§ 3.5 p.m.
§ VISCOUNT INGLEBY rose to call attention to the working of the Chronically Sick and Disabled Persons Act 1970; and to move for Papers. The noble Viscount said: My Lords, I beg to move the Motion standing in my name on the Order Paper. In three days' time it will be the first anniversary of the Royal Assent to the Chronically Sick and Disabled Persons Bill. We were grateful to the Government when, shortly after taking office, they introduced the constant 1155 attendance allowance, but I think it is fair to say that disabled people have been waiting and wondering. I do not know whether there will be an explosion in this House this afternoon, but what I hope is that there will be a " fall-out "—a fall-out of good will starting from this House, spreading through the Civil Service and into the town halls. Having listened to the Secretary of State in another place on Friday, I am myself convinced that he has the interests of disabled people at heart; and having listened to the Minister of State in this House about a year ago, I am quite sure he has the interests of disabled people at heart, too, because if your Lordships remember he was pressing the late Government for the introduction of dropped kerbs. I am hoping that we shall hear something from him about that later this afternoon.
§ My Lords, local authorities vary greatly in the amount of money they spend on disabled people. The figures were given in Hansard of another place on February 24. At the top of the league, or table, is Oldham, which spends £70 per registered disabled person, and at the bottom of the league is Salford, which spends only £3 although I do not think they will be able to keep that up for long with Mr. Alfred Morris in a neighbouring constituency! My own county of the North Riding spends (or spent, because these are the figures for 1969–70) £16 per registered disabled person; or, if you like to express it another way, five pence per head of the population. The Secretary of State said recently that he envisaged an annual growth rate of 9½ per cent. in the expenditure by local authorities on the sick and disabled, and I therefore suggest that it would be a fair question to ask our local authorities just how their estimates for the current year compare with those of the previous year.
§ It would be quite beyond me to try to review the whole of the working of the Chronically Sick and Disabled Persons Act; so I should like just to concentrate on one or two aspects of it. First, I should like to say a word or two about access to public buildings, because this is particularly important for disabled people. This problem was highlighted recently when the film The Raging Moon, about disability, was shown at the ABC2 Cinema in the Tottenham Court Road, 1156 when neither the author, Peter Marshall, nor one of the stars, Michael Flanders, was able to attend the film showing because both of them were in wheelchairs and the cinema was inaccessible to those in wheelchairs.
§ Recently, a movable ramp has been invented by the Bath Institute of Medical Engineering. It is made of expanded metal and can be screwed down or taken up again within an hour. I believe there can be few local authorities who would not benefit from one of these ramps. Our friend who opened the batting in another place on Friday said that if there was a recipe for the disabled it was a touch of sympathy, a dash of understanding, a lot of imagination and the whole topped off with immediate, positive action. I would suggest that here is an opportunity for local authorities to show their good will. I would suggest that they get in touch with the Bath Institute at St. Martin's Hospital, Bath, to find out whether one of these ramps would meet their own requirements.
§ Talking of immediate positive action, I should like to congratulate the Secretary of State on his boldness in ordering 1,000 chemical closets—" a thousand decent, seemly, chemical closets" as he described them in the debate last Friday. He was referring to the fact that there are 200,000 households in this country which have a very severely or appreciably handicapped person without an inside W.C. I think this was a bold stroke on his part, and I hope very much that the local authorities will be equally bold in taking up the suggestion which I have made. Of course, suitable housing is a tremendous help to disabled people. I know this from my own experience. If I am left on my own, have to do the washing-up and cannot get my knees under the sink, I do not get on very fast. It is something of tremendous importance. I was very encouraged to see that in the six months after the passing of the Act, 27 local authorities had submitted housing schemes which include purpose-built accommodation for the disabled. This is a very real problem, one that obviously cannot be solved overnight and which will require a tremendous effort on the part of the local authorities assisted by the voluntary bodies. I have the honour to be the President of a housing association for this purpose, the St. Giles Housing Association.1157
§ There are two other matters on which I should like to touch. One which particularly affects disabled people is the sense of isolation we sometimes feel, a sense of lack of involvement in society, of being a little bit out of the main stream. Obviously, the best answer here is to have a job, but in this connection the figure at the moment of employable disabled people who are at the moment unemployed is 12.7 per cent. which is very much greater than the national average; and the tragedy is, of course, that in a time of difficulty when people are having 10 cut back a bit it is often the disabled people who suffer first. As lime goes on and we provide better training for disabled people, there are going to be more arid more disabled people with a skill. But what is the use of a skill if you cannot find work? I was very glad to hear in the debate on Friday that the Department of Employment and Productivity are already engaged in a survey of the whole problem of employment for disabled people. I should like to ask the Government when this survey will be completed, because this is a pressing problem at this time.
§ The other guard against a sense of isolation is social life. Again, I read in my Hansard for last Friday that a survey had shown that 7 per cent. of disabled people have no regular social contact with neighbours or friends. When you come down into the under 20 age group the figure is very much higher. 33 per cent. one in three, it appears, of disabled people under the age of 20 have no regular contact with their friends and neighbours. This, I would suggest, gives a tremendous opportunity for visiting by able-bodied young people, and I would commend those youth clubs who have gone out of their way to ask young disabled people to come into them and to join in their activities.
§ I should like to finish by saying this. I am sure that all disabled people want to be as independent as they possibly can and., if possible, to earn their own living, when of course—just as a matter of incidence—they will cost much less to the community. What we should like to ask from the Government and the local authorities is the right environment to enable us to do this. I beg to move for Papers1158
§ 3.16 p.m.
§ MINISTER OF STATE, DEPARTMENT OF HEALTH AND SOCIAL SECURITY (LORD ABERDARE)
I know that the whole House will be extremely grateful to the noble Viscount, Lord Ingleby, for giving us the opportunity to debate this subject. May I say with great respect to him how much I enjoyed listening to his speech, which was both eloquent and highly impressive. It is also a great pleasure, I am sure, to all your Lordships to see the " Mobile Bench " back in action again. The noble Lord was kind enough to say some nice things about my right honourable friend the Secretary of State and me and I am very grateful to him. He asked me about my dropped kerbs, which have nothing to do with fallen arches, but are in fact the idea that I put forward at the time of the debate on the Bill, which was that there should be sloping kerbs at pedestrian crossings to help both those in wheelchairs and also those pushing perambulators. This is a matter for the Department of the Environment and I will ask my noble friend to reply when he winds up the debate. I am sure that the noble Viscount will feel very well satisfied that, despite the long labours of your Lordships, a great many noble Lords have put their names down to speak in this debate. I am particularly pleased to see my noble friend Lord Cullen of Ashbourne breaking silence after many years and I am very much looking forward to hearing what he has to say.
As the noble Viscount said, this is a most appropriate moment to review the effect of the Chronically Sick and Disabled Persons Act. It is almost a year since it came on the Statute Book and we are much better informed now since the publication of the recent survey of the handicapped and impaired in Great Britain published by the Office of Population Censuses and Surveys. The two parts of this survey already published contain a mass of statistical information and there is still another volume to come concerned with finance. It is certainly not easy to absorb all this information in a matter of a few weeks, but at the same time there are certain general findings of the survey which are immediately applicable to the consideration of this problem.
1159 I have not been long enough on these Government Benches to forget the time when I was sitting opposite and I can well remember then feeling how many shortcomings there were in our social services. I can remember how my colleagues and I demanded the expenditure of more money on various aspects of the services and I can also remember thinking how complacent the speeches were from the Government Front Benches. Now that I sit on this side of the House I hope sincerely to convince your Lordships that we are indeed far from complacent in this matter, that we recognise the serious problem that exists, that we know that with limited resources it cannot be solved by the passing of one Act and that we have a consistent and constructive policy which we have already started to implement.
The noble Lord quoted my right honourable friend's speech in another place last Friday and he put admirably the policy that we are pursuing. Quite simply, it is that whenever reasonably possible our aim should be to keep people as active as possible and to keep them at home. In this the dictates of humanity are often supported by the lessons of cost benefit. We have already announced various measures, all with the aim in view of assisting the handicapped to live at home. In cash terms, we are providing £30 million per annum extra for the payment of an invalidity allowance to the chronic sick and an attendance allowance to the very severely disabled. Apart from increasing old age pensions generally by £1 a week from next September, we have made special provision for the over 80s, we have improved the earnings rule for the wives of chronic sick persons and we have increased the benefit for dependant children of a chronically sick parent. In every case we have made it clear that this is only a beginning and that we hope to improve on these provisions, which at least demonstrate our deep concern for the disabled and the handicapped and which are intended to carry out our first priority of enabling people to manage on their own.
I think it worthy of note that we see here one of the advantages of the amalgation of two Ministries into the one 1160 Department of Health and Social Security; and I readily concede that this was achieved under the previous Government. My right honourable friend the Secretary of State for Social Services is able to strike a balance between cash and care and to ensure that both sides contribute to the solution of individual problems. But cash alone is not the whole answer. To help the handicapped to live at home there must be available other services provided by the local authorities, such as home helps, home nursing, meals-on-wheels, day centres, adaptation of housing and various facilities in the home which can be of such assistance to handicapped people. Of necessity, these are individual matters and must be left to the local authority to make an individual assessment. It is worth mentioning that although Section 2 of the Chronically Sick and Disabled Persons' Act 1970 gave statutory form to local authority's powers, it did not introduce any new services; nor did it provide any money for their implementation. However, this Government have allocated additional financial resources to local authorities to enable them to carry out some of their responsibilities in this field.
In terms of capital, in this and the following two years the Government are making available loan sanction to enable local authorities to build 36 homes designed specially for the physically handicapped, 72 day centres for the physically handicapped, 31 combined day centres for the handicapped and elderly, together with a number of smaller capital projects. In terms of revenue we have accepted local authority proposals in the rate support grant negotiations which will add 12 per cent. to their expenditure this year and a further 12 per cent. next year. On top of these agreed amounts, an extra £11 million over two years has been added by the Government for the improvement of local authority health and personal social services, including Section 2 and related services which we wish to see improved. It is of course ultimately the responsibility of local authorities how they spend the money allocated to them, but we are confident that they will recognise the needs of the physically and mentally handicapped in their plans for spending this additional money.
1161 In the Hospital Service we have direct responsibility for the allocation of funds, and we have increased capital expenditure on services for the mentally handicapped, the mentally ill and the elderly by some £90 million over the next four years, and about £105 million additional revenue expenditure. As your Lordships are aware, we have also set aside an extra £3 million for special units for the young chronic sick. I am able to give the House some further information about the allocation of that money. We have so far allocated £1,304,000 to start 18 schemes in the present year This will provide a further 455 beds, a very considerable increase over the present provision of 28 units and 710 beds. There are also three schemes planned, to begin this year, which are being financed from the normal allocations, and we have asked Regional Hospital Boards to put in firm bids for schemes to start in the next three years which will take up the balance of the £3 million allocated.
In particular we wish to see a significant increase in the domiciliary services available to the handicapped. The O.P.C.S. survey draws attention to the need to increase the provision of home helps. At least twice as many are required to meet the needs of disabled housewives. It suggests that home nurses and health visitors, too, have a most important part to play, and although there are many other urgent calls on their time they make an important and valuable contribution in meeting the special health needs of the handicapped person living alone. There is need, too, for more homes, more training centres and more and better trained staff to run them. It is for such purposes that we have allocated additional funds to local authorities and we shall do our best to see that they are put to good use.
Preliminary study of the survey suggests that there are in England alone some one and a quarter million people of all ages living in their own homes who are handicapped to the extent that they need some help from others in carrying out at least some of the normal activities of daily life. Nearly half a million are so severely handicapped that most activities prove difficult for them while there is a smaller number, amounting perhaps to one-sixth of a million, who are very severely handicapped and cannot be left alone for more than a short period during 1162 the day. Most of these people are elderly and the majority of them are women. Perhaps the most striking figures in the survey are that there are 8,200 people very severely handicapped living alone and of these 8,000 are women and mostly old. It seems likely that a very high proportion of them are already receiving local authority services and one should never underrate the support given by families and by neighbours. Nevertheless, there appears at first sight to be a priority need here, and my right honourable friend has already announced that he is asking local authorities to take active steps within their own organisation and by consultation with general practitioners and voluntary bodies to ensure that very severely handicapped people who are living alone have all the help that they need.
The report of the survey shows that for Great Britain as a whole over 40 per cent. of all handicapped were at that time receiving local authority services. A higher proportion, some 50 per cent., of severely and very severely handicapped people were getting local authority services, and they were provided to as many as 70 per cent. of the severely and very severely handicapped living alone. This is not a negligible provision. It provides a very sound basis for further development.
I should like to say a word about Section 1 of the 1970 Act which will come into effect on October 1 next. We have been accused at various times of delaying the implementation of this section and of misinterpreting its meaning. As far as the delay is concerned, we need time to prepare guidance. Moreover, we have always felt that it was right, and indeed essential, to allow directors of social services to have time to organise their departments before embarking on any major new exercise of this sort. Indeed the time between now and October 1 is short enough. As for the meaning of the section itself, it was always accepted at the time of the passing of the Act, both in another place and here, that the main objective was to identify those in need of assistance and to put them in touch with the available services. Quite clearly, we want everybody within a local authority area to know the services that are available, and this is the object of Section 1(2) of the Act.
Moreover, the O.P.C.S. survey makes it quite clear that many of the disabled 1163 object to being registered and naturally their wishes must be respected. My Department is anxious to do all that it can to help, and we are engaged on the preparation of a booklet for wide distribution which would give guidance to handicapped people and their friends on how and where to seek help. I am sure that in this field in particular there is great scope for the harnessing of voluntary effort, and I believe it to be of the first importance that local authority staff faced with so many daunting problems should make the best possible use of the voluntary assistance available to them. While on the subject of the part that can be played by voluntary bodies, I find it impossible not to mention the name of the noble Baroness, Lady Swanborough —or Stella Reading, as she was better known to her very many friends. She epitomised the spirit of selfless service that inspires voluntary societies, and the W.R.V.S. stands as a worthy memorial to her massive achievements.
Quite clearly we also want local authorities to know what their problems are, and this they can best achieve by a local survey as envisaged under Section 1 of the Act. Near total identification may be a final step in a process which begins with local surveys, or a gradual process of identification may be carried out simultaneously with surveying and publicity work. But it is for authorities individually to determine what would be most helpful for them and most useful for handicapped people in their area; we should not wish them to divert many highly qualified people to the task of determining the level of need and hence diminishing the services for the people for which this Act provides.
My Lords, there are two particular matters to which I should like to refer. The survey shows that the chief cause of handicap is arthritis. There is a great deal of research being carried out into this condition but we are in touch with the Medical Research Council about the possibility of sponsoring additional research. I should emphasise that this is an extremely complex field and that it is not money which is the limiting factor so much as finding profitable research lines to pursue.
Secondly, a word about aids and equipment which are so obviously important 1164 in helping the handicapped to live at home. My right honourable friend has the whole question of aids and equipment for the disabled under review and this is one of the matters now being discussed with the local authority associations. My right honourable friend the Prime Minister, as well as the Secretary of State and I have recently visited the Disabled Living Foundation Exhibition and we are maintaining close contact with the voluntary bodies active in this field. Our task as we see it is to find ways of spreading information to those concerned about reliable aids.
I have been able to touch on only one or two matters covered by the Chronically Sick and Disabled Persons Act, and I fully realise that there are a number of other subjects covered in the Act to which your Lordships will wish to refer in the course of this debate. My noble friend Lord Sandford will do his best to answer some of those questions when he speaks at the end of the debate. I have no doubt that a good case will be made for devoting more resources to one or other aspect of the sections in the Act. Nevertheless, we have to realise that in the context of demands on total resources this Act covers only one portion of the population in need and there remain insistent demands to provide more facilities for the hospital service, the mentally ill, the old who are not handicapped, the homeless, the alcoholics, the drug addicts and a host of others. I would suggest to your Lordships that within the short time that this Government have been in power we have made a significant start in providing for the handicapped and that we have amply demonstrated our concern and our determination to devote greater resources to those who are most in need.
§ 3.36 p.m.
§ LORD CULLEN OF ASHBOURNE
My Lords, I propose to draw a veil over the number of years during which I have received delicate hints from some of my noble friends and some pretty indelicate ones from other quarters—that I should get to my feet and make my maiden speech. This long period of silence makes this experience no less unnerving, so I crave your Lordships' indulgence for a few moments. The reason that I have decided to take the plunge to-day is because this is a subject which interests 1165 me deeply and one in which I have a particular personal interest. What this Act sets out to achieve is a society in which the sick and disabled can live with dignity; a society in which they can find opportunity and the tools necessary to leading useful and satisfying lives, and where help is given with discretion. If all this is to be accomplished, it would seem to me that the prerequisites are understanding, good communications and of course money.
There are many points to be made as to how these ideals can be put into practice and noble Lords will have heard a great many, I am sure, but I should like to stress two, to my mind, vital ones —the utilisation of existing voluntary services and the means of communication. Ours is a country, I believe, without peer in its record and achievement of voluntary service, and I would suggest that we should seek to harness the know-how and considerable spadework of certain voluntary bodies concerned with the problems of the sick and disabled. It is possible that to derive maximum benefit from these bodies a survey should be carried out with the aim of investigating any overlap of activites, but the work already done by these bodies and which has been entirely financed by voluntary contributions would surely save the time and money of local councils. I would mention, for instance, the work of the Central Council for the Disabled, the original publication of a four volume loose-leaf book entitled Aids for the Disabled, financed entirely by the National Fund for Crippling Diseases and now known in many countries, and the work of the Disabled Living Foundation which I visited last week.
That Foundation, situated in Kensington High Street, has set up a permanent exhibition of a truly remarkable range of aids, many items being adaptations of standard manufactured articles, including not only wheelchairs, hoists, adjustable beds, crutches, sticks, portable ramps, handrails and so on. but also aids for washing, cooking, laundry, eating and drinking, reading, sewing and knitting and a host of other gadgets. All problems of the disabled are studied. be it housing, furniture, clothing, employment or recreation, and information concerning all these matters is easily obtainable from a sophisticated filing system known, I 1166 think, as Storage Retrieval. At the moment this service is entirely free to individuals, and, by subscription, to institutions such as local authorities, hospitals and voluntary organisations. In my view, this exhibition should be copied in other large cities. I believe that Lady Hamilton, who is the Chairman of the Disabled Living Foundation, would be happy to assist with her knowledge and experience in the setting up of similar establishments. Backed by the information service in London these exhibitions would be much cheaper to run than their prototype. They would, I believe, be invaluable in communicating what services and equipment are available.
Every effort should be made to communicate with the doctors and the disabled persons themselves. There are many who are not desperately disabled and who are philosophically learning to " live with it ". They could be greatly helped and their burdens made lighter. But how are we to reach these people? Surely, by the mass media. So much could be done by informative articles in the newspapers and magazines, and on the radio; even better, by television programmes showing a disabled person using these aids and equipment in his home. Such a programme would be immensely encouraging and helpful to the disabled, instructive for doctors and medical students and of great interest to other viewers. There are several noble Lords who hold commanding positions in the newspaper and television industries and I urgently appeal to them to use their influence in support of this concept.
My Lords, we all know how much greater is the response to this Act by some local authorities than by others. Some of them may, perhaps, think that an extra heavy burden has been put on their shoulders. I do not seek to minimise their task. Some of them have responded magnificently; but some show a very regrettable reluctance to act at all. In other cases disappointing performance probably stems from lack of knowledge to understand the problems, and lack of communication with bodies possessing that knowledge. Here, I would cite a personal experience, or rather the experience of my wife who, with the invaluable aid of Mr. Barran of the Automobile Association. conducted a virtually 1167 single-handed campaign on behalf of disabled drivers. She found all along the line the same story—complete lack of understanding of the actual problems involved and lack of any real direction from the top to those members of the police and wardens who have to carry out the provisions of the Traffic Acts. Finally, she saw Mr. Ainley. I think that then he was First Secretary at the Ministry of Transport. After listening courteously he said, with true understanding. " In other words, you want the spirit of the law extended to disabled persons and not the letter." Mr. Ainley promised to take up the matter with the relevant authorities, since when great progress has been made and much hardship avoided; and we both hope that many disabled drivers share my wife's gratitude to those who have tried to solve this problem.
Incidentally, my Lords, Section 21 of this Act, which deals with the subject of disabled drivers, is, I gather, to be implemented any day now. It will certainly be a relief when this occurs and when badges for disabled drivers issued by one authority are recognised by others. I should like to ask the local authorities to consider whether the appointment of liaison officers, either from themselves or through the voluntary services, would not be helpful in co-ordinating the activities of the statutory and voluntary organisations in their respective areas. If these liaison officers were to meet each other at regular intervals and report on progress, would they not help to raise the standard of services provided by the less enlightened? It is so much a question of human relationships, and 'therefore dependent upon a flexible attitude to individual cases and circumstances. The spirit of the Act rather than a rigid adherence to the letter of the law is what is really important. In this matter the criterion is that there are no criteria.
Turning for a moment, my Lords, to the matter of finance I do not think it can be too often repeated that what needs to be examined is net cost. A relatively small expenditure of ratepayers' money to assist a disabled person to live in his own 'home is preferable to the much larger cost to the taxpayer of maintaining him in hospital. Thorough co-operation between hospitals and local 1168 authorities could result in a very large net saving of money. From a financial point of view plans hammered out to release disabled persons and return them to their homes would, apart from being humane, ease the pressure on the hospitals and be financially prudent.
There is one small observation which I should like 'to make on the subject of Section 4, which deals with the means of access for the disabled to or within a building. It often imparcticable to provide lifts for all the people who visit a building. When this applies I think it would be kindly to display a notice indicating that the lift is for elderly and disabled persons. It is not unusual to see such persons patiently waiting to enter a lift while it is being used by young, able bodied people who could very easily use the stairs and be the better for the exercise. I have in mind such buildings as the Royal Festival Hall, with which your Lordships will be well acquainted, and which is one of the very few buildings in which entertainment and culture is provided and where lifts are installed.
Finally, my Lords, there is much to be done in the short term. I think that good communications and active cooperation between the statutory and voluntary organisations and the hospitals are all important. In the longer term, if we are to attain the high standard of service to which I am sure all noble Lords will aspire, we must not overlook the need for teaching the hospital ancillary services, the social welfare services and medical students about the special problems of the disabled. I am indeed grateful to your Lordships for your indulgence.