§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Howie.]
§ 4.15 a.m.
§ Mr. C. M. Woodhouse (Oxford)My somewhat ludicrous appearance with this sling round my arm this morning obliges me to begin by disclaiming a personal interest in the subject that I wish to raise. The subject is one of much more serious interest to much more deserving people.
I wish to raise the matter of the desirability of enlarging the categories of the disabled who should be entitled to be supplied by the National Health Service with a small car capable of carrying a passenger as well as the disabled driver in place of the single-seater invalid tricycle, whether petrol-driven or electrically-propelled, which is now the standard issue in most cases.
I would like to invite the comments on this subject of the new Minister, on whose appointment I should like to congratulate his Department as well as himself. I feel confident that he will give the same careful consideration to my representations as I used to do to representations when he was standing on this side of the House and I was sitting where he now sits.
I know that many hon. Members are interested in this subject, but I think it appropriate that I should raise it, both because the most suitable type of vehicle, which is the B.M.C. Mini Minor, specially adapted, is made in my constituency and also because a considerable number of disabled people who have written to me about this problem live in my constituency. That, in turn, is no doubt because of the superlative medical services which are available there.
I could, therefore, quote a great many examples to illustrate the need for a more generous policy in supplying small two-seater cars instead of single-seater tricycles, and all the cases that one might quote would be somewhat different because every disabled case is, in some way, unique. But all are alike in their need for adequate transport in order to lead a near normal life, so I shall confine myself to one example only, an example 714 already known to the Minister from correspondence, the case of Mr. Peter MacBryan, in my constituency.
I emphasise that I do not raise this matter as a party issue, or to initiate party auction in generosity. I made the same points as I make now to the hon. Gentleman's predecessor and had a negative answer, so I am well aware, having been a Minister at the time when I last broached the matter, that the issue is not one between political parties but rather between humanity and finance, or, put in more concrete terms, between the Ministry of Health and the Treasury.
My hope is that the new Minister may be more successful than was his predecessor in dealing with the Treasury. I will only add a slight expression of surprise that although the new Minister when, in opposition, wrote quite sympathetically and encouragingly in reply to my constituent, on the other hand, when he came into office, his reply to my last letter about Mr. MacBryan's case was very similar to that of his predecessor, though only, if anything, a little more abrupt.
The general case for supplying suitably adapted small cars for the disabled is very well set out in a pamphlet published last year and called "The Case for Supplying Suitably Adapted Small Cars to the Disabled," published by the Joint Committee on Mobility for the Disabled, and the grounds it brings forward are three. The first is social, that a disabled person should not be condemned to ride alone, especially if he or she is married. The second ground is mechanical. It is the unreliability of the standard tricycle and the difficulties of repairing it and maintaining it. The third is that of cost. Detailed figures are given in this pamphlet to show that the adapted Mini Minor costs less than £100 more than a tricycle, that it lasts longer and that it is hardly any dearer to run.
Those are the general grounds, to which I will only add evidence drawn from the specific case of Mr. MacBryan. He suffers from haemophilia. He suffered severe physical shock as a result of an air raid when a small child. Subsequently, he had to have both his legs amputated. Unfortunately for him, the 715 medical evidence was such that the amputations could not be directly attributed to the air raid, so he has no entitlement to a pension.
Mr. MacByran is fortunate, however, in being able to work for his living and, more fortunately still, has a wife who is well qualified to take care of him. But they never travel together, because he is entitled to only an invalid tricycle and when they go out together his wife must travel separately, by bus. Needless to say, they cannot afford a car of their own, so they cannot benefit from the provision by which the Health Service would pay for its adaptation.
The hardship involved in such a case needs no elaboration, but it is aggravated by other circumstances. Since a tricycle moves less evenly on the road than a four-wheel car, Mr. MacBryan is subject to jolts which could easily cause a haemorrhage. I have already mentioned that he suffers from haemophilia. Further, his tricycle is liable to breakdown and the servicing facilities in Oxford are inadequate. He informs me that he once had five breakdowns in four weeks just after his tricycle had been serviced. He also describes a grim experience when he was stranded alone on the road for four hours.
There is an even more serious example, though this was not told to me by Mr. MacBryan. Another disabled person in the Oxford area once had his tricycle catch fire while on the road. It was completely burned out. It may be argued that a car is no less liable to such an accident, but in a car a disabled driver would not be alone and without help, as this man was in his tricycle.
No one who has met and talked with these tragically disabled people can feel anything but admiration for the efforts that they make to overcome their handicaps and live a normal life. I could give many more examples, but the Minister is familiar with them and I am equally familiar with his predecessor's replies. For this reason I ask the new Minister to approach the matter with a fresh mind.
I would like the hon. Gentleman to answer some specific questions. First, I am told that it is still the practice in this matter to give preference to war 716 disabled men. That was no doubt right when facilities were in short supply, but is it still right, 20 years after the war? The unfairness of this discrimination was emphasised to me during the General Election by a man who is himself a war disabled ex-Service man. It seems to him, as it seems to me, that the time has come when we should adopt the criterion of need rather than that of the circumstances in which the disability originally occurred.
Secondly, is it really so that to extend the right to cars instead of tricycles to include cases like that of Mr. MacBryan would require legislation? A considerable extension was made by the previous Minister of Health last July, without legislation. What, then, are the present limits of the Minister's powers, and have the present statutory limits now been reached? In other words, are there no more cases which could be brought within the scope of the existing powers to provide cars without fresh legislation?
Thirdly, I have been told more than once that this is a matter of priorities and that the priorities are being reexamined. What progress, therefore, has been made in this process of re-examination, and how far down the scale of priority would cases like that of Mr. MacBryan come? Could the Minister, for instance, give some examples of cases having a higher priority than Mr. MacBryan's, although not yet qualified for an adapted two-seater motor car?
My fourth question, which arises from the matter of priorities, is the question of cost. Everyone would agree that, while there are undoubtedly many hard cases, it would be desirable, ideally, not simply to put them in an order of priority, but eventually to meet all of them, at any rate, wherever the eventual line might be drawn between those whom one would have to call the deserving and the undeserving, because I have no doubt that cases in any way comparable with Mr. MacBryan's would fall on the side of the deserving. If that were accepted, what would the cost of such extension be?
There is a corollary to that. Does the Minister accept or reject the calculations put forward in the pamphlet to which I have already referred and published by the Joint Committee on Mobility for the Disabled? The figures given in that 717 pamphlet suggest that, taking into account both the capital and the running costs over the lifetime of a vehicle, there is not a great deal of economy—I do not want to exaggerate this, and will not put it any more strongly than that—in preferring a tricycle to an adapted Mini Minor from the point of view of cost.
Those are the questions to which many disabled people, and their sympathisers throughout the country seek answers. I hope that the Minister's reply will not simply be that the facilities provided in this country for the transport of the disabled are already the best in the world. That I know to be true, but I regard it as no reason why they should not be better still.
§ 4.28 a.m.
§ Mr. Terence L. Higgins (Worthing)I have received a very large number of letters on this subject from people in my constituency and elsewhere, and I support my hon. Friend the Member for Oxford (Mr. Woodhouse) in everything that he has said and in the questions that he has asked. There is a lack of data on the subject, and it is very important for us to ascertain the exact comparative costs of providing invalid tricycles, including the costs of the special establishments needed to repair them, as against the small cars at present provided for the war disabled.
Could the Minister tell us what efforts are being made to develop a two-seater invalid tricycle in place of the present single-seater? One sees a large number of two-seater tricycles on the roads driven by non-invalids, and that raises the question of whether it is not possible to provide two-seater tricycles at precisely the same cost as the single-seaters. If that could be done, it would enable us to provide, at no extra cost, against the loneliness and other hardships that my hon. Friend has stressed.
§ 4.29 a.m.
§ The Minister of Health (Mr. Kenneth Robinson)I must thank the hon. Member for Oxford (Mr. Woodhouse) for taking the opportunity, even at this hour of the morning, of raising the subject of transport for the disabled. It commands great sympathy amongst hon. Members and throughout the country, and particularly in the hearts of those who, because of family circumstances or their jobs, are associated with the disabled and the 718 problems that face them in their daily activities.
The hon. Member for Oxford is one of those who feel very deeply on this subject. He has presented his argument with great sincerity, and with the commendable purpose of getting more done for these unfortunate persons whose cause he has championed. I should also like to thank him for the kind personal remarks he made about me in my appointment.
I will try to answer the specific questions that the hon. Gentleman put to me, and also the question of the hon. Member for Worthing (Mr. Higgins), who supported him. I do not want to take up a lot of the time of the House in detailing the criteria under which applications from disabled persons for powered cars are judged. They have been mentioned in the House on many previous occasions.
Briefly, there are three categories of eligibility. First, there are those with amputations of both legs, at least one of which is above the knee; secondly, those who suffer from paraplegia or some other defect of the locomotor system which has resulted in the total, or almost total, loss of the use of the legs so that they are to all intents and purposes unable to walk; thirdly, those who are less severely disabled, but who need a vehicle to get to and from their work because their walking ability is very limited. The war pensioner who is eligible in any of these categories may receive a small four-seater motor car.
There are nearly 4,000 pensioners in England and Wales who are driving cars provided by my Department. The correspondingly disabled National Health Service patient receives a single-seater invalid tricycle and there are at present over 14,000 of these machines in use. This is the main point at issue in the debate, the fact that one man gets a different type of vehicle from that provided for another who may well be his next-door neighbour, simply because the one was disabled while serving in the Armed Forces and the other was not.
The hon. Member asked why it was that nearly 20 years after the end of the war there should still be this distinction in favour of the war pensioner. He will agree, I know, that successive Governments since 1945 have held the view that those disabled in the service of their country have a special claim to 719 our sympathies and should enjoy a traditional preference in the social services of the country. I do not think that the House will dissent from this view. But if that view is accepted, it is difficult to argue that the mere passage of years should diminish the right of the disabled ex-Service man to special consideration when decisions are being taken, as we have to take them, about the resources that are available for those who need assistance. I accept that the hon. Member for Oxford was not suggesting that the privileges of war pensioners should be themselves diminished, but, rather, that those privileges, and, in particular, the opportunity to have a car instead of a tricycle, should be extended to others.
The hon. Gentleman asked to what extent legislation entered into this problem. Motor cars are provided for war pensioners under the very wide powers contained in the Royal Warrants, but the provision for Health Service patients derives from powers contained in Section 3(1,b) of the 1946 Act which enables me to provide
medical, nursing and other services required at or for the purposes of hospitals.The view taken by the legal department of the Ministry of Health is, briefly, this. With perhaps some straining of the wording of the Section, it can be held that a tricycle has a connection with hospital treatment and that its provision can be deemed a hospital purpose, that it can be regarded as an appliance for a disabled man receiving hospital services, akin to an artificial limb or a pair of crutches. But a car cannot be regarded in this light. It would be in substance a welfare service not limited to the medical needs or the treatment of the patient himself. It would provide, as the hon. Member clearly said, not merely transport for the patient, but for his family and friends as well. We have already gone a little way beyond the power available under the present legislation.Since last July cars are being provided for civilians injured as a result of enemy action in the last war and for those married couples where both partners are eligible for invalid tricycles and are prepared to surrender their tricycles. The supply of motor cars in those instances is outside out statutory powers and is possible only as a result of special 720 authority. I am sure that it would not be right to make any more general provision of motor cars under authority of this sort, and it would first be necessary to ask Parliament whether such a service should be provided.
The main question is how far the provision of cars for the disabled generally is a development which is desirable and what priority should be attached to it. I do not think that there is anything between us here. The development would be costly. I cannot disclose precise figures because, as hon. Members will appreciate, it is not the practice to disclose prices paid in Government contracts, but I can give some facts.
It is not the margin between the price of the tricycle and the price of the motor car which is the important factor here. There are at present over 14,000 tricycles in use in England and Wales. If it were a matter merely of replacing each one of these machines with a motor car, that perhaps might not be regarded as too high a price to pay in order to secure this improvement in the services which we provide. But we know that the cost would be very much greater than that. We have gone very carefully into this in the Ministry and we believe that the number of cars which we should require would not be 14,000 but very much nearer 50,000.
The difference is made up of those who for one reason or another use one of our tricycles and also those who are so seriously disabled that they themselves are unable to control a tricycle but could easily nominate someone to drive a car for them. On the basis of 50,000 cars we have calculated that the additional cost over the lifetime of the cars would be about £37 million. Before we can commit ourselves to a continuing expenditure of this order we must have regard to all the other claims on our resources.
The hon. Member for Oxford very honourably fulfilled his undertaking not to treat this as a party matter, but I am sure that he will think it fair if I remind him that the Government of which he was a member felt unable to do this even at a time when we were told that the economy had never been stronger.
In these matters we have to consider priorities. I hope that I do not have to apologise for using this word again. It 721 is not just the claims of other disabled people over those of Mr. MacBryan. I have the greatest sympathy with his case and I am very sorry if he felt that my letter to him since I became Minister was in any way abrupt. I assure him that I have every sympathy with his case. It is not only the claims of other people over his type of case, but the claims of other aspects of the Health Service. We have to consider the building and equipping of new hospitals and rebuilding and re-equipping existing hospitals which are out-of-date.
We have to consider the provision of more and better accommodation for the mentally sub-normal, and the abolition of the prescription charges so that we can once again provide a Health Service free to the patient at the time of need. These and many other developments are what we have to consider side by side with the provision of motor cars so that we may make the best use of what money is available for the Health Service.
I do not subscribe to all the criticism, much of which is, I think, unfounded, which is often levelled against the invalid tricycle. It is a vehicle specially designed for the disabled, and for that reason it is much more adaptable than an ordinary motor car. We believe that, 722 properly driven and maintained, the tricycle will give good and reliable service and it does fulfil a real need for many of the disabled. I do not think that Mr. MacBryan's experience is typical. Of course, there are difficulties, but, by and large, it is now a reliable vehicle.
Nevertheless, I can understand the desire to have a motor car instead of a tricycle. In this case, however, as in so many others, we must adjust our wishes and sympathies to our means. We are very much aware of the needs and wishes of the disabled, who are a special concern of the Health Service, but at present we cannot commit ourselves to any extension of the service provided for them.
When the provision of vehicles for those additional categories recently announced has been fully implemented, I shall be looking at the whole broad question of the provision of vehicles, but I must make clear that any review can take place only against the background of priorities generally, and I mean priorities both within and without the National Health Service.
§ Question put and agreed to.
§ Adjourned accordingly at nineteen minutes to Five o'clock a.m.