§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. E. Wakefield.]
§ 11.12 p.m.
§ Mr. Eric Johnson (Manchester, Blackley)
There was an Adjournment debate on the subject of motor cars for the disabled on 17th May, 1960, when the matter was raised by the right hon. Member for Caerphilly (Mr. Ness Edwards). The subject was also discussed 856 in greater detail in the course of a debate in June of the same year on a Motion moved by the same right hon. Gentleman.
My reason for wishing to return to this question tonight is that it seems to me that the position of the availability of motor cars for the disabled has changed since that time. I should like to illustrate the need for a change of policy in this matter by mentioning the case of two constituents of mine. They are a married couple. They are not war pensioners, but they have each been allotted a powered invalid tricycle, and they would much prefer to have, instead of those two tricycles, a two-seater car between them.
When I first wrote to my hon. Friend about this last July the husband alone had a tricycle. He wanted to change it for a two-seater car, which he was obviously not able to do at that time, on the ground that his wife was an invalid. She could hardly walk at all. She could not go about her shopping in the normal way and he wanted to be able to take her in the car with him.
However, since then, in August, the wife was allotted an invalid tricycle. I pointed this out to my hon. Friend the Parliamentary Secretary to the Ministry of Health and suggested that it would be much more convenient and, it seemed to me, much more sensible to provide them, if it were possible, with one car instead of two tricycles, because it seems rather absurd to me, as I think most people would agree, that when this husband and wife want to go out together they have to set out from their two separate garages on their two separate tricycles instead of going together in one two-seater car. I understand that the cost of the maintenance of the two tricycles is appreciably more than that of one car.
On 4th December, I asked a Question about this matter, which was answered by my hon. Friend, and other hon. Members besides myself asked a number of supplementary questions. On 11th December, I asked a further Question and two supplementary questions, and I received a Written Answer to yet another.
As a result of this series of Questions and Answers we got this information. We learned that the provision of cars 857 had been traditionally part of the preferential treatment for war pensioners. My hon. Friend said she thought there was still a general feeling that war pensioners should have a preferential treatment, but she also told us that it would be cheaper to supply one car than two tricycles. As a result of the second batch of Questions, we discovered that in 1960 and 1961, taken together, 23 additional married couples were provided with tricycles, but that in 17 of those cases one of the partners already had one. During the same period, 1,636 cars were provided for disabled war pensioners, and my hon. Friend said there was no difficulty about getting an adequate supply of those cars.
Then when I asked my hon. Friend if she could give any reason, other than the principle of giving preference to the war disabled, why the Minister should not allow married couples to have one car instead of two tricycles if they so desired., she replied that she had said the previous week that it was better in many circumstances for two disabled people to have two vehicles because they were then both independent. That well may be so, but what my hon. Friend ignored was the fact that I had asked her if they might have one car instead of two tricycles if they preferred it, and when I pointed this out all she said was that my right hon. Friend the Minister of Health was not prepared to make an exception.
Let me sum up the position. As a result of those Questions it would appear that even if all the married couples who have received tricycles during the past two years had ventured to suppose that they knew better than my hon. Friend what sort of vehicle was best suited to their requirements and they had been supplied with a car per couple instead of with two tricycles, it would have meant that only 23 more cars would have been needed in a period when 1,636 cars were supplied to the war disabled pensioners and there was no difficulty in getting enough cars.
If there had been a shortage of cars I would have been perfectly prepared to accept the principle that the war disabled should have preference, but I find it hard to believe that by preferential treatment my hon. Friend means that these cars should be withheld from those 858 disabled people who are not war pensioners, even if cars are available, in order that it may be said that war pensioners are being better treated than those who are otherwise disabled. I do not think my hon. Friend would really believe in that principle, and I am sure it is not one to which war pensioners themselves would subscribe.
My hon. Friend has admitted that the cost of two tricycles is more than that of one car. It would not be surprising in the least if I found she was resisting the request for two tricycles on the grounds that it was necessary to keep down Government expenditure, but here she is insisting on spending more when the people who want the vehicle are in fact asking her to spend less.
When I first wrote to my hon. Friend about this matter last July she referred me to a statement made on 4th April, 1960, by my right hon. and learned Friend the Member for Hertfordshire, East (Sir D. Walker-Smith), who was at that time Minister of Health, and it was to the effect that it had been decided to provide cars for those war pensioners disabled in the service of their country who were eligible for Government power-propelled tricycles; but that the only civilian war pensioners included were those who were disabled in the service of their country as members of the Civil Defence organisations, and who sustained injuries while on duty.
Tonight I want to ask whether my hon. Friend will reconsider the whole question of cars for the disabled, and, if she does not feel able to go as far as agreeing that it is possible to provide cars for all disabled persons who now qualify for invalid tricycles, whether she could not at least see whether that could be done in the case of married couples who both qualify for such a tricycle. It seems to me that that is something which could be done without legislation, otherwise I would not have ventured to suggest it in an Adjournment debate.
In the Adjournment debate on 17th May, 1960, my hon. Friend explained the possible legal difficulty as to whether a small car which could carry passengers came within the meaning of Section 3 (1, b) of the National Health Service Act, 1946. The relevant words are:…medical, nursing and other services required at or for the purposes of hospitals.859 The right hon. Member for Caerphilly in that debate asked, very reasonably, why it was possible to provide a three-wheeled vehicle under that form of words and it was not possible to provide one with four wheels.
It might be preferable for the sake of accuracy if I quoted my hon Friend's exact words in reply to that proposal. They were:The view taken by the legal department of my Ministry is roughly this. With some straining of the language of the Section, it can be held that a tricycle has a connection with hospital treatment and that its provision is a hospital purpose. It can be regarded as an appliance for a disabled man receiving hospital services, akin to artificial limbs or crutches.It seems to us, however, that there is a great distinction between an invalid tricycle and a car in the context of Part II of the National Health Service Act. The use of a car would, in substance, be a welfare service not limited to medical needs or the treatment of the patient himself. It would provide not merely transport for the patient but transport for his family and friends as well.My hon Friend said later:…it is not for the House to decide what a Statute means once it is enacted. That falls within the province of the courts. The question whether cars should or should not be provided for the disabled generally is, however, a matter for Parliament to discuss…"—[OFFICIAL REPORT, 17th May, 1960; Vol. 623, c. 1244.]I do not believe that my hon. Friend's argument would hold good in the case of a married couple both of whom had qualified for tricycles, because it seems to me that the car, if they were provided with it, would be an appliance just the same as a tricycle would be, but it would be an appliance provided for the use of two patients at the same time. It would be just as much an appliance as the two tricycles would be. Anyway, if the Minister saw fit, would there by any reason why, if he were able to grant this request, he should not restrict the use of the car to the couple themselves and provide it for them only on that understanding?
What then remains of my hon. Friend's case against granting my request? Nothing except perhaps that, irrespective of what the disabled couple may think would suit them, the lady in Saville Row knows best. That attitude would be so uncharacteristic of my hon. Friend that I look forward to hearing her reply that she has found it possible to do 860 something which in her heart of hearts I know she would like to do, and that is to accept my plea for disabled couples.
§ 11.25 p.m.
§ Mr. A. Bourne-Arton (Darlington)
I will not trespass more than a moment on the time of the House to add a postscript to the eloquent plea of my hon. Friend the Member for Manchester, Blackley (Mr. E. Johnson) about the husband and wife who are both entitled to tricycles.
My hon. Friend the Parliamentary Secretary may recall a constituency case of mine in which both the husband and the wife were disabled and each was entitled to a tricycle. Unhappily, one of them—the wife, I think—was incapacitated to such an extent that she was incapable of driving a tricycle. Instead of their having the two tricycles to which they were entitled, I begged my hon. Friend to see whether the regulations might be so stretched that they could have a two-seater vehicle.
On that occasion my hon. Friend felt obliged to be guided by the strict letter of the regulations rather than, as I have no doubt she would have wished, the warmth of her heart, but I hope that she and my right hon. Friend, when reconsidering this matter, as I hope they will in the light of this debate, will feel that it is not perhaps illogical that a husband and wife both of whom are entitled to a vehicle and only one of whom is capable of driving may be considered eligible for a two-seater car.
§ 11.26 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)
My hon. Friend the Member for Manchester, Blackley (Mr. E. Johnson) has anticipated a number of points which I must give him in reply. That means, of course, that we have covered much of this ground before. But I still think it necessary, in order to put into perspective his plea for special consideration for married couples who are both eligible for an invalid tricycle from my Ministry, to remind him and my hon. Friend the Member for Darlington (Mr. Bourne-Arton) that at present the Department has issued 12,667 tricycles to National Health Service patients in England and Wales. This comprises 861 10,302 petrol driven tricycles and 2,365 electrically driven. There are some people who qualify but have not the physical capacity to control a petrol driven vehicle, and to them we supply an electrically driven one. Also, the total number on issue increases at the rate of about 550 vehicles a year.
Power to provide these vehicles derives, as my hon. Friend reminded us, from Section 3 (1) (b) of the National Health Service Act, and—it is important that we should be quite clear on this point—that Section enables my right hon. Friend to providemedical, nursing and other services required at or for the purposes of hospitals.With that power, the vehicles are supplied under administrative rules laid down by my Department which define the categories of eligibility.
The categories are: First, and, therefore, most important, the double leg amputation with one amputation above the knee; second, patients suffering from paraplegia or other defect of the locomotor system equivalent to the total or almost total loss of the use of both legs so that the patient is to all intents and purposes unable to walk; third, patients similarly but slightly less severely disabled, still with very limited walking ability, who because of the disability need a machine to get to and from work—often referred to as the earning category.
It is true—again, I think that all hon. Members know this—that we provide tricycles and motor cars for war pensioners; but those are provided under powers contained in Article 23 of the Royal Warrant of 1949, and I must repeat that we have always maintained a traditional preference for war pensioners. It has always been felt that we should be as generous as possible to those people who have been disabled in the service of their country, and even today there has not been a change in that feeling of generosity and of preference towards war pensioners. However, I emphasise that in that respect we are enabled to do so under entirely different powers.
Over the years, we have steadily improved the tricycle which we provide for National Health Service patients. We are at all times looking for further improvements in this vehicle. We have 862 come a long way from the old hand-propelled tricycle with a motor attachment and only an apron as weather protection, which some hon. Members will remember seeing on the streets years ago. Our present vehicle has a modern saloon body and an improved and self-starting engine.
It is sometimes suggested that, failing our being able to provide cars for National Health Service patients, we should convert our present single-seater tricycle to a two-seater, but I remind hon. Members that the present tricycle was designed as a single seater. Indeed, the user is required to undertake not to carry passengers. It is true that space is allowed at the side of the vehicle—any hon. Member who has seen the modern tricycle will know that it is quite wide—but that space is provided to take a folding chair, which is often essential to the disabled person.
The tricycle might take him to the point where he wishes to disembark, but considerably disabled men often then have to transfer to a folding chair. The space at the side of the vehicle is provided to enable them to carry that folding chair. While it may be possible to adapt the existing tricycle to make it a two-seater, it would need extensive modification and it would be far from satisfactory because of the considerable developments, particularly the heavier engine, which would have to be included.
Moreover, if it were done and if it were used for the conveyance of ordinary passengers, as could happen if a two-seater were provided, it would no longer be an appliance and our present powers would not cover the provision of such an article. For the same reason, we could not provide cars for National Health Service patients. As my hon. Friend has raised this matter on the Adjournment once more, I have again sought legal advice in order to be as sure as I can on this ground. I am told that legislation would be needed if we wished to provide such vehicles under the National Health Service Acts.
My hon. Friend found an ingenious way of suggesting that we might do what he wants us to do by providing a car for a married couple when both are disabled, regarding it as an appliance made for two. But in fact it would still be 863 a motor car. It could be used for other purposes. No matter what might be laid down as part of the requirement for those who were to receive a car, I do not think that anything could possibly be enforced which could prevent the car from being used to all intents and purposes as an ordinary car. In those circumstances, it would not be an appliance. Indeed, the provision of a car goes further than what is needed to provide locomotion for individual disabled patients. I do not think that it should be regarded as a proper adjunct to a service primarily concerned with treatment.
My hon. Friend referred to possible cost. In this case, in the context of providing cars for National Health Service patients, in the debates to which he referred, I and other speakers gave an estimate of the cost. We said it would be about £2½ million, with additional maintenance, after spreading out the programme of replacement of the tricycles by cars—and we visualised a period of years for replacement—at about £1 million. But I think now—and the more I think about it the surer I am—that the cost would probably be very much greater and that the figures we have given probably represent a considerable under-estimate.
§ Mr. E. Johnson
Did not my hon. Friend tell me in an Answer to a Question that the cost of one car was less and that it would only apply to a very small number of cars for married couples?
§ Miss Pitt
That is true. I did so inform my hon. Friend. But he cannot look at this in isolation and think in terms only of the few people who would be covered if it were possible to accede to his request to do it where married couples qualify. We should have to visualise a very substantial development if that were possible. I want also, for one moment, to emphasise that there are still a number of people who prefer tricycles. Some National Health Service patients, for instance, are admitted to football matches if they are in their tricycles. They feel that they are independent. Even those war service pensioners who have cars are not always happy in having to have a nominated 864 driver, who may not always be available when wanted. Will my hon. Friends be surprised when I say that, under the extension of the car scheme for war pensioners, one in ten of those eligible have opted to keep tricycles because they prefer them?
I come now to the cases where husband and wife are eligible. There are, under the National Health Service, 79 married couples who have Ministry motor tricycles. I understand the sympathy that their plight commands. I understand that both my hon. Friends are pressing hard for these cases. But, as I have already indicated, we have no power to make an exception. I stress the point I made in my answer to my hon. Friend's Parliamentary Question on this subject. I think that Members thought then that I was being light hearted, but I am serious in saying that it is easy to overlook the importance of independent mobility in the case of married couples. Indeed, in some circumstances, having a car would deprive one partner of the mobility which is the whole purpose of the scheme. For instance, if the husband went to work, he would take the car and the wife would be housebound, if unable to drive him to and from work. In some cases the wife would not be able to retain the car.
I know of one case where the wife can drive an electrically propelled vehicle but I do not think she could drive a car. Few people with electric vehicles are able to drive a car safely. Although it might be thought that, if a car were available, married couples could easily arrange outings, it would actually mean some restriction of their movement and of their independence. In the case of the married couple in my hon. Friend's constituency, it is true that both now qualify for a tricycle. The wife is to be provided with one when storage facilities are available. Both in this case are at work, and I suppose that in theory, were a car provided, the husband could take his wife to work and then go himself to his job. Again I think that it would deny a certain amount of independence. In fact, in October the husband wrote confirming that they had been rehoused and that the wife was willing to accept an invalid tricycle. 865 Previously she had said that what they wanted was a grant to enable them to purchase a car.
Although it would be cheaper to provide one car than two tricycles, and although this problem is high-lighted by the examples that my hon. Friends can quote, I think that any exception would lead to demands for further concessions from other National Health Service patients. For example, if a car were granted, perhaps the less severely disabled of the pair might possibly have the virtually unrestricted use of the car and there might be more severely disabled individuals who would still have tricycles. There have been requests for other groups to be considered as exceptions, such as industrial injury cases, 866 Bevin boys or miners generally. Perhaps not least, we should consider those eligible for tricycles who are unable to drive. They have no means of transport at all. Therefore, I do not think we can supply the categories mentioned or make exceptions as suggested. The present service is generally recognised as a very good one, and I think that many—
§ The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at nineteen minutes to Twelve o'clock.