HC Deb 23 October 1967 vol 751 cc1390-402

5.15 p.m.

Mr. Jack Ashley (Stoke-on-Trent, South)

I am very glad to have the opportunity in this Adjournment debate to speak for a group of people whose constant companions are pain and poverty. They are a group who endure their suffering with silence, dignity and courage. They are a section of the community whose plight has been largely neglected by the nation, men and women who live within the confines of a bedroom, a hospital ward, or a wheelchair. They are the chronic sick and disabled.

Their dreadful ordeal can be ameliorated only by skilled medical attention and the devoted care of their families. The financial hardships which most of them have to face are the direct responsibility of this House. It is a sad fact that with a few honourable exceptions, like my hon. Friend the Member for Plymouth, Sutton (Dr. David Owen), the hon. Member for Plymouth, Devonport (Dame Joan Vickers) and my hon. Friend the Member for Holborn and St. Pancras, South (Mrs. Lena Jeger), this House has tended to neglect the needs of that group whose plight calls for urgent and compassionate action.

It is true that the Minister of Social Security promised to examine the needs of this group. On 27th June last year, the then Minister said: As part of our review of social security, we have under examination the needs of all chronically sick and disabled people regardless of their age, marital status, means, or position in insurance."—[OFFICIAL REPORT, 27th June, 1966; Vol. 730, c. 1213.] That was a year ago. My right hon. Friend the Member for Lanarkshire, North (Miss Herbison) had many achievements to her credit. She was a Minister who won deserved tributes for her compassionate concern with those in need. I urge her successor, who is no less compassionate and has already impressed the House with her determination and concern, to take early action in this House. I realise that none of these problems can be solved overnight, but the time is now long overdue when my right hon. Friend the present Minister should place before the House concrete proposals to help the disabled.

The statement to which I have referred gave recognition to the chronic sick and disabled as a special category and this in itself is a step forward. The widespread assumption that chronic sickness and severe disablement is a short term illness suddenly prolonged is fallacious and wholly invalid. There is proper provision for Service and industrial injured persons, as there should be, but not for the chronic sick and disabled, who are victims of neither war not industry. So we accept the pathetic pantomime that how, where and when a person becomes sick or disabled determines the amount that she or he receives from their country, often for the rest of their lives.

Thus we have such intolerable anomalies as people suffering multiple sclerosis or rheumatoid arthritis who are only receiving half as much as those who are disabled by industrial injuries. Their incapacity can be identical, their family responsibilities exactly the same. They can often endure the same kind of pain, but one receives only half as much as the other to meet his own and family needs.

That is quite wrong. Is it fair, is it right or civilised? Is it the kind of injustice that the nation will condone when it knows the facts? Is it the kind of anomaly that this House will tolerate? I believe not. I believe that despite the financial difficulties, which I do understand, we really must decide that the needs of all chronically sick and disabled should be provided for, irrespective of how they arose.

How big a problem is this? It is incredible that in the age of nuclear energy, space trips and computers we do now know how many chronically sick and disabled we have. I refuse to believe that the Government do not think it worth the trouble of finding out. Therefore, my first request to my right hon. Friend is that she should give the House a categorical assurance that a research project will be put in hand immediately to find out how many chronic sick and disabled we have. This could be the beginning of a systemised tabulation, so that at all times the Government know the size of the problem for which they have to make special provision.

It is important that when this research is undertaken it should not specifically exclude the chronic sick or disabled on grounds of sex. This is not a frivolous point, because, although women, at last, have a vote in this country, no married woman working for her husband, home and family is entitled to any State benefit whatsoever in respect of disabling illness. This is an obvious hangover from the pre-Suffragette era, and I have no doubt that my right hon. Friend will make every effort to emancipate her sex from this indefensible and objectionable anomaly.

As a woman and a compassionate Minister, I know that my right hon. Friend will readily understand my plea for a constant attendance allowance. To the chronic sick and disabled, self-sufficiency is, by definition, out of the question. They must have constant attendance which, even if it is carried out by affectionate relatives who give up their work, has an economic price. To insist that this price should be paid by the chronic sick and disabled or their families, for whatever reason, is a proposition which I do not expect to hear from a spokesman of this Government.

The main request which I wish to put to my right hon. Friend is that she should provide a basic income with special supplementary allowances to all disabled people in Britain, whatever the cause of disablement and irrespective of previous National Insurance contributions. The amount of this income should be related to the current retirement pension. The supplementary allowance should be based on the degree of disablement and the number of dependants. Such an income should be taxable, and obviously it would benefit most those with insufficient income to receive even the present small tax concessions. To qualify for this national disablement income, it should not be necessary for the qualifying person ever to have earned income. Certain people, such as the congenitally disabled, could receive the national disablement income from school-leaving age until they drew the retirement pension, although supplementary allowances would vary according to circumstances.

Sickness benefit, which was designed for short-term illness, is a quite unsuitable provision for something which is sometimes life-long, and the measures taken by the short-term invalid—such as postponing mortgage and hire purchase payments, arranging for an overdraft or a loan—are desperate and dangerous in the case of the chronic sick. He is unable to catch up with the debts which he has created. Only a national disablement income can meet the genuine needs of the chronic sick and the disabled. It is a humane measure which will at once benefit the individual and the community.

Every chronically sick and disabled person kept out of hospital or an institution by the payment of a national disablement income would save the community money. The financial gains could be clearly calculated. But the gains in terms of enriching the lives of those who already bear a heavy burden would be incalculable. To enable thousands of afflicted men and women to live in their own homes without poverty adding insult to their injuries would be a step of which this Government could be really proud.

5.25 p.m.

Mr. Jasper More (Ludlow)

I apologise to the hon. Member for Stoke-on-Trent, South (Mr. Ashley) for not being able to get back to the Chamber in time to hear completely his speech on this most important subject. However, I am glad that it has been raised, because it seems to me—and I am sure that the hon. Gentleman has put this point to the House—that we have here one of those pockets of poverty in our land for which remedial action is long overdue. I have had brought to my notice within the last six months two cases in my constituency which call aloud for a general revision of the law which would make it possible for the unfortunate people who find themselves in this sort of disability to lead what one might call a human existence.

It is not entirely a question of total poverty. One case in my constituency concerns a widow who is not without means. She lives in a small house. She has to look after her son who is still at school. To be able to live at all, she has to employ not one but two women to help in doing the elementary things in looking after the house. She would be more than willing, if she were allowed to do so, to contribute her own money to the limit of her income to enable the home to be kept for her son. But it is a question of means. With everything rising in price these days, she will probably have to go to hospital and someone else will have to look after her son.

That is the type of situation—and there is a large number of similar situations in the country—which calls aloud for speedy and remedial action. The House should be grateful to the hon. Member for Stoke-on-Trent, South for having taken the opportunity to raise this subject.

5.28 p.m.

The Joint Parliamentary Secretary to the Ministry of Social Security (Mr. Norman Pentland)

I apologise to my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) for my short absence from the Chamber, which was unavoidable, during his speech. It is unusual for an Adjournment debate to come on so early.

I listened very carefully to the major portion of my hon. Friend's speech and to what the hon. Member for Ludlow (Mr. More) said. I realise how deeply my hon. Friend feels about the plight of the disabled and the chronic sick. I know that he has vigorously projected his views on more than one occasion on this human problem both inside and outside the Chamber. I listened to him with understanding, because before I was elected to Parliament I worked in an industry which has had, over a long time, more than its share of industrially disabled. After living in my constituency in the County of Durham for the whole of my life, I have abundant personal evidence of the problems which face the severely disabled and the chronic sick. I can, therefore, assure my hon. Friend that I fully appreciate his concern about them.

My hon. Friend would be the first to recognise that provision for the disabled is not something which can be discussed coyly in terms of cash benefits. Improvement and extension of the services and facilities available to the disabled is, as my hon. Friend will recognise, at least of equal importance in enabling the disabled to live as full and happy a life as possible in the community.

My hon. Friend referred, I understand, to the need for a research project to be undertaken. I should like to draw his attention to a reply which was given at Question Time this afternoon by my right hon. Friend the Minister of Health. My right hon. Friend was replying to a Question by the hon. Member for Moray and Nairn (Mr. G. Campbell), who asked the Minister of Health whether he has yet decided upon an inquiry into the numbers of permanently disabled persons, following studies by Bedford College, London, with a view to compiling a register of such persons in England and Wales. My right hon. Friend replied: Yes, Sir. The Government Social Survey will undertake next year a study of adults living at home who are substantially and permanently handicapped by limitations in their movements. The survey will show the extent to which they receive and need help from local authority services and will assist in the development of those services. My right hon. Friend the Minister of Social Security is also keenly interested in this field, and I shall be discussing with her how far the survey can yield information of particular value to her. My hon. Friend can, therefore, be assured that my right hon. Friend will be having consultation with the Minister of Health to obtain the information that is vitally necessary in the problem that we are discussing this afternoon. I might add that the Minister of Health will also discuss with my right hon Friend, the Secretary of State for Scotland, the possibility of extending the survey to Scotland.

The main point made by my hon. Friend was to seek the establishment of a national income for all chronically sick and disabled people. Perhaps I should state the provisions which are at present made under Acts of Parliament. The basic provision for all chronically sick and severely disabled people is sickness benefit, with retirement pensions for the elderly. The basic rate of sickness benefit is being increased as from the end of this month to £4 10s. for a single person and £7 6s. for a married couple.

A man who falls sick or becomes incapable of work through disablement, once he is established in the employment field to the extent of having paid 156 contributions for weeks of work, can draw sickness benefit indefinitely until either he is able to return to work or, on reaching retirement age, his sickness benefit becomes a retirement pension, guaranteed to him by the contributions with which he has been credited during his years of sickness benefit.

Where the resources of a disabled person who is incapable of work fall short of his requirements, supplementary benefit is available and is payable as of right. To the basic rates of supplementary benefit, which at the end of the month will become £4 6s. for a single person, and £7 1s. for a married couple, there are added an allowance for rent, which may be the full cost, and rates, and a long-term addition of 9s. for supplementary pensioners and for those who have been drawing a supplementary allowance or National Assistance for two years or more. There may be further additions to meet substantial extra expenditure resulting from disablement.

Neither sickness nor supplementary benefit can be paid under the present system to a disabled housewife in her own right. In times of sickness, as when she is well, the housewife normally relies on her husband's earnings. If he falls sick, his sickness benefit is increased for her. If he also needs supplementary benefit, her requirements are taken into account in assessing the payment to which he is entitled.

I now come to a comparison with the industrially injured and war pensioners. The special risks of service in industry and the conditions to which people are compulsorily exposed in the national interest during a war have been held to justify special provision for these special categories. Whatever argument there may be about the appropriate provision for other disabled people, the Government believe that there would be very strong opposition to any suggestion that preference for the industrially and war disabled was wrong. Indeed, this preference is common to all countries which have social security schemes.

I might also add that the financial comparison is not as extreme as is sometimes alleged. For example, a chronically sick man with a wife and two children will not be expected to live on the basic £9 8s. which he will have from the end of this month by way of sickness benefit. The assessment of his requirements for supplementary benefit purposes will be £10 17s., to which rent and rates will be added, an addition of probably at least £1 10s. a week. There may be, as well, further additions for special expenses.

Only a minority of the war and industrially disabled are 100 per cent. disabled and qualify for full pension and allowances. Five thousand people are currently receiving industrial injuries disablement pensions at the 100 per cent. rate. Of these, less than 2,000 are getting constant attendance allowance. Only a few hundred get the allowance at the maximum rate, which, as the Industrial Injuries Act makes clear, is intended only for exceptionally severe disablement.

There is a fundamental difference between what can and should be done by way of special and limited schemes for special categories and what can and should be done for disabled people in the population at large. Nevertheless, it may be that in course of time features of the special schemes will prove suitable for adoption to a wider field. This possibility is certainly being kept in mind.

As my hon. Friend knows, Ministers involved in this problem have made it clear on a number of occasions since we took office that there are many priority tasks yet to be undertaken by the Government. I assure my hon. Friend that provision for the chronically sick and disabled is one of our priorities. He will, I know, readily recognise that it is not possible to solve all the problems in this direction at one time, but I assure him once again that the Government will tackle each problem as speedily as possible.

5.40 p.m.

Mr. W. R. Rees-Davies (Isle of Thanet)

There is a distinct advantage in having put dangerous drugs behind us early; the only difficulty it has put us in is that this debate came on somewhat sooner than we had all anticipated. I apologise to the hon. Member for Stoke-on Trent, South (Mr. Ashley), who has brought up this most important subject, that, as was so with others, I was elsewhere when he began to do so and came into the Chamber only as he was concluding what he had to say. Thanks to one of our Liberal colleagues who has now left the Chamber I obtained a rapid report of what the hon. Member for Stoke-on-Trent, South had said, and knowing, I thought, what it was likely he was going to say, I found that that accorded with what I found he had in fact said—if I may become rather cryptic in the matter.

I want first of all to agree with the Minister in this, that I do not think it harms his case but I think it of import- ance to recognise that most of those who are the war disabled and most of those who are the industrially disabled regard themselves as being a special category.

In so far as I have any interest to declare, I am a member of the executive of the British Limbless Ex-Servicemen's Association. I am not their usual spokesman in the House; I think it is better, perhaps, to have somebody who is not a war disabled person. However, I must say, not speaking for myself, that those who are war disabled, the generality of them in the country, feel that, coming as they do under the Royal Warrant, they ought, by virtue of the injuries which they suffered in time of war, be treated as a special case, and I pay tribute to successive Governments for having done so.

It has been a long and very often an uphill fight to get the right allowances. It is, of course, true that those few of the war disabled men who are in the 100 per cent. category get a variety of allowances which are of the very greatest value and enable them to lead a reasonable life. That is the least we can do for those who are war disabled. Of course, the overwhelming majority are not. They are 50 per cent., 60 per cent., 70 per cent. disabled, and very few of them require any constant attention or other allowances—certainly till they become aged.

I remember being closely involved some years ago now in the battle with the then Tory Government to get the allowance specifically increased for those who were over 65 who would feel the greater burden of being limbless. One notices those injuries more as one gets older and they cause more trouble than they did before. That is undoubtedly true. Because of the evidence which some of us gave, we were able in this country to set a precedent which existed nowhere else in the world and to give a special additional allowance to the disabled aged 65 and over. The industrially disabled, too, many of them—for example, those in the trade the Minister was referring to, the miners—very often suffer from special diseases contracted by the very nature of their work. Those people feel that society owes them a greater debt because they may suffer from pneumoconiosis or may have suffered in the old days from some chest disease brought on by the very nature of the work which they did.

I do not think that we ought to erode the principle either in the case of the war disabled or in the case of those industrially disabled. But that does not mean that when we consider those who suffer from polio or who suffer—shall we say? —from legs which are completely useless from one of a number of incurable diseases, we should not recognise that there are those classes of people who through no fault of their own are unable to work in the way a normal person can do. They are, of course, in a chronic position; that is to say, they are in the same position physically as many of those who are industrially disabled or war disabled. I certinly would have no objection.

I feel sure that the limbless ex-Servicemen for whom I think I can speak—although I am not speaking officially for them I think I know a good many of them sufficiently well to say that I can reasonably speak for them—would not feel it wrong if those who are chronically sick and disabled from other causes were entitled to receive some regular form of emolument or attendance allowance along rather similar lines to that which they receive. I think that that must be investigated. I think there is a case for saying that they should perhaps not receive as much as those who suffer either from war or special disablement, who should get a rather higher benefit, or a more easy benefit; but that is not to say that the others ought to be deprived.

What is the position? I happen to have in my constituency, in the Isle of Thanet, probably more aged people and also a good many more sick people than are to be found in the great majority of other constituencies. I have a very large number of those who are resident in various hospitals and homes, varying from the famous Royal Sea Bathing Hospital to other hospitals and institutions both geriatric and otherwise. Some of them suffer from diseases which render their limbs useless for any effective work. Indeed, the so-called figures of unemployment hide the fact that a number of people are wholly unemployed because of their chronic sickness. They have come to Thanet because of the healthy, good air at Broadstairs and Margate—better than anywhere else.

Hitherto the Ministry of Social Security has sent particularly able men to handle matters in Thanet, because there are so many cases there. We get some of the very best of the civil servants. This is well known. They assess these cases. Fortunately, they do it very well, but, of course, it is a particular assessment in each case. There is no entitlement or right to any of those people who are chronically sick to get 2½d. next week by virtue of it; they can get only the allowance of the day.

I imagine that what the hon. Member for Stoke-on-Trent, South was trying to get was some form of—I would not say exactly, a pension—a right to a continuing payment arising out of a person's illness if it is chronic. That is the issue, is it not? I think that on the whole this is right. Once it has been established that a person is chronically sick, instead of having a system where he claims £4 6s. a week plus an addition for the family if need be and an amount for rates which they have helped to pay, so that we arrive at a figure which is purely, if I may say so, an old benefit figure—that is to say, based upon the fact that a person is incapable, which is rather like a dole—I think we ought to be working towards the day when those who are chronically sick should receive a benefit based upon a straight right, plus an additional amount to take into account constant attendance which they need and the need for certain necessities which have to be administered to them.

This problem has another facet to it. It is the problem that so many of these people are in homes. They are either in homes of the Greater London Council or of the Kent County Council, or they are in private homes which are, of course, subsidised by the county and by the ratepayers. Most of those who are chronically sick are in homes of this kind and we do not see what the problem is because what is paid for is their board and lodgings; and they are permitted in effect to keep 16s. 6d. pocket money a week.

It seems to me that on the whole if people ought to go into a home, for which the public are going to pay through the Kent County Council, or other county councils in other parts of the country, we should deal with them as though they are drawing pension, but which should be paid to the home, and they should draw pocket money. Therefore, I find no great fault in that system.

Where they do not go into homes of that kind which are subsidised, I should prefer to see them receive a basic rate plus a services amount to take into account their particular needs, which are obviously much greater than those of other persons. It may be that such a person needs someone to dress him. It may be essential that he has someone to accompany him when he goes out. It may be that he can drive a car but needs an allowance towards the cost of petrol. I should much prefer it if such matters could be settled through the Ministry of Social Security which would decide on the amount of payment for 12 months, subject to review, without its becoming a positive entitlement to a pension. It might be better if it could be fixed in that way and we tried to bring the chronic sick into line with the war disabled and industrially disabled.

Mr. More

In the case of disabled or chronic sick people now living in their own homes and faced with the alternative of going into a publicly supported institution, not only would it be better from their point of view but it would save the taxpayers' money if they were given sufficient provision to enable them to remain in their homes rather than throw themselves upon public assistance.

Mr. Rees-Davies

My hon. Friend has hit upon an admirable point. He has hit the nail on the head, for two reasons. By giving such people the knowledge that they will receive this additional money over a period of twelve months, greater public money will be saved. At the moment, they feel that they have to go into homes to receive their full entitlement. However, there is another reason, and it is a human one. Psychologically, I should much prefer that those who can get about on their own should get about on their own and work on their own account to the extent that they can for the sake of their own mental health and happiness, rather than go into a home where it may be that they will tend to give up. For both those psychological and financial reasons, it is far better for this to be regarded as an entitlement and one which should have long-term considerations.

When I came into the Chamber earlier, it contained the hon. Member for Stoke-on-Trent, South, my hon. Friend the Member for Ludlow (Mr. More) and a lately arrived Minister. I see now a number of "eager beavers" sitting on the benches opposite who obviously have been hatching up a tremendous plot. They are ready for a big rage, and I can see them whispering among themselves. Indeed, I can almost hear them saying that the only time that they have been delighted to hear me speaking was today, since it has given them time to think of what they want to say. However, it is a good way to end an old Session to know that, for once, one's colleagues on the Government benches are delighted that one should make a speech.

I feel that there are serious pockets of poor, including the chronic sick and the disabled, for whom the Government have done little or nothing over the past three years. By today's standards, they were given very good treatment up to that time. We look to the Government now to ensure that they catch up fairly fast and to see that the small pockets of chronic sick and disabled are looked after properly in the future along lines of approach which encourage them to remain in their own homes in the knowledge that, once they know that they are chronically sick and disabled, they will be given the opportunity to make such contribution as they can in their homes with the assistance that they need.