount of £500? Would such a person have to go into a home?
§ Mr. Scott
I am not sure whether my hon. Friend is talking about the present situation or about what will happen after the Bill has become law and the new funds have been set up. I shall explain in detail how the new arrangements will work for people who need support from both a local authority and the independent living fund and who have exceptionally high costs.
As we all recall, the ILF was announced as an interim measure in 1988, pending the introduction of the community care arrangements along the lines that were recommended by Sir Roy Griffiths. Those arrangements are now in place and will be implemented from 1 April, but as the ILF has been so successful the Government have decided to continue support for the main concepts behind it, which are giving cash to disabled people and recognising that by doing so we give them independence and the power to determine how best to meet their own care needs. I believe that that is right and fitting. It is sensible that this should be carried forward into the new arrangements, where the fund will operate in partnership with local authorities, which will no longer be merely 37 providers of services but facilitators of a wide variety of care provisions. I hope that that will become increasingly true of the role of local authorities in the future.
I suspect that our debate will be mainly about the ILF. The House will have noted, however, that we have also taken the opportunity in the Bill to put the funding for notability on a new statutory basis. I shall return to that towards the end of my remarks.
So we embark on the establishment of two new funds. Before I go any further, I wish to place on record my warmest thanks to the trustees and staff of the existing ILF. I am sure that during the Bill's passage, and especially today on Second Reading, right hon. and hon. Members on both sides of the House will want to take the opportunity to place on record their gratitude to all those associated with the fund. I know, because of my close contact with them over the years since the fund came into existence, that their work has not always been easy. They have had to develop a new way of working with disabled people under the sometimes critical eyes of the disability lobby and various arms of government. The trustees, under the chairmanship first of Winifred Tumim and then of Trevan Hingston, faced many difficult decisions over the five-year life of the trust.
§ Mr. Frank Field (Birkenhead)
I am sure that we all want to underline what the Minister has said about thanking the trustees for the work that they have done. As he is complimenting them on the way in which they developed the task that was presented to them by the Government, will he say whether they were all happy about being wound up?
§ Mr. Field
I shall listen to what the Minister has to say, but I ask him now whether he is not rewriting history. When the fund was established, it had nothing to do with a measure to fill the gap between what then existed and of community care. It was introduced because the Government had introduced income support, under which those who were very disabled would have received less money than previously. They introduced the ILF to ensure that those people were not worse off and we congratulated them on that. The fund developed into a success which the Government did not believe possible. It is rather sad that we are mourning the loss of the ILF while welcoming a rather smaller initiative to follow in its wake.
§ Mr. Scott
Perhaps it would have been better if the hon. Gentleman had waited to hear what I was about to say about the proper transition from supplementary benefit through to income support, as a result of which we thought it necessary to fill the gap between that change and the move to care in the community, which was already in preparation. It is—[Interruption.] The hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) might like to undermine the tribute that I have been paying to the trustees—well, I know he would not. I shall move on to the 38 new arrangements that are being made. If the hon. Gentleman wants to make a proper intervention in due course I shall be only too happy to gve way to him, as he well knows.
I pay tribute to the two chairmen, Winifred Tumim and Trevan Hingston, who faced many difficult decisions over the lifetime of the trust. No decision was more difficult than that of winding up the trust and bringing about its closure in November 1992—that is to say, its closure to new applications at that juncture.
It has been quite clear for a long time that to make proper provision for the ILF to hand over its caseload to the two new funds that will come into force on 1 April 1993 there would have to come a time when the ILF could not accept new applications. I well understand—it has been impressed on me by a number of the trustees—that there has been some misunderstanding about the discretion of the trustees in whether the fund could have stayed open in the particular circumstances of the delays in dealing with disability living allowance cases. Some people have had to wait several months to have their DLA claims processed.
It has been said, and technically it is correct, that trustees of charitable funds have discretion. However, I have always recognised that the need for an orderly handover prevented the trustees from being able to exercise their discretion in those circumstances. I want to make plain my regrets and apologies if any of the trustees feel that the excellent work that they have done for disabled people over the five-year life of the fund was in any way undermined by that misunderstanding.
Having paid tribute to the two chairmen of the ILF trustees, I want now to pay a particular tribute to the director of the fund, Judith Hoyle. She is on secondment from the Department of Social Security and has been with the fund since its inception five years ago. She has played a major part in its success. Through her, I also pay tribute to all the staff who have worked so conscientiously to ensure the fund's success. I am aware of their immense contribution to its work. With them, I bracket the social workers who have visited the potential beneficiaries of the fund and done great work in assessing their needs and making provision for them.
§ Ms Liz Lynne (Rochdale)
The Minister said that he is grateful to the trustees. Will they be able to continue with the successor bodies? If not, is not it strange that he is saying how great they are when, in effect, they are virtually being sacked?
§ Mr. Scott
I understand the hon. Lady's point. In essence, the two new funds—the independent living (extension) fund and the [...]independent living (1993) fund—will have a wholly different role from that of the ILF over the past five years. The ILF made total provision, on a charitable basis, for a trust where direct application was, in effect, made to the trustees. In the new circumstances——
§ Mr. Scott
No, not in the middle of a reply to another intervention. I shall give way to the hon. Gentleman in due course.
The main thrust of new cases being provided for by the 1993 fund will come to the trustees after an application has been made to a local authority and the local authority has 39 begun an assessment of the needs of the disabled person. Then, the 1993 fund will have the job of deciding whether to top up the help that is already being given by the local authority. The work of the new bodies, whether the one that provides for new cases or the one that manages the existing caseload and decides whether cases need to be reviewed because of extra need, will be wholly different from the work of the existing fund.
§ Mr. Scott
No—[Laughter.] This is obviously a matter of great humour for the Opposition Front-Bench spokesmen, who have little enough to laugh at these days.
It is important to recognise that, although the two new funds have a wholly different role, disabled people whose needs have previously been met by the ILF may feel that the use of the same name gives a sense of continuity. I deliberately decided to incorporate the title of the old fund into the new funds, but with the caveat that one fund deals with new applications and the other deals with the existing caseload.
I acknowledge the important role and contribution of the Disablement Income Group and DIG (Scotland) in launching the fund five years ago. The ILF was established jointly by DIG and the Department and, without the group's support, it would have been difficult to launch the fund in the first instance.
It may be hard to recall what a courageous step that was for the Disablement Income Group at a time when many disability organisations wanted nothing to do with a discretionary fund but wanted a statutory, regulated system continued. To those critical of that decision I would only say—addressing my remarks to DIG and with apologies to Sir Christopher Wren—that if one wants to see the monument to that courageous decision by DIG, one need only look at the lives of the 21,000 people now receiving help from the fund.
§ Mr. Frank Field
I, too, congratulate DIG on being courageous enough to put its head above the parapet when everyone else, lacking in courage, kept their heads firmly below it—and were most unpleasant to DIG in the process. Is DIG happy with the fund's winding up?
§ Mr. Scott
I cannot speak for DIG, but no doubt the hon. Gentleman has access to its views. I had an extremely pleasant meeting with the ILF's outgoing trustees. Many of them perhaps felt some disappointment at not being able to contribute to the work, but they all took great pride in their achievements over the fund's lifetime.
Although it may be invidious to mention individual trustees, we owe a particular debt to Peter Large and Pauline Thompson of the DIG. If I may mention two more names without in any way diminishing my respect and praise for others, Jack McGregor of DIG (Scotland) and Eilis Gallacher from County Derry played a major part in ensuring that the needs of Scotland and Northern Ireland were fully met through the fund's operation. I pay particular tribute to them.
§ Mr. Keith Bradley (Manchester, Withington)
As the Minister if praising DIG so lavishly, and rightly, may I ask whether any DIG representative will be among the five trustees who have yet to be appointed by the Government?
§ Mr. Scott
The hon. Gentleman must control his impatience until he sees the names—but I do not anticipate that DIG will be represented on the new body of trustees. The hon. Gentleman should await the outcome, because final decisions have to be made on the new trust fund's composition.
I will recap—as this was mentioned in an intervention—on why the ILF was first introduced in 1988, at the time that we reformed the supplementary benefit system and introduced income support. Although I was engaged elsewhere during much of the lifetime of the supplementary benefit scheme, we can all, as constituency Members of Parliament, remember many of its complexities. A number of the weekly additions rules were not well targeted and were too complex for many customers to understand.
Local authorities long had responsibility for providing care, but the arrangements made for the disabled had precious little flexibility. The traditional response to the most severely disabled in particular was the offer of a place in a residential or nursing home. Between the abolition of the supplementary benefit additions and the introduction of community care, the ILF was introduced to bridge the gap.
The fund's purpose was to allow those severely disabled people who did not want to go into residential care but who needed substantial levels of care and domiciliary support to remain in their own homes.
§ Mr. Barry Jones (Alyn and Deeside)
As to the Minister's decision to exclude those over working age, I must inform him of the great disappointment of the Alzheimer's Disease Society, which feels that an element of discrimination is at work—bearing in mind that older people suffer dementia and that those who look after them suffer physical and financial hardship. Will the Minister reconsider that decision? It has been badly received in my constituency and has caused great anguish nationally.
§ Mr. Scott
I entirely understand the point that the hon. Gentleman has raised, but let me make two more points. He will acknowledge, I hope, that any scheme of this sort must be introduced within the available resources. Substantial extra resources are being provided for independent living as a result of this legislation and I forecast even more expenditure over the years to come.
We must determine the priorities. I thought it right, and the Government feel it right, that the available resources should be concentrated in particular on those who have become disabled earlier in life. They are likely to have substantially higher care costs than older people and they will not have been able to build up savings or acquire pension rights which are frequently available to such people. As was shown by the Office of Population Censuses and Surveys report examining the difference in income levels between younger disabled people and able-bodied young people, and between older disabled people and older people who are not disabled, the gap is greater at the younger level than at the older. I therefore think it right to concentrate help on the younger disabled and I am prepared to defend that decision. I understand 41 the feelings that the hon. Gentleman has expressed., but, within the resources available, I believe that it is right to concentrate them in the way that I have suggested.
The ILF had a small beginning, spending only £1 million of the £5 million provided in its first year of existence—1988–89—but since then it has grown to be a respected organisation in the disability world, currently administering a budget of nearly £100 million and making payments to some 21,000 people. One reason for the growth in the caseload is that the fund was more effective in delivering help to where it is really needed than the system that it replaced. It should be borne in mind that that system gave regulated, statutory help with the costs of domestic assistance. The hon. Member for Birkenhead (Mr. Field) will recall that there were never more than 6,000 people receiving those supplementary benefit additions and that average individual payments amounted to less than £30 a week. Today, we have some 21,000 cases on the ILF with payments averaging about £114 a week.
I believe that, in a flexible and individually tailored way, the ILF has been a considerable success throughout its lifetime. We all know that by far the most popular aspect of the ILF is the flexibility and freedom of choice that cash payments bring. Dignity and independence are as important to disabled people as they are to everyone else in society. Disabled people have come to value the ability to select and employ their own carers. The new 1993 fund will ensure that disabled people continue to maintain that dignity and independence in two ways. First, it will ensure that the package of care put together for their needs involves a partnership between the disabled person, the professionals from the local authority and the ILF; secondly, it will continue to provide at least an element of cash payments to support the services provided by local authorities.
§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)
Unless the deed says so, I do not see any procedure in anything that the Minister has said to enable the people whom the Bill is supposed to serve to have an adverse decision reviewed, either by the local authority or the trustees of the fund. If there is no process of review or appeal, would decisions of that kind be subject to judiciable statements in the courts by way of judicial review?
§ Mr. Scott
I suppose that almost anything may be subject to judicial review nowadays, but, in essence, the hon. Gentleman is wrong. If someone is dissatisfied with a judgment made about the fund's role in topping up local authority care, the trustees will be able to ask for their case to be reviewed, and, if necessary, two or more trustees will be able to look individually at the provision that has been made. Clearly, in a partnership between local authorities and trustees, there will be some constraints in regard to the exercise of that judgment, but there is nothing to say that, if the trustees feel that a mistake has been made about the assessment of their need in excess of the fund, the position cannot be re-examined—as long as the amount does not exceed the maximum.
§ Mr. Donald Dewar (Glasgow, Garscadden)
Obviously, this is a matter of some concern. The fund is to provide a top-up payment, which may often be quite modest. The majority of help will come in the local authority package. The Minister has talked rather generally about the arrangements being a partnership, and of course we all 42 hope that individuals will be consulted; but will the right hon. Gentleman say a little about the rights of the individual in cases of disagreement between local authority and recipient? If the local authority wishes to make a financial payment, as distinct from providing services, can it do that?
§ Mr. Scott
The hon. Gentleman knows as well as I do that there is currently no provision for local authorities to provide cash. They can provide services. Whatever may happen in the future, at a time when local authorities are taking on so many extra responsibilities in relation to community care, it is surely a mistake to add to those responsibilities a duty to manage cash. I do not know what the future may hold, but at present authorities have no power to provide cash.
What authorities have, however—under the terms of the introduction of community care—is a responsibility to consult and involve disabled people in the decision-making process about the package of care with which they will be provided. If that exceeds the £200 limit that the authority must provide in terms of services, a social worker from the ILF will become involved in discussions with local authority social workers to decide what extra cash payment may be necessary in the circumstances. Anyone who is dissatisfied at that point can return to the fund's trustees and ask for the matter to be reconsidered—as, indeed, the local authority can be asked at any time to assess whether the package of services should be re-examined. Circumstances may have changed, or it may be felt that the assessment has gone wrong.
Of course, the introduction of community care has taken us into new territory. No doubt we shall have to monitor carefully how it all works in practice and, in particular, the workings of the partnership between local authorities and the new 1993 ILF.
§ Mr. Dewar
I believe that there are guidelines on the pricing of the local authority contribution, but how exactly will it work in practice? Presumably, the local authority is the only arbiter when £200 worth of services have been offered. After that it will be up to the ILF, but I assume that there will be some disagreement between the fund and the local authority—and, possibly, the recipient—about precisely how the services should be priced and costed.
§ Mr. Scott
Applications are already being made to local authorities and they, in a sense, will be the gateway to the cash that the 1993 fund may be able to provide for disabled people. I believe that authorities are approaching the provision of community care positively. I also believe that the trustees of the new fund will approach their role positively. I am not saying that there will not be the odd hiccup, but I, too, have adopted a positive attitude to the partnership that is evolving. I believe that it will meet the needs of disabled people.
The hon. Member for Roxburgh and Berwickshire knows how much I respect him and I know that it is the Opposition's job to be critical of anything that Governments do. I do not ask him exactly to rejoice in the current developments, but I ask him at least to be pleased 43 that it is possible to continue providing cash for the most severely disabled people in our society, when that has proved so important to them.
§ Mr. Kirkwood
The Minister of State is provoking me. He is, of course, dealing with difficult and complex questions. What concerns me is that we have only about a fortnight before the procedure comes into operation. We do not know the names of the trustees and we have not seen the guidelines, the regulations or the statutory instruments, but the Minister expects everything to be sorted out in the wash. The matter is too important to be left to the vagaries of such a timetable.
§ Mr. Scott
The hon. Gentleman may not have caught up with everything that has happened. The staff of the ILF is already preparing for the new fund, two new trustees are in place and operating the system, and others will be appointed in the near future.[Interruption.] All seven trustees will be appointed before the fund comes into existence. They will be in place in the next two weeks. The staff members of the independent living fund are already in discussion with local authorities.
As we launch the new arrangements, the first job is for local authorities to receive applications from the most severely disabled people and from disabled people generally within their curtilage. The authorities will then assess their needs. First, they will assess needs against the level of services that are likely to be needed. Where they feel that the £200 limit will be exceeded they will want to have discussions with the staff and trustees of the independent living (1993) fund. There is nothing very complicated about that, although the hon. Member for Roxburgh and Berwickshire may feel that there is. Apart from the odd hiccup, the system will operate sensibly and sensitively.
§ Mr. Barry Sheerman (Huddersfield)
The Minister does not seem to understand the point. We have been entirely helpful. Given the background of chaos and the problems caused to many people over the DLA, we are trying to help the Minister to avoid another administrative cock-up that will damage his reputation and that of the Government. The people connected to the present independent living fund are extremely concerned that they were not consulted about the new body although they have a wealth of experience. The team for a system that will be operating in two weeks has not been set up. We are genuinely concerned for the recipients and for the Minister's reputation.
§ Mr. Scott
Before I spoke I was tempted to take a bet on how long it would be before the hon. Gentleman mentioned the disability living allowance. The problems of the DLA were the problems of success. I do not think that there will be problems with the independent living fund. The gate-keepers in the operation of the new ILF will be the local authorities. Sensible discussions are already taking place between local authorities and ILF staff about how matters will be handled.
Local authorities are now in the driving seat for community care for disabled and severely disabled people. They will be the facilitators of care whether it is provided at home or in a residential setting. That is why the time has come to make some changes in the concept of the 44 independent living fund and how it will operate in the future. The aim is to extend the good work of designing and providing packages of care, which may well turn out to be a mix of services and cash for the most severely disabled people.
§ Mr. Frank Field
The House should not be fooled too much by the Minister's skill in convincing us that all is well. Those of us who think that, where possible, we should give people the money to do their own thing rather than adopt a paternalistic attitude have been defeated. Whatever the Government's reasons for introducing the measure, it is a defeat for that principle. We are moving from extending people's freedom by giving them cash to local authorities being generous gate-keepers, the Minister hopes, for the new benefit.
§ Mr. Scott
Local authorities have a statutory duty to provide care packages for the elderly, the disabled and other vulnerable people. When the community care arrangements of Sir Roy Griffiths were seen as the most sensible way forward, cash provision was not envisaged. There is now such provision through the continuation of the independent living (1993) fund and that is a great prize for severely disabled people. I note the hon. Gentleman's scepticism. We shall have to see. I shall certainly do my best and I know that the trustees and staff will do their best to continue in the tradition of the foregoing independent living fund in providing sensitive, sensible and generous packages of help for disabled people to enable them to live in their own homes where that is feasible.
§ Mr. Frank Field
I intervene again on this important issue. I shall not do so at any other stage in the debate. There is all the difference in the world between giving people cash and hoping that local authorities will deliver care packages. Local authorities currently operate under restraints. The packages will be designed largely in line with what local authorities can currently provide using the people that they employ. There is a great difference between a person having the money to design his own package and having discussions with a local authority which then fits that person into the scheme which it thinks that he needs and in line with the number of workers that the authority employs.
§ Mr. Scott
I understand the hon. Gentleman's point. The Government's aim and that of many local authorities is that authorities will not simply provide services using the people that they employ, but will co-operate with voluntary organisations and private sector providers. The local authority will be the facilitator for the care packages which will be delivered by other organisations and individuals. Increasingly, local authorities will take a much more flexible approach to providing or facilitating the necessary care packages. The independent living fund will be an important top-up to those arrangements for the most severely disabled people.
§ Mr. David Willetts (Havant)
Does my right hon. Friend accept that the extra money for local authorities for community care will be ring fenced and that the Government have made it clear that 85 per cent. of those funds are to be spent on private provision of services? Does he agree that one of the arguments for precisely such an arrangement is that it will deal with the anxieties of the 45 hon. Member for Birkenhead (Mr. Field) by ensuring that local authorities' care plans are not determined by the services that they themselves provide?
§ Mr. Scott
My hon. Friend makes the point well. I hope that the arrangements will lead to a great deal more flexibility—[Interruption.] Perhaps the Opposition do not understand these matters. They are so locked into the tramlines of former provision that they do not know the extent of the potential in the new arrangements which my colleagues in the Department of Health and local authorities will be enabled to introduce.
I shall briefly describe the character of the two new funds. The independent living (extension) fund applies to existing cases. The partnership arrangements, with which I shall shortly deal, apply to new cases. Nearly two years ago I first announced that there would be no disruption of the arrangements for existing independent living fund beneficiaries. It would not be fair to individual disabled people to unmake the successful care packages that were devised for them, nor would it have been fair to expect local authorities at a stroke to take on and manage agreements that had been entered into by others.
The independent living (extension) fund has been set up as an independent charitable trust to continue to make payments on the same basis as now to all people who are currently receiving money from the independent living fund or who have temporarily had their payments suspended from 1 April. It would be possible for someone who had entered a short-term care provision and was therefore not receiving a weekly payment from the ILF still to be part of the existing caseload taken on by the extension fund on 1 April.
In practice, the only difference that any recipient of independent living fund support should notice on 1 April is a change of name on the cheque at the time of takeover. The extension fund will continue to have review powers, just as the independent living fund does. Resources for the extension fund in 1993–94 will be of the order of £120 million for the United Kingdom. That is rather more than a 20 per cent. increase on the provision that has been made for this year and should enable adequate provision to be made for any upward reviews, in terms of the care that is needed by disabled people.
I turn now to the independent living (1993) fund. The independent living fund was the pioneer in allowing people with disabilities to take a proactive role in determining how best their care needs could be met. We all welcome that.
§ Mr. Peter Thurnham (Bolton, North-East)
My right hon. Friend has just said that we all welcome the work of the ILF, but is it not a fact that when it was introduced it was attacked by the Labour party and described as an abdication of the Government's responsibilities?
§ Mr. Scott
Yes, but the Opposition will have to go through the whole process all over again.
The ILF was the pioneer in allowing people with disabilities to play that role, with support and professional back-up which is an important element in the package. 46 That is why, in establishing the 1993 fund, we have built on the case work approach. From April this year, the vast majority of disabled people, including the bulk of those who would have looked to the ILF for help in the past, will, in the first instance, look to their local authority. For the most severely disabled people, whose care needs are so great that without additional help they would have to go into residential or nursing care, the 1993 fund will provide an additional option for social workers in planning packages of care with their disabled clients.
We expect that each year around 1,500 people will get a cash payment from the new fund, as well as help from their local authority. The budget for the first year of this fund will be just over £4 million for the United Kingdom. One has to reflect on the fact that the budget for the larger-scale ILF was £5 million in its first year, only £ 1 million of which was taken up. For a much more restricted caseload, I believe that £4 million is an even more generous provision to meet the demands that are likely to be put upon the fund in its first year.
I have already mentioned that the 1993 fund will work as a partnership between itself—the trustees—and the local authority. All the most severely disabled people who are likely to come within the purview of the fund will already, overwhelmingly, be likely to be in touch with their local authority social services departments because of existing needs. As with the current ILF, the new fund will be restricted to people on low incomes and to those who live alone or with someone who is unable to supply all the care that they need. Eligibility will also be limited, as I think I have already stated, to those of working age—those between 16 and 65.
Where it is clear that the cost of care in the community will be above the national threshold—which, as I have already stated, we have set at £200 a week—the social worker will want to consider whether the client might be eligible for help from the new fund. The fund would then be able to make a topping-up cash payment of up to a further £300, making a total of £500 a week.
I believe, in essence, that the new system will ensure that a significant group of disabled people will be able to look to the primary facilitators of community care, the local authorities, for their community services without losing the extra flexibility of an element of cash payments.
§ Mr. Dewar
Presumably the qualifying criteria will be a matter for the trustees of the new fund which is to take over new cases. They will, I presume, start on the same higher payment component care, the disability living allowance, basis, but in future they will have to keep within a budget, which will be cash limited. If they cannot do so, the criteria may have to be altered as happened in the past.
§ Mr. Scott
Manifestly, the new fund, as with the existing fund, will be run on a cash-limited basis. It will be up to the trustees to deploy their resources as necessary. It has been broadly true over the life of the existing independent living fund that there has been an underspend of the cash limit, perhaps because of the trustees' prudence. Nevertheless, we believe that the provision that has been made for both the new fund and the existing cases fund will be adequate to cope with needs for the foreseeable future.
Motability is the organisation that enables people to use the top rate mobility component of their DLA to buy or lease a vehicle specially adapted to their needs.
47 Motability was launched by the Labour Government and, I believe, by the right hon. Member for Manchester, Wythenshawe (Mr. Morris). It has always had strong all-party support in the House. Governments of both parties have funded it consistently throughout the years.
I intend to mention three Government grants that are made to support the mobility component and facilitate the purchase or lease of vehicles. The Government pay for the administration of Motability which, in the coming years, will be over £2 million. The equipment fund was set up in 1991. It provided £1 million a year for more sophisticated adaptations to meet the needs of the most severely disabled people. From April this year we are doubling that contribution from £1 million to £2 million. The tenth anniversary trust, which was set up in 1988 with £5 million from the Government and £5 million from the clearing banks, provides extra help for the charitable work of Motability—that is, for those people who cannot afford the full cost of leasing, hiring or adapting a car.
Motability has been an immense success story from its very inception by the right hon. Member for Wythenshawe and others, such as Lord Goodman, who were in at the start and developed the scheme. I am delighted to say that very shortly my right hon. Friend the Prime Minister is to present the keys of the 350,000th Motability vehicle which has been provided under the scheme.
In recent years we have seen many improvements in the spread and coverage of help for disabled people. That has happened under Governments of both parties. In the years since I have been Minister for Social Security and Disabled People I have been proud and happy to play my part in that continuing development. I wholeheartedly welcome the community care changes. I am pleased that the system of support that the independent living fund offers to people with disabilities has survived and is to be developed and taken forward, to take advantage of the wider developments in community care that are being put in place.
In my view, the Bill represents a constructive way forward, building on the foundations set by the ILF and the experience gained from the workings of that body. I am happy that the Government are continuing to fund these organisations, which offer flexibility, independence and a sense of dignity and self worth for many disabled people in our society.
The Government have expanded and developed the range and scope of help for people with disabilities. This Bill, in my view, marks another step in the movement towards a more caring society which offers additional opportunities for all its members, not just those who happen, for the time being, to be able bodied. I believe that the whole House should welcome these improvements.
§ 5.7 pm
§ Mr. Barry Sheerman (Huddersfield)
The Bill is important not only in the most general sense; for thousands of severely disabled persons and their families it is crucial and goes to the very core of their existence. However, the Opposition have serious reservations about it, which I shall explain in due course. The Second Reading of the Bill is not, however, the time or the place for ritualistic parliamentary disagreement. It is a unique opportunity to examine the manner in which we provide 48 services for disabled people in our society towards the end of the 20th century. It is also a convenient time to assess the contribution of the soon to be dismantled independent living fund which the Bill seeks to replace.
The Minister will, I believe, be told by those who sit on this side of the House and by his hon. Friends of serious misgivings, worries and criticisms regarding the new arrangements that are encapsulated in the Bill. I can assure the Minister that we shall be making those points, but constructively and positively.
My task is to examine the extent to which the Bill meets the needs, hopes and aspirations of disabled people and the extent to which it is in tune with the growing desire of disabled people and their families for a sensible system under which they can be in control of their destiny, based in their own homes with as much independence as they wish. The Bill must be judged on the extent to which it empowers and liberates—indeed, satisfies—those whom it is designed to help.
To understand the development of services provided for disabled people, one has to go back at least to Lord Beveridge, the subsequent National Assistance Act 1948 and to the dramatic change in the climate of service provision which emerged with the Chronically Sick and Disabled Persons Act 1970, introduced by my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris). Those Acts have to be judged fairly in the context of their time. They were based not only on the best available expert opinion but on the fullest understanding that existed then of the needs of the people being helped.
Times have changed. The tradition of service incorporated in those Acts tended to have three salient characteristics or features. The first was a strong emphasis on the ethic of professionalism, the view that the care professionals' perceptions of disabled people's needs and of the priorities in allocating resources were paramount and, in any case, should be considered more valid than disabled persons' perceptions of their own needs.
Secondly, there was a mixture of provision by central Government benefits agencies, such as the Department of Social Security, and local authorities through their social services departments. Thirdly, in the case of local authority provision, there was a lack of statutory backing and an emphasis on discretionary provision. It is still the case that the only statutory provision that seems to exist for disabled people is that local authorities should keep a register and give information on available services, although very few authorities fulfil even that minimal task.
The consequences of the approach that I have just described can be summed up by saying that some good work was carried out in those years by statutory agencies and the newly emerging organisations of disabled people, but that, as times changed and demands altered, the deficiencies became increasingly obvious. One expert, Professor Michael Oliver of the University of Greenwich, said:Numerous studies over the years show that clients are very unhappy about the way professional assessments have distorted or denied their needs".Some care professionals are equally unhappy about a system that has forced them to tailor their needs assessment to available resources and currently available provision. In many cases, that goes against their best professional judgment.
The drawback of such a system was that, too often, disabled people were, and still are, forced into a position 49 of dependency, causing the inevitable feelings of powerlessness, resentment, cynicism and mistrust which a dependency culture entails. In addition, the lack of statutory duties placed on local authorities is mirrored by the lack of statutory rights for disabled people. I shall not unearth the disagreement that I had with the Minister only a couple of Fridays ago about the Disabled Persons (Civil Rights) Bill. Too often, a patchy and inconsistent pattern of provision nationwide results from different local authorities having distinct attitudes to their discretionary powers or distinct levels of resources with which to implement them. Nothing that the Minister has said today fills us with confidence that we are not going back to the bad old days.
Overall, a system of provision did exist—and still exists—which is not only problematic and unsatisfactory in many ways but which many argue is more expensive than the alternatives and, therefore, hardly good value for money. It could be argued that the independent living fund came about partly because of the qualitatively very different attitude towards provision which emerged in the 1970s. We must be clear about where it came from.
I am something of a historian and it is important to get the history as right as we can. The fund clearly stemmed from disabled persons and their families. They were clear about their aspirations: they wanted full integration and participation in the community rather than being left in isolated residential establishments, and they increasingly wanted to control the resources that could make their lives more fulfilled.
Professionals, intellectuals, and even political parties and Governments gradually became aware of, if not fully convinced of, those aspirations. The introduction of care in the community was therefore, in many ways, a missed opportunity to take those aspirations fully on board and to deliver them. It perhaps points in the right direction but is still a missed opportunity.
However, the independent living fund was a successful example of the introduction of a system much in line with the new ideas. Again, the historian in me suspects that, in part, the birth was unexpected and the development uncharted. I agree with my hon. Friend the Member for Birkenhead (Mr. Field) who knows that there was a crisis, that the Government met it and, almost by accident, produced something that grew into a rather nice child from a rather unexpected baby, if I can mix metaphors. The birth was unexpected and the development uncharted, but we would be very foolish to underrate its innovative character and the value of its existence in the past five years. We pay tribute to the Minister for any hand that he had in it. We do not deny its importance, and any hon. Members who believe that good, healthy pragmatism is useful when considering how to solve social problems will join me in that tribute.
Even the Minister would have been surprised to learn what was going to happen to his creation in five years. The fund was very different, set up by the Minister in 1988 in partnership with the Disablement Income Group as a Government-backed independent discretionary trust—I freely admit that we had many apprehensions about that—largely as a result of the gaping hole in the benefit system which resulted from the change from supplementary benefit to income support, with the consequent abolition of the domestic assistance additional requirement.
The new scheme had two purposes. The first was to assist severely disabled people who need paid domestic 50 help or personal care if they are to live in their own homes. The second, as Peter Large said—no one has ever put it better—was to makethe difference between a life in which most of your choices are made by others and a life in which you can mostly choose for oneselfThose words will come back to haunt the Minister, and I shall explain the fear of many people who work in social provision.
The fund was empowered to make grants of up to £560 a week in London, £520 a week in the south-east and £450 a week elsewhere. As I have said, it was a runaway success. The number of individuals helped with grants has risen from an estimated 850 at the scheme's inception to the figure of 21,000, which the Minister gave. I got the figure of 22,500 from the fund, so we roughly agree. In any case, both figures give the measure of the fund's growth. By the time applications closed in November 1992, it had proved extremely popular and cost effective. Why?
It was so popular because it enabled people to obtain precisely the personal assistance that they needed, which has practical advantages. A private contract allows a disabled person to specify exactly with what his personal assistant is to help, which gives a flexibility that local authority job descriptions may not. For example, district nurses are clearly not supposed to help to clean the floor, but the definition of what they are allowed to do might not fit well with the disabled person's priorities. In any case, district nurses are unlikely to have any say in defining the job description. In addition, there are immense emotional benefits to the disabled. One person who was interviewed said:Employing my own personal assistant has given me the freedom to fulfil the type of lifestyle I wish to follow… I am in total control of making all the choices in my own life.Examples of the liberating and empowering effect of the independent living fund abound in all the research.
The Minister will be well aware of the Greenwich survey for which he kindly provided a foreword. The survey shows clear examples of cost-effectiveness. Empowering people saves money; it does not cost more money. Mike Oliver and Garry Zarb surveyed a variety of cases in Greenwich and found that in all the savings were considerable—as much as 50 per cent. The figure given by directors of social services with whom I have talked in the past few days was 20 per cent. to 50 per cent. No one said that the costs were higher; everyone said that the costs were appreciably less.
Oliver and Zarb say:Giving disabled people what they say they want is cheaper than giving them what the authorities think they need.That comment goes to the heart of the matter. Oliver and Zarb also say:Our work in Greenwich suggests that providing disabled people with the services they demand may be cheaper than continuing to fund, inflexible dependency-creating ones.The empowering approach exemplified by the independent living fund is well summed up in recent research by Jenny Morris, who carried out a study for the Rowntree trust entitled "Community Care or Independent Living", which came out a couple of months ago. In tracing the approach to the independent living movement which emerged among organisations representing and controlled by disabled people in the 1970s and the 1980s, she draws a sharp distinction between the conventional view of independence—that people need to be able to do everything for themselves if they are not to be treated as 51 dependent and subordinate—and the more positive and pragmatic view of independence as the ability to achieve goals.
Jenny Morris also sees independent living as a civil liberties issue. People have not only the right to have control over basic living tasks, such as when they get up, when they go to bed, when they go to the toilet and what and when they eat, but the right to have a personal relationship, to seek employment and to engage in leisure and political activities. If those rights are to be more than mere verbiage, measures must be taken to make them effective.
Despite its record of success, the fund is to be abolished. We have given bouquets to the Minister and we have shown a little bit of humility in recognising that we did not understand how good the fund would become. We now come to the hard question. As the fund is so successful, why is it to be wound up and replaced by something far inferior? Despite the fund's record of success, it is to be abolished and its work is to be taken over by two new bodies. The independent living (extension) fund is intended to take over the existing caseload of the independent living fund and the independent living (1993) fund is intended to take on new cases. I was amused when the Minister explained that it was an entirely new body with the same name. I am not sure whether this is a case of changing names to protect the innocent or a case of keeping the same name to protect the guilty. The changes are rather confusing.
There is another confusing point on which I seek to draw the Minister. He paid some nice tributes to the trustees of the fund. He said that the 10 trustees, five of whom were appointed by the Secretary of State and five of whom were from the Disablement Income Group, had done a wonderful job. I hope that the Minister will throw a reception for them and will ask them in to the Department for champagne, or whatever is appropriate. As I understand it, the Minister has not thanked them personally and has not explained to them face to face why good and honest servants who have done a darned good job for five years and who have made the fund the jewel in the crown——
§ Mr. Sheerman
That must have happened since I talked to the trustees; it was a rapid invitation. I am glad that the Minister has done that.
The trustees with whom I have talked are concerned. They have run the fund extremely successfully for five years. They have a wealth of knowledge that they could impart to the Minister to help the two new bodies, but the Minister has not asked them. Some of them feel frustration and bitterness. They feel that they have done a remarkably successful job, yet their experience is for nothing. Why on earth has the Minister not taken counsel from them and taken their advice in setting up the two new bodies? It is not good enough to say that the new bodies are entirely separate new projects which have little to do with the old one. The trustees have expertise and good will. The Minister has a reputation for listening to and acting on 52 opinions expressed by people who know what they are talking about, but that reputation will suffer. I do not intend to go further on that point.
The funding of the independent living (extension) fund will be limited. I understand that the figure was originally to be £170 million, but that it is now to be £120 million in 1993–94. We are still a bit concerned about that, and I hope that we can talk about that later. The best estimate is that, by the end of March 1993, 22,000 people will have benefited from the fund. From simple sums on the back of an envelope, assuming a minimum average of £110 a week, a total of £124 million is necessary. The figure of £120 million looks close to a shortfall. That is worrying, especially when one considers new needs and the increased needs of some of the people who already draw from the fund. Perhaps the Minister will give us a little more detail on that later. I do not intend to make a great issue of it now, as I am sure that my hon. Friends will say more about it later.
There is a further matter of great importance and great principle. Those over 65 are to be excluded from the new arrangements. In November 1992, 34 per cent. of the independent living fund's caseload comprised people over 65. It is not good enough to say, as the Minister says regularly, that the Government have decided to put the emphasis on people in the younger, working age group, especially as the independent living fund has been enormously successful for people over 65 as well as for those between 16 and 65. To cut off that percentage of the population from a scheme that has been so highly valued seems mean-spirited. We are not talking about a lot of money from the Exchequer. It seems that the change is Exchequer-driven rather than driven by the Minister
The administrative arrangements for making an application to the independent living (1993) fund are clumsy and complicated. The beauty of the independent living fund has been its simplicity, which disabled people have admired. The Minister made us even more worried when he talked about gateways and gatekeepers, and about local authorities being in the driving seat. Surely we should now put the disabled person in the driving seat. That is what the independent living fund did. We do not want a committee of local authorities and Government Departments having to make decisions for the disabled person.
§ Mr. Scott
I was at pains on more than one occasion to make it clear that the whole thrust of the care in the community policy was to involve disabled people in the decision-making process about the package of services provided for them. No longer will local authorities tell people what they get. They will ask people what they want and they will seek to provide it.
The hon. Gentleman talked about the attitudes of professionals. I meet many professionals and I believe that their attitudes have changed radically over the past two or three years. They do not simply tell people what they will get. They are moving into a new culture of listening and seeking to provide.
§ Mr. Sheerman
I am not much mollified by that intervention. The Minister has referred to gateways and gatekeepers, and to local authorities being in the driving seat. If he looks at Hansard tomorrow, he will see that that was the language that he used. The Association of Directors of Social Services, the Association of 53 Metropolitan Authorities and the Association of County Councils are all worried about the bureaucratic nature of the new arrangements and about the loss of the close direct relationship with the fund that existed under the old ILF arrangements.
§ Mr. Willetts
I confess that I am becoming increasingly confused as to what the Opposition's policy on provision for severely disabled people is. If the Opposition support the principle of community care, how can they wish to keep the old arrangements for the independent living fund, which are manifestly incompatible with the principle of giving local authorities legal responsibility for community care?
§ Mr. Sheerman
The hon. Gentleman is anticipating my remarks somewhat. We strongly believe that policy in these matters should be driven by what disabled people want. Had the hon. Gentleman listened to the earlier part of my speech, he would know that that is exactly what drives the Opposition's policy. I hope to show that it is possible to achieve a proper synthesis between the ILF and care in the community.
Previously, applications could be made directly to the ILF. That was one of its strengths. The new procedures involved what the Minister described in the debate on 25 February asa tripartite settlement, as it were, between the customer, the local authority social worker and the social worker for the independent living fund."—[Official Report, 25 February 1993; Vol. 219, c. 1126.]What is supposed to happen is that the local authority provides the first £200, then, if it seems appropriate, an application can be made to the fund up to a ceiling of£500 in total. Last week, I telephoned a number of directors of social services. I said earlier that we were concerned about whether the new arrangements—like them or not—would be up and running by 1 April. The Minister must realise that there is an enormous amount of confusion even among people of the professional excellence of directors of social services. Directors place totally different interpretations on the£500 limit. A senior member of the Association of Directors of Social Services believed that if the total sum of an application was more than£:500, the person would automatically end up with no independent living fund money and would have to go into residential care. Other directors of social services interpret the£500 ceiling quite differently. Enormous confusion exists among the professionals who, from 1 April—and even now in terms of applications—are supposed to be making the arrangements work.
Moreover, applications are eligible only if the applicant is on the highest level of disability living allowance. Three official bodies—local authority social services departments, the Department of Social Security and the fund—will be involved. That seems unsatisfactory on several counts. First, it involves a clumsy system of divided responsibilities—a recipe for administrative confusion and delay. As I said earlier, the AMA, the ACC and the Association of Directors of Social Services have all picked up on that point and have described the new arrangements as likely to lead tomuddled personal assistance provision for the severely disabled".That last quotation is from a press release issued by the Spinal Injuries Association.
Secondly, circular LASSL (93) makes it plain that people are supposed to apply for money from the new fund 54 only if they have received at least £200 from the local authority—£210 with the extra £10—and with the approval and assistance of their local authority social services department. The Minister talked about gateways and gatekeepers. What if the local authority department is unsympathetic to the individual? What recourse will there be in such circumstances? What if the authority chooses not to exercise its powers to assist disabled people? We must remember that most of the powers are discretionary rather than statutory. What if the local authority simply does not have the money to supply the first £200? That is possible because, although the £539 million is ring-fenced as a transitional grant for community care in local authority budgets, the money allocated for services to disabled people is not ring-fenced within that ring fence. We know what will happen in some local authorities when that budget is under pressure: the money allocated to services for disabled persons could be diverted.
§ Mr. Willetts
A moment ago the hon. Gentleman was complaining about excessive bureaucracy in the arrangements. Is he now saying that he wants not just a ring fence in respect of the central Government contribution to community care cases but a ring fence within that ring fence? That would be a nightmare.
§ Mr. Sheerman
Not at all. There are plenty of examples of money in local authority budgets being ring-fenced for specific purposes. I ask the hon. Gentleman to be a little patient, as I shall return to his question in due course.
The effect of the changes will be to cast doubt on the effectiveness of the new scheme, to introduce a large measure of uncertainty, to disempower disabled people and to move a large measure of control back into the hands of local authority social services departments.
Thirdly, the circular does not make it at all clear what happens if the total application exceeds £500. The phrasing in the explanatory notes to the circular can be interpreted in two ways—either help can be provided up to a ceiling of £500 a week or applications in excess of £500 will simply be ineligible for help. We seek guidance on that, in the interests not of making a paltry point but of trying to help people.
In any case, the £500 limit does not make sense economically as, in many areas, residential care is more expensive than that—as my right hon. Friend the Member for Wythenshawe pointed out the other evening. The Greater London Association for the Disabled did some research on residential care costs and came up with a sample of figures—£510, £605,£800 and £925 a week. Similarly, the British Council of Organisations of Disabled People found that residential charges at the Royal hospital Putney, not far from the Minister's constituency, varied between £605 and £807 a week—again, significantly higher than the £500 ceiling. As a means of saving public money, that ceiling is frankly bizarre and, in our view, will lead to more money being spent rather than less.
Jenny Morris's research for the Rowntree trust highlights another important issue. In many cases, suitable residential care facilities simply do not exist. The alternatives to being empowered to live in one's own home may be a geriatric ward or the nightmare of being forced to remain in an abusive family situation. The Spinal Injuries Association, which has expressed deep and well-argued disquiet over the new proposals, has aptly described the possibilities under the Bill as "imprisonment 55 without crime". The BCODP has made a strong statement to the effect that forced institutionalisation is a breach of human rights, and is prepared to refer the proposals in the Bill to the European Commission on Human Rights in Geneva and the European Court of Human Rights.
In the debate of 25 February 1993, the Minister, referring to the old independent living fund, said:a system based upon individual assessment, and on the discretion…of individual trustees, has been a considerable success, and has been able to respond much more flexibly to the needs of individual disabled people than any regulated system might have done."—[Official Report, 25 February 1993; Vol. 219, c. 1125.]Well said, sir. The important question is why, having established a proven success in the ILF, the Government now seem determined to move backwards to a far more regulated and less satisfactory system. Is their commitment to individual freedom of choice more apparent than real?
We do not say everything about the independent living fund is sacrosanct and cannot be changed and improved. The Minister is an expert on Puccini, and on his opera "Turandot" in particular. He will remember the princess's lovely line to Calar, "Do not touch me, it is sacrilege". We are not saying that. We are saying that there could be modifications but that the essence of the ILF should be carried on.
The manner in which the changes have been introduced is also disquieting. The old fund closed its list for applications at short notice in November last year leaving existing applicants to rush their applications to completion and causing a hiatus in funding until the new arrangements came into force. I have received many letters from people who missed out because of that and the injustices that occurred
It is not clear at this late stage who will administer the new arrangements. There seems likely to be little continuity of personnel or expertise. The staff of the Disablement Income Group are extremely demoralised because, despite making approaches to the Government and civil service during the preparation of the Bill, their views were not sought or listened to. Five years of expertise in this difficult and sensitive area have been discarded.
Nor does there seem to have been any real consultation with bodies representing disabled people. The Spinal Injuries Association and others have complained about that. When the ILF is decommissioned on 31 March, it is not clear whether the new arrangements will be set up in time to ensure an orderly continuity to cover existing clients. That is a very real worry. The 21,000 or 22,000 people concerned are very dependent on the effective working of the fund. Although the Minister said that there would just be a different name on the cheque, the important point is whether the cheque arrives in time on the day. That is vital.
The timing is doubly unfortunate. The Government's community care initiative was intended, ostensibly at least, to increase consumer choice. However, just as it is coming into force, the ILF, which has successfully promoted consumer choice for five years for a consumer group whose choices were previously extremely limited, is being quietly strangled. We are not even given the option of leaving the ILF in place in its proven and successful form, at least until community care has bedded down. That 56 would seem to be another enlightened, pragmatic approach in respect of the changeover! Disruption will be piled on disruption and the clients will suffer.
I do not go as far as Professor Oliver, who said:So successful has one scheme been in giving users control over their own services that the Government have abolished it. It was called the Independent Living Fund.That is quite strong language, but very perceptive.
If the abolition of the ILF and its replacement by an alternative and more clumsy scheme makes little sense in terms of service provision, there must be another reason for the change. I suggest that there is a hidden agenda. In a sense, the ILF has been too successful. Its growth from an envisaged total of about 800 clients to some 21,000 or 22,000 has led to a much higher level of expenditure than originally expected, even bearing in mind the lower cost per head. Expenditure rose from £1 million in 1988–89 to £97 million in 1992–93.
If a good grant scheme like the old ILF is available, people tend to use it. That can reveal a higher level of need than was originally anticipated. The Government's response has been to replace a good grant scheme with a bad one. I contend that it is the Treasury's desire to control expenditure that is the real hand behind the present changes, not a desire to improve services. That is the root of the new measures incorporated in the Bill.
The trouble that the Government find with a direct payment scheme is that it tends to make the true level of need very obvious indeed. Under the traditional system of funding services and then setting cash limits on them, that need could be concealed. For example, service constraints could mean that if too many people needed a home help, the home help would come once a fortnight instead of once a week. That disguises the true position. While that may conceal the scale of need, it is totally unacceptable. The proposal amounts to pushing disabled people back into a grey limbo.
In the words of a member of the ILF's trustees, the new arrangements have taken thespiritual essence of the Fundright out of the centre.
The Opposition believe that the Bill represents a real missed opportunity. I do not say that in a spirit of party debate. I say it in terms of what I have called enlightened pragmatism. The Minister had a great success on his hands. Instead of using it as a springboard and an opportunity to change the lives of disabled people, he has drawn short. He has either gone into reverse or stopped.
As I said earlier, fundamental changes are occurring in our society which the Minister is underrating. Disabled people will no longer accept the definitions of status or situations that were considered appropriate even a few years ago. There is an unstoppable movement for empowerment. In a real sense, the Minister significantly encouraged that movement. He set up the ILF.
The challenge before us today is to listen to the groundswell and the change in ideas and beliefs in the disabled community. We should learn from the experience of the past five years. Those changing ideas were reflected in a report by the Select Committee on Social Services which stated:We recommend that the ILF should continue to exist, not only for an interim period, but also after the implementation of community care legislation, and should be provided with sufficient resources to meet the claims of those who meet the present criteria for help from the Fund, and whose needs have not been met through the eventual implementation of community care policy.57 Some hon. Members have seen and understood the changes in ideas and know how we must learn from recent experience. I am sorry that the hon. Member for Mid-Kent (Mr. Rowe) is not in the Chamber. I believe that he has seen the future and knows that it works. He understands better than most in the House how the empowerment of disabled people comes from giving them resources directly, by giving them the cash and leaving them to make their own decisions.
It may not be too late to improve the Bill or to do something in parallel which could save it. If the ideas of the hon. Member for Mid-Kent were incorporated in the Bill and if local social services departments were able to give direct cash payments to individuals, the result could be a dramatic improvement for disabled people in our society.
The sensible way ahead is always for legislators to listen to the people and to act accordingly. The people affected by the Bill want to be able to empower themselves and the best way to do that is to improve the existing ILF both in statutory rights and in rights of appeal.
The Opposition take no hard ideological line on the question. Sensible people believe in markets and market mechanisms when they work and reject them when they are inappropriate and do not work for people. In this case, we believe that they work. At the end of the day, giving disabled people what they say they want is better and cheaper than giving them what we think they want. We believe that the future priority of all Governments must be to assist the empowerment of disabled people and an early introduction of personal assistance schemes are a right that cannot be resisted much longer.
§ Mrs. Marion Roe (Broxbourne)
In spite of the very heavy programme in the Chamber involving debate on the European Communities (Amendment) Bill, I am pleased that the Government have at last found time for the Second Reading of this important Bill, thus fulfilling the Conservative party manifesto pledge at the last general election.
The final stage of the Government's community care reforms will take effect from 1 April. It is vital that financial support will continue to be given to the most severely disabled people in the community to ensure that they can live in their own homes and exercise the independence which so many of them deeply cherish.
I am sure that I am right in saying that the principles of community care are supported by all parties in the House. The most important aspects of the reforms are choice and the flexibility that the reforms provide for care to be tailored to individual needs and the fact that individuals should be consulted on how their needs should be met.
As president of the Broxbourne organisation for the disabled, which represents disabled people and their carers in my constituency, I have been made well aware of the enormous benefit that disabled people have derived from the independent living fund.
I should like to stress to my right hon. Friend the Member for Chelsea (Mr. Scott) that, under the new independent living (1993) fund, the fact that disabled people are consulted about their needs must be a key factor in the package of care that is proposed. I accept his assurances that that will be so.
I learned the importance of such co-operation the hard way through personal experience. A couple of years ago, 58 I was challenged by members of the Broxbourne organisation for the disabled to spend a day in a wheelchair. It felt that I should discover for myself that when getting around the constituency grave mobility difficulties must be overcome and that local authorities' good intentions are not enough to encourage disabled people to get out and about and to give them the support and help that they need. I accepted the challenge and realised very quickly that life for those who are wheelchair-bound would have been made much easier if they had had a say in the provision of facilities for disabled people.
My first engagement was to visit a canal barge that I had launched some months before to test the wheelchair lift that was installed to ensure that disabled people, like everybody else, could enjoy the delights of sailing on the River Lee. To reach the barge, my husband, who was acting as my carer, had to push me over a large area of deep cobblestones on the quay. The result was that by the time I reached the barge I felt that I had been given a series of electric shocks. It was the most uncomfortable ride that I have ever undertaken. If only local authorities had thought to consult the users of the facility before designing it.
At the end of my day in the wheelchair I visited the local library, which prided itself on providing good access to the building for wheelchair users. When I arrived, I was advised to attempt to enter the building on my own without my husband's help. I turned the wheels of the chair up the ramp towards the spring doors, only to discover that they opened towards me. As I tried to pull the doors open, my wheelchair started to run backwards down the ramp, much to the amusement of onlookers. Although I have strong arms, it took me about 10 minutes to get inside the library; a weaker person would not have made it. All the good intentions of the architect and local authority were lost because the users of the service had not been consulted first.
I give full credit to Hertfordshire county council, because following this incident it changed the doors to the sliding variety to overcome the problem. There is no doubt that the consultation process is paramount in assessing the needs of disabled people. Their voice should be heard as well as that of their carer, if appropriate.
Severely disabled people value the independence that the independent living fund has given them and I therefore welcome the Bill because it will ensure that that vital support will continue.
The Health Select Committee, of which I am Chairman, is conducting an inquiry into community care. We intend to publish the first part of our report next Thursday. I cannot, of course, reveal our findings or our recommendations, but I have no doubt that hon. Members will find our report extremely helpful and interesting.
§ Mr. Alfred Morris (Manchester, Wythenshawe)
The reverse side of this one-page Bill bears the legend:Presented by Mr. Secretary Lilley, supported by Mr. Chancellor of the Exchequer, Mr. Secretary Hunt, Mr. Secretary Lang, Secretary Sir Patrick Mayhew, Mrs. Secretary Bottomley, Mr. Nicholas Scott…To be fair to the Secretary of State for Social Security, I prefer to think, for reasons that I shall explain, that the real presenter of this Bill is the Chancellor of the Exchequer.
59 This is in truth a Treasury Bill. The other Ministers named are but camp followers supporting a measure that severely disabled people feel could deprive them of their independence. They fear that sooner or later, unless there is an urgent change of policy, they will be forced into institutions, at far greater cost to the taxpayer than that of enabling the independent living fund to help them.
For severely disabled people, that is what this debate is all about. They see what they regard as their incontestable right to live in their own homes, instead of being shut away in long-stay institutions, being challenged by the new arrangements the right hon. Member for Chelsea (Mr. Scott) announced last November.
In my Adjournment debate on the ILF on 25 February, I posed a series of questions about the future of the fund of enormous importance to all severely disabled people. Some were answered by the Minister, others were not. Since then, I have had further answers, but there are still unresolved questions which I want now briefly to raise again. One of them is whether the Minister can give me a categorical assurance that no existing beneficiaries will have to wait for payment after 31 March, when the shutters finally come down on the old ILF.
That question was put to me before my Adjournment debate by Peter Large of the Disablement Income Group, than whom no one knows more about the work and value of the ILF, and he raised it again in a letter I had from him last Friday. His concern is that payment mechanisms—accounts, cheques, authorisation slips and so on—will not be ready in time. Very charitably, he says that the DSS has beendelayed by the Treasury's reluctance to allow a new Fund.On 25 February, I quoted from Peter Large's earlier letter to me about the fund:You can imagine our distress",he said,to see the threat of the ILF being throttled to death".Recalling that statement, he says in his further letter of 11 March:I have to write now to tell you that the ILF as we have known it is dead. The two new funds are but pale ghosts of the original ILF. The assassins from the Treasury have done their work.From a Fund that will have spent some £117 million helping over 22,000 disabled people last year, we move to a Fund spending in its first year a mere £4 million on an estimated 1,500 people. All pretence of allowing discretion on the part of the Trustees has been ended.He goes on to say:The Trust Deed and the Agreement in respect of both funds effectively stifle all initiative and ensure that all goes according to the demands of the Treasury. Anyone who knows anything about severely disabled people will be horrified to read the four documents.Thus, Peter Large is in no doubt that this is a Treasury Bill, nor should any of us be in any doubt that, much apart from being a mere supporter of the Bill, the Chancellor of the Exchequer is its real author.
In future, disabled people will have to face questioning by two vetting authorities: the local authority social services department and the assessment officer of the independent living (1993) fund. Both the local authority and the fund will have the power to refuse, reduce or stop help. The disabled person has no right of appeal to anyone. Moreover, an upper cash limit is imposed on payments to keep a severely disabled person out of an 60 institution. Existing beneficiaries and those of the new fund will face intrusive questioning about their private habits and needs.
In regard to the upper limit on payments, the right hon. Gentleman said in reply to my speech on 25 February:I do not believe…there is anything offensive in our setting an upper limit beyond which it is not unreasonable that people who need help should…decide, sometimes reluctantly, that the time has come for them to go into residential care."—[Official Report, 25 February 1993; Vol. 219, c. 1126.]The Spinal Injuries Association describes this as "a most shocking statement". It askswhether £500 is now the going price of freedom in this country?The association quotes the case of a severely disabled young doctor, living in the community, who needs more than £500 a week in personal assistance services, and poses the question, "Has his time come?" As my hon. Friend the Member for Huddersfield (Mr. Sheerman) recalled, the association sees the upper limit on payments as "imprisonment without crime" and an infringement of that young doctor's civil rights. Whenever before did a Government so explicitly impose a price on personal freedom?
I asked on 25 February for details of the trust deeds for the new funds. Their publication since then confirms the worst fears of the organisations for which I sought my Adjournment debate. As we have heard, Peter Large says that anyone who knows anything about severely disabled people will be "horrified" by the documents the Minister has now published.
There are, however, still two important questions that remain unanswered. The first is what happens to severely disabled people who ask the ILF for help between now and 1 April? The answer, say the organisations that represent them, is that no help is available and that there are even worries about future payments to existing beneficiaries now receiving direct payments from local authorities. The second unanswered question is what happens to existing beneficiaries now receiving direct payments from their local councils? Some councils make direct payments to severely disabled people to enable them to buy in personal help and so remain living in their own homes. Will they be able to continue them?
The independent living (1993) fund has a number of most unsatisfactory features. For example, the upper payment limit includes the local authority contribution in kind of £200. Thus effectively there has been a twofold cut in help: first, more stringent criteria of eligibility have been introduced; and, secondly, the maximum limit for individual payments has been reduced.
As no one will be able to insist that a local authority makes its due contribution, both the council and the trustees of the new fund will have a power of veto. Again, and very unfortunately, the director of the fund's job specification suggests that hewill decide whether its help is the most appropriateHow will this be decided? Will some existing beneficiaries be referred to their local authorities when they seek more help? The old ILF enjoyed some flexibility in its operation. This has now gone.
The independent living (1993) fund cannot alter the age groups of beneficiaries. The age limits of 16 to 65 are set down in the deed, which also specifies priorities in saying thatAny applicant who is young and in work should be given priority for receiving financial assistance.61 The Minister is aware that, over and above the withering criticisms there have been of the upper limit on payments, there is profound concern about his decision to impose an upper age limit for help. In a statement on its reaction to the Minister's reply to my speech of 25 February, the Alzheimer's Disease Society, of which I am an honorary officer, says:We believe the age limit for applications to the successor bodies to the ILF penalises people for being old as well as ill.Such age discrimination is a crude example of a Government minimising public expenditure at the expense of an extremely needful group of people.Jane Lakey, of the Policy Studies Institute, gave details of an instructive case in an article in The Guardian:Mary is 75 and lives with her sister. They manage to stay in their own home with help from the ILF…Mary and her sister use their ILF money to employ an assistant to help with shopping, washing and cleaning, which they can no longer manage themselves. Their assistant has become a friend.Mary is quoted as saying that if they did not have access to the ILFThey would try to put both of us in a home. And we are happy here, with good neighbours and friends".I ask the Minister urgently to meet the Alzheimer's Disease Society to hear at first hand about the very disturbing effect of his decision to impose an age limit which, in the case that I have quoted, would most certainly have involved higher public spending and the loss for disabled people of their homes and friends.
The Bill gives powers to make grants to Motability, as the Minister said, as well as to the ILF's successor bodies. As many right hon. and hon. Members will know, I was centrally involved, as the then first-ever Minister for the Disabled in this or any other country, in the creation of Motability; and I have been a patron since its inception 16 years ago. The idea of creating Motability came to me when I was introducing the mobility allowance and we created a wholly unique partnership, one between the Government, voluntary effort, the banks, insurance companies, motor manufacturers and dealers, that has made it possible for hundreds of thousands of disabled people to secure cars. Without it the great majority of beneficiaries would not have a car at all.
Nobody then imagined that Motability would turn out to be such an outstanding success, with a total now of some 350,000 new vehicles supplied since we launched the scheme in the 1970s, If account is taken of the number of people in the families of disabled people who benefit from Motability's work, its beneficiaries must now have reached a total approaching the size of the Chinese army! My hon. Friend the Member for Huddersfield said that the Minister had a big success on his hands with the old ILF. What kind of success, then, has Motability been?
The success of the contract hire scheme is shown by the fact that well over 85 per cent. of people coming to the end of a three-year agreement choose to have another Motability car. Our promise of financial support for Motability in the original memorandum in 1977 has been honoured by successive Governments over all the years since it was set up; and I am sure that this will continue.
Enormous demands are now being made on Motability's own resources to help where the mobility component of the disability living allowance is insufficient to pay for the car the disabled person needs. The amount spent on grants has risen from £366,000 in 1988–89 to nearly £2,500,000 in 1991–92. These demands make the 62 Government's grant for administrative costs essential. Without it Motability would be unable to continue its work.
I know from my own experience what a huge difference a Motability car can make to many families. Without the scheme often the disabled member would be literally housebound. It was gratifying to learn that Motability's own surveys show that, besides describing the beneficial effects on their own lives, new customers say that for the first time ever they are now able to help others.
I pay warm tribute to the staff of Motability and Motability Finance Ltd., to the enthusiastic co-operation of officials of the Department and to the governors of the charity, who selflessly devote so much time to its work.
Voluntary financial support for Motability will be needed even more in the future; and I am glad it is now undertaking a fundamental review of fund-raising activities. I also note Motability's gratitude to the Department for the creation of the equipment fund, which has made possible grants for the most severely disabled drivers and passengers. At the same time, I am most grateful to the right hon. Member for Chelsea for the tribute he paid in his speech to my part in creating what is a most important organisation for disabled people who are unable to walk.
When the Minister comes to reply, I ask him to do so constructively to the renewed concern I have expressed about the inadequacies of the ILF's successor bodies, to deal with the unanswered questions I have posed, and to offer some hope to the severely disabled people, not least the elderly among them, whose claims I have sought to articulate in this debate.
§ Mr. Alan Howarth (Stratford-on-Avon)
As we debate this Bill, the centre of our concern should be the scope that it provides for severely disabled people to live independently. I know that is at the heart of the personal concern of my right hon. Friend the Minister for Social Security and Disabled People. He was the father of the independent living fund, just as the Disablement Income Group was the midwife. I pay tribute to them, to the trustees of the independent living fund and to the staff at Nottingham for their achievements since 1988 in making it possible for independent living to become a reality for significant numbers of the most severely disabled people.
We should see support for independent living as, above all, a moral imperative. In a great many cases disability is less a function of physical impairment than a failure by us—family, friends, professionals, society and politicians acting on its behalf—to do as much as we can to enable the physically impaired person to take control of his or her life and to take his or her full place in society.
I was glad, therefore, when my hon. Friend the Under-Secretary of State for Health recently told the House:The cornerstone of our community care reforms is the empowerment of the individual."—>[Official Report, 26 January 1993; Vol. 217, c. 858.]He was speaking in the spirit of the opening words of the foreword to the White Paper, "Caring for People":Helping people to lead, as far as possible, full and independent lives is at the heart of the Government's approach to community care.Similarly, the social services inspectorate, in its guidance for local authorities on assessment procedures, takes it as a principle that people should 63be in charge of their own lives and make their own decisions, including decisions to take risks.Those are clarion statements, but I want to be surer than I am that the practicalities of policy remain fully consistent with them. The trust deed that constitutes the independent living (1993) fund contains a provision in section 2, under "Definitions and Interpretations", which states that "pay to" shall includeapply for the benefit ofBut that is the crucial distinction. To elide it is to travel back to a paternalism and to assumptions about dependence from which it has been the achievement of my right hon. Friend the Minister and of the ILF to carry us forward.
I lay my main emphasis on the desirability of provision to assist disabled people being made in the form of cash payments, enabling them to be in charge of purchasing and organising their own domestic and personal assistance. The Government have no objection to that in principle—that is what the social security system does, what the ILF has done and what the two new funds are to do.
However, the Government raise objections to local authority social services departments making cash payments. They observe that it is contrary to the provisions of the National Assistance Act 1948. In this Bill, we have a legislative opportunity to dispose of that obstacle. The Government raise other objections. They say that there would be problems in defining appropriate eligibility to receive such payments. That problem arises with any benefit and presents no difficulty that cannot be surmounted as a matter of routine. The Government again say that there would be problems of cost control. But the various disciplines on local authority spending are real enough and well known to us all. I see no difficulty in social services departments assessing the value of care that they should provide for a client and paying over the relevant sums, at appropriate intervals, with requirements for clients to account for how the money has been spent, and for a periodic review of assessments. The Government also say that it would be excessively bureaucratic. I would suggest, with respect, that it would be less bureaucratic than the scheme that the Government intend, whereby social services departments will organise, in detail, the provision of the various services required by a client.
My hon. Friend the Under-Secretary of State for Health recently acknowledged to the House the extent of support for cash payments. It did not sound like the fiercest opposition when he said that the Government are not ready at this stage to take that on board. I hope that I can assist him to persuade colleagues—whoever they are, whether in the Department of the Environment, or in the Treasury—who need to be persuaded to take that plunge.
Social services departments, of their nature, are unable to provide services to clients with the same sensitivity, flexibility and precision as disabled people themselves. Notwithstanding the personal commitment of local authority staff, bureaucracies are always liable to fit the client to the service, rather than the other way round.
Ann Kestenbaum, in her research for the ILF, and Jenny Morris, for the Rowntree trust, have both documented this in persuasive case histories. Jenny Morris quotes a disabled woman, Elizabeth, who says:Yes, sometimes they're very patronising. They're overbearing and they want to do more than I actually need. 64 They want to give help in a…this is a hard word for me to say but I'm going to say it…custodial sense rather than facilitate. It's a big difference. When you're being custodial you're, well you're dictating aren't you, more or less, you're smothering a person's sense of independence.That is exactly what we do not want to do. Care in the community must not be institutionalisation in the community.
The simplest way out of that snare is to enable local authorities to pay cash to clients. The psychological and practical value of this to severely disabled people is immense, as the ILF's experience attests. Ann Kestenbaum found:When clients and family carers were asked what it was about their care arrangements that they valued most highly, a number of themes repeatedly emerged: choice of care assistant; continuity; flexibility; respite; self-respect; control; and choice of where to live. These benefits were clearly perceived as being directly related to their ability to pay for care.She cites moving case histories to exemplify those points.
Jane Lakey of the Policy Studies Institute has researched the same issue more recently. I shall quote what some of her interviewees said:I know I can feel at ease with people I choose.Because they're employed you don't feel embarrassed to ask for too much help.I can get the hours that are most helpful to me. Times for lifting and bathing as I wish.You can pick who you want. Someone with the same interestsYou can employ friends. People you know and like and do things you want to do.You can tell them more and instruct them and not feel you're begging them to help you.Other people have commented how important it is to them to be able to give back rather than simply to take
Only 5 per cent. of the ILF's severely disabled clients have found themselves unable to handle the recruitment and management of their assistants. The new confidence and the enhancement of self-esteeem that the experience provides are restorative and enabling for disabled people. A number of disabled people have used the experience as a springboard to get into work.
Cash payments are, moreover, better value for money. Helpers employed through ILF grants cost less per hour than helpers employed by social services departments and fewer of them are needed as they are more flexible and adaptable in what they will do. Disabled people usually want a streamlined system to minimise the complication in their lives of helpers, equipment and so forth. They have an obvious interest in cost-effective arrangements that enable their incomes to go as far as possible.
Local authorities acknowledge that the money goes further in the hands of clients. At the annual general meeting of the Association of Directors of Social Services last autumn, there was unanimous support for a resolution calling for local authorities to be empowered to make direct payments to disabled people. The association stated:The case for direct cash payments, following careful assessment and the application of eligibility criteria, is overwhelming in terms of autonomy, direct management, quality assurance and value for money. In addition such schemes encourage flexibility and creativity beyond that which a local authority may be able to offer.The Association of County Councils and the Association of Metropolitan Authorities back the directors. I am not aware of any disability organisation that does not agree with them. As it is, however, the Government have not accepted the point and I am apprehensive that the new 65 system to be established by the Bill will produce less satisfactory results than we could achieve. To provide, through different channels, a mix of services and cash will not, I fear, be the best arrangement, in many cases at least.
The Spinal Injuries Association tells us that the average cost of care in its field is £300 per week. There is no way, if the first £200 worth of support has to be provided in the form of local authority services, that the client can, with another £100 from the 1993 fund, design and control his own arrangements for assistance.
It is expected that the new 1993 fund, with £4 million, will support 1,500 new clients in the year. They will receive an average of £50 cash a week compared to the average payment by the ILF of more than twice that. The figure of 1,500 new clients compares with 8,500 new clients for the ILF in 1992. I understand that there is a backlog of 6,500 applicants. It is hard to believe that there will not be some numbers of disappointed disabled people.
The 1993 fund starts with £4 million, which is due to rise to £17 million by 1995–96. It is intended as a fund to top up the provision to be made by local authorities. My right hon. Friend the Minister expressed confidence that it would be sufficient. But it may be as well to remember that the ILF itself was originally conceived as a top-up fund. It started at £5 million in 1988. By 1992, by which time local authorities were contributing in no more than half its cases and numbers were rising towards the present 21,000 clients, its budget was £97 million. I hope that the Government will be alert to recognise any need that emerges to increase the fund beyond present plans. After all, how confident can we be that the extra £26 million made available for local authorities will be applied to benefit the most severely disabled? One local authority has told the Disablement Income Group that it expects to use part of that money for day and respite care for children. The £26 million is not ring fenced for the most severely disabled and it may seep away.
Much depends on whether the money provided for community care generally proves sufficient. None of us yet knows. Local authorities are, however, worried about it and consequently they are worried about the risks that they will take in making assessments of need about the £200 level. The 1993 fund has only £4 million. If the trustees decline to make a grant to a particular client and the local authority has committed itself to an assessment above £200, it will be obliged to meet the full cost. There is, therefore, a pressure on local authorities to minimise their assessments of client needs.
I hope that the £117 million to be provided for the independent living (extension) fund will also be sufficient for its purposes. The fund will inherit 21,000 clients. Latterly, I have been advised—I hope that my hon. Friend the Under-Secretary will correct me if I am wrong—that it has been paying out grant at the rate of £125 million a year, with administration costs on top of that. Lord Henley has said in another place that all those in receipt of funds from the ILF will be protected under the new arrangements. The very detailed requirements for financial reporting month by month set out in the agreement between the trustees and the Secretary of State mean, at any rate, that the Government will get a prompt alert if that pledge looks like running into difficulties.
I should like to draw my hon. Friend's attention to section 6.1 of the agreement, which adds specificity to section 6.3 of the trust deed by saying: 66the Trustees shall not pay pursuant to the Trusts of the Deed more than £560 per week to or for the benefit of any person.I may have misunderstood, but it struck me that that might be inconsistent with the statement of my right hon. Friend the Minister of 25 January when he said:Subject to its cash limited provision, the successor body will have an unfettered power to review the awards of existing beneficiaries."—[Official Report, 25 January 1993; Vol. 217, c. 587.]I mention that not in any nitpicking frame of mind, but because it would seem a not insignificant point, as the needs of clients are liable to rise as they grow older and the £560 limit on awards set by the ILF might need to rise over time. I should be grateful if my hon. Friend the Under-Secretary, or my right hon. Friend the Minister, could resolve that difficulty for me.
The Government are setting a limit of £500 on how much can be spent per week to support the needs of a severely disabled person through the local authority and the 1993 fund together. Is it wise, or cost effective, to set this cap? Domiciliary care is pretty well always cheaper than residential. The Spinal Injuries Association has told me of the case of a young man of 28, totally paralysed from the neck downwards as the result of a trampolining accident. After four years in hospital and residential institutions he was able to move into his own flat, thanks to a package of help from the ILF and his local authority worth £650 to £700 per week. If that young man were to have his accident today, he would not apparently be so fortunate. Can it really be the case that the £500 limit would mean his being confined in an institution, which would be more exepensive to the local authority as well as deeply frustrating for him? I hope that my right hon. Friend the Minister can confirm that that is not so. If it is, I hope that the trustees and my right hon. and hon. Friends will argue vigorously for an increase in the £500 limit.
By the way, the schedule of meetings set out for the trustees in such detail in the deed will not help them very much in making their case. If they meet only in October to minute the Secretary fo State in November as to their funding requirements for the following year, they will be far too late for the public expenditure survey round. It looks as if the Treasury got at that bit of drafting.
My right hon. Friend said that anticipation of mounting costs is the reason why the Government have set an age limit for new clients of the 1993 fund. I appreciate that my right hon. Friend has positively sought to provide more and better help to younger, severely disabled people who have not had the opportunity to build up savings and pension entitlements. I applaud that, as I am sure we all do, but I am somewhat bothered that section 4 of the first schedule of the 1993 trust deed, as the right hon. Member for Manchester, Wythenshawe (Mr. Morris) observed, goes so far as to say:Any applicant who is young and in work should be given priority for receiving financial assistance.The annual report of the ILF for 1991–92 shows that 37 per cent. of its clients were aged 60 or over. Already, there is discrimination against people over 65 in respect of disability living allowance. I feel that elderly people have an equal claim on our society for care. Nor need the cost be unmanageable. The Government's own estimate is that it would cost an additional £2 million if the fund were permitted to take on people over retirement age, rising to £9 million by 1995–96. That is not exorbitant.
The trust deed, the agreement and the circular of 4 March between them do not, I think, provide answers to 67 a number of specific, practical questions. Who will apply to the new fund—the local authority or the client? How are joint assessments to be made? How is £200 worth of local authority services to be defined and measured? What £200 buys varies, in any case, significantly in different parts of the country, but that is a different point.
There appears to be scope for confusion and even, I fear, antagonism. Will harmonious co-operation be furthered by the requirement on the trustees in section 8(7) of the deed that, if they are of the opinion that any local authority is not fulfilling its statutory obligations to provide personal care to a client, they shouldforthwith report the matter to the Secretary of State"?Was it necessary to put that in? We do not want disabled people losing out amid disagreement and rows between local authorities and the fund. No doubt rows would be exceptional, but there is a danger that arrangements designed and put together piecemeal will not be efficient.
The relatively complicated processes required are also liable to take a lot of time. If, in order to wind it up, the ILF had to be closed to new applicants four months before care in the community was due to start on its new basis, how much longer will it take for a new, untried and more complicated system to deliver help to severely disabled people? We could have a disturbingly long hiatus.
The new system is due to be operational two-and-a-half weeks from now. After tonight, money can be paid into the two funds by the Department. I understand, however, that much has still to be done to establish the new administrative arrangements. Do the new funds yet have their director? I believe that the ILF staff at Nottingham have had their contracts extended until July, but they have not been encouraged to stay and many of them are leaving. It would surely be preferable to have as much continuity as possible between the ILF and the two new funds. The Department's press notice of 24 November explained that the ILF would be closing the next dayto ensure an orderly handover of cases to the successor bodies".There is an enormous amount that the successor bodies can learn and inherit from the ILF.
For example, over its five years, the ILF has developed assessment procedures that provide a model which I very much hope will not be discarded in the new system. Will the ILF's admirable social worker's report form be carried forward and used, with appropriate modifications, by the new funds and by local authorities?
My right hon. Friend the Minister of State confirmed, I think, that none of the trustees of the ILF has been appointed to be a trustee of either of the new funds. I understand that there has not even been consultation with them. That seems curious. It is true that the ILF trustees have been rather sturdy people; they have needed to be positioned as they have been between the Treasury and the disablement movement. But I do not think my right hon. Friend the Minister for the Disabled ever minded that.
I recognise, as my right hon. Friend observed, that the new bodies will, in important respects, be different from the ILF. The ILF was a joint charitable undertaking between the Government and the Disablement Income Group. The deeds establishing the new funds preclude independent trustees. The emphasis in the description of the trustees' role is on monitoring and financial oversight. 68 The affairs of the trusts will be run by the director, whose appointment must be specifically approved by the Secretary of State and whose job description is clearly set out in the second schedule. The Government plainly intend to exercise tighter control, as is evidenced by the more detailed criteria for eligibility written into the funds. The emphasis in the documents on management practice, while perfectly proper, does perhaps express a somewhat different ethos.
I do not know whether the outgoing ILF trustees would wish to serve on the new bodies. I hope, however, that they would. My right hon. Friend the Secretary of State can appoint another five trustees for each fund. My right hon. Friend the Minister of State did not encourage us to expect this to happen, but I hope that my right hon. Friend the Secretary of State will, after all, invite some of the former trustees to continue to serve. It would help at a practical level with continuity. I hope especially that, come what may, my right hon. Friend will appoint some trustees who are themselves disabled. That would send a signal to disabled people that their voices are heeded, that their expertise and commitment are valued and that the Government believe it right that disabled people should share ownership of the system which we establish for their support.
I thank my right hon. and hon. Friends for their continuing commitment to the cause of independent living. I congratulate my right hon. Friend the Minister of State and my right hon. Friend the Secretary of State on their achievement in securing funding for the new trusts. I am sure that they will be vigilant and determined to ensure that funding in the event proves sufficient and that the practical operation of the new trusts, in collaboration with local authorities, fulfils the hopes that the most severely disabled people, and all of us on their behalf, have of them.
§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)
I was interested in the remarks of the hon. Member for Stratford-on-Avon (Mr. Howarth), who made a full and, if I may say so, eloquent speech. His interest in the subject is well known. I am sure that his remarks will repay careful study.
I shall begin what I hope will be a brief contribution to the debate with a couple of boring technical points, but I would certainly sleep slightly easier in my bed if I were to receive explanations. First, the Bill is presented under Standing Order No. 48. Surely the Department of Social Security has the power to introduce the grants that we are discussing. If that is so, why is the Bill necessary? Why has Standing Order No. 48 been used to bring the Bill forward? As a fortnight will pass before the new procedure is implemented, perhaps I shall be sent a letter if my questions cannot be answered when the Minister replies.
Secondly, the Bill has the stench of hybridity about it.
§ Mr. Kirkwood
I am receiving some reassuring body language from the Minister. I know that he is a specialist on hybridity as well as crosses from the right wing into the penalty box. That might not be understood by everyone. I wish only to say that the hon. Gentleman is an extremely good inside forward. I have the pleasure of playing in the same parliamentary team. We seem always to get beat.
69 As I have said, there is an element of potential hybridity. If the Department has considered that, I would welcome some reassurance. It is a peculiar procedure to be giving grants and establishing organisations by means of private deed.
I turn to the substance rather than the technicalities. I feel that the prevailing mood is that the House is rather disappointed that the Government have approached the matter in the way that is set out in the Bill. Hon. Members on both sides of the House, including myself, had misgivings when the independent living fund was set up. We have all come to recognise, however, that it has played a valuable role for a specialist group with extremely severe disabilities. Have we embarked on the best way of making long-term provision for their needs? We have not stepped back to take a longer term view.
There is an argument for continuing with the ILF. I understand, of course, that the position will change after 1 April when community care is introduced, and I welcome that. Community care, in principle, is an extremely good approach. A case could be constructed, however, that people with extremely severe disabilities should be dealt with outwith the provisions of community care.
Perhaps we should start by asking about the entitlement of those with severe disabilities. What should we be offering them? What choices should we be offering them? What do they expect? If we as a community do not help them, they will not be able to help themselves. It is almost a moral question, and it is one which seems not to have been properly addressed. What duty do we as a legislature owe people who have extremely severe disabilities? These questions are not merely administrative or financial. It seems to me that they are much more fundamental than that. I have the feeling that many in the House take the view that the severely disabled deserve better consideration. Our approach should be more thorough and longer term than that which we seem to be debating this evening.
Does the Bill represent everything that people with severe disabilities may look forward to in the longer term? I hope that that is not the position. I understand, of course, that there is a need to make changes because of the consequences of the introduction of community care, but I hope that the Minister will say that a careful review will continue to be undertaken by the Department.
We have had the Office of Population Censuses and Surveys studies and I accept that the Government have done much for the disabled. I do not take the view that was adopted by previous Opposition Front-Bench spokesmen. The new management of the official Opposition seems much more reasonable and more sensitive to the real problems. At the same time, the Government must make clear what they believe can be done in future. Surely this is not the end of the story.
Once the new system is up and running we may have time to reflect on what benefits are available, and will continue to be available, as a result of using quasi-independent trustees. I certainly recognise the courage of the Disablement Income Group and others who decided to interpose themselves between the needs of disabled people and the Treasury. It was a brave decision to take and they were vindicated for doing so.
The discretion available to the trustees of the ILF was innovative and the power was used with great skill in sorting out some of the problems and dealing with some of the tight budget constraints that appeared latterly. What experience have we gained from that? Are not we in danger 70 of throwing some of it away in the changes. I hope that the Department will carefully consider the lessons that can be learnt from that combination of independent trustees' discretion and judgment and all the other matters that have formed the system to date. I hope that proper analysis will be carried out so that we can have the benefit of that experience.
I think that the mood of the House reflects my impression that the concept of an independent living fund has been ever so slightly marginalised—indeed, not ever so slightly; it has been marginalised—in the changes, which is a matter of some regret.
A number of administrative questions need to be answered. The hon. Member for Stratford-on-Avon touched on many of them, so I shall not reiterate them. Cash in hand is absolutely crucial. The Government's position in constraining the assistance able to be deployed by the new funds to those of working age is a bit mean-minded. The parliamentary questions to which the hon. Member for Stratford-on-Avon referred struck me as being good value for money—£2 million, rising to £5 million or £6 million over a number of years. The Government have not yet explained adequately why they have rejected that.
What discussions have there been with local authorities? There was some banter earlier when that point was raised. The Minister plays an old and mean hand at the Dispatch Box and tries to soothe our worries. However, there are real concerns about the consultations that have been undertaken and those that have still to be undertaken, as well as about the shortness of time in which to get the system properly up and running by the date set by the Government.
In an intervention I asked the Minister about the process of reviews and appeals. It is my belief that the Government will end up in court in a short time because some of the elements of discretion that will be exercised by local authorities will put them at the wrong end of judicial reviews in high courts throughout the land. That does not make for good law. We, as legislators, should be absolutely certain that we do not leave the courts to take in our dirty washing because we are not doing our job properly.
Other hon. Members have already called for an assurance that payments will not be delayed by the changeover in the system. We do not want any of the chaos that occurred with the disability living allowance and disability working allowance for all the reasons that the Government have given. We must not put people through that again.
When will we know the identity of the trustees who will share the burden of such a heavy responsibility? I can think of no reason why those who have gained experience with the independent living fund should not be invited to serve on the new bodies.
Who will have access to the trust deeds for the new bodies? They were published on 25 February, but I have not yet studied them to the extent that they have been studied by the hon. Member for Stratford-on-Avon. I assume that they are generally available to Members of Parliament, but will they be made readily accessible to those outside this place so that they can study them and ask questions about them?
When will the regulations—if there are to be any—be introduced? Perhaps the trust deeds will stand by themselves, which would be a strange parliamentary 71 procedure. The guidelines and implementation of the funds would be described, constrained and set out in trust deeds rather than in statutory instruments. If there are to be statutory instruments, will they be subject to the negative or the affirmative procedure? Will they deal with the procedures for review or repeal?
The hon. Member for Stratford-on-Avon dealt adequately with the point about payment in cash directly to the recipient.
I welcome the Motability scheme as a beneficial scheme for those with access to it. However, I am puzzled why the administrative expenses should be so high. If my researchers are right, the scheme cost £1.8 million in administration in 1992–93 for an equipment fund of only £1 million. I accept that increases have been admitted during the course of the changes, and the Minister referred to them in passing—£2 million administration costs for a £2 million equipment fund. Nevertheless, I do not understand why it should cost that amount to administer what I accept is a beneficial scheme but which involves a relatively small amount of money.
What estimates have been made of attrition rates? The Government are being a little optimistic about new people gaining access to what is, in effect, a cash-limited fund. What has been the experience with the rate of deaths among those who have benefited from the fund? It is important to know what provision has been made for increased access by new applicants.
The question of ring fencing has a particular application north of the border. Although there was ring fencing in the community care budget south of the border in England and Wales, the community care budget for Scotland has not been ring fenced. I want an assurance that the Bill and the provisions of the community care budget will not have a knock-on application in Scotland after 1 April.
I want to raise a point about resources and the £500 ceiling. I understand that there are two component parts to that. I cannot think of any way to index that figure. I may be wrong because I have not studied the trust deeds to the same extent as the hon. Member for Stratford-on-Avon. However, it is an important question and we need to know how the Government intend to achieve some level of indexation for the middle to long term.
The sum of £4 million that has been set for the extension fund is not enough. I need to be convinced that it is anything like enough money to meet the demands on the fund. The hon. Member for Stratford-on-Avon and I referred earlier to an extension to those aged over 65. That matter should be reviewed.
The measures contained in the Bill should have been brought to the House a long time ago. The process of consideration has not been properly thought through. The consultation, such as there has been, with interested parties has been inadequate. The level of resources provided in the Bill appears to be inadequate for the tasks set out. If the needs of those with severe disabilities are to be properly catered for, I fear that the House will need to return to these matters before very long.
§ Mr. David Willetts (Havant)
I welcome being able to participate in a debate on legislation in which a clear manifesto pledge is implemented so effectively. The Bill implements this pledge in the Conservative party manifesto:The Independent Living Fund has proved a great success in giving severely disabled people an opportunity to live in the community. We are committed to maintaining a fund which supports the most severely disabled people.The Bill is a distinctive and subtle mixture of continuity and change, which is just what one would expect of the Government. In particular, the continuity comes from the name of the new fund.
An enormous amount of help is now provided to disabled people. The total benefits budget is approximately £15 billion—an increase three times the rate of inflation since 1979. One difficulty in debating that budget and its enormous increase is that many people outside the House think all that expenditure goes on the severely disabled. They do not appreciate that under some of the definitions of disability with which we now work—for example, in the recent work of the Office of Population Censuses and Surveys—people with relatively modest impairments to movement count as disabled. There are 6 million disabled people in this country and I am sure that there are right hon. and hon. Members who would count as disabled under some definitions now in use.
None of the uncertainties about what exactly constitutes a disability affects the Bill, because it undoubtedly deals with the severely disabled—those whose disabilities are much more severe than those suffered by people oh, for example, invalidity benefit.
The Bill can be traced back to the social security benefit review of the mid 1980s and the enormous pressure under which the Government found themselves to simplify the then supplementary benefit rules. I vividly remember the then Secretary of State for Health and Social Security, my right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler), coming to a meeting bearing two volumes of supplementary benefit regulations and saying that the system was collapsing under the weight of its own complexity. He argued that it was impossible to expect social security office staff to administer a system that had become so intricate.
The pressure therefore was for simplification, so the Government simplified the system to create income support, which is in many ways superior to the scheme that it replaced. But the Government found that many of the specific areas of help provided under supplementary benefit could not be ignored. The domestic care addition, then paid to 6,000 severely disabled people, was a classic example. While moving from a complicated system to a much simpler one, the Government found themselves having to introduce a new element of discretionary help for the severely disabled to replace the old domestic care addition. Hence, the independent living fund was born.
There has been almost universal praise for the discretionary ILF in today's debate, but it struck me that no one referred to the social fund. The social fund was a parallel initiative in providing discretionary help for people in particular need. It had the same origins—it, too, was an attempt to keep the new income support system simpler than the previous supplementary benefit system. I hope that hon. Members who praised discretion today will not, next time that the House debates the social fund, give 73 sermons on how the discretionary distribution of public money somehow contradicts a fundamental principle of the British constitution.
§ Mr. Frank Field
We have been intervening because we are burying the independent living fund in all but name. Is the hon. Gentleman proposing that there should be a Bill to do the same to the social fund?
§ Mr. Willetts
As the hon. Gentleman knows, I support the principle of the social fund. With the establishment of the two new funds under the Bill—the extension fund to cover people receiving payments under the old arrangements and the 1993 fund—there will still be an element of discretion in the system. I respect the hon. Gentleman's comment, but it does not address the fundamental point—if discretion is acceptable in respect of the severely disabled, why is it not acceptable elsewhere in the system? The arrangements make a reasonable attempt at providing a framework of general rules by which public money is distributed and for a reasonable element of discretion.
There is a second paradox in some of the arguments made today, particularly by Opposition Members. A perennial dilemma in public policy is the way in which central Government should handle their relationship with local government. We are used to hearing the criticism that ours is a centralising Government taking discretion away from local authorities and denying them the freedom that they need. Yet hon. Members who happily make that criticism are also among those who plead most vigorously for severe limits on local authority discretion when it comes to the new community care proposals that are to be implemented in April.
The hon. Members who argue that ours is a centralising Government are the ones who are the most vociferous in pressing for ring-fenced grants and specific central Government limits on the action that local authorities may take. When it comes to practical implementation, those hon. Members' commitment to local authority discretion seems rather wanting.
We heard today from members of Labour's Front Bench the ultimate logical absurdity, by way of a demand for a ring fence within a ring fence. Labour is not happy with the overall ring fencing of £565 million for central Government grants to local authorities to spend on community care, but wants ring fences within that—for specific assistance previously covered by the ILF. The only business that would thrive under that system would be fence making.
There must come a point at which, if we are serious about giving a role to local authorities, they must have the discretion to exercise their judgment in distributing the enormous sum of public resources available to them.
§ Mr. Dewar
Does the hon. Gentleman object to the concept of extending local authority power by allowing authorities the discretion to make cash grants in the circumstances of particularly difficult cases? The Minister seemed to be saying—I hope that I am not misrepresenting him—that local authorities are too busy and that administrative difficulties might be created. He gave that as the reason for not allowing such discretion. I hope that the principle of such an extension might appeal to the hon. Gentleman.
§ Mr. Willetts
I will refer to that aspect later. The hon. Gentleman's instincts are good in respect of policies that particularly tempt me.
Like many hon. Members who spoke today, I have been much influenced by the work of Jenny Morris of the Rowntree trust, who has undertaken valuable and practical research into the assistance that disabled people particularly want. We all know the buzz words of independence and flexibility. While many working in social service departments recite those words as mantras, research by Jenny Morris and others show that independence and flexibility are still not necessarily the experience of the severely disabled.
I would like to set out some of the lessons of the research about what flexibility and independence really mean. One thing that we have learnt is that receiving domiciliary care in one's own house is not always the best route to flexibility and independence. I fear that we may be going from one extreme to another. Everyone is now supposed to be against institutional care in favour of care that enables people to live in their own homes, but one's own home should not become a prison. People should not be given care only if they stay within those four walls; it should be possible to provide a care package that allows people the freedom to leave their own home from time to time. One of the strong messages of the research is that domiciliary care must not become a sophisticated and up-market form of imprisonment.
It is also important that people requiring care should be able to exercise the maximum choice in the care they receive. One of the anxieties that many Conservative Members have had over the past few months—as Ministers know—is that some local authorities will succumb to what must be a conflict of interests. They are the purchasers of care, yet many are also providers of care. They will be strongly tempted to push as much as possible of their budget in the direction of their own employees. That is why I welcome the 85 per cent. rule, which will require local authorities to spend a very high proportion of the extra grant that they will receive from Government on private providers. There is no reason why services for groups such as the severely disabled should be provided by public sector employees.
§ Mr. Frank Field
For the first time that I have heard him speak in the House, the hon. Gentleman seems to be caught in a time warp. It is perfectly proper for him and his hon. Friends to point out that it is wrong for Opposition Members to be committed to the idea that public provision must be better than private provision. Is he not making a similar error by saying that the Bill marks an advance because it will tie local authorities to providing 85 per cent. of care through the private sector? Is not the big divide one of freedom? The Bill marks a failure in our attempts to protect and extend the freedom of the individual. It marks an increase in paternalism: no matter what skills the hon. Gentleman deploys in presenting his case, that is what is happening. Whether it is local authority or private provision is a secondary issue; it is less important than allowing people to choose for themselves.
§ Mr. Willetts
The fundamental dilemma presented by the Bill is whether we believe in community care. Despite the attempts of the hon. Member for Huddersfield (Mr. Sheerman), I was not persuaded of the possibility of combining the previous arrangements for the independent 75 living fund with the principles of community care, which give local authorities the lead responsibility for the assessment of the needs and means of people who come within the categories laid down by community care policy. The ILF was established before the implementation of community care policy. It strikes me as unfair on local authorities—and, indeed, inconsistent—to say, "We back community care and believe in this discretion for local authorities, but we are not prepared to give them such a role in regard to severely disabled people." That is the dilemma on which the hon. Member for Birkenhead (Mr. Field) and the Opposition Front Bench seem to be impaled.
§ Mr. Willetts
I entirely accept that and I was about to deal with it in my speech. The individual—a person requiring care—should be empowered by the policies, if I may use an expression that originated with the new right in America and has now been picked up by the Labour Front Bench. I do not believe that community care makes such empowerment impossible.
§ Mr. Sheerman
Let me add my voice to that of my hon. Friend the Member for Birkenhead (Mr. Field). The empowerment of the individual is what is important. Community care is not such an ideologically iron construct that we cannot build into it the idea on which it was originally based. Originally, it was seen by both sides of the political spectrum as the ability to enhance the development of individual potential. We should subscribe to that concept, but we should apply a criterion—does community care achieve what it was originally intended to achieve? Sometimes it does, in the Government's terms; sometimes it does not. In the present instance, Labour is saying that it does not.
§ Mr. Willetts
Two different points are being made and Opposition Members are in danger of confusing them. I accept that community care reforms must be implemented in such a way as to give maximum choice and power of decision to those receiving care. That is fundamental and I will come to it later in my speech. I do not think, however, that it follows that community care can be provided only for certain groups and that the ILF must be kept on its old basis for severely disabled people.
It seems to me that the sensible approach is to ask how the new community care reforms can be introduced in a way that maximises power of the individual. We cannot say that the community care policy applies to some groups, while the old ILF structure applies to other groups.
§ Mr. Sheerman
What would the hon. Gentleman say to the hon. Member for Mid-Kent (Mr. Rowe), who would agree with him about empowerment through community care, but says that that can be facilitated by giving local authority social services departments the ability to pay cash to individual disabled people?
§ Mr. Willetts
I have already been pressed about that and I shall return to it in a moment. My hon. Friend the 76 Member for Mid-Kent (Mr. Rowe) has been sadly absent this evening, given the contributions on the subject that he has made in the past.
I accept that our objective is to maximise the independence of the recipient of community care. We should draw on the research that has been done and on our own conversations with severerly disabled people.
§ Mr. Barry Porter (Wirral, South)
I hesitate to intervene when all the experts on compassion are gathered together, but I am rather puzzled. The right hon. Member for Manchester, Wythenshawe (Mr. Morris) and one or two others have suggested that the Bill is Treasury driven. I am present only because I do not see why the severely disabled should be subject to a flint-hearted Treasury if that can possibly be avoided. How what money there is should be distributed, whether it should be cash limited and whether local authorities should do this, that or the other is a matter for the hon. Members who have appointed themselves as experts.
Is this a Treasury-dominated Bill? Is it an attempt to save money, or is it an attempt to launch a better and more organised system, whereby the severely disabled are treated in the way in which human beings should treat them?
§ Mr. Willetts
I must confess that, when I hear that the Bill is supposedly Treasury driven, I experience a mixture of emotions, having been a Treasury official for six years. I am not sure whether a Treasury driven Bill is necessarily as terrible as some hon. Members clearly assume it to be. If "Treasury driven" means that a Bill applies sensible criteria to the spending of taxpayers' money—even in regard to social security and benefits for disabled people—I very much hope that this Bill is Treasury driven. I also believe, however, that, within the community care arrangements it is perfectly possible to pursue the crucial objective shared by hon. Members on both sides of the House—that the recipients of care have the maximum power and ability to decide when it comes to the pattern of care that they receive.
There are clear lessons to be learnt from the work of researchers such as Jenny Morris and from our own practical experience of the right and wrong ways of delivering care to those who need it. One of the obvious practical messages is that recipients of care do not like their living rooms becoming like Victoria station. They do not like a host of public employees employed by different services thinking that they have a God-given right to knock on the front door, come in and check on the occupants or deliver some distinct service. It is important to have a limited range of contacts, with one or two people providing a variety of services. For example, I regret the tendency for home helps to be called home carers and to cease to provide the range of services that they provided when they were home helps. That is a perennial complaint by recipients of care services. There is no party element in that comment; the observation could be made by any hon. Member. There is no reason why the proposed community care changes should not help us to address that problem.
Another important matter is the power of disabled people to employ the care that they choose. That has been touched upon in the comments about cash. I am struck by the conversion of Opposition Members to the cause of private employment contracts and the cash nexus. I was brought up when the ultimate hero of the welfare state 77 among Opposition Members was Richard Titmuss, who wrote about the gift relationship in blood transfusions and who thought that bringing the cash nexus of private contractual arrangements into the provision of welfare was corrupting and somehow removed the overriding ethical purpose of the welfare state. Several Opposition Members called for the direct payment of cash, the direct employment of providers and clear contractual arrangements. That represents an extraordinary transformation of thinking about the welfare state. Conservative Members greatly welcome that.
§ Mr. Sheerman
I was taught by Richard Titmuss at one time. If anything, he was almost the ultimate pragmatist. He said that if a concept worked for the individual and delivered the service it was ideologically sound. If it did not work and did not deliver, another way should be found. To tar Richard Titmuss with a narrow-sighted ideological view of the world is a Treasury reaction and it is not right.
§ Mr. Willetts
The hon. Gentleman, who sat at the feet of Titmuss, will agree, I hope, that Titmuss's definition of the core of the welfare state, its ethical function, was incompatible with private contractual arrangements. There has now been a plea for such arrangements. I shall now discharge my earlier promise to address the issue of whether local authorities should be allowed to give cash to people who need care.
I understand that for local authorities suddenly to become issuers of large numbers of giro cheques would represent a dramatic change in their functions. In effect, they would become branches of the Department of Social Security and instead of changing the way in which care was allocated the Department would be reinvented. However, two arrangements are widely used to avoid the legal obstacle to local authorities giving out cash and they achieve the flexibility that we should like to see. One such arrangement is for local authorities to give money to charities which would then pass it on to people who are in need of care. The other arrangement is for trusts to be established specifically for the purpose of helping severely disabled people. Perhaps the Minister can explain the Government's view of such arrangements, which seem to enable crucial flexibility to be maintained without breaking the requirement that local authorities do not simply hand £10 notes over the counter.
I have spoken about the background to the measure and about the need for independence and flexibility and what those great terms mean in practice. Finally, let me set out two grounds for optimism about the policy on disabled people. We often address the difficulties, but we do not always remind ourselves of fundamental changes that seem to bring great hope to disabled people. The first such change is technological advance. Severely disabled people have benefited greatly from rapid technological change since the war. That has made it possible for them to receive much more assistance and to enjoy much more mobility and flexibility in meeting their personal needs. Of course, it also makes it possible for increasing numbers of disabled people, even those who are severely disabled, to hold down jobs. Advances in computer processes have enabled people with little control over their limbs to carry out remunerative employment. Therefore, I especially welcome the disability working allowance, which is an attempt to encourage the future employment of disabled 78 people. I hope that it will grow from its rather modest beginnings as more and more disabled people hold down paying jobs.
The other cause for optimism is the changing pattern of wealth and income in our society. One of the fundamental changes is that older people are becoming richer. That change is no surprise because in a successful free market economy people acquire assets during their working lives and run them down in retirement. A high proportion of disabled people are older citizens: many of them are over 60.
We speak about disabled people and about the extraordinary transformation in the financial circumstances of retired people, but rarely do we bring the two together and recognise that some retired disabled people hold assets and enjoy the ownership of their home, a telephone, television set and central heating—the sort of benefits that everyone now expects. That increase in wealth and income which is a feature of today's retired population has improved the prospects of many disabled people because they are disproportionately represented in the retired population.
I welcome the Bill and the Government's extraordinary record in trebling the amount spent on disability benefits. Their record surpasses that of any Government this century. I hope that the Minister will address the specific issues that I have raised.
§ Mr. Norman Hogg (Cumbernauld and Kilsyth)
The hon. Member for Havant (Mr. Willetts) will forgive me if I do not follow closely on what he said. He made an interesting speech and even had the audacity to quote from the Conservative party manifesto. Anyone who does that is bound to cheer up our proceedings.
I pay tribute to the work of the independent living fund during its five years of existence. I am sure that hon. Members will agree that providing the support necessary to enable disabled people to live in their own homes rather than in residential care is a worthwhile aim. The ILF has carried out its function with great success. The fund has been administered with great skill by the trustees and has become an invaluable source of help for disabled people. About 21,000 or 22,000 disabled people receive help from the fund, and I and many of my hon. Friends wish that the Government had had the wisdom to keep the fund functioning instead of winding it up in this manner.
It has also been a good deal for the taxpayer, a point that was made by my hon. Friend the Member for Huddersfield (Mr. Sheerman). Residential care is very expensive. The small amount of taxpayers' money used for grants from the independent living fund has saved the Exchequer money in the long run. The average ILF grant is about £106 a week. I cannot think of a residential home that could provide care for that sum of money.
Before I discuss the new arrangements, I must say a word about the manner in which the ILF was closed to new applicants. The use of a parliamentary answer on 24 November to announce the closure of the fund at midnight the very next day left many disabled people in the lurch. How could anyone be expected to find out about the closure of the fund and organise the submission of an application within 24 hours? Such a deadline might have been more acceptable had it been announced well in advance, but that was not the case. There was no 79 consultation whatsoever with organisations representing the disabled and no warning was given that the door would slam shut in this manner.
The plight of those trying to submit new applications was made worse by the fiasco over the disability living allowance. The condition that applicants had to be in receipt of the higher rate of attendance allowance or the care component of DLA caused great difficulties for potential applicants because of the mess over the administration of those benefits. I am sure that all hon. Members have received as many letters about this as I have.
Since 25 November, disabled people who would have applied to the ILF have had nowhere to turn. Given the success of the ILF, acknowledged by the Government in the need for the successor arrangements dealt with by the Bill, what justification can the Minister have for cutting off all help between the end of November and April? Was this not a callous act where the money saved was far outweighed by the hardship caused to disabled people?
The new arrangements themselves give great cause for concern. The Government have cut the scope of the new independent living (1993) fund. The new fund is intended to deal with only 1,500 applications per annum and it is being restricted to people of working age. Common sense tells us that the age restriction is a major cut in provision, as the elderly disabled relied heavily on the ILF; 34 per cent. of the ILF's caseload were over the age of 65.
The Minister said in reply to a parliamentary question tabled by my hon. Friend the Member for Glasgow, Garscadden (Mr. Dewar) that the cost of extending the new fund to cover people over retirement age would be only £2 million next year. Will the Minister reconsider this restriction, given the small amount of money saved by it? Again it seems as though the Government are set to cause great distress to the elderly disabled in order to save a very small amount of money. In my view, it is simply not worth it. I hope that the Government will think again.
The Minister made great play of his view that most of the sort of help provided by the ILF will be provided by local authorities, following the introduction of the new community care arrangements. The Secretary of State for Health did indeed announce extra funds for local authorities for this purpose, totalling £26 million next year. However, the fact is that, although overall local authority budgets for community care are ring fenced in England and Wales, the extra money announced by the Secretary of State for ILF purposes is not. Is there not a great danger, given the pressures that local authorities are already under over community care, that this money will be swallowed up in the general community care pot?
It is not only the total amount of money available that causes concern; the restrictions upon its use also cause concern. As I understand it, the criteria for help from the new ILF are that, where the costs of independent living for a disabled person exceed the costs of residential care, he or she will be able to apply for help from the fund. That will happen only after the local authority has assessed the needs of the person concerned. It would therefore appear that independent application to the new ILF is excluded. Instead, everyone will have to go through the local authority.
80 In addition, the help provided by councils will have to be in kind—I think that it was described by the right hon. Member for Chelsea (Mr. Scott) as services. They will not be allowed to give cash grants in the way that the ILF did. The only group who will now get cash grants will be those for whom the costs of living in their own home exceed those of residential care. That is, surely, a retrograde step which will deprive many disabled people of the freedom of choice that they were able to exert under the ILF.
Disabled persons who received help from the ILF could, under the old arrangements, use a cash grant from the ILF to organise their care in the manner best suited to them. How can that be the case under the new arrangements, when most people will not receive help in the form of cash grants? Help in kind is inevitably less flexible than help with cash, over which the recipient has control. I do not understand the Government's thinking, since they constantly claim that choice is a hallmark of their administration.
Are the Government saying that disabled people are unfit to exert free choice? Can they not be trusted to obtain the best help, with the resources available to them? I am confident that local authorities will do their best to administer the new arrangements with the greatest sensitivity, but it is difficult to see how they can match the freedom conferred by the cash grants allocated under the old ILF.
All these new arrangements will need to be carefully monitored. I hope that they live up to the claims that the Minister and others have made for them. I have made it clear that I should have preferred the ILF to continue. Given the Government's determination to end it, I hope that the new arrangements can at least be amended. The least that should happen is that the exclusion of those over retirement age should be rescinded and that help from the new fund should be extended to them.
The Government should also think again about the funding arrangements. I realise that there are pressures upon public spending, but it will be a dark day indeed when we have to start economising on help for the most vulnerable people in society. I hope that the Minister will address some of these points when he replies to the debate.
§ Mr. Sheerman
As I understand it—perhaps the Minister will confirm this when he winds up the debate—the law in Scotland on cash payments is different. The hon. Member for Havant (Mr. Willetts), who is now leaving the Chamber and who intervened several times during my speech, should appreciate that, as I understand it, the law in Scotland is different and that cash payments by local authority social services departments to adults are permissible. Can my hon. Friend and the Minister clarify why that should be so? It means that some bold and interesting experiments that could not be carried out in England could be carried out in Scotland.
§ Mr. Hogg
I am grateful to my hon. Friend for raising that point. He is right to say that the situation in Scotland is different. We would argue, of course, that in Scotland we do it better. Therefore, we are always willing to give advice on these matters. If, therefore, the Minister wishes to contact me about them, I shall gladly give him advice.
§ Mr. Peter Thurnham (Bolton, North-East)
Thank you, Madam Deputy Speaker, for allowing me to participate in this excellent debate. I apologise for being unable to attend all of the debate because of developments in Bolton where, tragically, a doctor died from AIDS but did not disclose his condition while treating patients. His name had not been revealed by the health authority, and I have been pressing all day for it to be revealed so that my constituents can at least allay their anxieties on that score. The development of AIDS is another matter for which there may be a need for more care in the community.
I especially enjoyed the opening speech by my right hon. Friend the Minister for Social Security and Disabled People. I should like to place on record how excellent his personal contribution has been. It is fair to say that the independent living fund was his creature. From small beginnings with a £1 million budget, the fund expanded to a budget of more than £100 million and is a good example of how there is nothing so permanent as that which is regarded as a temporary arrangement. I believe that the arrangements now being discussed will prove to be just as important as my right hon. Friend's 1988 initiative.
In 1988, the right hon. Member for Manchester, Wythenshawe (Mr. Morris) condemned the fund by saying that it would be seen as an abdication of the Government's responsibility. However, as my hon. Friend the Member for Havant (Mr. Willetts) said, one of the remarkable features of the debate is the coming together of thinking among the parties. The Labour party is now endorsing the thoughts of Conservative Members, which goes to show that the original thinking behind care in the community is now being done by Conservative Members as much as it ever was by Labour Members.
§ Mr. Sheerman
I know that the hon. Gentleman is an entrepreneur. We know each other in a different guise as co-trustees of the National Children's Centre, which is based in my constituency. It was not the Government who were the driving force behind the independent living fund but the disabled people themselves and what they wanted. If the hon. Gentleman saw a going concern, which was enormously successful and had been running with great acclaim from the consumers for five years, would he, as an entrepreneur, wind it up and start something completely different?
§ Mr. Thurnham
Firstly, on 1 April new arrangements for community care will come into force. They did not exist when the ILF was set up. Secondly, we have set up two funds which will continue to provide for existing recipients of the benefit and for the topping-up of additional requirements. I am sorry that I was unable to hear the hon. Gentleman's speech, but perhaps he could explain what he is driving at.
§ Mr. Sheerman
I gave full weight to the Minister's contribution in setting up the ILF, although I also said that it went far beyond his expectations. It was set up because of pressure to fill a void or gap in social security provisions because of changes in the over-arching laws on social security. We were arguing that, these days, such provision should be driven by what the disability lobby and disabled people want. The matter should not be put into the hands of social services departments or other people who will act as a barrier between those who know 82 what they want and a decent independent living fund, which can respond quickly and without intermediaries to existing need.
§ Mr. Thurnham
The hon. Gentleman has not enlightened me. I should have thought that he would favour the new arrangements for community care, the responsibilities that have been given to local authorities and, now, the top-up. I think that he will agree that, when one is dealing with the most disabled people, one source should not be regarded as the sole provider of all care. It is a matter of partnership and if additional people can be involved, so much the better. I intend later to cite the cases of one or two constituents who feel that the partnership still needs developing because the carers are contributing the most.
We are setting up the independent living fund anew, with two new arrangements. I should have thought that the hon. Gentleman would welcome that as an additional provision to those of the local authorities'.
§ Mr. Sheerman
We shall have a system which will he less well funded. To get help, a disabled person will now have to go through what the Minister called "gatekeepers". The hon. Gentleman was here for the Minister's speech although he did not hear mine so he will have heard that the gatekeepers will be the local authorities and the new independent living fund, which will send their own social workers to make an assessment. The DSS will also have a role. There will be a new bureaucracy instead of the direct relationship which, knowing the hon. Gentleman, I should have expected him to applaud. There will no longer be a direct relationship between the disabled person and the independent living fund. I am sure that the hon. Gentleman understands that the Bill will put three intermediaries or gatekeepers into that relationship. Why on earth should disabled people want gatekeepers between them and their express needs and desires?
§ Mr. Thurnham
The hon. Gentleman begs the question of how well local authorities will carry out their duties. Under care in the community, it is clear that their duty is to assess what the needs are and then establish how they are to be met. If there is to be an additional provision, I welcome it. I cannot understand why the hon. Gentleman suggests that one should ignore local authorities' responsibilities. They are important responsibilities and cause me great concern in case they are not exercised correctly.
In the past few days I received a letter from a family in Bolton. It runs to nine pages so I shall not read it all. It is from Mr. and Mrs. Whiteley who describe eight years of the most intolerable incompetence by the local authority, as a result of which Mr. Whiteley lost his job and the family lost their house while the council said first one thing and then another about help in caring for their son Andrew. He is now nine years old and suffers from spina bifida. Caring for him is more than Mrs. Whiteley can manage on her own. The local authority has messed this family about so much that Mr. Whiteley had to give up his job, and the family have lost their house, because of the administrative confusion.
It is most important that local authorities carry out their responsibilities properly. In that respect, the Government should be congratulated on the provisions that they have made. There has been a substantial increase 83 in financial provision, with a trebling of the money for care, which has increased from £5 million to £15 million in real terms over the past 14 years. There has also been a substantial increase in the number of people provided with care. When the Labour party was in power only 360,000 people received help with the cost of care or mobility. Now, 2 million people receive such help.
Although there have been criticisms of the way in which the benefit agencies introduced the new allowances, substantial numbers of people have benefited and in a shorter time scale than when the Opposition introduced the mobility allowance and took four years to deal with far fewer people.
I have just received a letter from Mr. and Mrs. MacDonald—Iain and Wendy—of 25 Rose Lea, Harwood. They say that the new arrangements are working well. Mr. MacDonald wrote to appeal about one matter relating to the disability living allowance but says:I am, however, completely satisfied with everything else. Thanks to your intervention my case has been handled personally by Mrs. Pauline Padley, Customer Service Section, Invalid Care Allowance Unit, D.S.S. Palatine House, Lancaster Rd., Preston. I cannot stress too highly the sympathy, help and understanding she has given to myself and my wife. She is a credit to herself and her Department…if the time could be found…to thank her I know how much it would be appreciated. It is the only gesture I can think of that would be in keeping with her continuing efforts on our behalf.I quote that letter as an example of how well the Government are making the new arrangements work. In this case, the invalid care allowance is the important benefit which the MacDonalds are receiving.
The calls for additional top-up funds through the new independent living funds will become greater. Just as the original fund grew from £1 million to £100 million—this is the point made by the hon. Member for Huddersfield (Mr. Sheerman)—the demand on the new funds will be substantial and will grow.
I refer to a letter that I have received from Mrs. Cummings of 280, Hough Fold Way, in my constituency. She cares for her adult son David who is severely handicapped and she points out that the funds that she gets at present from the independent living fund are supposed to be sufficient for 21 hours of care per week. She finds that the costs are greater than the amount that is being provided by the ILF, leaving her out of pocket. Each month, the ILF provides her with £322, but each month she actually pays out more than that and receives less care than the 21 hours that she is supposed to be able to receive. She would like the ILF to have greater funds for her requirements. She would also like additional funds to cover respite care so that she and her husband could have a holiday. The funds that they have at present are not sufficient to provide for that.
Mrs. Cummings gives the example of how Crossroads care committee in Bolton has arranged to fund one family with £8.50 a week to buy in care at the weekends. However, Crossroads charges £8.90 per hour at weekends. So the amount provided is not enough for one hour's care. She also refers to other recipients of care from the Crossroads fund who do not receive enough to meet requirements. She gives the example of a family who are allowed £200 a month by the ILF, although the amount 84 required for the number of hours of care specified would come to at least £240 on current costing. Again, she presses for further help in that respect.
Mrs. Cummings then points to the extra costs that arise when people suffer from incontinence. I should like the Government to consider the better provision of incontinence aids because the costs of such aids can lead to substantial extra charges for individual carers who find that the supply of aids as arranged at the moment is insufficient for their needs.
I am delighted to say that a new respite care centre is being set up in Bolton through the voluntary arrangements worked out with the Bolton Handicapped Action Group. I commend its work to the Minister and I hope that he will have an opportunity to come to see its work. The group has set up in partnership with the health authority and now, I believe, with the local authority to provide a package of care. It will manage the new respite care centre which, I am delighted to say, will be called Grosvenor House, thanks to the support of the Duke of Westminster who was happy to lend his name to the initiative.
I confirm that the way in which the Government have provided additional funds will give the flexibility that is so important with care and especially for those who are the most severely disabled. At present many people's care packages cost less than £500 a week because of the uncosted input of the individual carers. There is anxiety about the possibility that if carers cannot contribute fully and if care has to be bought in, sufficient care could not be provided for £500 a week. That raises the threat of the person who is disabled being moved into a home against the family's wishes. I should be grateful if my hon. Friend would consider that aspect and if he would give assurances that the future level of care limits will be reviewed so that people need not fear that the one for whom they care so lovingly may be moved into a home that is not of his or her choice when the family would prefer that person to be able to live at home if funds were available.
I commend the Bill to the House and I congratulate the Government on their record of care for the disabled. I look forward to a continuing growth of the funds for people with disabilities. Although the Opposition have had thoughts on these issues, when in power they failed to fund the requirements of the social services budgets. Only this Government have been able to find the money to provide for such a substantial increase as we have seen to date and which, I am sure, will continue.
§ Mr. Malcolm Wicks (Croydon, North-West)
As we near the end of the debate, it is important to recognise that we have heard many good speeches and two very brave speeches. As has been said, one such speech was made by the hon. Member for Havant (Mr. Willetts). He quoted from the Conservative party manifesto and thus nailed once and for all the vicious rumour among the Opposition that all the copies had been collected up, ring fenced and burnt. It is unfortunate that he did not have time to quote other pledges in the manifesto so that we could debate them, too.
The other brave speech was made by my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris). Waxing strongly—rightly so—about Motability, he compared the numbers benefiting from Motability with the size of the Chinese army. To have made that 85 comparison on the day that the Foreign Secretary made a statement about Hong Kong was brave. Motability may soon have its finest hour. The hidden message in my right hon. Friend's speech will not be lost on military strategists in Beijing.
The key words today have been cash, care and choice. We are at the interesting stage of looking more rigorously at the association and interface between care and cash and, therefore, at the interface between two Government Departments—the Department of Health and the Department of Social Security. As a new Member of Parliament, I am struck by the fact that one cannot ask parliamentary questions about how one Department co-ordinates with another, yet in many respects today we have been discussing that very theme. Increasingly in social policy we are dealing with matters that cut across departmental boundaries and we need to get the discussions right in this area.
We are also approaching 1 April when principles, policies and philosophies about community care will be tested by realities and by practice. The timing of this debate is good. There is widespread agreement that the goals of community care are right and that they are goals that we all want to be implemented. The White Paper "Caring for People" said that the components of community care includedservices that respond flexibly and sensitively to the needs of individuals and their carers; services that allow a range of options for consumers…services that concentrate on those with the greatest needs.In discussing the ILF, we are often talking about those with the very greatest needs.
All the objectives are excellent, but we must now ask tough questions about the practice. I hope that we shall do that during the rest of today's debate and in Committee. There is a sense in which, as we approach 1 April, the waters of community care are becoming murkier As we move towards the end of March, there is a sense that we are moving towards, not greater clarity, but greater confusion. In certain letters that have been leaked, although not always published, we are hearing more about costs and less about choice. I worry about that.
This is an appropriate opportunity to ask Ministers some clear questions. Is there now a limit on what social services authorities can spend on those with disabilities? Is the £200 limit now a clear limit?
§ Mr. Wicks
The Minister shakes his head, and I am pleased about that. I should like clarification of that point. In the social work press and more widely, there is concern that Government officials and the social services inspectorate are now warning local authorities that they should not offer too much to clients. The Minister may want to correct this. A headline in The Independent—which never tells a lie—on 12 March read:Councils told to 'hide' care services shortfall".The article said:The Department of Health has advised social services directors to keep secret the services they lack after community care comes into force next month.In a letter, an official says that they should not give people a list of nursing and community care services which they ideally need, in case the council is sued for maladministration if it cannot afford to provide the service.Given that we are all agreed on the objective of openness and the need to bring carers and the cared for 86 into the discussion about care packages, how can such secrecy be part of the deal? The Minister may want to shake his head again. I hope that, in conjunction with his colleagues from another Department, he will be able to tell us that social service authorities are not being cash-limited in that way. If they are, there can be no effective and honest partnership between those needing care and the care providers, which means that the objectives will not be fulfilled in practice.
Hon. Members on both sides of the House have expressed concern about the £500 limit. If we are to judge community care partly by the extent of its impact on people in the greatest need, the question of the £500 cash limit, which will inhibit proper community care, is crucial. I hope that the Minister will say something clear and reassuring about his willingness to consider amendments in Committee. I understand that, at present, fewer than 1 per cent. of those benefiting from ILF money will be affected. I take that point. Nevertheless, that represents a significant number of individuals.
Moreover, I think—and I shall be happy to be corrected—that, in practice, the £500 is a larger sum than is implied because, under the old ILF scheme, one could also get support from social services. If that is now being costed at up to £200, more than 1 per cent. may be caught by the care trap. I seek clarification on that.
Whether we are talking about one or two people or several dozens or more, the crucial question must be what will happen in practice. What happens if the care package that is devised costs £600 or £700, as it may well do in the most extreme cases? Will that person have to go into institutional care? Some say that they will have to he dragged screaming and kicking if that is the case. Again, the Minister shakes his head.
What happens if the social services department cannot afford to spend any more under the cash limit, given that the ILF regulations specify that the figure must be no more than £500? I am told that we are talking here about some of the most serious cases of paralysis—people who have broken their neck in a road accident and those suffering from multiple sclerosis or are in the more advanced stages of motor neurone disease.
To those listening to the debate, £500 may seem a great deal of money—and it is a great deal of money—but a great deal of money is needed if someone who requires round-the-clock care is to be cared for in the community rather than in residential care, which is the principle to which we all aspire.
As has been said, there is, in any case, no sense in asking a person to move into residential care if that will cost more than a package that could be devised. The individuals affected may be few: it would be nice to have some estimates. In any case, what happens to them will be a key test of the Bill, and we need to consider that both today and in Committee.
I am worried that what should be a new dawn for community care is fast becoming a debate about residential care not only as regards the ILF and its cash limit per person but in different ways. Certainly, all the initial controversy following all fools' day will be about residential care—about whether people are having their costs paid and about the concerns of home owners.
I have another fear. As a result of the Government's ideology and dogmatism, social service authorities will have to spend 85 per cent. of the new money on the so-called independent sector, which is predominantly, 87 although not exclusively, the private sector. The private sector is mainly—again, not exclusively—in the business of institutional care, so that will pull the money towards institutional rather than community care. If, as we have said today, the £500 limit stays and we cannot shift the Government on it—I hope that we can—some critical cases, who, despite terrible disabilities, live in the community and often thrive in and contribute to it, may be moved into institutional care.
Moreover, there must surely still be many people suffering from terrible conditions who are in institutional care but who, in the right circumstances and given the right opportunities, cash and care—and, of course, the choice—could come back into the community and live more fully than they do at present. Let us not forget that group. We need to think how we can enable them to come back into the community if they want to. Can they do that with a package of care costing £500? Some will need more, and that is an important point.
The theme of cash or care and the association between the two Government Departments may be a more fundamental theme for the future than this small but important measure concerning the ILF suggests. Our society is faced with important questions about the costs of disability and aging. We know that the Bill does not cater for those over 65, but we have to consider the costs of disability and aging and who should meet them.
In future, in some of our mainstream debates about social security, and not least about pensions, we should ask about both the private sector—occupational pension schemes—and the public sector—the national insurance Fund—and determine whether the risks against which we should insure ourselves include the risk of the need for intensive care as well as pensions. If we discuss pensions on one day and community care on another, we start to make great mistakes about the risks facing us in our later life and the different ways in which we should insure against them.
§ Mr. Charles Hendry (High Peak)
I am grateful for the opportunity to contribute to the debate. I am glad that the Government have found time for it in their programme. At a time when many of our attentions seem to he diverted overseas, it is nice to find time to consider matters rather closer to home which have a direct bearing on many of our constituents' daily lives.
The Government's priorities for disabled people can be categorised in three ways: first, a desire to enable people to live as independently as possible; secondly, a commitment to target more resources on people who are disabled in a way that recognises their particular needs; and, thirdly, a commitment to look at their wider entitlement and interests to enable them to play as full a role as possible in society. The Bill addresses all three.
Hon. Members have referred to a number of the ways in which the independent living fund has grown over the years. It has grown from £1 million in 1989 to £100 million today and is now helping 21,000 people, or more—this is one of the rare occasions when the Labour party is saying that we are helping more people than we say we are helping. The Opposition's support and encouragement on that are welcome. The House should be reminded that the introduction of the ILF was criticised and questioned by 88 the Labour party. In listening to the Opposition's concerns today, we should bear in mind the fact that they have not always been fulsome in their support.
We should also bear in mind the fact that the fund has helped far more people than were being helped under the old supplementary benefit system. Before 1988, 6,000 people were being helped to the tune of some £30 per week. Today, 21,000 are being helped with a weekly average of over £110 per week. That shows clearly the Government's ongoing commitment.
That takes us to where we should go next. There can be no doubt about the success and popularity of the ILF. We must accept, however, that the benefit was introduced initially to help the most severely disabled people. All of us have had constituents come to us and say, "My friend down the road has been given support from the independent living fund. Why can't I, since my condition is similar?"
Inevitably in such cases, the boundaries become frayed and, in time, they are enlarged and more people benefit. It is very good that we can claim to be supporting more people than we ever envisaged supporting. However, we must also remember that the intention is to help the most severely disabled. The proposals will enable that intention to be maintained.
We must also consider areas where there is clear consistency, not just in name, but in the way in which the fund will operate in future. Through care in the community, it is the intention that care should be tailored to meet the individual needs of disabled people and that the structure of the support should be flexible to allow that to happen.
Also, and this is paramount, individual disabled people must be involved in determining how best their care needs can be met. We must stress, and the Government have made it clear, that the needs and wishes of disabled people should come first.
§ Mr. Bradley
If the package designed by the local authority conflicts with the wishes of the individual, would the hon. Gentleman support the right of an appeal system within the proposals?
§ Mr. Hendry
Any new system develops over time. We do not set a principle in cast iron and then, 20, 30 or 40 years later, say that it should not be changed. We must consider how the system operates and identify the difficulties. If flexibility or alterations are required in time, that can be achieved. To suggest that we are simply casting something in stone does not reflect historical precedents accurately.
§ Mr. Bernard Jenkin (Colchester, North)
In the care in the community programme, we are dealing with local authorites which are ultimately governed by elected councillors and subject to the pressures of the normal lobbying process, not least the letter to the Member of Parliament asking him to intervene on behalf of the client concerned. Does my hon. Friend agree that the idea that we are creating a system in which there is no appeal procedure, redress or comeback is entirely false?
§ Mr. Hendry
I agree with my hon. Friend. Many of us have received letters from our constituents about the independent living fund. We have raised cases on their 89 behalf and have been able to ensure that those cases were reviewed properly and effectively. Members of Parliament can and do properly play that role.
I would also like to consider the fact that we recognise a need for change, but are also trying to establish a principle on a secure and long-term footing. On several occasions in my constituency, parents who are inevitably getting older have expressed their fears about their severely disabled children who may now be in their teens or twenties. They want to know how their children will be supported when they have died. That is an immensely responsible attitude.
From the conversations that I have had with such parents, and having seen their sincerity, I have no doubt that they would like their disabled children to be looked after as much as possible in the home where they were brought up within the community. Parents recognise that in familiar surroundings it will be easier for their children to face the pressures.
Several comments have been made about the role of the disability living allowance. Introducing something as large as that in one go has caused teething problems. I commend the Government for being willing to introduce something on a scale which will help more than 250,000 people. I commend them for introducing it in one go instead of phasing it in over four years, as the Labour Government did with mobility allowance; that helped only about 5,000 people. The Government took a brave and important step.
There will inevitably be a rush of cases and a huge administrative caseload to be handled. However, I congratulate the Government on the way in which they have reacted to that and I congratulate the people working in the benefits offices on the way that they have dealt with those problems. As a result of their efforts, 60 per cent. of claims are cleared within a month and older people are being targeted as priorities.
I am aware of cases in my constituency where people have felt that their cases have been delayed unduly. However, in relation to the vast number of cases that have already been handled, I have no doubt that the majority are being handled efficiently and effectively. There is now a system in place which is trying to push matters forward.
§ Mr. Bradley
What does the hon. Gentleman think about a situation in which the application of one of his constituents may have been delayed and missed the cut-off point? That person may have been awarded DLA, but would not have been able to apply to the ILF. Should such a person be compensated because he or she was unable to receive help from the ILF?
§ Mr. Hendry
One of the difficulties in implementing change is that there must be a cut-off date. We cannot get away from that. If after the cut-off date we say that anyone close to the cut-off date will receive special remedial treatment to ensure that that person does not receive less money than he might otherwise have received, we completely undermine the principle of change. If we are to make changes and tough and sometimes brave decisions, we must accept that there will be difficulties.
It is easy for the Opposition. They are not trying to raise taxes to pay for the support. They are not responsible for Government decisions. It is easy for Opposition Members to say time after time, "Let's throw more money at it." As it is not the Opposition's money, they can spend it as if it is going out of fashion. That has always been the 90 Opposition's tendency. However, if the Opposition ever want to be taken seriously as credible politicians, they must accept some of the financial facts of life.
§ Mr. Thurnham
My hon. Friend has just referred to the Labour party as the "Opposition". In a number of town halls around the country, the Labour party is charged with and is responsible for the delivery of services. From my experience and from the reports from constituents, I have noticed that many restrictions are placed on home helps—or, as they are now called, home carers—which include trade union restrictions and limits on whether they can work at weekends. I have heard that carers have been told that they must not work at weekends and they have had to do that work in secret. Opposition Members have said that they want more openness when such extraordinary arrangements are taking place. Does not that show that, when the Labour party is in power locally, things are very far from perfect?
§ Mr. Hendry
As is so often the case, my hon. Friend is absolutely right. I would like to pay tribute to the incredible amount of work that he has carried out on behalf of disabled people through his involvement in charitable work and in pushing their case in the House.
I need no lectures or advice from my hon. Friend the Member for Bolton, North-East (Mr. Thurnham) about the difficulties involved in living with a Labour local authority. My constituency is in Derbyshire and we have one or two problems with our county council, not least in that area. It consistently refuses to charge for home helps. To suggest to people who, in many cases, have significant resources and would be happy and keen to pay towards the costs of home helps that they may not do that is absurd. Ultimately fewer people will receive home helps because there is no way of getting the additional resources from the people who would be happy and willing to pay towards that provision.
§ Mr. Jenkin
It is important that we do not tar all Labour councils with the same brush. I draw my hon. Friend's attention to Strathclyde regional council, with which I became familiar when I contested a Labour stronghold in Glasgow, Central in the 1987 general election. That council made a very bold move, probably unconsciously, realising that it was privatising its social services, when it made its social workers self employed. The council employed people on piece-work contracts which effectively made the work force much more flexible so that they could provide a much more flexible service to clients. I would not always criticise Labour local authorities in the way that my hon. Friend has just done, although there is always justification for doing that in certain cases.
§ Mr. Deputy Speaker (Mr. Geoffrey Lofthouse)
Order. The debate is now ranging rather widely. If hon. Members will keep their comments within the boundaries of the debate, we shall be able to discuss the Bill thoroughly.
§ Mr. Hendry
I am grateful for your guidance, Mr. Deputy Speaker. I shall come directly to another aspect of the Bill that is worth our attention—Motability. All hon. Members will welcome the enormous growth in the provision of cars for disabled people under the Motability scheme. Since 1977, Motability has had a tremendous record for supplying cars. It hardly seems possible that in November 1991 Her Majesty the Queen presented the 91 250,000th car, yet less than two years later the Prime Minister will be handing over the keys for the 350,000th car. If we look at the number of cars that were provided last year, it presents an astonishingly good picture of an organisation that works effectively. In 1992, there were 75,195 applications for a car under the scheme, of which 63,745 were granted. That is an amazingly high figure and is a testimony to the way in which the Government have backed Motability by contributing to not only its running costs but its capital costs. The Government have worked in conjunction with the private sector, car manufacturers and those who convert cars to provide a real benefit to many members of the community.
I became aware recently of the case of a multiple sclerosis sufferer whose family had not taken a holiday together because of his inability to travel around the country. With little support from me, Motability moved fast to provide and convert a car, and as a result he and his young family enjoyed a holiday. I pay tribute to its work and the way in which it has helped countless thousands of others. More than 140,000 people have cars under the Motability scheme.
We should be grateful for the increased quality of cars. Not many years ago, we lived in mortal fear not of the quality of driving but of the fact that dangerous little three-wheelers were scurrying around the streets, posing a threat to many others. Disabled people can now have not only the dignity but the comfort of a standard car under the scheme, which is a tribute to the scheme and what it has been able to achieve.
§ Dr. Liam Fox (Woodspring)
I hope that my hon. Friend will give credit to car manufacturers and banks for the help that they give to the scheme. Many hon. Members often attack the clearing banks for their behaviour in some sectors, but this is one area where they are contributing much to helping disabled people.
§ Mr. Hendry
I willingly do so. I paid tribute to the way in which car manufacturers have helped. I extend the warmth of my congratulations to the banks.
The significant increase in resources allocated to the independent living fund has demonstrated the Government's record of support for disabled people. When the Government took office in 1979, 360,000 disabled people were receiving help with the costs of their care and mobility but the figure has now increased to 2 million, which shows how vastly increased our commitment to disabled people has been in the past 14 years.
This year, £14.9 billion will be spent on the long-term sick and disabled, which represents an increase of £9.9 billion in the past 14 years. Any Conservative Member who suggests that the Government lack commitment in looking after the needs of disabled people need only look at those figures to realise how substantial our record of support has been.
The Bill deals with disabled people as whole; real people rather than simply statistics and numbers. I will not rehearse a range of arguments across education, transport and other matters but will consider a couple of aspects, the first of which is the right of disabled people to employment. I was very pleased and honoured recently to open a conference in my constituency on behalf of the 92 placing, assessment and counselling team in Derbyshire, which considers how employers can better take account of disabled people.
One of the things that struck me most during that seminar was the way in which the scales fell from the eyes of local employers who believed that there may be problems in hiring disabled people but who gradually realised that they should look beyond the disability at disabled people as whole people and hire them on the basis of their strengths and skills. One small element in that concept was the way in which the Government changed the title of my right hon. Friend from the Minister for the Disabled to the Minister for Disabled People. The Government recognised that they are disabled people and not an analogous lump. The more that employers do so, the better it will be not only for disabled people but for companies and employers.
I pay tribute to companies in my constituency that have gone way beyond their quota in hiring people who have disabilities. One firm, Otter Controls in Buxton, has made it a policy to take on people with disabilities. Despite the difficulties of the recession, from which it is now recovering, it has done all that it can to ensure that it continues to be a major employer of disabled people.
§ Mr. Alfred Morris
The hon. Member referred to the right of disabled people to employment. He will know that there is very strong feeling in all the organisations of and for disabled people in Derbyshire, in particular, about the importance of the Civil Rights (Disabled Persons) Bill. May I take it that the Bill has his support? I know of the hon. Gentleman's interest in this field. He will know how strongly the Bill is supported by the organisations of and for disabled people in Derbyshire.
§ Mr. Hendry
I have told the organisations in Derbyshire that have made representations to me that I feel that the position taken by my right hon. Friend the Minister is correct. The Government wish to proceed through voluntary measures, and if that does not prove sufficient my right hon. Friend will reconsider legislation. I am instinctively opposed to unnecessary legislation. The rights of disabled people are immensely important, but it is much better to use voluntary procedures than to introduce legislation and the difficulties that go with it. As the legislation on equal opportunities for women and race relations have shown, there are inevitably difficulties when enshrining sufficient rights in law.
The final matter that I wish to consider is access for disabled people. I commend a young lady in my constituency who is significantly disabled and who recently was pushed around the town of Buxton in her wheelchair by a disabled colleague. She took her video camera to try to highlight for the benefit of people such as myself who are blessed in not suffering from the disabilities that she has the day-to-day problems that disabled people experience in trying to live their lives as normal people. A lot of Buxton was designed by the Georgians, who believed in pillars and lots of steps, so it is not easy for a disabled person to move around in a wheelchair. The town was built on many slopes and hills, which makes life more difficult. My constituent's work has done much to bring to the attention of the county council and myself the difficulties that disabled people face.
The Bill gives us the opportunity to look more generally at the needs of disabled people but particularly at the way 93 in which we look after and service the needs of the most severely disabled people in our society. I commend the Bill and recommend that the House gives it a Second Reading.
§ Mr. Bernard Jenkin (Colchester, North)
My hon. Friend the Member for High Peak (Mr. Hendry) has given us an able assessment of the benefits of the Bill. Indeed, throughout the debate hon. Members have successfully explored its benefits for severely disabled people. I should like to comment on the contribution by the right hon. Member for Manchester, Wythenshawe (Mr. Morris) before he leaves the Chamber, and in due course on the speech by my hon. Friend the Member for Havant (Mr. Willetts).
In a debate on a motion relating to the Bill of the right hon. Member for Wythenshawe——
§ Mr. Jenkin
I am grateful. In that debate I thought that we explored extremely well the subject of disabled people and civil rights. It opened my eyes to some of the disadvantages of the current set-up.
I remain unconvinced, however, that civil rights legislation in this area would solve the problem that it seeks to solve. There has been a gradual increase in the number of disabled people in employment and the disabled working allowance is proving of benefit, providing encouragement and incentive, not compulsion. That seems a better course.
§ Mr. Alfred Morris
The hon. Gentleman has referred to the debate in the House on my Civil Rights (Disabled Persons) Bill on 26 February. He will know that the issue was debated for five hours on that day and that the motion was carried by the House after the Minister had spoken. I hope that he shares my pleasure in that decision by the House of Commons on that day. It is certainly shared by all the organisations of and for disabled people.
§ Mr. Jenkin
I certainly take note of the House's decision that day, although of course there was not a large number of hon. Members present to vote. I take note of the view expressed by the House in the early-day motion on the subject. I pay tribute to the right hon. Gentleman for the campaign that he has waged—no one in the House has contributed as much to the debate on disabled people. I am sure that that debate will continue and that we will all continue to listen to the points that the right hon. Gentleman makes. The debate is by no means over.
I want to concentrate, first, on the purpose of the Bill; secondly, on the funding provided to enable it to be put into effect; and, thirdly, and perhaps most importantly, on the principles of assessment that will be used to apply the benefits of the Bill. I should begin, however, by discussing the background and the financial restrictions under which the Government are working.
We have a huge budget deficit. I am impressed that this debate should be taking place not to moan about the quantities of funding available, but, in a constructive spirit, to discuss how best the limited funds available should be allocated. That is a tribute to both sides of the House.
This Bill, as my hon. Friend the Member for Havant pointed out, fulfils a manifesto pledge that we made at the 94 general election. Its purpose is to help with financial support for the most severely disabled people. It unashamedly builds on the success of the independent living fund. I do not regard it as a step backwards from that fund; I regard it as an extension of the work of the fund, although we are delegating much of the responsibility for that to local authorities.
The Bill establishes the extension fund, supplementing the independent living fund, and the 1993 fund for new applicants, but it is the partnership with local councils that will represent an advance in the provision of care for the disabled—it is not a step backwards.
Secondly, the funding provided for the implementation of community care includes £26 million in the ring-fenced total of £565 million. The £26 million is for the severely disabled and that represents an overall improvement. Overall funding of community care has been generously increased for the forthcoming year. I refer to what was said by the incoming president of the Association of Directors of Social Services, quoted in The Independent on 3 October 1992:We recognised that the public spending round would be difficult and we think that in the context of the present economic climate Mrs. Bottomley has done well to get this money and to give us specific funds for the second and third year of implementation.That is not a cheapskate formula; the overall provision for the disabled, within overall community care budgets, is generous indeed. If we remember that the total provided for the disabled from the DSS budget is about £15 billion—a threefold real terms increase—it can hardly be accused of being cheapskate. The Government have clearly demonstrated their continuing commitment to the disabled.
My third point concerns the principle of assessment and the interesting discussion that we seem to be having about cash payments as opposed to direct provision. I have great sympathy with the points made by the hon. Member for Birkenhead (Mr. Field) in this regard. It is important to understand, however, how the local authority will fulfil the role of care adviser in the provision of care for the disabled under the care in the community proposals. First, the local authority will identify people who appear to be in need of care services; then it will assess what support or help they need. It will then share those assessments with the people Concerned—the most important aspect of this method of empowerment. It is important to involve the client in decisions about the type of provision, and that is expressly provided for under the care in the community proposals. Clients' wishes and preferences must be discussed with them so that their needs are reflected from a material point of view and so that they are involved in decisions about their care.
Finally, the local authority will decide what services should be arranged in response to the assessment. Such services may be provided by the local authority, but increasingly a greater proportion will be purchased under contract from organisations in the independent—the non-local authority—sector. That, too, is important, because there is a danger in the arrangements for community care that the services will be producer dominated. By specifying a limit on the quantity of services that can be directly provided by the local authority, a separation between purchaser and provider is created, and that will improve the authority's advocacy on behalf of the people who require the care.
95 If someone appears to need health services or help with housing, the authority has a duty to get in touch with the relevant people. This system will replace the system of special higher rate income support payments, currently available to the less well off people who enter residential and nursing homes, to help meet the costs of their care. The current system has a bias in favour of residential care, regardless of what is best for the people concerned. The reforms remove that bias, offering users genuine flexibility and choice in how they are looked after.
My hon. Friend the Member for Havant drew our attention to the excellent work done by the Rowntree trust. I wish to draw attention to the developing ideas that we have for care advocacy and further separation of the role of the client and the care advocate, and that of the financier and provider. In particular, I draw attention to a case that I share with my neighbour, my hon. Friend the Member for Colchester, South and Maldon (Mr. Whittingdale). It involves a family whose child is mentally handicapped and which recently lost control of the child. The simple reason is the easily imagined one. When a severely handicapped child is born, the parents naturally say that they will look after the child, but things become more difficult as the child gets older. Looking after a severely mentally handicapped teenager is a demanding operation.
In that case, the strain on the marriage and on family life and finances proved too much for the parents, and they finally accepted that the child would have to enter an institution. Imagine their shock when they realised how much that would cost. Let me emphasise that the health services had offered the child high-quality care, but it was institutional care, not family care or care in the home. For the lack of anything between £2,000 or £8,000 for the additional help that they needed in the home to enable them to continue looking after their child, the health service is now picking up a bill for about £35,000 a year.
That is where the argument for service advocacy or brokerage comes into play. We could not only make resources stretch much further, but involve the families of disabled or mentally handicapped people or the clients themselves where they are capable of making the decision. The money could be allocated to them, instead of to the health authority or the local authority to invest in plant—that is, a residential home or residential care of one sort or another.
The Rowntree trust draws attention to stories involving people in the work that it does. For example, Patrick, who had spent almost all his life in residential care until he moved into a home of his own at the age of 27, said, "It means exercising choice and control and having the right to choose who gets me up and who puts me to bed." In another case, 40-year-old Maria explained: "It means I can get up in the morning when I want to, I can go to bed in the evening when I want to, go out when I want to."
Extremely good though institutions may be, the present arrangements of institutionalised care often fail to enable disadvantaged people to lead their own lives, or to lead their lives with their families.
§ Mr. Thurnham
My hon. Friend quoted what seems a high figure for the cost of the care of a constituent's child, at I think £37,000 a year. Does he agree hat there are differences in how well organisations can manage their 96 budgets? Voluntary organisations can also call on charitable causes for their capital costs if not for a contribution to their running costs.
My son is now at an establishment called Brookvale, near the constituency of my hon. Friend the Under-Secretary—in Bury, South—where costs for care are only £15,000 a year, but the standard of care is very high. That compares to the cost of £30,000 a year for neighbourhood network homes in my constituency, run by the local authority, where I do not believe that, in all cases, the care is as good as it is at Brookvale.
§ Mr. Jenkin
My hon. Friend highlights the point that I am making, which is that different types of provision, provided at different standards, are available. We want the client and the families of the client to be involved in the choice of the provision. A purchaser-provider approach often means that the price of such provision is not as expensive as it is when it is provided by a top-down approach.
As we are debating service brokerage and carer advocacy, I shall say something about the ambiguity in the attitude of the Opposition. What we have successfully achieved in the independent living fund seems to have converted a substantial part of the Opposition to the idea of service brokerage. However, as my hon. Friend the Member for Havant pointed out, that does not seem to extend to the social fund. I feel that it should extend to general practitioner fund holding because that is a form of service brokerage where the purchasing power is put in the hands of a care adviser—a general practitioner. He or she then decides, on behalf of the client, how best to allocate resources on behalf of the patient. It means that the community care proposals that are to be implemented at the beginning of April are an interim step on the long road to more responsive care in the community, in its generic meaning, of all kinds. It is artificial to have a care advisory or brokerage system simply for the disabled and not involve the health services and all the other relevant services.
The ultimate social services system of the future must ensure that, where moneys for health and social services for those acute cases are all held under one fund, and a single broker advises the client or the client's family on the services that are required, they are purchased from the local authority, the private sector providers, the health service and all the other institutions, bodies and charities that are involved in acute care. That interesting and exciting challenge lies before us as we develop social services and health care in the 1990s. I commend the Bill to the House.
§ Mr. Peter Luff (Worcester)
It is a tribute to the House that, for the second time in a little over a fortnight, we have been afforded an opportunity to have a serious debate about the needs of disabled people. It has been a privilege to hear some of the speeches made on both sides of the House on that important matter.
I was, however, a little disappointed at the ribaldry among Opposition Members when my hon. Friend the Member for Bolton, North-East (Mr. Thurnham) praised the hard work done by the civil servants in the disability living allowance unit and elsewhere to assist disabled 97 people. I pay tribute to those officials, with whom my constituency office works closely to achieve satisfactory outcomes.
§ Mr. Thurnham
My hon. Friend spoke of Opposition Members. Is it not right to point out that, during almost all the debate, there have been twice as many hon. Members on the Government Benches as there have been on the Opposition Benches? Even now, there are 10 Members on these Benches and only five on the Opposition Benches.
§ Mr. Luff
My hon. Friend makes his own point, which will be noted by everyone outside the House.
I hope that it will be in order, when paying tribute to those staff, also to pay tribute to the House of Commons staff who work closely with them to achieve satisfactory outcomes for disabled people in our constituencies. The Benefits Agency staff and the DLA staff are always anxious to do all that they can to promote the needs and interests of those in genuine need. In particular, I should like to praise the staff of the Benefits Agency office in Worcester, who work so hard and consistently for disabled people.
The original independent living fund was a bold partnership. It was not without controversy when it was introduced but it has become a central part of the Government's commitment to disabled people. Perhaps it is not surprising that within two years of the fund's introduction the Select Committee on Social Services was writing:On 9 February 1990 the Minister for Disabled People issued a press release headed: 'Independence is the key to better lives for Disabled People'. The help provided by the Independent Living Fund cannot be appropriate for all disabled people. We believe however that the Independent Living Fund has given meaning to the Minister's phrase for many disabled people. Our concern is that the Government has not fully appreciated the innovatory nature of the ILF in giving some disabled people and their families the resources to build up their own packages of care. We recommend that the ILF should continue to exist not only for an interim period, but also after the implementation of community care legislation, and should be provided with sufficient resources to meet the claims of those who meet the present criteria to help from the Fund, and whose needs have not been met through the eventual implementation of community care policy.I was delighted to find that the Conservative party's manifesto, to which I still attach great importance, contained a strong commitment to maintaining a fund to support the most severely disabled people.
Slightly more than two weeks ago we debated the Civil Rights (Disabled Persons) Bill. I am sure that hon. Members on both sides of the House accept that there is no more fundamental civil right for a disabled person than the opportunity to decide how he or she will live his or her own life. In that context, the ability of the individual to remain in his own home is of central importance. It is important also to emphasise the mobility aspects of this civil right and to welcome especially the features of the Bill that relate to Motability.
The Bill widens the legislative powers that govern the Government grant that is paid to Motability. It will enable the Government to ensure that they can continue to fund the organisation in future. I am glad to say that Motability commands genuine cross-party support in the House. It helps disabled people to obtain a car or a powered wheelchair on favourable terms, thus increasing their independence.
98 The people most often helped by the charity are the severely disabled, who are unable, or virtually unable, to walk. They include people with cerebral palsy, spina bifida, muscular atrophy and many other crippling conditions. We have heard unusual tributes from hon. Members to the role of the clearing banks in helping to fund Motability, and it should be recognised that it is a partnership. It is a registered charity that is assisted by the Department of Social Security, clearing banks, motor manufacturers and dealers and insurance companies. I am sure that we all have constituents who benefit from the operation of the scheme.
The Government pay significant sums to Motability and about 140,000 people are now being helped. Since the scheme's inception, about 330,000 vehicles have been supplied. It is worth bearing in mind that the scheme has helped the environment, apart from the disabled, through its pioneering role in pushing the case for lead-free petrol.
Reference to the mobility features of the Bill enable me to correct an omission from my speech——
§ Mr. Alfred Morris
The hon. Gentleman has referred to motor manufacturers and dealers, clearing banks, insurance companies and other interests that were brought together to create Motability. Speaking as a patron of Motability, may I say that I hope that he will appreciate that it has always relied as well on a great deal of voluntary effort. Many people give of their time to ensure the success of this very important organisation, and have done so continuously since it was started by the memorandum of 1977.
§ Mr. Luff
The right hon. Gentleman's intervention is a timely one. I intended to move on to emphasise that aspect of Motability's work and to link it with the work of another scheme for disabled people, shop mobility, which makes an enormous contribution to the mobility of disabled people. It enables them to make their purchases in ordinary shops in shopping centres, for example. I was privileged to see in great detail the work of shop mobility at Worcester when I drew its Christmas raffle some months ago. The role of the voluntary sector—individuals—in helping the disabled to achieve independence in their lifestyle must never be overlooked.
The Government should be proud of their record in responding to the needs of disabled people. The increase in spending has been phenomenal, and that is spending of which the ILF is a part. Spending has trebled in real terms since 1978–79, and is now £14.9 billion. We have seen the introduction of the disability living allowance. It has not been without its problems, but already there have been nearly a third of a million successful claims. I especially welcome the disability working allowance, which provides a top-up for the earnings of disabled people.
I attach enormous importance to giving independence to disabled people and their ability to choose their own lifestyle in the context of the role of carers. Expenditure on the invalid care allowance has increased significantly from only £4 million when the Government came to power to about £366 million today. The number of beneficiaries has increased from 5,000 to 195,000.
It is entirely appropriate that one of the key objectives to the Government's proposals for community care is to ensure that service providers give practicial support for carers a higher priority. That is recognised in the Government's White Paper, "Caring for People". There is 99 clear recognition in that document that helping carers to maintain their valuable contribution is right and a sound investment. Local authorities and health authorities will be expected to continue to develop services for carers in advance of the introduction of assessments in April.
It is not going too far to say that carers are perhaps the most long-established voluntary sector that looks after the disabled. I am concerned that their work should not be over-professionalised. It is work that often goes unsung, and even more often it is unnoticed. I am sure that the entire House would wish to offer thanks and gratitude to those who are doing so much to promote the interests of disabled people.
§ Dame Elaine Kellett-Bowman
My hon. Friend is far too young to remember that the process started with the work of the Council for the Single Woman and her Dependants. It has continued for many years since then.
§ Mr. Luff
My hon. Friend makes an important point. Many of us are accustomed to seeing carers in that context. There are so many relationships that relieve the state of a financial burden and enhance the quality of life of the individuals who receive care.
I welcome the role of local authorities. The Government are often criticised for diminishing their role, but that is not our objective. It is often our objective to take powers to others, and I have in mind grant-maintained schools. They represent an attempt to give power to parents, not to take power from local authorities.
The Bill will do exactly the opposite of what our critics sometimes accuse us of doing because it will significantly enhance the role of local authorities. The ILF and its successors provide help on the basis of a care plan that is agreed between the fund, the disabled person and the local authority. As a result of assessment, the authority will provide a specified level of service, which the fund will then supplement by a cash payment to the client.
If the system is to work properly, it is essential that local authorities have full confidence in their ability to live with their side of the care-in-the-community bargain. I know that a year or so ago, when care in the community had still not been fully implemented, nursing homes in my constituency and in the area covered by the county council were worried that they would not be in a position to take on that responsibility. I made vigorous representations to the Government, as a result of which, I believe, the Government have responded appropriately to ensure that local authorities can play their full role in delivering care in the community. I welcome particularly the generous funding that the Government have made available to local authorities to enable them to do that. If there were not the confidence that the necessary funding was in place, I do not think that there would be the same confidence in the value of the ILF and its successors.
Local authorities have been allocated significant additional funds to support their new responsibilities for community care. The ring-fenced grant of £565 million for England, specifically and exclusively for community care next year, is very welcome. That sum includes some £399 million that would otherwise have been spent through the DSS; £140 million to facilitate the introduction of the changes; and £26 million to help meet the needs of severely disabled people.
100 It is important that we remember that that ring-fenced money is in addition to the general increase for social services spending next year. Taking both of those into account, councils in England will receive a massive 15 per cent. increase in their personal social services standard spending assessment next year, to a total of £5.6 billion. It is an important development if the needs of disabled people are to be properly protected by local authorities.
I take particular comfort from the £26 million to which I referred, which is being provided in recognition of the additional costs that will fall to local authorities as a result of the closure of the independent living fund to new clients and the establishment of the 1993 fund. That sum is budgeted to rise to £53 million in the following financial year and to £100 million in the year after that. By any standards, that is a significant sum of money.
In that context, it is little wonder that my county council, Herefore and Worcester, has given a warm welcome to the Government's approach to care in the community in general, and to the two new funds in particular. However, the council does have two difficulties, which are not unique to Hereford and Worcester. The first difficulty is that in delivering care in the community, whether for disabled or able people, the council has to deal with a large number of authorities. The second difficulty is the large number of elderly people retiring to the area, many of whom have significant disabilities.
On the council's first difficulty, it has to deal with three health districts—North Worcestershire, Worcester and District, and Hereford—as well as nine district councils. It also has to deal with the various voluntary bodies, housing associations and other organisations. It has to liaise with all of them to deliver the service effectively. There is a continuing, strong and powerful case for further rationalisation of the administrative boundaries of government to enable the effective delivery of Government policies.
On the council's second difficulty about the pressure of numbers, anything that the Bill does to relieve the pressure for residential accommodation in Hereford and Worcester will be welcomed.
§ Mr. Oliver Heald (Hertfordshire, North)
Does my hon. Friend agree that one of the great benefits of the ILF is that it has been able to meet a huge increase in numbers—from 6,000 to 21,000—very effectively? Is not that something to be welcomed?
§ Mr. Luff
That is right. There has been a dramatic increase in the numbers being helped across the whole range of Government assistance to the disabled. When we hear criticisms about, for example, the disability living allowance, it is important to remember the very sharp increase in numbers helped. It is a great tribute to those involved in the delivery of the various help available to disabled people.
My county council expects the Bill to be of particular value in the rural areas, where it is especially beneficial to be able to keep disabled people in their own homes rather than force them into residential accommodation, often against their will. If that provision is to be delivered effectively, it will mean a close working relationship with a large number of bodies, such as housing associations.
It is important to remember that one reason why such a large number of elderly, often disabled, people are attracted to my area is that the county council has 101 followed Government policy and encouraged the provision of private sector care. It has not resisted that, as some Labour-controlled county councils have done. However, the council is concerned that, because it has encouraged that provision and worked closely with the private sector in providing care for the elderly and the disabled, it will be penalised under the funding arrangements for care in the community.
I very much welcome the way in which the Government have approached the special transitional grants, which have significantly reduced my council's fears. The geographical patterns of DSS spending on residential care are very different from the patterns for standard spending assessments. Inevitably, DSS expenditure is linked to the areas where the homes are located. Because of the often different political perspective on how such care should be provided, the homes operate with very different rates in different parts of the country.
I understand that it is the Government's intention that, in the long run, all funds for community care should be distributed through the revenue grant, on the basis of standard spending assessments. However, the Government recognise that a precipitate rush to that mechanism would imply a significant and rapid shift of resource, which might lead to severe problems for the elderly and the disabled in specific council areas. Therefore, I welcome the transitional arrangements. It is all part of the confidence building that enables me to have confidence that the successors to the ILF will deliver the necessary care to disabled people. I hope that the Government will keep a careful eye on the transitional arrangements to ensure that there are adequate funds for county councils such as mine.
I understand that the entire caseload of the ILF will be transferred to the extension fund. I have been told that people will "in the main" be unaware of any changes to the fund other than the change of name. The term "in the main" causes me some alarm. We know that many of those who benefit from the fund are people in great personal need. We also know the very real distress that any change—or even the threat or rumour of change—in their financial arrangements would cause. I hope that my hon. Friend the Minister will assure me that the term "in the main" will be struck out and that individuals will, in fact, be unaware of any changes to the fund. It is important that that fear or threat is removed.
There is some controversy about the reduction to 65 in the upper age limit under the new fund. I know the reasons that the Government have given for that, and I respect them. In current circumstances, it would be irresponsible to argue for any increase in the upper age limit. However, I hope that the Government will carefully monitor the way that the funds operate and that if they think it appropriate at some stage to increase the upper age limit they will do so.
I especially welcome the way that the Bill has built on the Government's determination to break down the barriers between the public and the private sectors and to build on the work of the voluntary sector. I am constantly impressed by the extraordinary efforts of the voluntary sector in my constituency. Indeed, I am often moved by the efforts of individuals to assist less fortunate members of our society. It has always seemed to me to be a tragedy that, previously, there was a view that care was provided either privately or publicly. Now, we are moving towards 102 a spectrum of provision. That is a healthy development in the way that we provide for the care of less fortunate members of our society.
The fund was an interim measure, but expenditure rose from £1 million on its inception to £100 million today. The Bill provides conclusive evidence of the Government's commitment to the disabled, but that commitment must not blind us to the excellent work of many local authorities, individual carers and the plethora of voluntary bodies to which I referred earlier. The Bill is more than anything else about providing disabled people with choice and dignity, and in that spirit I commend it to the House.
§ Mr. Keith Bradley (Manchester, Withington)
The debate has been interesting and wide-ranging and we commend those hon. Members who made practical contributions, as well as those who expressed philosophical views about the future needs of the disabled. I commend in particular the opening speech of my hon. Friend the Member for Huddersfield (Mr. Sheerman) and the excellent contribution of my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris).
It would be remiss not to point out that, although much of tonight's debate centred on the independent living fund and its successor, notable plaudits were handed out for the work of Motability. We pay particular tribute to my right hon. Friend for his work in establishing that scheme. It is no exaggeration to say that the continuation of Motability, which has been a worldwide success, is greatly to be welcomed. It gives me particular pleasure to pay tribute to my right hon. Friend as a fellow Manchester Member of Parliament.
We heard excellent contributions also on the practical details from the hon. Members for Stratford-on-Avon (Mr. Howarth) and for Roxburgh and Berwickshire (Mr. Kirkwood) and from my hon. Friend the Member for Cumberanuld and Kilsyth (Mr. Hogg). Interesting philosophical contributions were made by the hon. Member for Havant (Mr. Willetts) and my hon. Friend the Member for Croydon, North-West (Mr. Wicks).
I cannot say that all the contributions were of the same significance and it was a cheap jibe on the part of the hon. Member for Bolton, North-East (Mr. Thurnham) to comment on the number of hon. Members on his side of the House as compared with this side of the House and then for the hon. Gentleman to disappear to the Tea Room. As the hon. Gentleman flitted in and out of the Chamber tonight, perhaps he should have been present to hear the concluding speeches.
The independent living fund was introduced to deal with the urgent need to repair the gap created by the withdrawal of special allowances for the disabled available under the old supplementary benefit scheme. I pay tribute to the Minister for Social Security and Disabled People for identifying that gap and introducing the fund quickly. However, under the old system the disabled had statutory rights to help but the ILF was a discretionary fund. It was successful because its trustees, director and staff recognised that they would have to fight all the way to win acknowledgement for the needs of the disabled, ensure the availability of funds, and use discretion in ensuring the continuity of payments.
It was said that the discretionary ILF, which we praised, should be compared with the social fund. Our 103 criticism of the social fund does not relate to the payments made in terms of community care grants but loans. It was never a feature of the ILF that the disabled were expected to pay for the services that they received or to repay cash payments made to them. There is a fundamental difference between the two funds.
At the centre of the thinking of the fund's trustees, director and staff, and of the Minister, was the rights of disabled people. I do not believe that the Bill is particularly supported by the Minister because the rationale behind the successor fund is clearly Treasury-led and is about money and not the needs of the disabled.
No right hon. or hon. Member expected the ILF to go on for ever. The Government announced as long ago as January 1990 that it would be replaced when the community care legislation came into effect. However, nobody could have foreseen the suddenness with which the fund would be wound up, in the form of a short statement from the trustees—who were placed in an invidious position—and a brief DSS press release dated 24 November 1992, informing potential claimants that they had one day to finalise their ILF applications. Nobody expected that the new fund would be so limited in its terms of reference in respect of new claimants.
The Government have announced two successor funds, the ILF extension fund—which is to take over the current caseload of 22,000 people—and the new ILF 1993 fund for new claimants. What is so unacceptable is the position of people who failed to apply to the old fund, along with the limitation in the scope of the new fund. I shall return to those points later.
Tonight's debate has highlighted key elements which I am sure the Parliamentary Under-Secretary will want to consider further. It has underlined the uncertain future of disabled people—first, in regard to the way in which the two successor trusts have been set up. It is strange that we should debate this Bill on 15 March, given that it will, in practice, come into effect in barely two weeks' time; moreover, only two trustees have been appointed. Indeed, I understand that they were appointed solely to ensure that a bank account could be set up to ensure the continuation of some payments from 1 April. It is scandalous that the other five trustees have not yet been appointed—if they have been appointed, their appointment has certainly not been announced to the House tonight.
It is disgraceful that, although the Minister paid fulsome tribute to the work of the previous trustees, staff and director, none of those people has been considered for appointment to the new fund. I am not arguing their case in particular; I am saying that their expertise, the importance that they have attached to the needs of disabled people and the continuity that they have provided are being lost through the Government's decision not to allow them to continue. I gather that, although they had been told that they were no longer required, they offered to stay in post for a further 15 months for the sake of continuity, to ensure that there would be no hiccups in the changeover and to prevent disabled people from being disadvantaged. Sadly, the Government rejected their offer.
I looked up the details of many of the trustees in "Who's Who". I find it incredible that someone with the expertise of Mr. Lyon—who was an ILF treasurer, has an impeccable record of service and was once president of the 104 Institute of Actuaries—was told that he was no longer required to help to organise the successor fund. The Government should seriously reconsider the nature of trustees. The rejection of any representatives of the Disablement Income Group—or, it would appear, of the disability world in general—is to be particularly deprecated. I hope that, in considering the appointment of the other five trustees, the Government will take into account the expertise of people from the world of disability to ensure that the interests of disabled people are properly represented.
I am also anxious about the amount of money that will be available, first, for the extension fund. We have been told that £117 million, in round terms, will be available, in 1993–94; that £119 million will be available in 1994–95;and that £121 million will be available in 1995–96. It is not clear, however, whether those amounts will be sufficient to cover in full any increase in the care costs of those already receiving support from the ILF. Mention has been made of people dropping out of the fund for various reasons, but a good deal of concern is felt nevertheless. The Government recently confirmed that,subject to its cash limited provision, the successor body will have…power to review the awards of existing beneficiaries."—[Official Report, 25 January 1993; Vol. 217; c. 587.]The worry is that if budgetary pressures develop there will be nothing to stop the new trustees of the extension fund reducing the payment or making less favourable the terms for payment. That pressure was put on the old ILF and the trustees had to make adjustments, if only in terms of who was eligible. I hope that the Minister will allay the worry that if budgetary pressure is put on the extension fund people who already receive help from it will not have the amount that is available to them reduced.
I reiterate what hon. Members have said about thousand of people being left out of the 1993 fund. The new fund will exclude thousands of people with severe disabilities. The restrictions proposed on access to cash from the ILF's successor are far greater than those which applied to the ILF, even though that has become increasingly restricted since its introduction in 1988.
The Official Report of 15 December 1992, c. 153–55, shows that the Government estimate that approximately 10,000 severely disabled people who might have looked to the ILF for cash help will not be eligible for such help from the new fund. A total of no more than 1,500 people a year are expected to receive help, compared with roughly 8,500 who were taken on by the ILF in the last financial year. That is a severe restriction on the number of people who will receive direct help from the 1993 ILF fund. Many of those people, if not the overwhelming majority of them, will be over 65 years of age. That is a major concern. More than one person in three, 34 per cent., who received help from the independent living fund in November 1992 was over the age of 65. The Government estimate that it will cost an additional £2 million in 1993–94 if eligibility is extended to include people over retirement age. That will rise to a mere £9 million in 1995–96.
In the context of overall Government expenditure, it is difficult to accept that such a relatively small amount could justify the exclusion of this age group from access to the new fund. Projecting as far forward as 1995–96 a mere £9 million could be allocated to the fund to allow the 105 extension of eligibility to those who are over the age of 65. I urge the Government to think again and to ensure that those people are not excluded.
The organisations representing that age group are extremely concerned. We have heard the view of the Alzheimers Association and I shall reinforce that view by repeating it. It stated:95 per cent. of people with dementia are over working age.Those people will be excluded from the fund. Age Concern wrote to me today and said:Discrimination against older people, in the form of denying them access to disability benefits, is unacceptable. Such discrimination implies that disability is considered normal in later life. Most older people live full and healthy lives into their 70s and beyond. The minority who do become disabled should not be denied extra help with the financial costs of disability.Those comments should ring loudly in the ears of Ministers and I hope that they will be further considered. If they are not considered, people with no opportunity to apply for help from the independent living fund may be forced into residential care.
Eligibility is further restricted because not only do people have to be between the ages of 16 and 65 but they have to be in receipt of the highest rate of the care component of the disability living allowance. After paying care costs with help from the fund such people would have to be left with income at or about the level of income support and would otherwise have gone into residential care. That creates a care equation on which local authorities will make their assessment for help from the new fund.
Under the care in the community provisions, local authorities will be required to assess the needs of people with disabilities, for the purpose of agreeing a care package, but when considering an application for a grant from the new fund on behalf of a person who meets the eligibility requirements the local authority will have to work out the total cost of that individual's community care package. The local authority will be expected to provide services that are equivalent to agreed thresholds, based on the average care costs to local authorities of a place in residential or nursing care.
This assessment rests entirely upon the local authority. What we see straight away is the lack of the right of the individual to be properly consulted. Mention has already been made of the need to reconsider whether the service element should be translated into a cash payment. We have heard many times tonight that one of the great successes of the old fund was that individuals had the right to be a party to deciding their care needs, to purchasing their care needs and to ensuring that their care needs met their individual requirements. However good local authorities will be in making those assessments, because of the general constraints placed upon them and their need to maximise what we do not believe will be a sufficient allocation of money for care in the community, they will be unable to meet sensitively the individual needs of disabled people. We want to protect those rights.
We are worried by the guidelines that have been issued. One section of the guidelines stresses that there should be a partnership with the local authorities. It says that the fund will provide help only on the basis of a care plan agreed between the fund, the disabled person and the local authority, whereby the authority will provide a specific level of service which the fund will supplement with a cash 106 payment to the individual client. The guidelines refer to an agreed care plan. If, therefore, the local authority or the fund do not agree the plan, the individual is caught in the middle and does not obtain access to the help that he or she so desperately needs. That problem could be overcome if the care package were funded by means of a cash payment and if the individual were allowed to spend that money on meeting his or her individual needs.
We are worried about the cost calculations, a point that has been made strongly in the debate, and the ring fencing of the £26 million that is to be handed over to local authorities. I am not, in many ways, a keen advocate of ring fencing, particularly at a time when we should give to local authorities freedom to get on with the job of assessing care packages in general for care in the community, not the particular needs of disabled people. However, because of the community care pressures on local authority budgets, it is inevitable that local authorities will look at the total money available and see how best it can be stretched to meet the needs not only of the severely disabled but of the disabled, the elderly and other groups for which they are responsible.
The great worry is that the £26 million will not meet the needs of the disabled people for whom that money is intended. When the Government look at the way in which the fund works in practice and at the way in which local authorities in practice draw up their plans, I hope that they will ensure that the £26 million meets the target for disabled people. As the system settles down, I hope that ring fencing will not be required. The Government have justified ring fencing of the community care budget in general, so they should specifically ensure that the £26 million for disabled people is ring fenced.
There is immense concern that the amount of money in the independent living (1993) fund will be insufficient to meet the needs of the people who will apply to the fund. In 1993–94, the new fund will have a budget of a mere £4 million, a tiny amount compared with the independent living fund's latest annual budget of £97 million. I know that they are not directly comparable, but, having restricted the number of people eligible and cut out the over-65s, the Government are allowing fewer people to get help by allocating a small budget which, on their own admission, will serve only 1,500 people. The Minister shakes his head. Does he seriously believe that only 1,500 people need help from the ILF 1993 successor fund? I look forward to the first reviews of that fund when we shall find out how many people have been left out of the system.
Many people were denied the right to apply to the old fund because of the bureaucratic delays and administrative chaos caused by the introduction of the disability living allowance. Many people have commended the Minister for not phasing in the DLA, but the people who applied to the DLA agency say that it has been phased in. They have had to wait months and months for their entitlement.
I am glad that the Minister has clarified the trustees' role. He passed the buck to them for denying to people who had suffered administrative delays the right to apply to the old fund. In answer to a question from me, the Minister said:It would have been open to the trustees of the independent living fund, before deciding to cease taking claims with a view to having an orderly hand-over of cases to the new trust in April, to deem someone who had applied for disability living allowance to have been in receipt of it and, 107 therefore, to be eligible for help through the independent living fund."—[Official Report, 10 February 1993; Vol. 218, c. 1081.]The trustees were outraged by that statement because they had given a commitment to the Minister that, at the end of the financial year, they would not pass on any commitments which could not be filled from the old fund. It was an outrage that they were told that they had the discretion to keep the fund open longer, not knowing how many people could be deemed to be in receipt, and then not being able to fulfil the financial requirements.
The Minister has tried to rectify the situation. I do not believe that he was responsible for that statement; I think that he was trying to cover up for Lord Henley in another place. I am glad that he has put the record straight because it was a scar on the integrity of the trustees. They were trying to do the best that they could in difficult circumstances with the cash available. It was never on offer to them to keep the fund open beyond the cut-off date.
Thousands of people who may have been eligible to apply to the ILF have been denied the right to do so because of the administrative chaos in processing their applications. In addition, if they had had their applications processed, that access may have been a passport to other benefits sooner. I believe that the Minister should reconsider the case of people who had made their applications before the cut-off date, who were subsequently found to be eligible for the DLA and who could have applied to the old ILF. Some compensation should be given to ensure that they have not been doubly disadvantaged by administrative delays and the lack of opportunity to get funds from the old ILF.
We have always been worried about the lack of consultation and continuity—the old fund will end before the new system, which is to come into operation properly on 1 April, has been set up. We are worried that, by 15 March, the Bill has still not completed all its stages and needs to go to another place for consideration. Many people involved in disability issues are concerned to ensure that there is no delay in payment to people already in receipt of money from the ILF. We want that assurance, but we also want the assurance that, despite the complexities that will clearly arise when the 1993 fund is in motion from 1 April, the relationship between the fund and the local authority will have been properly worked out and established.
I have no confidence from the documents that I have seen that there has been proper dialogue. As two of the trustees were appointed only a couple of weeks ago, there has clearly been no dialogue between the trustees and the local authorities about how the system will work in practice. We must ensure that the arrangements are in place and that there is no delay for the limited number of people who will seek care through the local authority and the independent living fund jointly. We must ensure that there is continuity and that there is not the administrative chaos that has been the hallmark of the disability living allowance.
Under the new system, the stated hallmark of most Government policies—choice for the individual—will be even more curtailed than it is now. People will no longer be able to choose their own carers as they would have been able to under the old independent living fund. The recent guidelines state: 108the 1993 fund will not consider applications direct from an individual who has not first been in contact with his or her local authority social services department".What is of great concern is the difficulties that individuals may have when the new system comes into effect on 1 April as a result of the massive job that local authorities will have to do in assessing a range of people who will come under their jurisdiction. People with the greatest needs may be put into a queue because they cannot make direct representations to the new fund, as they could to the old fund, for someone to come to see what their situation is. They will have to rely on the local authorities.
There is massive concern that the resources in the coming months will be limited. Naturally, priorities will be set by the local authorities about where they start the whole process. As the independent living fund element has been so delayed—I stress that we are debating it only a couple of weeks before it will come into practice—there will be further considerable delays which will hit the most severely disabled people. I hope that the Minister can give us assurances tonight that there will be no delay or, if there is likely to be delay, what contingency plans he will prepare to ensure that the needs of disabled people who will apply first are met.
Many disabled people have been in limbo since the old fund was abolished on 25 November. They have been asked to wait and there have been assurances that the new fund will be there to meet their needs. Those assurances can be met only if the administrative arrangements are clearly in place and if a proper relationship is established between the local authorities and the new funds. If not, disabled people will again be caught in the middle—caught in the care trap. They may be less able to suffer such delay than people with less severe disabilities are. It will be seen as a scandal by all; it will certainly be seen as a scandal by people with severe disabilities.
This has been a wide-ranging debate. The Opposition will not vote against the Bill tonight because we do not want to deny disabled people access to funds. When the Bill goes into Committee, we shall press the Government on crucial points. I hope that as a result of the contributions of my hon. Friends and myself tonight the Minister will give special consideration to the role of the trustees and their relationship with the disabled community, special consideration to the needs of the over-65s and special consideration to whether there will be a ceiling on the contributions of the local authority and of the independent living (1933) fund. If applications are not made to the independent living fund, local authorities will be free to extend their contribution. If an application is made to the independent living fund, there will be a ceiling of £510. We seek assurances on that and, equally, that the figure will not be set in concrete as the one that will be around for years to come, but will be annually reviewed in reports to the House to ensure that the sums available through the local authorities' service contribution and the independent living fund meet the needs of disabled people. That issue and many others will be discussed in Committee.
We welcome the opportunity to discuss the practical and philosophical issues affecting disabled people. I hope that the Minister will be able not only to allay the Opposition's many fears but to address the anger that has been expressed by people who work with disabled people 109 and by disabled people themselves, who do not believe that their needs will be properly met by the two successor funds.
§ The Parliamentary Under-Secretary of State for Social Security (Mr. Alistair Burt)
I thank the hon. Member for Manchester, Withington (Mr. Bradley) for putting the case with his customary clarity. I shall endeavour to answer his questions.
We have had a good and wide-ranging debat—much of it, I feel, conducted on the false premise that the change in the nature of the independent living fund somehow does away with a category of care for a whole group of people. That is not the case; it is a false belief, arrived at by those who have considered the Bill out of the context of community care as a whole. I hope to show that the worries expressed by Opposition Members are not founded.
As always in disability debates, a high degree of knowledge and care has been brought to bear by hon. Members on both sides of the House. We have heard a variety of extremely good speeches. I commend the opening speech made by my right hon. Friend the Minister for Social Security and Disabled People—a man who understands disabled people very well—who put the Government's case extremely well. My right hon. Friend was answered in a number of good speeches by Opposition Members. I commend in particular the comments by the right hon. Member for Manchester, Wythenshawe (Mr. Morris)—a friend of long standing—who speaks with great knowledge on these matters.
The kindest part of the speech of the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) was the reference to my footballing prowess. Whatever deals may or may not be negotiated in the next few weeks, I shall certainly remember those remarks.
I was grateful also to the hon. Member for Croydon, North-West (Mr. Wicks), whose experience in social policy matters is a great asset to the House, as are the comments of my hon. Friend the Member for Havant (Mr. Willetts), who brings a degree of intellectual rigour to these matters of which we shall all live in dread for many years to come. His was another excellent speech.
Some hon. Members, including my hon. Friends the Members for Bolton, North-East (Mr. Thurnham) and for Colchester, North (Mr. Jenkin), brought to our attention down-to-earth concerns about the problems of disability in their own constituencies. Others spoke more widely about the Government's record on disability and carers. My hon. Friends the Members for Worcester (Mr. Luff) and for High Peak (Mr. Hendry) made significant contributions in that regard. We had a wide variety of different speeches, all of them made with clarity and care, and I shall do my best to answer in the most logical and straightforward way, bearing in mind the constraints of time.
The hon. Member for Roxburgh and Berwickshire asked why we needed to proceed under Standing Order No. 48 and referred to problems of hybridity. The Bill has been introduced because it was found that payments to the independent living fund and Motability were not properly covered by section 64 of the Health Services and Public Health Act 1968. Under the Public Accounts Committee concordat, it is not appropriate to rely on the annual 110 appropriation Act alone to sanction outgoing payments. The Bill is introduced under Standing Order No. 48 because its main object is to create a charge on public funds. Questions of hybridity are for Madam Speaker to rule on rather than for the Government to determine. I understand that those matters have been examined and that there is no problem of hybridity in this case.
The hon. Member for Roxburgh and Berwickshire also wanted to know whether regulations will be introduced. The schemes are discretionary schemes set up by trust deeds. Accordingly, there is no need for Government statutory instruments or directions. The trust deeds and the conditions of grants set out the parameters within which the trustees can exercise their discretion. In a sense, that forms the regulatory framework that secondary legislation and regulations would have formed had there been an Act and statutory procedure.
If that were the case, the hon. Member for Roxburgh and Berwickshire also wanted to know, quite rightly, who would have access to the trust deeds. The trusts are private trusts and the deeds are not necessarily available to the public generally. However, the founding trustees have agreed that the deeds should be made available in the Library and I am sure that they would be willing for the deeds to be made more widely available. I am sure that we all hope that that is the case. There is no reason why the deeds should not be made available to the agencies which expect to make most use of the funds. I cannot see a particular problem in relation to that.
My hon. Friend the Member for Stratford-on-Avon (Mr. Howarth) made a significant contribution which was full of detail and obvious knowledge of the subject. I pay tribute to that. He questioned whether the trust deed was over-restrictive. The trust deeds and conditions of grant set out the parameters within which the trustees are able to exercise their discretion. The two new trusts will derive the whole of their resources from the Government. It is therefore perfectly proper for the Government to set down clearly the conditions under which the money is granted.
The trusts are not controlled by regulations. Therefore, all the controls on a very significant amount of money must be set down in the key trust documents. Accordingly, they are set down in detail. The conditions may appear pernickety, but they amount to no more than good accounting practice. It is better to be as clear as possible about the requirements in advance than for the Government to seek additional information later.
My hon. Friend the Member for Stratford-on-Avon raised a point, which was also raised by several Opposition Members, about the continuity of trustees. My right hon. Friend has already expressed his gratitude to the trustees, as I do, of the current independent living fund. The current fund was set up as an interim measure jointly by the Department of Social Security and the Disablement Income Group. The trustees have done a splendid job, but the new 1993 fund will operate in new ways in partnership with local authorities.
It is of course our intention that at least one of the trustees should be disabled. However, I do not believe that there is a need for continuity of trustees. There will be continuity of the staff at Nottingham, but I believe that the time has come for a new group of trustees to carry the work forward following the introduction of community care. Notwithstanding the excellence of previous trustees, 111 it cannot be the case that new trustees are not available who would also show similar expertise, care and attention to the matters in hand.
My hon. Friend the Member for Stratford-on-Avon also suggested that the director and staff had not been encouraged to stay. That is not so. The director of the ILF had been on secondment from the Department for five years—an unusually long secondment. The creation of the new funds provided a suitable opportunity for a change and we have recruited a new director.
As for the staff, it is not true to say that they have been encouraged to leave. Far from it. The Department has encouraged the existing staff to stay. Indeed, the contracts of the directly employed staff have been extended in advance of 1 April to provide reassurance for the staff.
§ Mr. Burt
Yes. A new director has been appointed. Her name is Margaret Baldwin. She is expected to take up her post in mid-April.
Two trustees have been appointed—Robin Wendt, the secretary of the Association of County Councils and member of the Social Security Advisory Committee, and John Shepherd, a retired finance director of Remploy. The two men will bring excellent care to the new body of trustees and plans are in hand to recruit the remaining five trustees. Three more will be appointed shortly and the rest in the near future. I am quite sure that the new trustees will exhibit the same degree of quality and care as that exhibited by the trustees of the previous funds.
Hon. Members mentioned the closure of the independent living fund, and I am anxious to answer their questions. The fund was not forced to close because of deficiencies in its funding. The timing of the closure to new applications was a matter for the fund's trustees. It was always intended that, in its present form, the fund would cease to operate in April 1993, although payments would continue to those who were receiving money from it as of 31 March. The trustees promised that they would ensure that all applications for help were processed by 31 March. They took the decision to close to new applications with effect from 25 November 1992 to process the applications already in hand.
One or two hon. Members asked why more time was not allowed. People were aware that the fund was due to close in April 1993 and therefore more applications were being made in anticipation. I am sure that hon. Members will understand that if a closing date had been set at some stage in advance, it would only have encouraged a last-minute sale, which would have made it impossible for the fund to continue.
The trustees took the decision to close with great reluctance but recognised that the fund had become a victim of its own success. By last November, there was a backlog of 6,500 outstanding applications, which the trustees had a legal obligation to clear before the planned and final closure of the fund on 31 March. I know that staff have worked hard to clear the backlog, assess applications and process cases.
§ Mr. Dewar
Before the Minister concludes—we have left him a full half hour—will he deal with the small but important point about people who might have been eligible to apply before the closing date but were not in a position to do so because of delays in processing DLA claims? How does he propose to ensure that they are not prejudiced? If it is clear that several months of support have been lost, some form of backdating should be considered.
§ Mr. Burt
The hon. Gentleman anticipates my next point and I am happy to deal with it. I appreciate that some people who were awaiting a decision on a DLA claim before applying to the independent living fund were unable to apply before 25 November. I regret that, but payments from the ILF are charitable and discretionary, so there is no question of an automatic entitlement or of backdating. I was grateful for the comments of the hon. Member for Manchester, Withington (Mr. Bradley) because it certainly was not the intention of Ministers to suggest that the trustees could have kept the fund open for such cases. That would have been impossible for the trustees and would have negated the point of the closure, which was to allow time to process the cases in hand.
The trustees have worked tirelessly for the independence of disabled people. I should not like a misunderstanding of the problems of processing DLA to cast doubt on the high regard with which Ministers hold them. Payments from the fund are not social security benefit payments, so there is no entitlement to them.
§ Mr. Bradley
The Minister is not accurately reflecting my comments. I said that it appeared that the Government were blaming the trustees for the problem, which clearly was so in the other place but now has been clarified. Although the fund is a charitable trust and there is no right to the money, if some individuals' applications for DLA had been processed they might have been eligible for payment under the fund. They have been denied the opportunity to have their applications assessed. The Government have a duty to compensate those people for the administrative chaos that the Government have caused.
§ Mr. Burt
I do not accept the hon. Gentleman's point, but I am happy that he has cleared up the position in relation to trustees.
The closure of the independent living fund did not leave those disabled people without redress or support. As always, the local authority maintains its overriding responsibility for disabled people. The independent living fund was set up to supplement existing care. Despite its closure, people could still go back to their local authority, and those who qualified are able to apply to the new fund. There is no possibility of any form of compensation or backdating for a fund whose payments are discretionary.
§ Mr. Dewar
The Minister will recognise that his statement will cause widespread disappointment and some anger—I certainly feel some anger. Surely, if someone is disqualified from applying for ILF help because the shutter comes down on 25 November, and at that stage his DLA application is caught in the logjam, and if he subsequently applies and receives help three or four months later, there would seem to be a prima facie case for saying that he has been deprived of lLF during that period 113 by the logjam and by the administrative inefficiency with which cases were processed. Surely that adds up to some claim for compensation under any form of common law.
§ Mr. Burt
No, I do not think it does. The fund always had to set eligibility limits depending on the pressure on it. The reason for the closure was the build-up in the backlog of cases—it could not possibly have processed any more of them. I repeat: I am not aware of any mechanism to allow compensation to be claimed for a discretionary fund.
I should like now to deal with the meat of the argument—whether setting up the new fund and the extension of the old fund in any way limits the opportunities for severely disabled people. I found extraordinary the degree of suspicion expressed by the hon. Member for Huddersfield (Mr. Sheerman) and other Opposition Members—suspicion of the expertise of those in local authorities charged with putting community care into effect. The whole idea of community care has been to carry forward the ideas of greater empowerment for all people who might need some form of assistance—hence the idea of care packages. The forces embodied in the success of the ILF—the tailoring of need and response to that need—are the very forces that have already shaped and will continue to shape community care for all. That is why the Bill cannot be seen in isolation from the community care package around it, and it is why the premise of the hon. Member for Huddersfield and others was wrong.
§ Mr. Sheerman
When I made that point I quoted bodies that were of that mind, including the Association of County Councils, the Association of Metropolitan Authorities and the Association of Directors of Social Services. If they do not know their onions, I suspect that the Minister does not know his.
§ Mr. Burt
Bearing in mind that this debate started with an admission by the Opposition of how wrong they got the original ILF, I suggest that they are wrong again. As they have spent most of the time apologising for being wrong about the first case I am not prepared to take lessons from them about this one. I have put the matter straight, and I shall deal with it again when we come to the facts and figures.
Opposition Members have displayed a fundamental misconception about how community care and the independent living fund fit together.
§ Mr. Jenkin
Does my hon. Friend agree that if we were to take the Labour party seriously on issues of empowerment, discretionary funding and discretionary care, its members would have to start by supporting fund holding for general practitionersu—a good example—and continue by supporting the social fund?
§ Mr. Burt
My hon. Friend makes his own point. We have heard a number of references to the Conservative party manifesto—often light-hearted references from Opposition Members. We have not heard many references to Labour's manifesto because the Opposition have already torn it up. We remain, as always, interested in further policy developments. The Opposition seem to get closer and closer, week by week, to policies espoused and put into practice by the Conservative party.
To return to the central point—the relationship of the independent living funds and the community care proposals, we must put the Bill's proposals in the context of other developments in the cash provision for disabled 114 people. In January 1990 the then Secretary of State for Social Security, my right hon. Friend the Member for Braintree (Mr. Newton), published "The Way Ahead: Benefits for Disabled People". He announced that the Government saw three main strategic strands in policy on benefits for disabled people. The first was to improve the balance of benefits available to people unable to work, and in particular to do more for those disabled from birth or from early in life. The second was to help those disabled people who could and wished to work by making it easier for them to take up and keep jobs. The third was to improve for those of working age and below the coverage of help with the extra cost associated with disability.
We have demonstrated that the independent living fund was set up to provide a supplement to the existing care provision. We all knew that care provision was moving on, in ways in which many hon. Members, implicitly and explicitly, have approved. That means the creation of a better relationship between the individual looking for care and assistance and those who are pledged to provide it. We have moved some way from the old ideas of the recipient of care being simply that—a non-participant of whatever was given.
§ Mr. Dewar
I accept that things have moved on and that the new ILF will be a top-up provision to help people with a certain level of disability to stay in the community and not move from their homes. However, it has not been properly explained why that top up should not be available to the over-65s.
§ Mr. Burt
The hon. Gentleman anticipates me again. I shall come to that point.
It has been suggested that, in some way, local authority services take away choice from the individual. That suggestion negates the concept behind community care. Local authorities and those who provide the services have also moved on. They are providing people who will look at those in need of care as individuals and set up the right sort of package for them. One example used is that of an individual who had an independent living fund grant and who was able to ask a carer to do particular tasks. The individual was not bound by a local authority job specification but could work at the behest and need of those in receipt of the independent living fund grant.
That is community care that is intended to work for the individual, who, being assessed to stay at home, if that is the best provision for him, will find himself able to have exactly that. So much of what used to be provided through the independent living fund for a section of the population is now provided for by community care. That is why the independent living fund can be reduced to provide only for the categories of people whom we have mentioned. Community care does the job for others. To see the independent living fund outside the context of community care, as so many Opposition Members have done tonight, is not right. That is why they have been fundamentally misled.
§ Mr. Burt
I should like to make some further progress, because I have a number of questions to answer.
115 The right hon. Member for Wythenshawe spoke of the worry about sheer practicalities. He asked why, when up to now disabled people have been dealing with only one agency, they should have to deal with the local authority as well. The premise was not based on fact. The majority of disabled people getting help from the independent living fund were also receiving support services from their local authority, and so have always been in contact with two sets of social workers. Therefore, it is much better for the entire package of care to be discussed between the parties concerned. The disabled person will benefit from having a complete personalised package of care.
The 1993 fund will work, as the circular to local authorities explains, by ensuring that all the eligible clients will be people already in touch with their local authority. The social worker assessing the person's needs will say, "You are in the right age group—16 to 65—you are getting the top rate of DLA care component, your income is insufficient to meet your care needs, you need help which will be assessed at roughly, say,£400 a week. That means that you might be eligible for help from the 1993 fund. Do you want to make an application?" The social worker and client will then apply to the fund. The fund's social worker and the local authority social worker will make a joint visit to the client. All three will then agree what package of care is to be provided.
It has been suggested that there may be great disagreement but there is no reason why that should be the case. People are now working to see that the individual needs of those in need of care are provided for. That is in the great spirit of co-operation, about which we hear so much from the Opposition when they are in the business of defending local authorities. They say often that local authorities can do the job. In relation to the disabled, they will be able to do that, and we shall back them.
The right hon. Member for Wythenshawe also asked what would happen about appeals and complaints. That is a fair question. Since April 1991, local authorities have been required to operate complaints procedures in relation to their social services functions. If an individual is dissatisfied with the outcome of the local authority assessment, he can make use of that procedure, which includes referral of the complaint to a panel with independent members if necessary.
Should cash payments be provided? We feel that the partnership arrangement between the individual, the fund and the local authority means that the individual has more not less choice as a total package of care is agreed, rather than some random services being provided by the local authority with a cash top-up from the fund. We do not believe that it is appropriate that the local authority should be able to make cash payments to individuals. There are difficulties in determining which clients would be eligible and in controlling costs. The need to develop funding and monitoring mechanisms is likely to lead to a bureaucratic and inflexible system.
The Government have given careful consideration to local authority payments and we have decided that at this stage it would not be wise to introduce such a provision. However, I see no reason for that to be an irreversible decision. I think I shall be responding to the mood of the House by keeping a close and careful eye on this issue for the future.
§ Mr. Sheerman
Unless the Minister was asleep when I made my speech, as he obviously is in his own, he should surely respond to those who have asked, including the hon. Member for Mid-Kent (Mr. Rowe), why such a scheme can be permissible in Scotland but not in England. He should explain why we in England and Wales cannot have cash payments. Why is such a system bureaucratic and cumbersome?
§ Mr. Burt
I have given the hon. Gentleman an assurance that I shall examine extremely carefully the possibility of introducing cash payments in future. At the moment, we are not convinced that it is the right thing to do. Some local authorities find ways of making small cash payments, and that may be the position in Scotland. It is for local authorities to ensure that they keep such payments within bounds.
Some hon. Members have asked whether moneys could be given to charities or trusts to enable them to do the work. When the full flexibility of community care is understood, some of the concerns expressed by Opposition Members will disappear. The objective of community care, and the way in which it can work with the ILF, is to enable local authorities to provide services up to a cost of £200 a week, with £300 available as extra top-up, but they need not be provided by the local authority. A local authority must simply ensure that £200-worth of services are provided, but that could be done through an independent provider. Indeed, the one provider could supply the £500-worth of services. The degree of individualisation and flexibility was not previously understood.
Opposition Members seem to be confused about the responsibilities of the 1993 fund and those of local authorities. The ILF did not remove any responsibilities from local authorities and nor does the 1993 fund. The 1993 fund simply provides an additional option for a particular client group—those aged between 16 and 65 years with care needs amounting to between £200 and £500 a week. People who do not fall into that group—that is those over 65 or those with needs that amount to less than £200 or more than £500 a week—will remain the responsibility of the local authority. For the majority of the severely disabled who do not fall into the special group for whom the 1993 fund was intended, the local authority will consider with the client what is the best way of providing or buying in care services. It is untrue to suggest that authorities will opt to pay £800 or £1,000 to place somebody in residential care when such expenditure, or less, could support that individual in the community.
In gist, if somebody is over 65 or is looking for care that will cost more than £500 a week, the local authority will be able to provide the individual care package that the ILF used to be able to supplement when community care did not exist. Opposition Members seem beset with the idea that our proposals should be considered outwith community care. They should understand that the community care individualisation package does the job for the vast majority of people who used to benefit from the ILF. That is why the concerns of Opposition Members are out of place.
In setting up the ILF extension and the 1993 fund, the Government are anxious to reassure those who are now on the ILF that they will be able to receive their new payments—the point was made by my hon. Friend the Member for Worcester—and notice nothing different—no change—except the name on the cheque. For the rest, the new fund 117 will deal with a much smaller group of people, perhaps only 10 per authority, so the degree of bureaucratic difficulty will not be as great as Opposition Members suggest.
There have been dealings with local authorities. I am convinced that the system will be a great success. I am convinced that, just as Opposition Members have now admitted that they made an error in denying the success of the original ILF, in years to come they will recognise that they have made an error tonight and will acknowledge that this is a good Bill.
§ Question put and agreed to.
§ Bill accordingly read a Second time, and committed to a Standing Committee, pursuant to Standing Order No. 61 (Committal of Bills).