DISABLED AND CHRONIC SICK

HC Deb 15 March 1968 vol 760 cc1905-73

11.4 a.m.

Mr. Gordon Campbell (Moray and Nairn)

I beg to move, That this House urges the Government to give high priority to the task of identifying in the community those who suffer from severe disabilities or lasting illness and are in need of special help owing to their inability, or much reduced ability, to earn a living and owing to their dependence on the care of others or on prolonged treatment. Only a short time ago we were discussing matters of quite a different nature. I am glad that I was fortunate in the Ballot for today and able to raise the quite different subject of the disabled and the chronically sick, and I am grateful to hon. Members, who have had such a short time of rest since the last sitting of the House, for having come here to take part in this debate.

The Motion I have moved is wide enough for discussion of all categories of severely disabled persons and chronic sick. But I intend to concentrate on groups which have been left out of our social security system. It is twenty years since the National Insurance system was introduced and since the National Health Scheme started, and, clearly, anomalies have now emerged. A month ago, my hon. Friend the Member for Worthing (Mr. Higgins) raised the case of one group which has been left out of the social security scheme. That case comprised what are called the non-pensioners, persons who were too old for the National Insurance system when it started and are still alive but too old to draw pensions from it.

I wish to refer today to other groups in a similar situation. Earlier, my hon. Friend the Member for Manchester, Moss Side (Mr. Frank Taylor) spent a Friday drawing attention to the position of certain categories of public service pensions. I regard today's debate as a further chapter in the series.

Like other hon. Members on both sides of the House, I am concerned with all the groups of permanently or very seriously disabled, including the war disabled and the industrially disabled. Here I must declare an interest in that I am 50 per cent. war disabled myself, though it is not very noticeable unless I happen to be wearing my national dress.

I want myself to call attention to particular groups, as well as the war pensioners and the industrially disabled, namely the permanently disabled. They are people who have been disabled from birth or from early youth and have never been able to work. Because they have never been employed or self-employed, they have never entered the National Insurance system, and the first point arising from that is that they are not, therefore, in any list. There are no records which show where they are and how many there are. Those who are in the National Insurance system are registered somewhere in Britain, but the people with whom I am concerned today are not identifiable, and their numbers are not known.

Another category of persons about whom insufficient is known and who are outside the system is that of housewives who are not in employment and who are struck down with a crippling disablement or afflicted with an immobilising or permanent illness. The crisis which this situation can cause in a family may be very serious where the wife has young children to look after and her husband is faced with the possibility of having to give up his job, which in most cases is the bread winning part of the family income and in many others the total source of it.

I have been pressing the Government for action to enable a register to be compiled of the permanently disabled and others who are outside the National Insurance system. There are no records, and those who are not in the system are, on the whole, those who are most in need. I am glad to say that a start has been made in this direction as a result of Questions and debates in which I have taken part. In reply to a Question of mine on 23rd October, the Minister of Health stated that the Government had decided that the Government Social Survey would undertake in 1968 a study of this problem and that the Minister of Social Security would also be concerned. In reply to another Question on 9th November, the Secretary of State for Scotland announced that Scotland would also be covered by the study.

This study by the Government Social Survey has been started, it was stated in reply to my Questions, to follow on the review undertaken under the auspices of Bedford College in London. I am glad to see that the Parliamentary Secretary to the Ministry of Health is with us this morning, because I would like to ask him whether the study has yet started. It was due to begin this year. I hope that he can tell us the present situation. In addition, can he inform us whether it is the Government's intention that this will lead to a register being compiled in consultation with the Minister of Social Security? As I have said, a system has grown up after twenty years in which there are now anomalies and where benefits are applied in a haphazard fashion.

It will not be easy to remedy the situation. Before attempting to do so, we must discuss the size of the problem and have a register of the disabled and the chronic sick. In addition, we need a definition and identification of the chronic sick, and that may be even more difficult than identifying the permanently disabled.

The position of those who are not insured under the national system is that, in general, they are eligible for supplementary benefits under the Ministry of Social Security's scheme. But these are misnamed because, if they supplement anything, it is only some private income which a disabled person may have, or support from family and friends. The fact that what used to be called National Assistance has been renamed Supplementary Benefit underlines the problem in this case where it does not supplement anything else because there is no pension.

It is also subject to a test of means, which is a difficult one to make in the case of the disabled, many of whom may be helpless and dependent upon the assistance, care and attendance of other persons. It may be that members of their families have to look after them and support them. That means that those supporting them lose earning power because they have to devote so much of the day to looking after them. Alternatively, it may be that they have to pay others to come in and attend to them and look after them. Therefore, a means test can be misleading if it does not take into account the dislocation and expense which severe disability can cause. I hope that the Government Social Survey's Study will produce information about such cir cumstances and about the special problems arising in these cases.

Here, it is important that one should recognise that the disabled would be given opportunities to help themselves. I have been discussing their difficult circumstances and the possibilities of financial assistance, but I do not suggest that they should simply be receiving sums of money, with nothing more done. It is astonishing what can be achieved by persons who are almost totally disabled, and the triumphs of will and application which one has observed make one realise that giving the disabled opportunities to do as much as they can helps them to get through life. But they cannot do this unless they have the basic feeling that they are not being overlooked or forgotten by the rest of the community, or being left to manage for themselves in virtually impossible conditions.

The approach of the rest of the community must be twofold: first, to give them the fundamental feeling that they have security and are not being forgotten or left out of the present social security system; secondly, that at the same time they are being given opportunities, within the limits of their mobility, to participate in ordinary life.

A great deal more can be done to help in various ways—for instance, in buildings and other arrangements. I will give a few examples. First, the design of buildings. If buildings which disabled persons need to visit are constructed with their requirements in mind, it can make an enormous difference. Secondly, parking arrangements. Special car parks and easily observable signs are important, particularly when disabled persons have to be helped or accompanied and someone also has to drive and deal with the car. Thirdly, travel by train. Many disabled persons find it extremely difficult to travel by train. I mention trains, but there are no doubt other forms of travel where they meet with difficulties. These are just a few matters where a great deal more could be done imaginately to help them.

I turn now to the chronic sick. This to me is a group of persons whose enduring illness so incapacitates them as to make them unfit to work and earn a proper living. If they fall into that category, they can be in the same situation as the permanently or very seriously disabled, especially if they have never been able to work, because again they have never entered the national insurance system. Even though they are not completely or seriously immobilised, they may none the less be the equivalent of 100 per cent. disabled because they are incapable of working and earning a living.

I understand that the Government are at this moment engaged in the task of trying to identify the chronic sick, as they are called. This name begs a lot of questions, but it is the one most easily understood and familiar in this context. I know that the Government are trying to identify this group for the purpose of prescription charges. I am sure that we should all like to hear from the Minister today how far the Government have proceeded in this task. I believe that the task on which the Government are at the moment engaged of trying to identify the chronic sick for the purpose of prescription charges may be rather different from the problem that I am raising. Presumably the group which the Government are seeking to identify consists of those who are in need of continual supplies of drugs and medicines. That group may well find prescription charges exceedingly expensive because they cannot do without continual supplies of drugs and medicines, but they may not be disabled inasmuch as they may be able to do a full day's work. There are two kinds of chronic sick in this respect, but, because the Government are engaged in this task at the moment, I should like to know how far they have gone and whether the Minister can say a little more about the problems of identifying them.

The mere fact that the Government have decided that prescription charges should no longer be "free" raises the point that it has been a mistake to talk about the National Health Service being "free". It is a fallacy to say that it is free, because it is paid for mainly out of taxation: about seven-eighths from taxation and one-eighth from the contribution in the stamp. It should never have been called "free", because that is so misleading. I prefer the term "tax-borne" Health Service. If it is inefficient or wasteful or abused, the public are paying more than they need or should pay for the service. The public are paying for it anyway. It merely means that they are paying for it out of high taxation rather than direct.

Rationalisation is required here. We want the highest standards in our Health Service, but we also want the best use of the taxpayer's money. The two, of course, are consistent. Where rationalisation is concerned, I favour the proposal of my Party for merging the Ministry of Health and the Ministry of Social Security. This would help the operation of steering more assistance to those who really need it and also the problem of identification of the groups about which I have been speaking.

I am glad to see the right hon. Gentleman the Member for Llanelly (Mr. James Griffiths), because he was very much concerned. He was, perhaps, the architect of the original National Insurance scheme. I recognise the difficulties of carrying out the sort of rationalisation which I have advocated and at the same time preserving the insurance rights which have been and are being earned by contributions under the National Insurance system. If people have been subscribing to certain rights they are entitled to and must keep them. At the same time, we need to make these changes and rationalisations to ensure that those in need receive benefits, particularly where the taxpayer's money, rather than the contribution, is concerned.

This ironing out of anomalies is a major task, as I see it, which lies ahead of any Government occupying the Treasury Bench. The priority must be for carrying out the survey and concentrating on help for the disabled and the chronic sick.

They can be helped in many cases in their own homes rather than in institutions or hospitals. It may be far less expensive for a disabled person to receive a direct grant and the help required in his or her home. It may well be preferable to him going to a hospital or institution which can be far more expensive for the taxpayer and makes demands for scarce nursing staff and others who are required for looking after other illness. This is something that we must explore, because the disabled want to be independent. If they can be helped to be independent this can also help the social security system and the Health Service by relieving them of this extra work and expense.

There is a confusing variety of services and offices with which the disabled and chronic sick are in contact. Besides the Ministry of Health which deals with appliances, amongst other things, and the Minstry of Social Security, there is also the Ministry of Labour and the Scottish Office. There is also the Ministry of Housing and Local Government because I now come to a point which has been of much concern to the disabled. That is the fact that the rate rebate scheme which came in two years ago, has created an unfortunate precedent in that the disability incomes of ratepayers is not taken into account in the examination of means.

So far as I know, this is the first time in any scheme of this kind that disability pensions have not been taken into account and disregarded. Other hon. Members and I have pressed the Minister of Housing and Local Government and the Secretary of State for Scotland, who are the housing and rating Ministers responsible for this legislation, about this. In the last Session of Parliament there was a Motion on the Order Paper with about 300 names to it. I therefore ask the Government to re-examine this because they have, unfortunately, created a precedent which could have bad effects if it were followed by other Ministers in other legislation.

My Motion is one which the Government should be able to accept. It calls on them to give high priority to something with which I am sure both sides of the House agree and about which the country as a whole is much concerned. It is certainly what they should be doing and I trust that by pressing ahead with the programme which I have described we will get nearer to improving the lot of these unfortunate members of our community as soon as possible.

11.31 a.m.

Mr. Harold Finch (Bedwellty)

I congratulate the hon. Member for Moray and Nairn (Mr. G. Campbell) not only on being fortunate in the Ballot but on selecting this important subject of the chronic sick and disabled for consideration today. I do not think there is a worthier objective than helping this section of the community, many of whom are unable adequately to help themselves. I think I am voicing the feelings of both sides of the House when I say that we are indebted to the hon. Gentleman for choosing this subject for debate, and I am sure that my hon. Friend the Parliamentary Secretary will pay close attention to the points which he has raised.

Having had considerable experience of the problems of the industrially disabled and the chronic sick, it appears to me that the most urgent problem which needs to be dealt with is that of the low cash benefits which are payable to them. If there is no security and if there is poverty among the disabled and the chronic sick, it has a serious effect on their home life. Every effort should be made to rectify the situation as quickly as possible.

I represent a mining constituency, an area in which there is a high proportion of men suffering from industrial injuries and diseases. These men receive disablement benefit, and they can receive the constant attendance allowance under the Industrial Injuries Act if they are seriously disabled. This allowance, which was put into the Act by my right hon. Friend the Member for Llanelly (Mr. James Griffiths), is an important factor in assisting these people, and, incidentally, war pensioners too.

Men who are disabled as by pneumoconiosis or serious accidents are often almost helpless. They need continuous attention. A wife or daughter must be in constant attendance on them. It was recognised that some extra payment should be made in these cases, and this was provided for in the Industrial Injuries Act. In many cases the allowance amounts to £3 a week. If the person is bedridden—mercifully, there are not many of these cases—the allowance can go up to £6 a week.

When we consider those who have sustained accidents not arising out of their employment we realise that they are in a different position. There are many men in the South Wales coalfields who are certified as suffering from pneumoconiosis, and if there is severe disablement they can receive the constant attendance allowance, but alongside them there are men who are certified as suffering from bronchitis, emphysema and so on, but because the disablement has not arisen out of their employment they do not come within the provisions of the Industrial Injuries Act.

These men are entitled to sickness benefit of £4 10s., plus £2 16s. for their wives, making a total of £7 6s., possibly with some supplementation. But what about someone who is seriously injured? He gets £7 12s. if he has suffered a 100 per cent. disablement. He can get sickness benefit, and £2 16s. for his wife, making £14 18s. a week. To this there can be added about £3, making nearly £18 in all. I am not saying that these figures are too high for those who are bed-ridden and need constant attention, but it is as well to compare their position with those who are sick.

We know that constant attendance is essential. A devoted wife has to spend most of her life looking after her husband in these cases. She has to forgo many of the pleasures and relaxations of life. The sickness benefit in this case is £4 10s., with £2 16s. for the wife, and some rent allowance. Whatever may be the merits or demerits of giving basic pensions for all disabled people, I say that these people should be given a constant attendance allowance.

We all know of the daughter who has to stay at home to look after her father. She is unable to go to work. We know, too, of the case in which the wife is seriously incapacitated and the daughter remains at home to take care of the household and so cannot take up employment. I maintain that there is poverty and hardship in these cases.

The hon. Gentleman said that these people were the forgotten section of the community. Years ago we in the trade union movement tried to improve the Industrial Injuries Act, but these people remained outside its provisions. The time has come to remodel the National Insurance Scheme. Great progress was made when the Act was introduced, but we have now arrived at the stage when it is necessary to remodel the Scheme. I am glad that the Government are going into this problem. We hope that it will not be long before we have a new National Insurance Scheme which will take into consideration the factors mentioned by the hon. Gentleman.

The hon. Member said that more help could be given in the home if a constant attendance allowance were payable because then many of the men and women would not have to go into hospital. If more security were available at home, the hospitals would be relieved of having to deal with some of these cases. I am glad to see that in some hospitals in Monmouthshire the waiting list of chronic sick has been reduced. But delay and hardship still exist. Children and others have to stay at home and take care of their infirm or disabled fathers or mothers or whoever it may be.

There is also the problem of the partially disabled. Under the Industrial Injuries Act a special hardship allowance can be paid for loss of earnings. A man who has been earning £15 or £20 a week may find his income reduced to £10 or £12 a week. He should be entitled to special hardship allowance. Consideration is given to the loss of earning capacity, but if a person suffers from bronchitis our legislation does not take into account any loss of earnings.

A man may be receiving a low wage because he can take on only a sitting-down job, being in such a serious state. He may be able to do only a little work. His loss of earnings may be considerable, and in many such cases there is poverty. Consideration should be given to a remodelling of the National Insurance Act. I am glad to see that my hon. Friend the Parliamentary Secretary to the Ministry of Social Security is here. I know that he will take note of what is being said about the partially disabled.

If we can provide a form of constant attendance allowance for this section of the community we shall go a long way towards providing a greater measure of security for these people, who richly deserve it. If a disability carries with it such physical incapacity as to necessitate daily care by another person, a supplement to the appropriate disability pension should be payable, depending on the degree of incapacity.

If the Ministry will bear those facts in mind and come forward with a Measure in the near future designed to improve the position of this section of the community, the House will receive the reward it richly deserves for helping this section of the community, whose members are often living in circumstances of poverty and distress but are outside schemes designed to help war pensioners and disabled.

I support the hon. Member and hope that the Motion will receive the unanimous support of the House.

11.43 a.m.

Mr. W. F. Deedes (Ashford)

I know that hon. Members on both sides will agree that we are under a debt to my hon. Friend the Member for Moray and Nairn (Mr. G. Campbell) for both his choice of subject and the way in which he has presented it. Many people outside the House will also be in my hon. Friend's debt. Just how many may be involved in the terms of the Motion is one of the more serious issues raised by the debate. I want to dwell for a moment on what can fairly be described as our prevailing state of ignorance, which is greater in respect of this problem than in respect of most other social issues.

It is difficult to identify the numerous categories falling within the terms of my hon. Friend's Motion. It deals with what might be called the Cinderella of the social services. I have heard it said that by 1970 one-sixth of our population will be physically disabled through disease, accident or the onset of old age—that is, a proportion of about 15 per cent. More exactly within the terms of the Motion, the approximate number that we are talking about this morning is 1½ million—that is, about 3 per cent.

If we break this down we find a formidable list. We know that there are about 650,000 on the Ministry of Labour disabled persons register; there are about 330,000 on local authority registers of handicapped persons; there are 160,000 sub-normal and mentally ill at home; there are at least 200,000 chronic sick in hospital. To those we must add 76,000 handicapped children in hospital, 144,000 incapacitated people at home and, finally, 660,000 people who are receiving industrial injuries benefit or war pensions.

All those categories come within the terms of the Motion. How many more groups there may be who are not in touch with these services is difficult to guess. There are public service pensioners. We might also fairly add a figure of 300,000 alcoholics. This is a deprived group, one which, incidentally, far outnumbers the small fraction involved in narcotics addiction. This makes a frightening total.

My hon. Friend concluded by saying that this was a subject about which the country is much concerned. He will agree that the country's concern would be infinitely greater if it knew the extent of the problem and the numbers involved. One of the tragedies is that we never manage to present this problem as a single social issue to the more fortunate sections of the population.

The Minister will later be able to tell us how far the social survey which is being undertaken in respect of one aspect of this problem has been able to proceed with its work and how soon we may expect to know more about this group which is substantially handicapped because of limitations in movement. I know a little about the pressures which are bearing on the Government's social survey, and I can only hope that the pressures from other sources will not unnecessarily delay the other work that has been put in hand.

But even this work will cover only a fraction of the problem, and it is not unfair to suggest that our national statistics are slapdash and that one of the first things we must do is to find a more sensible way of collating and presenting them. In a number of fields this leads to an attitude of intensive but inefficient benevolence. We have not, for example, caught up with the big transition which is going on from institutions to community care. This goes far outside the subject of mental health, in respect of which a great deal has already been done in this way. I am sure that the Minister will agree that there are other categories of handicapped and chronic sick and other people who suffer disability in respect of which there is a movement away from institutions and towards community care. Unfortunately, many services have not caught up with this important social change.

Around all this, moreover, we seem to have built a labyrinthine system of sickness benefit and pensions sufficiently complex to ensure—at least in my experience—that a sadly large minority of people are depriving themselves, if not of their full entitlement, then at least of the services which they might otherwise receive. In terms of administration we are dealing with a much more complex field than most people can comprehend—a more complex field than is absolutely necessary.

I do not want to dwell so much on finance or incomes or the opportunities referred to by my hon. Friend which should be given to the disabled. I want to say something about the services, and, in particular, the local authority services. We all look forward with close interest to the forthcoming report from the independent Committee under the distinguished chairmanship of Mr. Frederick Seebohm, which has for some time been studying the local authority personal social services and the structure of family services.

My main purpose in intervening is to express the hope that we shall make the report, when it is received, something of a landmark and be ready for it. I cannot help thinking that when we receive this report on local authority services we shall be in for something of a shock. I know nothing of the contents of the report, but what I know of the subject leads me to think that the Committee can hardly report otherwise. No hon. Member with experience and a dispassionate view of some of the local authority services could expect otherwise. These services are widely disparate and unequal in different areas; and, alas—this is no reflection on some county councils—they are frequently wasteful of human resources.

There is not one of us who is not constantly made aware in the course of our constituency work that there is no field of social welfare in which it is harder to find the right answer—not just quickly, but the right answer at all—to cases which arise than that of in the words of the Motion, those in need of special help owing to their inability". This is the most difficult field of all, and all of us constantly encounters problems to which we cannot find an answer.

A good deal is to be found wrong and needs to be put right in the field governed by local authorities. I want to anticipate the Seebohm report to the extent of say ing that I think there is much more wrong with our organisation in central Government. I can pose now the central question which the Seebohm report will raise. If the local authority services covering this field are to be co-ordinated and unified, where is central responsibility to rest? We shall not be able to continue much longer with handicapped and deprived children, a large branch of this subject, within the principal care of the Home Office, though this is an interest shared by the Ministry of Health; with pensions and related benefits under the roof of the Ministry of Social Security; with sickness, mental health and a growing range of problems in that sphere under the roof of the Ministry of Health; with employment and a great deal to do with that and disability under the roof of the Ministry of Labour; and, finally, with fringe interests under the Ministry of Housing and Local Government, which is rightly concerned with appropriate dwellings for appropriate people. All these Departments can and will show good reason to defend their share of responsibility for the handicapped or the deprived.

Every one of these Departments in a sense is doing its job. Yet one of our main handicaps is the problem of pinning down central responsibility for the group of people we are talking about. We worship the doctrine of ministerial responsibility, but in so many of the cases which arise it is almost impossible to identify where responsibility lies. I do not want to touch more than briefly on one sphere in which some of us have lately experienced difficulty—a tiny fraction of chronic sick, those involved in drug dependence, where—as the Parliamentary Secretary to the Ministry of Health will concede—there has for too long been a dichotomy between the Home Office and the Ministry of Health.

As the sociologists keep reiterating, there is a need for public education here. There is also need for something else. Much of what my hon. Friend spoke about lies not only in the hands of specialised services but in the kind of community care and voluntary work to which any society should be proud to contribute. The crying need is to sort out the community services which are working here, iron out some of the anomalies and try to establish sensible relations between, first, the Government services; between, secondly, local authority services; and between, lastly, the vast and almost unidentifiable fabric of voluntary social services. I do not think that this will be done without a major shift at the top. As long as the central administration is so ill-coordinated, so long shall we suffer from numberless anomalies.

It is not altogether a matter of money. It is also a matter of method. One failure of our present method is manifest when we have to admit this morning that we just do not know how many people we are talking about. I hope that we shall not merely wait for the Seebohm report and then spend a year or more discussing it with local authorities and eventually finish up with some patched-up compromise solution. We ought to start thinking now about how this enormous corner of our society is to be given an administration which will produce better results with the resources we have. I very much hope that this debate will be a starting point in that quest.

11.57 a.m.

Mr. James Griffiths (Llanelly)

I join in the tributes which have been paid to the hon. Member for Moray and Nairn (Mr. G. Campbell). I hope that I have correctly pronounced his constituency, because I am anxious to reciprocate his behaviour, because he pronounced "Llanelly" with a delightful accent. The hon. Gentleman has raised a question of great importance. The core of the problem, as the right hon. Member for Ashford (Mr. Deedes) said, is in our modern society that of identifying those who are in need.

There are two trends in our society which make this difficult. First, the whole trend in the movement of population is away from villages and small communities to large towns and conurbations where people live in an anonymous society. They scarcely know who lives next door. It is possible for people to live in a road or street, to be disabled and to suffer poverty without their neighbours knowing anything about them. This is one of the very important changes which is taking place in our society as we move to the modern urbanised society.

For the last quarter of a century we have been discussing the question of how we can make the best use of our land and resources and not allow the population to become tremendously over-concentrated, which causes many economic and social problems, including that of identification. For many centuries there was one sure method of identification in communities—the church or the chapel. The vicar or minister knew his flock and their circumstances and was able to bring their needs to the attention of whatever authorities existed. In this secular society this built-in advantage is disappearing rapidly.

I am speaking not about the religious aspect but about the very important social aspect. We have not yet found any kind of organisation to fill that very great need. Very few people belong to a church or chapel these days and those who do not are therefore outside the scope of the pastoral work, to which I pay tribute and to which the country owes so much.

I had something to do with the introduction of the National Insurance Scheme, and the National Assistance Scheme as it was then called. We were making a very big change. We were all agreed that the Poor Law had to go, but the question was how to replace it. The responsibilities for cash payment to those who needed assistance were entrusted to the National Assistance Board, now the Supplementary Commissioners, and the welfare services were transferred to the local authorities. I was conscious that there might be anomalies and problems as a result of the changeover because under the old system the cash payment and, very often, the welfare service were the responsibility of the old board of guardians that had an officer called the relieving officer who, at his best, was a very fine public servant. He was one of the people who could find out what was happening to people everywhere. We have not yet been completely able to replace him, particularly in the identification which he was able to make.

I agree that we must find ways and means, perhaps by compiling a register, of identifying people in need for whatever reason. The surveys taking place now may help us in this. One of the values of a Friday is that we can discuss such matters. I hope that my right hon. Friends in the Government will give consideration to what changes may be necessary at the top in Ministerial and Departmental responsibility.

All our services have grown up over the generations and centuries, and responsibility for them has become divided between various Departments. The separation of the children's services between the Home Office and other Departments is a mistake, and something must be done about it. I hope that all the ideas put forward will be considered. It has been suggested that there may be a case for the amalgamation of the Ministry of Social Security and the Ministry of Health. I hope that we shall also link up the local authorities with the administration of the National Health Service and hospital service. Something is lost at present; democracy at the grass roots tends to wither. I hope that that problem will be considered in the review of this whole question.

When introduced the National Insurance Act, one of the things provided for was local advisory committees. I was very anxious to bring into a committee local people representing employers and workers and the community generally, including all engaged on voluntary work, who are very important. Those committees still serve. I hope that my hon. Friend will consider the establishment of local advisory committees which can bring together the experience of the local officers of all Government Departments and all the other people dealing with these matters.

First, there is the Ministry of Social Security. Then there is the welfare committee of the local authorities responsible for so many of the services. There is the Ministry of Labour, and there are the voluntary organisations. There is a very strong case for creating local committees to bring them together, particularly if we are to have a register of those who are disabled, sick or living in poverty because they cannot earn their livelihood. I want to bring local opinion and experience into these matters. We must provide means of identifying those in need, and a combination of a register and local machinery of that kind would be of very great advantage.

When I considered the machinery to implement the National Insurance Act I found that I had to establish 1,000 local Ministry of National Insurance offices. They are now Ministry of Social Security offices. That was done between 1945 and 1946, when the legislation was being considered by the House, and 1948, the date we fixed for its operation. That was a very unfortunate time. I believe that there is the strongest possible case for having under one roof in one office, all the local offices of Government departments connected with people who are unemployed, sick, disabled, or pensioners. That is what I should have liked to have, and I hope that we shall have it. I have visited some of the countries in Europe and know that some of the Governments on the continent do this. I wish that we could have done the same, with a worthy building where everybody in trouble seeking help for whatever reason does not have to ask, "Where do I go? Which office is concerned with what I want?" He could go to one office in which there are all the services. I should also like to see local services linked with this.

In Wales we are now considering the review of the structure of local government, and England is following, as it sometimes does when we give a lead. This provides an opportunity to provide offices such as I have described, for I see that already in London, with the amalgamation of authorities, some municipal buildings are becoming available, including some towns halls. I believe that they are not being sold. The establishment of such offices would be a contribution towards solving the problem of identification. It is a major problem. How many of us know how many old people are living alone? Can any Government Department give me an answer? Can anybody anywhere give an answer? Take any borough anywhere, such as the Borough of Westminster here in London. Is there anyone who knows how many single aged people, old gentlemen and old ladies, are living alone without contact with anybody, without relatives? That is another problem of the anonymous society—the problem of loneliness. It is one of the most tragic problems, the problem of growing old without relatives and perhaps friendless, outside the care of everybody.

Therefore I hope that both nationally at Departmental level and particularly at local level we shall find ways of registering such people, if that is the right way to tackle the problem, by canvassing. There is no reason why that should not be done. It is the responsibility of local authorities to see that everybody goes on the electoral roll. Why cannot we make it a responsibility of a ventral body in each locality and a central Ministry to see that people are not only registered to go on the electoral roll but to find out exactly what their circumstances are? I know that this is a delicate matter, and it must be approached with great tact because they do not like people coming to their house. On the other hand, if some of the suggestions which have been made can be looked at in the review which is now taking place of all the services, the hon. Gentleman will have rendered a service in raising this subject today.

In the course of his speech, he referred to young men and women who are physically or mentally disabled, and sometimes both, from birth or from childhood, who are not and never will be able to work, and, therefore, fall outside our social insurance scheme. In my lifetime, I have given a great deal of thought to this problem. When the late Aneurin Bevan was Minister of Health, he collaborated with me in producing the National Insurance Act, and one provision in it tried to meet such cases. It provided that young men or women age 16 and over who were disabled in this way and unable to earn a livelihood should be entitled to a grant from the National Assistance Board, appropriate to age, whatever the family income. In other words, such a person was treated as having an inherent right to secure a weekly payment from the Assistance Board, whatever the family income. I may say that I am as proud of that as I am of anything.

However, what I find all the time is that this is not known, and that brings me to the second problem in our society, which is that of getting across to people the services and the payments available to them. I hope that further steps will be taken to make these matters more widely known, because people still fall outside our schemes because they or their parents know nothing about them.

I want to support the proposals put forward by my hon. Friend the Member for Bedwellty (Mr. Finch). In the review of the National Insurance Scheme, I hope that, when consideration is being given to sickness benefit, two other benefits will be extended to the permanently disabled and the chronic sick which are already available to those entitled to pensions under Royal Warrant or to benefits under the Industrial Injuries Act in certain circumstances. I refer, of course, to unemployability allowance and to constant attendance allowance.

I often shy at the word "selectivity" because it is so often used as a method of denying people benefits. However, this is the kind of selectivity that I can support. I like it when it gives people added benefits. The two benefits to which I have referred would not cost much. Indeed, perhaps my hon. Friend could tell us how much it would cost to provide the long-term sick and disabled with an unemployability supplement if their sickness or disability means that they will not be able to work again, or, if they are at home and need constant attention and care, to pay them this constant attendance allowance. I do not see why it should not be done without waiting for the general review, which may take a long time to consider and implement.

I feel that, all too often, the chronic sick are those who are most neglected in our social services. They do not form organisations or pressure groups. They do not lobby the House of Commons. It may be that, for that reason, their voices are not heard. However, I hope that out of this debate on this quiet Friday there will come a realisation of the urgent need to deal with the problem of the long-term sick and disabled. We have all seen the burden carried by the wives who care for their permanently disabled husbands or children at home. One of the best services that we have developed is that of home helps I hope that that service can be developed still further. It should be made possible for a wife looking after a sick husband at home who has to be cared for day and night all through the year to be given at least one night off each week so as to enable her to get away from the strain.

I agree with the hon. Member for Moray and Nairn that many disabled people are still capable of some work. In that connection I want to pay tribute to the great efforts made by Remploy, and I would like to see the system extended. There are still large numbers of people capable of work who cannot find employment on the open market. They are anxious to make a contribution, and the best service that we could render to them would be to find them opportunities to make that contribution. Remploy is doing it, and many local authorities are providing similar opportunities.

The hon. Gentleman has raised a matter of very great importance. The greatness of a country is judged by how it cares for its young and old, for its disabled and unfortunates. We can claim as a country that our effort is not a bad one but it is one which we can still improve. It can be improved in ways which the hon. Gentleman has outlined to us, and I thoroughly support him in what he has said.

12.18 p. m.

Mr. David Price (Eastleigh)

I am sure that the high tenor of the speeches so far shows the debt which the House owes to my hon. Friend the Member for Moray and Nairn (Mr. G. Campbell) for raising this subject. After some of the events of last night, when we see in the papers that there is concern about gold and the general position of the economy, it is particularly appropriate that we should take time to recognise the position of a considerable section of our community.

I should like to reinforce the point made by my right hon. Friend the Member for Ashford (Mr. Deedes), when he said that we should expect an increase in the numbers of chronic sick and disabled in our community over the years, and I want to suggest some of the reasons why that will be so.

The first is the natural rise in the population. The second is better surgery, better drugs and better nursing. Let us pay tribute to what has been done by the medical profession and the pharmaceutical industry. Many people are alive today as chronically sick who owe their continued survival to drugs.

Thirdly, I believe that the increase to be seen in the Ministry of Health figures for mental disorders suggests that the number of people deemed chronically sick due to this cause is likely to rise. At least, we should be prepared for it. With the advances in psychiatry and par ticularly the pharmacological therapy of mental disorders there is hope, on the other hand, that many mental disorders which we are unable to deal with at the moment will be treated successfully in a few years' time. It is a balance of the two, but certainly we should prepare for an increase. We need not this morning go into long analyses of why it is so—the stress and strains of modern life, and so on—but we should recognise that this is a growing problem.

Then there are the disabilities of old age, to which the right hon. Member for Llanelly (Mr. James Griffiths) has referred very movingly this morning, as he always does on such occasions. We must recognise, however, that as we improve our medicines and general geriatric care in the hospitals we shall get more people at the top age end of the population who will come into this category of disabled or chronic sick.

My own special interest and experience of the disabled and chronic sick relates to paraplegics. Like all hon. Members I have had in the course of my duties examples of most of the categories we are now discussing, but if I harp rather more on paraplegics than on other categories within the terms of the Motion it is simply because it is paraplegics of whom I have most experience.

In paraplegics we have a very good example of the problem that the Motion raises—that of identifying the total number. I have asked Parliamentary Questions, and have always been told that the Ministry does not have the full figures. It knows how many have been through its hospitals to a certain date, but not the total number, the breakdown of the number, the degree of disability caused by their paraplegia and the cause of the paraplegia. In order to get improved treatment and care we must be able to identify the source of the disability and chronic sickness.

As the House knows, I am rather an enthusiast for statistical analysis. I suggest to the Ministers present that the proper use of the computer enables us to handle large quantities of figures in a meaningful way. One therefore hopes that those Departments represented on the Government Front Bench this morning, all of which use computers in their normal administration, will use them also for forward-thinking and model-building as to how the services should work.

In the identification of the disabled and chronic sick, it is interesting to note that the blind are identified by the source of the disability. With the Forces pensioner or the Industrial Injuries pensioner identification is made by the occupation in which the person became disabled or chronically sick. I should like to see right through the community of the sick and disabled identification done in both ways—by occupation and the nature of of the disability or sickness.

A number of categories are not recognised in the whole provision of our services, particularly in the cash benefits. Here, I agree very much with what the hon. Member for Bedwellty (Mr. Finch) said. First, there are those who have become disabled or have contracted chronic sickness outside their employment. It is very difficult to explain to a man why if he falls off a derrick used in the construction of a power station he gets full Industrial Injury benefit, but if outside that works he falls and sustains a similar injury he gets only sickness benefit—or supplementary benefit, if necessary. I shall not go into the figures now because I appreciate that all hon. Members present know them far better than I do, but, as a broad generalisation, I would say that the difference is a factor of two.

The second category comprises housewives with injuries or disease contracted outside gainful employment. It is not very easy for me, for reasons that are obvious, to speak about this category, but let me give one example. At Stoke Mandeville I met a woman, the wife of a small farmer, who is now a spinal paraplegic in a wheelchair. I suggest that her injury is as serious to her family as if her husband had the injury; we all know the key rôle played by any wife but particularly the wife of a small farmer. Here, I may say that I support very strongly the campaign being run by the Disablement Income Group. I believe it to be absolutely right.

Then there are the adults who have been disabled since childhood, the disabled children and the pensioners whose ability to look after themselves is diminished by industry or disease. As the hon. Member for Bedwellty pointed out, the impact of disability falls on the whole economic life of the family. It is true to say that a disabled member of the family means a disabled family, because the disablement reduces or eliminates the earning power of the disabled person and can reduce or eliminate the earning power of other members of a family. Particularly, it can cause extra expense: in fact, I know of no case where it does not cause extra expense. But I add at once that a disabled family can be just as happy and purposeful as any other family. One of the things that are so important for the disabled or the chronic sick is to make them feel that they are, as they are, normal members of the community.

I suggest that the reference point for looking at any improvement in cash benefits, services or the provision of after care is the cost of hospitalisation because at the end of the day if disabled or chronically sick people cannot cope or get worse they end up in hospital. I have made some inquiries in the Library, and as far as I can discover the average national cost of a person in an orthopaedic hospital is £38 a week. I gather that that figures does not cover the capital cost of the facilities, but if I am wrong I hope that I may be corrected.

Let us take £38 a week as our reference point. We could do an awful lot with that amount. Let us cut it in half and say £19. There is an awful lot we could do with that. Our aim should be to get as many as possible of our disabled and chronic sick out of hospital and back into the community. The reasons are worth repeating. First, it is better for the disabled person. Second, and in the shadow of the economic crisis, it is cheaper for the community. Third, as the right hon. Member for Llanelly pointed out, many disabled or chronically sick people can contribute to the economy—but they can also contribute to society.

Fourth, I beg the House to agree that we should do everything we can to avoid the creation of ghetto communities of disabled and chronic sick, circumstances in which the remainder of society feel "We are doing right by them because we put them there in their little ghetto, their little community." We want these people as integral parts of the community. A blind man or a disabled child is every bit a normal member of the community as any of us here present.

What needs to be done is, first, to define the problem, but to define it in numerate terms, not sweeping generalisations, and, second, to adopt a total programme aimed at getting as many of the disabled and chronically sick out of hospital and into their families. We must also recognise, however, that a number of them do not have families to go to, and we want to see some sort of community to which they can go without its being an institution or a ghetto—a home and a base from which they can operate in the community because they lack families.

Thirdly, there is accessibility. To anyone in a wheelchair this is a particular problem. I pay tribute to what the right hon. Member for Leeds, West (Mr. C. Pannell) did when he was Minister of Public Building and Works by sending circulars to local authorities, but I do not think the response from local authorities has been very good. I wonder how many people realise that when a person lives permanently in a wheelchair he is living in a two-dimensional and not a three-dimensional world. A kerbstone is a real obstacle to get over. You, Mr. Speaker, will know that in the City of Southampton a great effort has been made over the years to ramp some of the kerbstones in the main shopping streets. This is not very difficult for a local authority to do. The same applies in the building of council houses and council flats. If it is done on the drawing board, it does not cost a penny more of ratepayers' money to build the houses or flats so that those with wheelchairs can live in them, but if it is not done then and the building is done in the traditional way, to convert it costs a great deal of money.

We also have to develop further the employment opportunities for the disabled and the chronic sick. I agree entirely with all that has been said about that. There is the matter of disabled incomes. This has been well canvassed by the Disablement Income Group. There is nothing I need add other than to say that when we relate back to the £38-a-week hospitalisation we might take a rather fresher look at the claims of disabled income groups.

I do not know how many hon. Members realise that many local authorities are extremely helpful to disabled drivers by giving them parking privileges. Those privileges do not extend across the boundaries of other local authorities. It is a question of each local authority doing right by its own disabled people. But we are a small country and in London there is a large number of boroughs. One has to go only a few hundred yards down a street to cross a boundary and find that there the privileges cease to apply. It would be a simple thing for the Government to give paraplegics a laissez-passer for parking. I would limit this to anyone who has received a disabled person's car or a grant towards the conversion of a car. I leave that thought with the Minister.

There is also the availability of therapeutic physiotherapy and remedial treatment. One of the difficulties experienced is that although we have a number of physiotherapy departments in hospitals it is often difficult for a patient attending such a department to park his vehicle. If we want to make paraplegics more independent we should make it possible for them to drive to a hospital, to get into a wheelchair and go into the hospital and to come back again. If there is nowhere for them to leave their cars the whole point of the exercise is lost.

There is the question of equipment. I should like to believe that I could take a year off with a good engineer in order to design better baths for the disabled. Then there is the question of recreation and leisure. Here I pay tribute to the work of Sir Ludwig Guttman and the paraplegic centre at Stoke Mandeville. I hope that his work for spinal paraplegics can be extended. Then there is the availability of information to the chronic sick and disabled. This is scattered around. It is obtainable by way of something from the Ministry of Health, something from the Ministry of Social Security and something from this or that society or local authority. It should be brought together in one place. I agree with the right hon. Member for Llanelly about local offices, but I want this to be supported by simple literature made available in handbooks for disabled.

I agree with my right hon. Friend the Member for Ashford and the right hon. Member for Llanelly that we need a change in the total approach to the disabled and chronic sick. To use a bit of contemporary management jargon, we need a total concept of techniques which would cut across the traditional demarcations between Departments and between central and local government. If we can change from the demarked management principles of the Pharisee to the total concept of the Samaritan we shall do right by the disabled and chronic sick in our community.

12.35 p.m.

Mr. A. H. Macdonald (Chislehurst)

It is a pleasure to follow the hon. Member for Eastleigh (Mr. David Price), because I wish to endorse what he said at the beginning of his speech. We are all conscious of the financial problems which were laid before the House in the small hours of this morning, but I hope there is nothing improper nor incongruous in considering now the topic introduced by the hon. Member for Moray and Nairn (Mr. G. Campbell).

The financial problems of which we heard this morning are a kind of artifact, but the fact that a proportion of our fellow citizens are disabled is unfortunately a continuing phenomenon of our human condition. Therefore, I do not feel that we are turning to anything less significant in devoting ourselves to this topic now. I join with other hon. Members on both sides of the House in congratulating the hon. Member for Moray and Nairn on his success in the Ballot and on choosing this topic for debate. I express admiration not only to him but to all who have spoken in this debate after a long and exhausting night. I have heard speeches this morning which seemed rather remarkably lucid, cogent and to the point. They made me feel rather embarrassed, because none of those hon. Members showed that he was exhausted even though he might have felt it. I confess that I feel exhausted, but I hope that I do not show it.

Something that was said by the hon. Member for Moray and Nairn I agree with entirely, and I hope that this does not cause dismay to my hon. Friends. He referred to National Insurance and regretted that this is sometimes thought of as a free facility. I agree with the hon. Member's thinking. These things are not free, indeed, nothing is free except, perhaps, air and sunshine. It is well that we should be realistic and should remember that these things have to be paid for. I am not sure that I would draw the same conclusions as I believe the hon. Member would, but he was certainly right in saying that we should face this fact.

I am sure that the hon. Member for Eastleigh was right to mention ghettoes. I have sometimes been anxious that, in our zeal to provide more official facilities for the disabled, there is a real danger of being more callous and indifferent to their problems instead of more thoughtful, because we are "stashing" them away, perhaps in the belief that we are doing all that we should. I am all for material and financial provision, but that alone is not the solution.

A few months ago, a constituent of mine who is severely disabled contacted me, wanting to know whether he could get assistance to have his telephone adapted, since he found it difficult to manipulate. I was not clear what facilities there were, and despite that television programme a few weeks ago, which suggested that Members of Parliament are expected to know everything, I must confess that I do not.

I therefore wrote to ask the Minister of Health for advice. I received a courteous and helpful letter from my hon. Friend the Parliamentary Secretary, who said that there was no need for additional legislation and that my constituent was already catered for under Section 29 of the National Assistance Act, 1948. I therefore told my constituent what to do and where to go. He followed it up and I am glad to say that he now has the provision which he sought. I am grateful for the advice which I received. Although I now know what facilities there are for people with this difficulty, I did not know then, so I cannot blame any constituents who do not know the extent of these facilities.

We should, therefore, give some thought to publicity, but of a particular kind. I am not thinking so much of publicity giving information to the disabled—although I include that—but more about publicity to the general public on the lines of Help the Disabled Week. My local authority recently advertised the facilities available to the disabled and there was some response, which is gratifying. There is certainly some need for advertising in that respect.

I have a communication here from the Information Service for the Disabled, which lion. Members probably know, in which it says that, out of the inquiries which they receive from disabled people …15 per cent. were unaware that any facilities were available to them from their local Welfare Department…. This shows the need for publicity, but there is a danger of swamping the present facilities. I want to speak carefully here, since I do not want to embark on an argument which will involve my local authority or any other in extra expenditure, not only because we must all be conscious of the need for economy but also, more particularly, because if I want it to spend more the place to say so is there and not here.

I was thinking particularly of publicity to make the public more aware of the extent of the problem. To quote from a communication from Help the Disabled Week in my local authority: …a national survey showed that, generally speaking, the disabled are lonely and an advance in the attitudes of the general public to their less fortunate neighbours is badly needed. This is the kind of publicity which is needed.

There are three voluntary clubs for the disabled in my constituency and when I visited them, all three made the same point, that, although they know of more disabled people whom they could accommodate, they cannot do what they would like to because of the difficulty of arranging transport for the disabled between their homes and the clubs. The local authorities in my constituency have purpose-built vans to this end, but there is a need, which is only to some extent being filled, for voluntary assistance. It is a little disappointing that the number of people who come forward voluntarily for what is, after all, no more than one afternoon a fortnight is relatively small. There must be many more who, if they knew the need, would be willing to give assistance on a rota by transporting these disabled people.

Publicity to the general public and the encouragement of voluntary assistance might persuade them to accept that this problem is with us and that we would ultimately be justified in spending more on it. The services provided by local welfare authorities are patchy and not uniform. The relief and assistance which a disabled person can get depends to some extent on the area in which he lives and it might be better or worse if he moved. Therefore, an appeal for voluntary assistance seems not only good in itself but a means of filling the gap until there is more social acceptance of the need to devote more public resources to this problem.

A lady in my constituency in a senior position in the Red Cross is responsible for running one of the voluntary disabled clubs to which I referred. Knowing that this debate was to take place, she wrote to me. I shall quote a passage from her letter because it is a quotation coming, so to speak, from the grass roots—I intend no disrespect to the lady—from someone who is actually dealing with this problem. She says: Tremendous strides have been taken recently in the official approach, but I feel that not enough people know of the help available. There is need for more publicity to make the public aware of the needs. Not enough is known about the service from local councils. She refers, in particular, to the facilities and help which may be given by local authorities for adaptations in the home to make it more convenient for a disabled person.

This brings me to another point in regard to adaptations. The financial side is not dealt with satisfactorily. I refer now to the case of another lady in one of the voluntary clubs—I hope that I am not setting these two ladies against one another; I shall be in trouble next time I see them if I have—who applied for assistance from the local authority for adaptations in her home. In this case, the husband is disabled. This lady took a part-time job, later converted it to a full-time job, and then worked overtime in order to make up the family finances which her husband, the former breadwinner, had brought in. Having done this, however, she was dismayed to find that she had lifted herself above the financial limits set by the local authority, the result being that she received not the grant which she had hoped to receive, and which she would have had if her circumstances had remained the same as when she made application, but a loan which she would have to repay.

Her effort in going out to work to replace the earnings which her husband had brought in became, to some extent, a penalty against her. Therefore, is not my right hon. Friend the Member for Llanelly (Mr. James Griffiths) right when he says that, when we provide funds in this way, they should be grants not necessarily linked to the financial resources of the rest of the family?

The whole financial structure of our welfare facilities ought to be seriously reconsidered. When a deputation from the Multiple Sclerosis Society came to see me some time ago, they instanced a case which made a profound impression on me. A man had contracted multiple sclerosis in a rather unusual way, the disease having been triggered off by his falling from a horse. I suppose that the shock of falling released the disease, which must have been latent within him. Because he was riding a horses in the course of his work—he was a farm worker—he qualified for quite substantial benefit. But if he had been riding that horse for pleasure, though his disability would have been the same, the financial contribution which he would have received would have been signficantly different.

I cannot believe that this is just. I beg the Government to think seriously about the whole financial basis of our welfare facilities, to make sure that in no respect are here such penalties or discriminations. The proper principle should be that any facilities and any financial assistance should be related to the disability and not to any extraneous or fortuitous circumstances

12.55 p.m.

Mr. John Astor (Newbury)

In following the hon. Member for Chislehurst (Mr. Macdonald), who spoke so eloquently, I add my congratulations and thanks to my hon. Friend the Member for Moray and Nairn (Mr. G. Campbell) for giving the House an opportunity to discuss this subject today. It is a little unfortunate that the protracted proceedings of yesterday's sitting have prevented many hon. Members from attending who would otherwise like to be here, and I hope that the Minister will not be misled into underestimating the amount of genuine concern which is felt by hon. Members on both sides about the problems of the disabled.

For me, the timing of the debate is apt. Only two days ago, one of my constituents, Mrs. Page, had the honour of being presented with the M.B.E. by Her Majesty The Queen at Buckingham Palace in recognition of her services to the disabled. The significant quality of this honour is that Mrs. Page herself is a severely disabled person, having suffered for many years the consequences of respiratory poliomyelitis, being permanently confined to bed and wholly dependent on artificial breathing apparatus.

My hon. Friend the Member for Eastleigh (Mr. David Price) spoke of the courage of disabled people and the way in which they overcome their difficulties. Mrs. Page not only has played a full and creative part in maintaining her family's life around her, but she embarked on a career in journalism as the editor of a magazine designed to help severely disabled people, to encourage them, and to spread information among the disabled so that they may know what facilities are available and also to educate other more fortunate people who have not hitherto been aware of the special problems involved.

It is due to people like my constituent, as well as many organisations, notably the Disablement Income Group, that a great deal of work has now been done to stimulate interest in the problems of the disabled. This is why a number of hon. Members on both sides have been raising questions on the matter when opportunity arose. The right hon. Lady the Minister of Social Security has recognised the problem. Only recently, she freely acknowledged the gap which exists in our Welfare State and expressed her concern to find a solution, with particular reference to the problems of the disabled housewife who at present receives no benefit. Her predecessor, the right hon. Lady the Member for Lanarkshire, North (Miss Herbison), also was sympathetic to the need to improve provision for the disabled and chronic sick. At one time, I very much hoped that she would bring forward proposals on these matters even ahead of the general review which at that time was awaited.

There is no longer, therefore, a need to convince the Government that the problem exists. They are sympathetic to it and they understand the need. Now, we have to encourage and urge them to bring forward a solution at the earliest opportunity. This is what the Motion does, in urging them to give the problem high priority.

I understand that, as a start, the Government have initiated a survey into the problems of the long-term disabled. But, in reply to a Question on 11th December, the Parliamentary Secretary to the Ministry of Health said that it might be two years before useful results are available from that survey. I appreciate that the information brought up by this survey will obviously be useful and fundamental, but two years in the life of a disabled person is a very long period, and I would hope that when the Minister winds up this afternoon he may be able to give an assurance that the Government will seek to remove some of the existing anomalies and improve the provision for disabled people, at least in some of the most urgent respects, even ahead of obtaining the results of the survey.

Reference has already been made to the plight of the disabled housewife who is at the moment not eligible for any benefit. Indeed, she has recently been described as being an invisible person so far as the State is concerned. This, surely, is one of the most urgent problems, which should not be too intractable to solve even ahead of the survey.

Similarly, I would hope that the Government would seriously consider bringing the benefits which are available to what are called the civilianly disabled more into line with those benefits which are available under the Industrial Injuries Scheme and also to those who are disabled as a result of their service in the Armed Forces; and this in particular I would urge, not only bringing the weekly benefits more into line but also making available constant attendance allowance which is at present available to people who come under these other two schemes.

I realise that those who are injured as a result of industrial employment or as a result of their service in the Armed Forces have always been considered as deserving to be treated as a special case, and I certainly would not seek to deny their entitlement to adequate and proper consideration, but for the invalid the effects of the disablement do not make any distinction as to the cause of it. The effects of the disability will of course be just the same quite regardless of how the illness was contracted. We have the same loss of earning power, the higher costs of special foods, and of extra warmth, which is required by some invalids, the cost of adapting a house so that those confined to wheelchairs may remain mobile, often the cost of special equipment, and the running costs involved, and, above all, the cost of paying a constant attendant in a case of very severe handicap.

I have never been able fully to follow the argument that people covered by the Industrial Injuries Scheme and the Armed Forces scheme should be uniquely entitled to disablement benefits. I agree that they should receive their compensation, but I find it very difficult to believe, as has sometimes been suggested, that those groups of people would begrudge similar benefits to others who are comparably disabled and suffering from the same handicaps.

The present time may not, of course, be a very propitious one for advocating an extension of the welfare services; we know the Government are trying to reduce expenditure; but in the case of the disabled and chronic sick there are two very important considerations to bear in mind.

In the first instance, if disabled people can be enabled to live at home by the provision of modest allowances to cover the cost of their constant attendants or to meet their higher living costs there would be a financial saving to the country in these cases, quite apart, of course, from the human benefit which would accrue to the invalids and to their families. The hon. Member for Eastleigh has already indicated the figures. I have seen estimates for the cost of a hospital bed varying from £50 to £80 per week, and, of course, only a fraction of this sum would be necessary to enable an invalid to live permanently at home; and incidentally, of course, one releases a hospital bed for the benefit of another patient who could gain advantage from the facilities and treatment available.

I had a letter recently from a constituent of mine who has suffered from multiple sclerosis for a period of 15 years, and during that time her husband has made considerable sacrifices so that she should be able to live at home, but she points out that if she had gone to hospital, as she may well have been qualified to do, even if we assume a cost of only £30 a week over this period, it would have amounted to some £23,000. That, of course, is a very substantial sum, and I believe that, certainly in these cases anyway, it would produce a financial saving as well as a big improvement in the lives of the disabled people with whom we are concerned.

The second consideration is that this group of people about whom we are talking have been overlooked by the Welfare State much too long already, and I believe that in common justice it is time that proper provision was made for them without further delay. They comprise one of the most deserving sections of the community. As one hon. Member opposite said, they do not organise lobbies, and indeed, until recently many people have been unaware of the extent of the problem. Indeed, the full extent of the problem is not even yet known, but from examples we have all seen in our own constituencies I think we all know that these people do all they can in their own power to overcome their handicaps and disabilities, and I think now it is time that we did what we could to help them.

It is true that medical science has done a great deal to reduce the severity of their handicaps. In many cases it has enabled them to continue living for many years. I do not think there is much further we can do to reduce the handicaps from which they suffer, but at least we can relieve the financial anxiety which they and their families suffer. I receive quite a lot of letters from invalid people and people living at home who have fortunately received help from one quarter or another, and over and over again one reads that, "The electricity bill has been a worry", and how they have dreaded the winter coming on and worried whether they would be able to afford the necessary warmth. They have problems of that kind, and I think it is time this problem really was tackled.

I believe also that in the country as a whole the urgency of this problem is well recognised, and I believe this is an instance in which taxpayers would say "Yes" and say that their money being spent to help these handicapped people, was money well spent, and that they would give that expenditure their blessing.

The Motion calls on the Government to give high priority to this problem. I hope they will be able to accept the Motion in the spirit in which it was so ably moved by my hon. Friend, and that they will treat the matter with a renewed sense of urgency.

1.8 p.m.

Mr. Patrick Wolrige-Gordon (Aberdeenshire, East)

I want very strongly to support the Motion which my hon. Friend the Member for Moray and Nairn (Mr. G. Campbell) has introduced. I do not want to detain the House long, and so I will not deal with the remedies which have already been so ably, I thought, set out, particularly by my hon. Friend the Member for Eastleigh (Mr. David Price), but as I listened to the debate, which has included a certain measure of criticism of our present administration of the welfare services, I was reinforced in my own conviction that the permanently disabled and chronic sick in our country are not themselves the problem. Many of them can call upon reservoirs of courage and spirit which make one marvel at the untapped wealth in the human heart.

The problem is with us, the country, society—whatever one may call it. We are discussing a Motion on which everyone who has spoken so far agrees. It is not in itself a Motion which goes very far. It calls on the Government to give higher priority to the task of identifying people in the community who are in need of special help. It does not even call for any money. It rests solidly on a point on which we all agree and apparently have agreed for a long time—the need for identification. However, it has not been done.

As my right hon. Friend the Member for Ashford (Mr. Deedes) brought out in his excellent and comprehensive speech, we have some idea of, but do not really know the numbers involved. But do we even know who should find out the numbers involved? Of course, we know in theory. As far back as July of last year, for example, the Secretary of State for Scotland explained to some of my hon. Friends and myself that local authorities have a duty to compile and maintain registers of disabled people in their areas. If that is done, there is no problem. It is easy to check with the local authorities. The chronically sick and permanently disabled are sedentary; they do not flit round the country very much. But every speech to which we have listened so far has questioned whether checking up with local authorities is a valid exercise.

The truth is that the performance of local authorities varies so much in different parts of the country that we have no accurate picture. The deficiency lies in administration—

The Parliamentary Secretary to the Ministry of Health (Mr. Julian Snow)

I cannot follow the hon. Gentleman's argument. If I understand him correctly, he is saying that the responsibility of local authorities is so complex a subject that it is not for the ordinary person to judge whether an authority is carrying out its duties efficiently. Is that the point?

Mr. Wolrige-Gordon

No. My point is that local authorities have a duty to compile registers of the disabled. If those registers were accurate and could be relied upon, there would be no need for a Motion seeking identification of people who need help and who are outside the provisions of the welfare services.

Mr. G. Campbell

In the inquiries which I have made and in replies to Questions which I have asked, it seems that the responsibilities of local authorities in England and Wales are different from those in Scotland. This is one of the anomalies. There is no actual duty placed upon local authorities to keep records of permanently disabled persons. Their responsibilities are fairly vague, and very different in different parts of the country.

Mr. Wolrige-Gordon

That bears out my point. In addition, a number of my hon. Friends have indicated the problems of all the different Ministries involved so that in every Department we get this uncertainty about who is responsible for what and whether that responsibility is being carried out.

One proposal put forward was the possibility of amalgamating the Ministry of Health and the Ministry of Social Security. At the moment, we are engaged in considering proposals for amalgamating social welfare in Scotland and for creating departments under the local authorities designed to comprise all the services. Without going into the merits of that proposal, I imagine that it is worth while considering the necessity of writing into the Bill a statutory duty on those departments to compose and maintain records of the disabled and the chronic sick.

It is not only a flatter of those concerned not knowing all the benefits available to them. It is a matter of those responsible not knowing about all those who are concerned. All in welfare speak of the need to discover for themselves people who are in difficulties through disablement and sickness. But we cannot rely on everyone who needs help automatically coming to find it. Here again, we have no idea of the numbers involved, but it is clear that some do not come and, therefore, this is a part of the welfare service and the Health Service which needs very drastic revision and some means established to discover the exact facts involved.

1.16 p.m.

Dame Irene Ward (Tynemouth)

I am glad to be able to add a few words in support of the Motion which has been so ably moved by my hon. Friend the Member for Moray and Nairn (Mr. G. Campbell).

We have had a most interesting debate, and I am sure that the Parliamentary Secretary to the Ministry of Health will agree that an enormous number of very practical proposals have been put before him from both sides of the House with a view to helping to deal with this very urgent and human problem.

If I may just follow up the speech made by my hon. Friend the Member for Aberdeenshire, East (Mr. Wolrige-Gordon), he referred to what might be thought to be the shortcomings of local authorities. As I understand the position, the Ministry of Health has made it mandatory on authorities to keep a register of the disabled and chronic sick. But, as happens all to often in administration, there does not appear to be any follow-up from the Ministry to discover how effectively local authorities have done their work. For example, if one examines the records of two places which have been mentioned, Chester and Kingston upon Hull, one local authority has done its work much more effectively than the other, and, as I say, it appears that there is no inspection of the work that the authorities do.

I know that this is a difficult subject, because everyone is very proud of our local government service and draws a distinction between local government service and the central Administration. However, sometimes we stretch the point too far. If the Minister of Health thought it necessary to make it a mandatory obligation on local authorities to keep registers, I think that he should go a little further and call for reports. If the reports vary to the degree we are led to believe, the Minister should take steps to ensure that we have an effective and efficient administration throughout the country.

I have noticed that where one gets efficient local government administration great progress can be made. But one is immediately up against a variety of circumstances under which local authorities administer their housing schemes. It gives me cause for anxiety that there is no specific obligation on local authorities for finding the right type of housing for the chronic sick and disabled. This does not involve a large amount of expenditure. The Ministry of Health and the Ministry of Housing and Local Government together ought to devise a plan which can be equally applied throughout the length and breadth of the United Kingdom.

A fortnight ago I came across the case of a railwayman who a long time ago lost both his legs in an accident. As he grows older his injury is added to by age. This man who had been very thrifty had acquired two flats of his own, but as he has grown older the circumstances under which he lives with a family in too small a flat makes it almost impossible for him to have a happy painless future.

The local authority, naturally I suppose, has decided that any person in occupation of a house or flat of his own cannot be regarded as eligible for a house under its housing scheme. This puts a premium on thrift and takes no account of the added difficulties which arise in disablement cases with advancing years. If the Ministry of Health and the Ministry of Housing and Local Government could get together and devise an overall plan we might make great progress.

The other day a very active member of the Disablement Income Group drew my attention to the fact that the new airport which has recently been established and expanded at Newcastle-upon-Tyne has no provision for the disabled. My hon. Friend the Member for Moray and Nairn also drew attention to this matter. We have a very active Disablement Income Group both in Newcastle-upon-Tyne and County Durham. Owing to the interest of this particular man who wrote to me, and Press reports of the Group's annual meeting, I was able, by exercising pressure on the appropriate Ministry, to get an acknowledgement from the authorities running the airport that specific action would be taken to meet the point that had been raised. This is all very interesting and I was satisfied with the result. But one would have thought that a Government—I do not specifically refer to this Government; any Government—if they were really interested in this subject, when money is granted for the building of an airport and plans are produced, would make it obligatory for arrangements to be made to cover the disabled and chronic sick who at times travel through airports.

I had an unhappy experience when I went to the Central Transport Users' Committee and pointed out some of the difficulties of those of the travelling public who are getting old, the chronic sick and the disabled. I did not have a very good reception. We have spent quite a lot of money establishing the Central Transport Users' Committee and we have spent a great deal of money financing British Railways. I cannot see why in those circumstances they should not conform to any suggestions—indeed I would make it mandatory—which take account of the needs of the travelling public in the categories I have mentioned.

I am a great believer in individual rights. Where public money is invested in some of the great services of our country, the public companies should have their attention directed to the need to do their job properly. I was disappointed when I went before the Central Transport Users' Committee. It had never had anyone going before it personally. It likes matters to be contained in memoranda. I am not very keen on memoranda. It is better to be able to say one's say and people cannot escape; they have to take note at the time. It is easy to answer by letter, but I am not very keen on letters. I like people to answer me directly. There was only one woman on that Committee, but I do not think that very much attention was paid to her. The Central Transport Users' Committee is supposed to exist for the protection of the public. I do not think that it has carried out its functions concerning disabled and chronic sick travellers.

Mr. G. Campbell

The point raised by my hon. Friend the Member for Tyne-mouth (Dame Irene Ward) about airports is important. There are some very good devices for conveying the disabled into and out of aircraft and it seems a great pity that the buildings do not adequately maintain those arrangements. I discovered this the other day quite by chance owing to an accident to the caliper on my leg on a flight to London. At London Airport I found they were able to bring a wheel chair and a ramp to the aircraft so that, from inside the aircraft to the building, I was conveyed in the wheel chair. It seems an anomaly that the buildings should not be constructed to conform with such services.

Dame Irene Ward

I am grateful to my hon. Friend for that intervention. I must apologise, because I have to catch an aeroplane to keep an engagement in the North. Had it not been for last night's controversy I might have got the sleeper. However, I am glad of the opportunity to take part in this debate.

Mr. Snow

I assure the hon. Lady that I have listened carefully to what she has said about airports, if for no better reason than that at one time I had a small but serious responsibility for these buildings. I shall draw the attention of my right hon. Friend the President of the Board of Trade to what the hon. Lady has said, and she will be written to.

Dame Irene Ward

I thank the hon. Gentleman.

It is extraordinary that, although we pride ourselves on our civilised approach to these matters, a disabled wife is the only individual who is not entitled to supplementary benefit. One of the things which the Disablement Income Group would like to know is whether, if we introduce a Bill under the Ten-Minute Rule procedure, it will be supported by the Government, to get rid of this anomaly. I think that it would be in order to introduce such a Bill, because it would not be a direct charge on the Treasury, but on the Fund. There are many hon. Members who would be willing to introduce such a Measure.

I am not very good at talking today, because of the all-night sitting. In debates of this kind we all welcome the approach of Ministers to the proposals that are put to them from both sides of the House, but then, somehow, all the support that is given, and all the expressions about the practicablity of the points which have been made are forgotten. I think that the Treasury, that remote body which does not get itself down to the grass roots of country life, is not interested in these things. Will the hon. Gentleman give us an undertaking that if we introduce a Bill of the kind to which I have referred he will persuade the appropriate Minister, which I think will be the Minister of Social Security, to take action, and that he will support her in her efforts to get the Treasury to approve the removal of this absurd anomaly.

Why should one tiny section of the community, the disabled housewife, be outside all the great schemes which have been placed on the Statute Book? The hon. Member for Chislehurst (Mr. Macdonald) drew attention to the wife who went to work to support her disabled husband. She worked hard—and that was backing Britain, by looking after her disabled husband—but the result was that her grant was withdrawn. It is inconceivable that anybody who has a modicum of brains, and he must have to get into this House, can allow any Government to be so lacking in humanity as to allow these ridiculous anomalies to continue. I think that we are far better when we deal with big problems, but we could make life so much happier, better and more encouraging if we could sometimes get our tiny details right. The small details always receive a lower priority.

I hope that the hon. Gentleman will give a satisfactory answer—I am sure he will—to the important points which have been raised today, and that he will not, when he leaves that Front Bench, forget all that he has said today. Let him go into battle with anybody in the Government who does not want to see some of these anomalies eliminated and some of the practical suggestions which have been put forward put into operation. I hope that when somebody is fortunate enough to be able to introduce another Motion on this subject, perhaps in six months' time, we shall get a full report that what has been said today has been dealt with, and that a great deal of misery and unhappiness has been done away with.

1.36 p.m.

Mr. T. L. Iremonger (Ilford, North)

The House cannot have failed to reflect what a wise and marvellous Member my hon. Friend the Member for Tynemouth (Dame Irene Ward) is. It has shown itself in one of its more combative and also one of its more benign moods over the period of the last few hours. My hon. Friend the Member for Moray and Nairn (Mr. G. Campbell) made such a splendid survey of the ground, as did those who followed him, that I should do well to confine myself to one single point. I am glad that the Minister is here, because I hope that he will give me some help and hope in answer to my plea.

I want to protest against the inadequacy for their purpose of Ministry of Health invalid tricycles and ask the Minister to replace them for all who are entitled with small cars in which they may carry passengers, and which others may drive in an emergency. There cannot be one disabled person or one member of a "disabled family", as one of my hon. Friends called it, who cannot make out a case in detail from personal experience to support my plea.

But I shall take one example only because I have in mind the case of a constituent who has written to me within the last few days about his wife's tragic difficulty which could be enormously relieved if this plea were accepted. His wife is a polio victim, totally immobilised, and the mother of a young child. Her life, that of her child and that of her husband would be transformed if she could take her child with her in her invalid tricycle, but she cannot because it is specially constructed to carry one person only. She is, therefore, crippled and handicaped almost as though she had no use of any transport.

If she needs to go outside the front door for shopping, to visit friends or anything else she has either to leave the child alone in the house or get someone in to mind it. The alternative is not to go out and get someone else to get everything for her, which is frustrating and demoralising in the extreme for her and for her husband, on whom much of the consequent burden falls, and it is inevitably bad for the child thus to be a crippling handicap on its mother and father.

There is no necessity and no justification in principle for limitations of this kind, if I understand them rightly. I ask the Minister to say that he will make arrangements in such circumstances for those entitled to have a small car instead of the monstrous and degrading mobile coffin with which they are obliged to put up under the prevailing dispensation.

The right hon. Member for Llanelly (Mr. James Griffiths) referred to democracy at the grass roots. This is the sort of debate in which the House responds to democracy at the grass roots. In fact, it was because of the care and concern about the problem of the disabled and chronic sick amongst the Conservative Party's Women's Advisory Committee in my constituency that I was specially alerted to the opportunities of this debate. The House owes a debt of gratitude to those people who take an active part in the political life of their constituencies by joining one or other of the two parties which are capable of making an effective contribution to the policies of Governments.

It might not be uncharitable or inappropriate incidentally, to take note of the fact that during the whole day there has not been a single Member on the Liberal benches. We have all been here all night. Only two Liberal Members were here during the late watches of the night, and not a single one has turned up for this debate—hut I bet there will not be a snide paragraph about that in the Guardian tomorow.

1.42 p.m.

Mr. Jasper More (Ludlow)

I congratulate my hon. Friend the Member for Moray and Nairn (Mr. G. Campbell) on bringing this excellent Motion before the House. It is a reflection on the House—and it should be on its conscience—that the raising of this subject has had to rely on the efforts of back benchers. It is regrettable that we have not had more initiative from the Government side. This is not the first time in the last six months that this subject has been before the House. In October a Government back bencher brought up the question of the disabled.

I am entitled to say—and I make here what is in part a political point—that it is lamentable that, with a few honourable exceptions consisting of the hon. Member for Stoke-on-Trent, South (Mr. Ashley) on the previous occasion and the three hon. Members on the Government side who have spoken in today's debate, there appears to be a total lack of interest among Labour back benchers in this very grave social problem.

In October the hon. Member for Stoke-on-Trent. South raised the question of the disabled in an Adjournment debate, particulars of which were printed on the Order Paper in his name. On account of the folding-up of earlier business the Adjournment debate came on at about 5 o'clock. I might be said that hon. Members in general had not noticed it or were not interested and that that was the reason why nobody took any interest in the matter. A brief look at the OFFICIAL REPORT, however, disabuses one of any idea that events occurred in that way. My hon. Friend the Member for the Isle of Thanet (Mr. Rees-Davies) spoke last in the debate on disabled persons and, according to the OFFICIAL REPORT, said: I see now a number of 'eager beavers' sitting on the benches opposite who have obviously been hatching up a tremendous plot. They are ready for a big rage."—[OFFICIAL REPORT, 23rd October, 1967; Vol. 751, c. 1402.] I remember the occasion very well, as will the Parliamentary Secretary. The Government benches were full, but hon. Members opposite had not come to talk about the disabled. When we finished we discovered that this was a cooked-up Adjournment debate to attack the Home Secretary on why he had not admitted into the country three students from Norh Vietnam.

Mr. Iremonger

Middle-aged students.

Mr. More

Hon. Members opposite were talking about three students from a foreign country. What we have been discussing today, according to the assessment made by my right hon. Friend the Member for Ashford (Mr. Deedes), could effect about 2 million of our own people. Why is there no interest among Labour back benchers in this question? Why are they not here today? Were they here longer than we were last night? Why, as one of my hon. Friends has said, have there been no Liberals here today? Do Labour Members not think about the subject? Do not they care about the subject? Is there no compassion among ordinary Labour Members of Parliament for this large class of persons, which has unfortunately been left out of the National Health Service?

I admit that I am making a party political point, but it is not only that. When the Government are being asked to make a much-needed reform it is sometimes more effective if urgings and promptings come from the benches behind them as well as from the benches opposite them. At least that was our experience when we were in Government.

It has emerged from the debate that we are concerned with three main issues. The first is the issue of identification. Surely this is a matter for speed. This must be the basis of any reform. It must be pushed ahead as soon as possible. The second issue is the question of organisation. Two or three of my hon. Friends have spoken of the excellent work done by different authorities touching different aspects of this important problem. There are, for instance, the hospital services, run by the central Government. My county council—of which I am a member—does excellent service through its health and welfare committees and, to some extent, its children and education committees. These are all excellent initiatives which touch on this problem at various points. As my hon. Friend the Member for Tynemouth (Dame Irene Ward) said, what is done by the local housing authorities and district councils is also very important. In my area the special housing that has been provided for the aged has made a real contribution towards solving the problem. There is also the invaluable and heroic part played by voluntary organisations.

It all comes back to what many hon. Members have said, that it is really the organisation as a whole that wants looking at. Not only is there too much overlapping; there are alarming pockets of destitution, helplessness and poverty which are simply ignored. In order to solve these problems organisation is the second essential.

The third essential is the financial provision. I do not want to repeat what has been said so effectively by hon. Members on both sides of the House. The hon. Member for Bedwellty (Mr. Finch) spoke of this as if it were largely a problem of poverty. It is primarily a problem of poverty. But it has also been pointed out that the National Health Service is a burden on the taxpayer.

Careful consideration must be given to the sector consisting of disabled people who have money but, unfortunately, find that the cost of their subsistence, having regard to the enormous obligations that they are compelled to undertake to live at all in their private houses, is so great that they are obliged to throw themselves on the public purse. We know what that can mean nowadays. It is important that we should concentrate—difficult though it is—on an investigation directed to the object of allowing these unfortunate people, as far as possible, to live in their own houses.

I now turn to what has always seemed to me to be an astonishing anomaly running through our excellent National Health Services and other services. Often people who can afford it can be looked after either out of their own incomes or privately. More often, destitute people have to be looked after in public institutions. There is also that marginal group, which must be large, of people who have money but would need only a little extra to run their own houses. One is always coming across the anomaly that this cannot be provided on a scale which would make their household viable. All this should be considered, since, in the long run, it must not only contribute to the happiness of the individual but save the public purse a great deal.

We are all agreed that the outstanding anomaly, the case needing most attention, is that of the disabled wife. This was brought forcibly to my attention in a letter which I received from a constituent last year, in which he says: My wife has had to endure the pain and misery of rheumatoid arthritis for about 12 years now, and for the last two and a half years has been unable to walk. She is quite incapable of doing anything very much other than feed herself, and is confined to her bed or a chair in the house unless an effort is made to take her out in the car. He says that it is difficult to afford a car and goes on: I, of course, have to pay for help in the house, food is a heavier item as I have not the time to be discriminating about purchases, and fuel to keep my wife in comfort during the winter is more expensive. I give all the above details as they affect me, but there must be thousands of people in the same, if not worse, plight. He does not pretend that he is a poor man, but is simply telling me his financial position. He goes on: At the moment an allowance is given by H.M. Inspector of Taxes of £40, which at the Standard Rate means I am saved the princely sum of £16 10s., which I can assure you does not go very far in alleviating my position. I am not surprised that he also points out: … although my salary might be considered reasonable, financially things can be difficult". He is still on the right side, and, fortunately, can carry this burden. But we should consider cases like this, because as the cost of living increases and things become more difficult more such cases will be on the wrong side.

When we had a similar debate in October, the Joint Parliamentary Secretary to the Ministry of Social Security gave us an excellent summary of the financial assistance which is available. Is that still up to date, since there is a very good reference in HANSARD on the subject?

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

indicated assent.

Mr. More

Although the case of the disabled wife is the most glaring, this whole problem should be dealt with comprehensively and as quickly as possible. Once again, I congratulate my hon. Friend on introducing the Motion.

1.54 p.m.

Mr. Paul Dean (Somerset, North)

I, too, congratulate my hon. Friend the Member for Moray and Nairn (Mr. G. Campbell) on having selected this subject for debate and on the able and sympathetic way in which he moved his Motion. Speeches from both sides have shown the wealth of experience and sympathy that we invariably get on these occasions. Although most of us were here not many hours ago, there is no sign of disability or chronic illness in the minds of any hon. Members.

The themes of this debate were to be expected, but they came out strongly. First was the lack of information about disability, where it is and what the connected problems are, and, therefore, the need to identify and define. Second is the important and unhappy fact that the number of disabled and chronic sick is bound to grow as the years go by. The advances in medical science and the tendency for people to live longer are happy factors in one respect but inevitably bring problems of disability and chronic illness which will be with us and will tend to increase rather than diminish.

Third is the anomalies in the public provision for these categories of people. Finally, and most important, is the need to lock in as closely as possible the cash services with the care services. That is why, particularly, we have suggested, and still feel, that a combined Ministry dealing with the two to get that central coordination which has been referred to would be very desirable. If the local officers could then seek out those in need and discover their requirements, we should have gone part of the way towards identifying those who require help.

There has been encouraging progress here since the Piercy Report on the Rehabilitation, Training and Resettlement of Disabled Persons in 1956. It is encouraging to know that the Government have now commissioned surveys to try to fill the present gap in knowledge. I hope that the Parliamentary Secretary can tell us more about when they are likely to produce results and when action might be expected.

One can identify six broad categories of disability or chronic illness, all of which have different provisions, particularly for cash. First is the disability and chronic illness resulting directly from employment or service in the Forces. Second is the disability which occurs while a person is employed but is not directly attributable to his employment. Third is the disabled housewife; fourth, the adult disabled from childhood; fifth, disabled children; and, finally, disabled pensioners.

Only in the first two of these categories—those who qualify under the Industrial Injuries Scheme or for war pensions—do we know much about numbers and the type and extent of disability. It is significant that in these categories, where the principle of disability is recognised and allowances are provided, we have a great deal of information, whereas in the other categories, where no specific allowance is made, the gap in our knowledge is greatest. Therefore, we have the anomalous position in these other categories of some receiving National Insurance benefits, some receiving National Insurance benefits plus supplementary benefits, some just supplementary benefits, and some nothing at all. It is particularly anomalous where, say, a disabled housewife has a husband who can work and she therefore receives no benefit.

The anomalies are very clear to the House, so I shall not quote the details of the different types of benefit. They show clearly that, whatever the position may have been in earlier years, the distinction between industrial and civil disability has lost much of its force in recent years, and that what really matters today is the disability itself and not how it was caused. That seems to us on this side of the House to create a strong case for recognising disability as such for some form of benefit. This is a point to which the Disablement Income Group, among others, has drawn attention. I pay tribute to the wonderful work it has done in identifying the problem and showing the needs of the disabled and chronic sick.

I know that the Parliamentary Secretary will tell us about the difficulties of definition. We accept that there are such difficulties, particularly as regards the chronic sick. If what we read in the Press is to be believed, the Government are having considerable difficulties over how the chronic sick are to be defined for exemption from prescription charges. We appreciate that it is very difficult to do, but I hope that the hon. Gentleman can assure us that there will be no question of their having to pay prescription charges, and that some form of exemption charges will be available for the chronic sick categories before the charges are introduced. This is a matter of great importance.

We have in the war pension and industrial injury arrangements a system which is working fairly effectively and in which a great deal of experience has been built up in assessing disability, rights of appeal and so on. I cannot believe that it would be impossible to broaden and adapt this now well-recognised system to deal with the problem of definition of civil disability. What really matters, and the criterion which can be valuable in judging these questions, is the inability of the person concerned to undertake normal activities either at work or in the home, and also the abnormal expenses which are very often involved. In a disabled family there is a need for extra transport and extra facilities in the home, special clothing, special household equipment and a multitude of other things which those of us who are not disabled take for granted and which mean extra expense and effort for the disabled. I hope that while the difficulties which still exist on definition and so on are being worked out the Government will give serious consideration to the point made by the right hon. Member for Llanelly (Mr. James Griffiths) about extending the concept of the constant attendance allowance which is available under the industrial injuries and war pension schemes to these categories. It would be at least a step towards dealing with the problems on the cash side.

There is also the problem of dealing with disability as a whole and recognising that it affects not only the disabled person but the family as well. This point has been well brought out in the debate. The case of the housewife who sacrifices leisure and all sorts of things which many families accept as normal in order to care for a disabled husband should command the greatest sympathy and practical action by the House. Yet at present that category tends to be left out, particularly on the cash side.

I turn briefly to the services. Employment has been mentioned. It is very important to a disabled person, for nothing is more likely to restore or maintain his independence than the knowledge that he can do some useful work, however simple. I hope that in this connection the Government will recognise that, good as the training centres and so on are, and encouraging as it is to see sheltered employment expanding and work centres coming increasingly into the picture, we need to find more effective ways of encouraging industrial firms to take on more disabled workers than they do at present. We cannot entirely blame them for the reluctance in some cases to employ the disabled. There are many processes in which it is very difficult to do so. But I hope that the Government will consider that there may well be a strong case for a greater incentive to industry to employ disabled people. In the long run this could well be less expensive than their spending the substantial sums that they spend at present in building their own centres to provide employment. I am sure that there is a need for both, but are we certain that more encouragement to established businesses would not be an effective way of dealing with this very real problem?

The question of transport has been mentioned. We who are not disabled take it for granted, and grumble about traffic jams and so on. But the problems we have in moving from A to B are as nothing compared with the problems of the disabled. My hon. Friend the Member for Tynemouth (Dame Irene Ward) mentioned the need for facilities at airports, and my hon. Friend the Member for Ilford, North (Mr. Iremonger) spoke about the invalid tricycle. It is often the ordinary simple things that can make all the difference to disabled people in moving about and going to their work or recreation.

The problem is not only one of those who want to go to work or do their shopping. It is important to remember that many of those who come into the category of the disabled or chronic sick are old, pensioners and housebound. Perhaps one of the most important things for someone who is housebound is to have a person with transport who can take him to the day centre, concerts, religious services and so on. A trip out once a week or once a month can make all the difference to the lives of the housebound. It is a simple matter, but one in which there is often a gap. This point was mentioned by the hon. Member for Chislehurst (Mr. Macdonald).

Perhaps the key to the care services is service in the community. In recent years there has been a strong development away from care in institutions to care in the community. This is not only socially right but is better for the disabled aril chronic sick, who are always better off if they can be cared for in their own homes. Old people often say, "Do not let me go into hospital because I will never come out again." In some cases they must go in but, where it is possible for them to have the supporting services they need, they should remain within the community.

It is easy to talk about the gaps that exist in the services we provide; for example, the need for short-stay accommodation so that those who care for old people can occasionally have a holiday; the need for half way houses between residential accommodation and hospitals, where a modest amount of nursing care can be made available; and the harsh economic difficulties. However many services are provided for people living at home, the provision of them is almost certain to cost a lot less than the cost of keeping these people in hospital.

The highest priority must be given to these supporting services, including home helps and home nurses. These services are growing, but unfortunately they have been casualties in the cuts in Government expenditure. It is unfortunate that the health and welfare services should have been cut, not only in the announcement made in December but also in the cuts announced last summer. It is regrettable that cuts of this sort should fall on services which provide the most economical way of supporting the disabled and chronic sick.

The importance of voluntary bodies cannot be over-estimated. Grants in aid to voluntary bodies will often mean the provision of a service more economically and, in some instances, more satisfactorily than a local authority can provide, particularly with the tremendous burden falling on local authorities today. The more we can encourage voluntary bodies working for the disabled and chronic sick to become ever-increasing partners with the services pro vided by local authorities the more complete those services are likely to become, and in the long run they will probably be cheaper to operate.

Our civil defence volunteers are soon to lose their function. Could they help in this connection? Some aspects of civil defence are broadly similar to, or connected with, the elderly. This body of men and women which will otherwise disappear could perhaps be urged to continue giving voluntary service to supplement the work of local authorities and other voluntary bodies.

An encouraging feature of help within the community is the way in which schools and youth clubs are anxious to be of assistance. This was a comparatively new concept only 10 years ago. It is now difficult to find a school or youth club which does not have as one of its aims the assistance of the disabled, chronic sick and elderly, a healthy sign in our modern society. Grants in aid to enable these bodies to provide services of this kind would be socially right and economically valuable.

In this debate we have covered a tremendous range, including almost every Ministry, certainly every home Ministry. We need at the centre a much closer locking in of effort than exists at present. The Parliamentary Secretary will no doubt say that the Ministries concerned cooperate closely, but I do not believe that one can obtain the necessary co-operation and identity of purpose which is necessary when dealing with the cash and care side—one part of the same problem for the individual concerned—when there is disjointed effort at the centre. Disjointed effort of this type reflects itself right through, with the hospital service being run from one engine, the G.P. service from another, the local authority services from yet another, with the Ministry of Labour's rehabilitation service coming in as a separate entity. Local committees are needed to obtain the identity of view and purpose that is needed in dealing with these problems.

We are speaking of categories of people who are not only immensely deserving of our sympathy but who require practical help from us. All of these people are in need and they have suffered as a result of devaluation and the measures that have flowed from it. Although the Prime Minister gave a pledge that those most in need would not suffer as a result of the Government's measures, I trust that the Parliamentary Secretary will give an assurance that these people will have the highest priority in the fulfilment of that pledge.

2.19 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Julian Snow)

The House is indebted to the hon. Member for Moray and Nairn (Mr. G. Campbell) for initiating this discussion on the problems of welfare which are presented by the disabled and chronic sick, problems which this House finds time only rarely to consider at such length and in such detail. The hon. Gentleman's experience and interest in this matter is well known.

Possibly with one exception, the speeches made today have been both well-informed and educative, certainly for me. It would be a pity if I threw too many bouquets about, but in addition to the introductory speech of the hon. Gentleman, to which I shall refer in detail later, we had outstanding speeches from both my right hon. Friend the Member for Llanelly (Mr. James Griffiths) and the hon. Member for Eastleigh (Mr. David Price). I thought his speech was singularly well-disciplined, and I found it extremely helpful.

The general subject covers a multitude of individual questions that all of us meet every week in our constituencies; questions which are very hard to answer, even when they are answerable at all. That being so, I do not think that I shall be able to answer every individual matter raised in this debate, but I can assure the House that those points that I have to leave out will be examined carefully, not only by myself but by my hon. Friends who have been attending today, more especially the Joint Parliamentary Secretaries to the Ministries of Social Security and Labour, and the Under-Secretary of State for Scotland. It is very important that those speeches should be examined carefully, because whatever may be the theoretical administration of existing legislation and whatever may be the improvements in the provision of services, such legislative and administrative activities can always be highly fertilised by speeches and representations in the House.

We all too often find that individual physical or mental disability becomes, through poverty, an even more intractable family and social problem. I agree with the hon. Member for Moray and Nairn that too often one of the most distressing factors is the loss of earning power of the family where there is disablement or chronic sickness. The extent of the Government's interest is well indicated by the fact that, as I have said, more than one Minister has made himself available here today.

Although there may theoretically be a claim for bringing all aspects within the compass of one Ministry, there are serious disadvantages as I think the hon. Gentleman would recognise, in having too vertical a structure. I know current Conservative feeling about the amalgamation of the Ministries concerned, and there are obviously extremely good reasons behind it, but one cannot say that it is a faultless theory. Many difficulties are involved. It remains to be seen whether, as the review of the social services progresses, changes in the allocation of responsibility will emerge.

Whatever changes there may be, it will always be true that each Minister is under an obligation to consider his own contribution to social services. Employment and social security are among the most important questions, but there are many others. We have had references to housing, education, science and transport—in relation to parking and public transport. Even the Post Office comes into it as, certainly, does the Ministry of Public Building and Works.

Although the hon. Lady the Member for Tynemouth (Dame Irene Ward) has had to leave the Chamber in order to fulfil a constituency engagement, I can assure the House that we shall examine very carefully what she had to say. A great deal has been done already in new building to provide such things as access for disabled persons.

All those Ministries are concerned in some way with aspects of the social needs of the chronic sick and disabled, and the way in which the problems should be taken into account. My view is that it would weaken rather than strengthen the total effort if all these aspects were brought under one umbrella, but it follows that one Minister in replying to a debate a s wide-ranging as this cannot deal now with all the interesting points that have been raised. However, I undertake, not only on my own behalf but on that of my hon. Friends to write to hon. Members on those matters with which I cannot now deal.

One point with which I shall deal later is that of prescription charges for the chronic sick but, first of all, it is well to consider what is meant by "chronic sick" and "disabled". The hon. Member for Moray and Nairn suggested that there should be a definition, but the words cover the whole spectrum of age ranges and a range of disabilities varying from extreme conditions requiring constant attention such as can be given only in a hospital to conditions in which there is hardly any interference with with ordinary living.

With such a wide range, it is inevitable that there should be different definitions for different purposes, and it is possible that there are some conditions that do not fall readily into any category—

Mr. G. Campbell

I agree with the Minister here. My point is that there are at least two ways in which the chronic sick might be defined. One would be for purposes of prescription charges, where the chronic sick may not be disabled but may be dependent on continued supplies of medicine, and the other would be for purposes of disablement and earning power. That is my point, and I think that the hon. Gentleman has agreed with it.

Mr. Snow

Yes. I shall elaborate on it later. I hope that the House will be patient, because quite a substantial number of views have been expressed, and I may have to speak for some little time.

I was saying that there are even some conditions which do not fall easily into any category. For example, the Ministers of Labour and Social Security are primarily concerned with questions of sheltered employment and the financial consequences of not being employed. They naturally apply tests of employability and the economic effects of such handicap. Quite small disabilities, in terms of ordinary living, may have disproportionate effects on earning capacity or training for suitable work. Quite serious disabilities may hardly affect, say, a professional man's earning capacity.

In health and welfare, the problem is what personal service is required—whether it be by doctors, nurses, medical auxiliaries or social workers—and what marks off some people as needing special attention. My own Department's interests and definitions therefore tend towards those with limitations of ordinary way of living, whether they are sick—that is, whether they require the services of a doctor—or not.

Even here, however, the definition will be different for different purposes. For instance, in hospitals it is dependence on nurses—or, perhaps, on the nurse. What counts in other cases may be dependence on continued medical treatment. Again, the question may be limitation of physical mobility or, indeed, the wider problem of the capacity to live an independent life.

The hon. Member for Moray and Nairn spoke of a definition related to prescription charges. For reasons commented on by the hon. Member for Somerset, North (Mr. Dean), this is a complex matter, but one of the main considerations will be that whatever criteria are agreed should be clear, easily applicable by doctors, and capable of being used consistently so that justice is done as between individuals. My right hon. Friend the Minister of Health is confident that something suitable will emerge from the discussions that are now going on with the various professions concerned. It is worth stressing that, numerically, the problem is not so great as it is sometimes supposed to be.

The Government intend that everyone over the age of 65 shall be exempted from paying prescription charges. This category will contain a substantial proportion of people suffering from long-term illness. I cannot elaborate on this point whilst the discussions are continuing, but my right hon. Friend will naturally be making an announcement as soon as he is able to do so about how the exemption arrangements will work. An article in The Times newspaper yesterday, which was rather characteristic of that newspaper's current lack of objectivity, did not help matters at all on the question of the definition of the people who will be exempt from the prescription charges—

Mr. Dean

Can the Minister give an absolute assurance that the chronic sick will not have to pay prescription charges; that some arrangement will be reached by the time charges are introduced generally?

Mr. Snow

Exemptions for the chronic sick will be provided. It is just a question of defining who are the chronic sick. This is the nub of the matter. Of course this is always subject to challenge on a matter of detail, but I do not think the House will find it easy to criticise the arrangements we hope to enter into with the professions concerned. There are always marginal cases.

As to the hospital services, although the Motion refers to the community the hon. Member called attention to the problem of people living in their own homes. I should like to review what has been done in this field by looking at one or two points affecting the hospital services. In parenthesis, I took the point about access to public buildings. Although that is not a matter for my Department, certainly access of the disabled and chronic sick to hospitals is. Although I am quite happy that this matter is currently one for consideration when plans are being processed through the Department, nevertheless I shall see if any reminder is necessary. I do not think it is, because I looked at the problem recently, but I will ensure that new hospitals take this into account.

Because the chronic sick in hospital are for the most part elderly, arrangements for their care and treatment have been considered in general as a geriatric problem. Geriatric departments with assessment and rehabilitation wards are being planned in conjunction with district general hospitals to cover the whole country under the hospital building programme. Since 1959 the number of consultants specialising in geriatrics has risen from 62 to 156. This reflects the efforts being made to meet the greatest needs—those of upgrading, modernising and replacing of existing outdated and unsuitable accommodation, and provision of necessary medical help. By 1970 it is estimated that there will be over 63,000 geriatric and chronic sick beds in total.

Over the 10 years 1956 to 1966 the number of geriatric and chronic sick patients treated as in-patients rose from 110,000 per year to 167,000. Also sig nificant is the rise in the attendances of geriatric and chronic sick patients at outpatient clinics specially held for them—from 24,000 in 1956 to 100,000 in 1966. In 1956 day hospital care for these patients was rare, by 1966 the number of day attendances at geriatric day hospitals was over 300,000.

Figures are sometimes rather boring, but they should be studied because there has been a suggestion in the debate that the position is static. That is not so. There has been considerable progress in the necessary provision. Out-patient and day care are making a significant and progressive contribution to enabling the chronic sick and elderly to remain in the community with a reasonable degree of independence, often in their own homes where they are usually most happy.

Hospitals also have to care for some younger patients—broadly adults from 15 to the age of 59—who have the misfortune to require long-term care for chronic disabilities or illnesses. In recent years we have made some progress, but we have realised that there is insufficient information about the size and nature of the problem posed by the needs of younger chronic sick patients. I emphasise this because the formula; necessary to be designed for carrying out this sort of survey is most complicated. It is not only a question of numbers but a question of the degree and nature of the disabilities and how best they can be provided for.

A survey in 1967 has shown that the number of chronic sick patients in hospitals in the age group 15 to 59 was 4,223 and 224 of these were accommodated for short-term care only to relieve relatives. Not only are their numbers relatively small, but their degree of incapacity, their interests and abilities are very diverse. All this makes it very difficult to group them in sufficient numbers to make it easily practicable to give them special and individual attention with a view to their rehabilitation.

Now that the national survey has been completed, the younger chronic sick in hospitals have been fully identified. This theme of identification has come out in speech after speech. I do not quarrel with that. A great deal more is now known about the needs of the younger chronic sick. We are now considering the form of further advice which may be given to hospital authorities on arrangements for the care of these patients.

As to local authority services, I certainly agree with the right hon. Member for Ashford (Mr. Deedes) about the inadequacy of knowledge as to the size of the problem. This makes our work in the Department and in the associated departments more difficult. It also makes the problem very difficult for local authorities. I quite agree that until we have a great deal more information—information which takes years to compile—we shall not be able to provide as efficiently as we would all like to.

The Motion is comprehensive in relation to local authorities. Their services will include people living in their own homes, remembering that the chronic sick and disabled have the same basic needs, hopes, fears and need for personal relationships as the more fortunate of us. Where they differ is that handicap sets a barrier between aspiration and fulfilment, if indeed it does not weaken aspiration. The aim of all services—and of course especially the health and welfare services should be to help remove that barrier, or lower it, so far as it stands between the individual and independent life for so long as he or she is able and willing.

Just what help each individual needs is continuing assessment, but there will always be some who need more care than can be practicably given them at home. For these sorts of cases the residential home is still needed.

Hon. Members may find that the Health Services and Public Health Bill, which will come before the House fairly soon on Report, is a very comprehensive Bill which touches on many other matters raised this morning. It concerns the introduction into the provision of certain accommodation and services from the private sector. This is a new feature for which Parliamentary authority is now being asked. Hon. Members should study the Bill with great care. Local authorities have increasingly recognised the need for the residential home and the need to get people into their own homes as far as possible. In the last three calendar years a total of 345 homes have been opened, providing 16,300 places for the elderly. Some of these homes have replaced obsolete premises such as workhouses, but most have expanded the total number of places available.

I recently had occasion to visit some of those old workhouses. Some have been modernised and have a wonderful staff attending not only old people but people who are old and sick, but others do not give a very good impression Although long since disused, it is a curious reflection on times gone by that in one or two places I have seen recently I have been shown old gaols where recalcitrant old people used to be put. That of course is something from the past, but many of these old buildings need to be pulled down and replaced by decent accommodation.

Over the next three years, depending on the rate at which authorities actually build and plan, the estimated number of homes to be opened will be at least the same as, and possibly slightly more than, has been going on in the last year or two. As to homes for the younger physically handicapped—that is, people needing residential care—ten homes had been provided by local authorities by 1967; seven more are now under construction or at tender stage, and between now and the mid-1970s local authorities have said that they would like to build more than 40 more. We shall make some progress towards this in the next three-year programme.

May I correct a possible implication arising from something said by the hon. Member for Somerset, North. I thought that he sought to indicate that the provision of new homes which cater for the chronic sick and disabled is likely to reduce in number. This is just not the case. The reductions which have been announced relate to reductions in what had been planned. I draw the distinction here—the hon. Gentleman knows that I have made this point elsewhere—that we may not progress as quickly as we would have wanted but that we shall be providing at a much higher rate than in years gone by.

Mr. Dean

I think the Parliamentary Secretary will agree that what was planned was the minimum that was required to take care of additional old people who need this accommodation and that it is very unfortunate that the cut fell, not only this time, but also last time, on this service.

Mr. Snow

That is relatively correct. I am anxious in this debate not to start making contentious points. Only one hon. Gentleman has done that. Had we had the information and been more alive to the problem, much more should have been done in previous years. I will leave it there, because I want to keep the debate on an even keel.

It is too early yet to say what decisions will be made by local authorities, which have been asked to review their planned expenditure. It seems to us, however, that it is quite truthful to say that the growth in this sort of provision and the average expenditure will carry on at a faster rate than other heads of local authority expenditure. There will, I think, not only be no falling back from the present position, but an actual advance.

The hon. Member for Moray and Nairn mentioned the problem of housing and access to buildings. I have dealt with this point to some extent. I take the hon. Gentleman's point. I was a little surprised that he thought it was so rare to find that there had been such provision of access. We will consider this and see whether any reminder is necessary.

My hon. Friend the Member for Bedwellty (Mr. Finch) and other hon. Members referred to the old question of the alleged low cash benefits and the need to review the constant attendance allowance. I am authorised by my hon. Friend the Joint Parliamentary Secretary to the Ministry of Social Security to say that the Minister of Social Security, in reply to a Question on 4th December, said that the constant attendance allowance and other possibilities which had been suggested were being studied; that the survey would cover the long-term disabled, and that the whole question of the specific constant attendance allowance is a matter of very earnest and urgent consideration. Until the survey is complete, I would not propose to go further than that.

I turn now to the question of services in the home. It goes without saying that the whole range of community health services is available to the chronic sick and disabled, as it is to others. The clinical leader in this field is obviously the general practitioner, so familiar a figure that I need not dwell on his rôle. However, the family doctor must be supported by nurses, both home nurses and health visitors. I again refer to the Health Services and Public Health Bill, which has dealt very extensively with this subject, not only with the object of producing better services, but to secure a much greater flexibility as between various local authorities and between local authorities and hospitals.

There is, in addition, the question of the home help service. A high proportion of the time of home nurses and home helps is given to those with long-term disablement. I call attention here to the growth, past and planned, of these services, especially of the fastest growing of all, the home helps, a service which was planned in 1965 to grow by nearly 50 per cent. in the following ten years. One problem has been to secure that the fullest use is made of the services of skilled nurses. In 1965 we sent a circular to local authorities advocating the employment, not only of State registered nurses, but of State enrolled nurses and of auxiliary staff, and we gave detailed suggestions for duties which these could undertake to relieve the trained staff. This has been followed up and studies of the success or lack of success of authorities in developing in this way are being made.

Similarly, also in 1965, a circular about the development of home help services was issued, advocating local studies of the need for the service and the development, side by side with the full-time paid staff, of "good neighbour" services of a less formalised nature. My right hon. Friend the Member for Llanelly spoke most movingly about a new factor in society, that of the isolated community, the anonymous society. He said that we seem more and more to be concentrating on residential areas as opposed to the rural districts with their small spread of population in which was the prevailing situation in which I rather imagine that my right hon. Friend has spent most of his life. It is true that we shall have to review this, not only in the light of the problem of loneliness, but also recognising the positive danger which exists from the lack of communication between people in adjacent properties.

My right hon. Friend also referred to the need to look at a more comprehensive type of office which would bring together all the facilities which are at the disposal of the categories mentioned. I agree with him that we should look to see whether such a concentration of offices could not be established as a matter of policy.

I want to talk a little more about welfare services. Beside the health services stand the welfare services, providing increasingly for the handicapped of all ages. Part III of the National Assistance Act provides a wide range of services giving social support and, providing, for example, meals in the home and elsewhere, clubs, day centres, advice and guidance on how to cope with handicap, various forms of giving practical help, miscellaneous aids and equipment, and adaptations, if necessary, to the home to make it more liveable in. These services, too, are growing, as may be shown, for example, by the growth of net expenditure, which has much more than doubled since 1959, the year in which provision of services was made a duty. Further development depends to a great extent on manpower, particularly trained social workers.

I must, however, at this point pay special tribute to voluntary workers, without whose help these and other services could never have developed as they have. I think the House will go along with me in saying that the war-time provision of voluntary aid under the auspices of such great people as Lady Reading was something we ought to maintain in our life. It would be a very sorry day if in any way voluntary services degenerated. In my view, there is, if anything, a bigger rather than a smaller part for them to play in future.

I want to talk about the mentally handicapped. The health and welfare services cater for the mentally and physically handicapped and a duty to provide mental health services was placed on local authorities in 1959. I can illustrate the considerable development since then in a number of ways. The number of places in training centres for the mentally disordered increased from less than 20,000 in 1959 to over 40,000 at the end of 1966, a substantial increase. In 1959, there was very little provision of residential accommodation for the various groups of mentally disordered. By the end of 1966, there were over 200 homes or hostels with more than 4,000 places. Expenditure overall on these services has risen from under £4 million in 1959–60 to about £20 million in the current financial year. Capital investment was at a record figure of £5½ million last year, and I expect to maintain that figure next year.

Now, the question of identification, which featured so much in the speeches today. Certainly, the question of identification is central for all who are responsible for providing services. It is a problem of communication as much as anything else. A wide range of workers in different services are in touch with the handicapped, presenting between them a wide range of possible forms of help. Co-ordinated work and co-ordinated records are means of bringing those who are already known in touch with the services which can most likely help them.

My Department, with the Department of Education and Science, issued a circular in 1966 urging all concerned in the services to review this problem, with special reference to school leavers. The replies by local authorities show that considerable efforts were made to adjust their services. Before considering further the organisational aspects of co-ordination, we must await the report of the Seebohm Committee on the organisation of personal social services by local authorities, which we hope soon to receive. To be considered with it in this context will be my right hon. Friend's forthcoming Green Paper on the organisation of the range of services for which he is responsible. I take the point made by my right hon. Friend the Member for Llanelly when he said that he hoped that, in the future, there would be, as between the National Health Service and local authority services, a closer relationship. I do not wish to anticipate what my right hon. Friend's Green Paper will provide, but I know that he has been thinking about this matter for a long time.

Identification is, however, also an individual problem which is still largely unsolved. Where contact is made, organisation can achieve a co-ordinated result. But contact is often not even desired by many who would rather keep their difficulties to themselves despite their need for help. We cannot, surely, force them to provide details if they want to remain in the background. This is one of our difficulties. But the greatest difficulty is to reach the unknowns who remain so through ignorance of the services which can be provided. Much extra work must be done in that direction. I have no doubt that it will be done. We have learned a lot today which will be considered by the Departments concerned.

As I have already said—this is particularly important in the context of identification—the most important asset is trained manpower, and this cannot be conjured out of a hat. I sometimes think that many of our young people coming out of secondary education now would profit by being given much more detailed information as to the sort of services which can and should be provided by the State but for which there is at present a great shortage of manpower.

It can, however, fairly be claimed that the authorities give proper priority to this task within the resources which they already have. But the increase in the numbers known to welfare authorities over the period since welfare services for the handicapped became a duty shows in itself what a growing problem it is, the more we get to know where these people are and who they are.

Mr. G. Campbell

The hon. Gentleman is discussing identification, but he has not yet dealt with the point which I put to him, namely, the need for identification of the permanently disabled over the country as a whole, with a view to compiling a register. I asked him what was happening in the study by the Government's Social Survey, which was announced on 23rd October in reply to a Question from me, and I hope that he will come to that.

Mr. Speaker

Order. There is a debate ahead. Interventions prolong speeches.

Mr. Snow

If the hon. Gentleman will have a little patience, I shall deal with that.

Mr. Kenneth Lewis (Rutland and Stanford)

Get on with it.

Mr. Snow

I have been told to hurry up. Having listened to three hours of debate in which a good many speeches were made, I am now trying my best both to speak quickly and to cover all the important points which were raised.

Mr. Lewis

This is private Members' day. The Minister has spoken for more than half an hour and the Government already get plenty of time.

Mr. Snow

I should like to know whether the hon. Gentleman's hon. Friends would agree with that attitude.

The number of people registered by local authorities in England and Wales as physically handicapped increased from 86,000 to 163,000 between 1959 and 1966. The register is constantly changing, and 31,000 new names were added in that last year. Within these totals, only 18,000 elderly people were registered in 1959, but the figure was 66,000 in 1966. At the end of 1966, 174,000 mentally disordered persons were under local authority care. The number is increasing every year.

I quote those figures as indices of of activity, not to pretend that the field is covered. The hon. Member for Moray and Nairn said that there is no register as such of the chronic sick and disabled. In fact, local authorities maintain registers, but these are not of Social Security origin, and there is at present no obligation for uniformity in the records. Neither are they complete. The hon. Gentleman is right when he says that there is a sort of embryonic register carried on, but we really have had to start from scratch to take into account the various characteristics of these disabilities.

Mr. G. Campbell

In the Government's Social Survey?

Mr. Snow

Yes. As regards the chronic sick and handicapped people living at home, the Government's Social Survey is now engaged as a matter of priority in planning, together with my Department, the Ministry of Social Security and the other departments concerned, the first major effort to find out the answers. The first pilot schemes will begin soon. I do not want to be too precise today about the final scope, which only the pilot trials can determine. My Department's main object will be to estimate accurately how many people living at home in Great Britain are substantially and permanently handicapped by physical disability.

In view of the other business to come before the House, I feel that I cannot continue to comment on the questions put to me by hon. and right hon. Members. I am sorry that the hon. Member for Ludlow (Mr. More) produced the one slightly acid note today. I am sure that, after a weekend's rest, he will feel better about it. I much regret that the hon. Member for Ilford, North (Mr. Iremonger) used the word "coffin" about the invalid tricycles which we provide. We do more in this country for our disabled people than is done in any other country in the world, and we are always progressing towards improved vehicles. It is a pity that over-zealous criticism should be directed at a service which is appreciated by many thousands of disabled people. We are not static in our attitude. We shall produce better vehicles as research and resources permit, and we are now taking powers—which the hon. Gentleman's party never took—to improve the possibility of providing cars for a greater number of the people concerned. We are trying very hard and, as a country, we have much to be proud of.

I have attempted, rapidly, I fear, to cover most of the major points raised in the debate. My survey is not complete, but time does not permit more. As I said earlier, my hon. Friends the other Parliamentary Secretaries and I will read carefully the record of this debate and will follow up individual points where necessary.

Question put and agreed to.

Resolved, That this House urges the Government to give high priority to the task of identifying in the community those who suffer from severe disabilities or lasting illness and are in need of special help owing to their inability, or much reduced ability, to earn a living and owing to their dependence on the care of others or on prolonged treatment.