HC Deb 04 November 1968 vol 772 cc653-62

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Ioan L. Evans.]

11.42 p.m.

Mr. Gwilym Roberts (Bedfordshire, South)

This is a very wide subject, and my hon. Friend will, I am sure, forgive me if I sometimes stray beyond the province of his responsibility and will pass on any relevant remarks to his right hon. and hon. Friends.

The difficulties of tackling the problems of the disabled are very great. First, there is the statistical difficulty of determining how many disabled people there are. I appreciate that some figures are available—for example, the 650,000 on the Ministry of Labour register—but it is a complex problem and not easy to determine the numbers involved. It is suggested that in Britain probably 1½ million people, and perhaps even 2 million people, have some form of disablement of one degree or another.

The second difficulty arises from what I term the absurd British attitude to disablement in that in this country, and perhaps only in this country, we categorise people according to where they were disabled and who they are. A war-service disabled person, for example, is in a different category from a civilian who has been disabled, and a major is in a different category from a private in the same regiment. Disablement in this country is largely a matter of who a man is and where he was unfortunate enough to be disabled.

The benefits can vary enormously. There is the whole spectrum, from the man receiving full disablement to the housewife who gets virtually nothing if her husband is at work. This often results in men being driven from employment to stay at home to help their disabled wives.

The only answer to the disablement problem is to provide a universal disablement pension. We may not be in a position to do this now, but after next January, when we expect more statistics to be available, we may be in a position to consider this type of disablement pension, the value of which should be related only to the level of disablement. That level is, itself, difficult to determine. In some countries it is measured purely by loss of earning capacity. Other criteria apply, such as loss of environmental benefits and so on. We might consider these factors. Already in some countries—for example, in Sweden—there is what is almost a universal disability pension of this kind. An urgent task for the Government next year will be to provide something universally for disabled people in this way.

The problems of the disabled are not purely financial. They have a multitude of other problems, the cures for many of which are the responsibility of local authorities. There is, for example, the provision of housing, toilets and special facilities of this type. If we are honest, we will admit that the whole position is extremely unsatisfactory from this point of view. Few local authorities—I know of only one or two—are providing special toilets for the disabled. Many local authorities are providing homes for the aged but are doing little, if anything, for disabled younger people. The provision of these facilities has been left too much in the hands of local authorities, or local authorities have too many permissive and too few mandatory powers in this matter.

There is also the question of transport, particularly the problem of the wheelchair. There have been several instances in my constituency where the machinery relating to wheelchairs is too cumbersome. We need more wheelchair clinics. Dastardly tricycles are offered as transport to the disabled and I had the experience of driving one of these during the summer. According to the local Press, the machine almost carried me away into someone's garden. The sad fact is that these machines are not capable of carrying anyone away. They limit people to travelling within a small radius of their homes. They are completely unsuitable and it is commonly believed that the majority of people who receive these tricycles could equally well receive and operate small cars which would have the advantage of being communal vehicles so that the disabled could be with their families when travelling. The cost of this is perhaps £40 million, with possibly another few millions later. There is adequate money from many sources for this.

The great need is for co-ordination. There must be co-ordination between Government Departments. Vehicles for the disabled in the South Bedfordshire area can only be serviced at St. Albans, which can be 12 to 15 miles away, almost beyond the range of this type of vehicle. There must be co-ordination between the Government and local authorities to provide grants for additional services. For example, a ramp has not been provided for the disabled outside Luton Central Library, which means that they are barred from using the library. There is another establishment, in Leighton Buzzard, providing a sound system for the disabled, based on loop hearing aids which has a multi-directional system. At present the Ministry is still providing most people, except children, with unidirectional aids. Here again we need co-ordination with local authorities, hospitals and family doctors.

The great need is to provide, as soon as the statistics are available next year, some universal pension, based on disability level only. We must stimulate and push local authorities into doing a great deal more for the disabled. There must be co-ordination between all the activities. The plank on which the hon. Gentleman and I were elected, on which we have fought through the years, is that we are a party of priorities. I submit that the disabled and their problems have a top priority.

11.53 p.m.

The Under-Secretary of State for the Department of Health and Social Security (Mr. Julian Snow)

I am very appreciative of the care which my hon. Friend the Member for Bedfordshire, South (Mr. Gwilym Roberts) has taken to give me notice of certain points he wished to raise tonight. It is always a help, because it enables one to give a better reply.

The term "disabled" includes both those handicapped by congenital deformity or by accidental injury. It includes those struck down by a crippling disease or disabled by continuous and chronic illness. It also includes a number of persons with special problems, the blind and deaf, for example. If I pass over their problems it must not be assumed that I am not very conscious that we must do more to help that category. Aspects of our efforts to deal with the many facets of disablement are the concern of Departments for which my right hon. Friend the Secretary of State for Social Services is not directly responsible. There are the closest links between Ministers of various Departments and I will try to take up as many as possible of the various points raised.

My hon. Friend has spoken of the difficulty of identifying the disabled and estimating their numbers. I answered a Question this afternoon on this. A survey is being carried out, and we hope that it will be in a publishable form within two years. Of the two hundred and fifty thousand questionnaires sent out 87 per cent. replied, which is very satisfactory. Of the large number who responded 11,000 handicapped people are now being given personal and more detailed interviews to elicit more information. Questions are being asked about their experience of and need for welfare and other services, about their financial position, the suitability of their housing, about employment and other matters and tests of disability will be administered.

The results of this survey should become available during the next two years, and we expect them to provide us with a great deal of information about the disabled which has never been available before, and which is essential if we are to plan sensibly and economically for the future development of services which will help them.

Financial provision in other countries is often drawn to our attention, as did my hon. Friend tonight, but a good deal of confusion can arise because they use abroad different terminology, but do not necessarily make better overall provision. The Swedish basic disablement pension is not radically different from our long-term sickness benefit. What is different in Sweden, and this is due at least in part to different social attitudes, is the treatment of the uninsured housewife. The Swedish housewife who is so badly disabled as to be incapable of doing her own housework gets a disablement pension in her own right; but her husband does not have his benefit increased for her as a dependant. Although we have traditionally worked the other way round, the preparation of new plans is going ahead, and as the House knows a White Paper outlining the Government's thinking on the future development of our social security provisions is to be published in the fairly near future.

My hon. Friend has referred to the problem which disabled people face in gaining access to public buildings. The attention of local authorities has been called to this in a number of circulars explaining their powers, and a British Standard Code of Practice, in the drawing up of which Government officers participated, has recently been published.

My hon. Friend referred particularly to public buildings in Luton, especially the Central Library. My information is that porters are available at the library ready to give assistance to anyone in need of help. The council is neverthe- less examining the problem again as a result of representations which have been made.

Reference has also been made to the question of dwellings for disabled people. Under the Housing Act, 1957, this is a local authority responsibility; the Ministry of Housing and Local Government has from time to time issued advice to authorities on the design of suitable dwellings for the physically handicapped. Housing authorities can help by designing some of the ground floor accommodation and bungalows they build for old people so that they are equally suitable for occupation by the physically handicapped. Though disabled persons can best be provided for in purpose-built dwellings, local authorities might often find it difficult to satisfy the demand in this way. There are ways of overcoming this, however; for example the ground floor of blocks of flats can be designed to meet the needs of the disabled, especially wheelchair users.

Powers under Section 29 of the National Assistance Act include the adaptation of dwellings to make them easier for disabled people to live in, or for relatives and others to care for them at home. Such adaptations are the provision of handrails, the replacement of steps by ramps, the widening of doorways to allow a wheelchair to pass through, or the provision of a ground floor bathroom and lavatory. All local authorities possess powers to adapt existing buildings for the general classes of the physically handicapped.

My hon. Friend referred to the fact that many of these powers are permissive, but I think there is some misapprehension here. For the past eight years local authorities have been under a duty to exercise their powers under Section 29 of the National Assistance Act, in respect of persons ordinarily resident in their area who are substantially and permanently handicapped by illness, injury or congenital deformity. The selection of priorities must nevertheless be decided locally by people who are familiar with local resources and needs. It is desirable that my Department should, as far as possible, confine itself to issuing advice and guidance, and by means of meetings and circulars to encourage the adoption by all authorities of the practices employed by the best of them.

I come now to the question of vehicles. My hon. Friend was guilty, perhaps, of a little exaggeration on one or two points. He spoke of what he called the dastardly tricycle, an expression which did not commend itself to me. Many people who are critics of the tricycle—and, heaven knows, they are open to criticism—forget that one of the all-important factors is access by the disabled person into the vehicle.

Mr. Gwilym Roberts

Has my hon. Friend, with his size—if he will pardon the reference—ever been in one?

Mr. Snow

Yes, I have—not one but several various models. I do not pretend that it is just like driving in comfort in an ordinary car, but, thank heaven, I do not happen to be a disabled person. The fact is that there are so many permutations and combinations necessary to make a vehicle usable by disabled persons that it is impossible to be dogmatic about it. I believe access to be one of the greatest problems confronting us.

My hon. Friend made another point which I did not much like. He spoke of the nearest approved repairer being out of range, or nearly out of range, of some of these tricycles. That is just not so, and I shall be happy to demonstrate to my hon. Friend that it is not by reference to figures relating to the range and capacity of these vehicles.

My hon. Friend suggested that disabled people should all be provided with cars instead of invalid three-wheelers and that the increased cost should not deter us from this. It would be unfortunate if all whose disabilities entitled them to a vehicle were offered nothing but a car because many of them would be unable to enter a small car, or, having entered, to drive it. Some of them would under the rules be able to choose a car if they wanted one, but no car can, for all the help which our doctors and technical experts give, be made suitable for them.

The invalid three-wheeler has been designed and continually improved to cater for just such people. It has easy access, convenient stowage for a wheel-chair, a large uncluttered interior, and, above all, light steering with facilities for the grouping of controls to suit the physical limitations of each individual.

Perhaps at this point, with the wit of the staircase, as the French say, I may remind my hon. Friend that we offered facilities to Labour and Conservative Members of the House of Commons Disabled Drivers Group to go and look at these vehicles when they were at the party conferences. I am sorry that my hon. Friend did not take that opportunity.

Mr. Roberts

I have tried them out.

Mr. Snow

My hon. Friend did not go to that particular demonstration.

We take great care to provide independent mobility for disabled people. That has been the whole basis of the provision of vehicles, it has been the formula which we have accepted, the social contract which we have undertaken, which provides a far better service for disabled people than is available in any other country of the world.

The three-wheelers are criticised because they are unconventional and different from the vehicles to which most people are accustomed. It is only by making them different that so many disabled people can be given personal transport. We have gone further in providing free vehicles for the disabled than anyone else in the world has done. But technology advances and standards rise, and the improvements which we have already made—better brakes and heating are two examples—cannot for long be envisaged as more than evidence of our determination continually to improve the vehicles which we supply. Next year, we shall incorporate a new and better suspension. After that, we shall move to larger engines and automatic transmission. I do not know whether my hon. Friend has tried out the prototype vehicle with automatic transmission. I can tell him that it makes a world of difference.

There is, however, a limit to resources, and there are many claims on them. It would be irresponsible, therefore, to say that financial considerations are irrelevant to the provision of vehicles. If we chose to spend more money on this service, we should have less left for other equally deserving people in need.

We have approved repairers, who, whilst I would not say that they are within the range of 100 per cent. convenience of the disabled people concerned, are strategically located. Small repairs can be carried out by any local garage, and reasonable repair bills will be met by my Department.

We should perhaps think for a minute about the question of co-ordination which my hon. Friend raised. It is not a new problem, but we are taking substantial steps to provide better co-ordination of the various services. I agree that they must be examined and the whole situation reviewed. It has long been recognised that it is not good compartmentalising the problems of the disabled and saying that we shall tackle them one by one. When a disabled person seeks help he needs held with all his problems at once. We have given a good deal of thought to the problems of co-ordinating the various services, problems which arise because of the different functions that must be exercised.

There have recently been two major examples of our intention to improve the co-ordination between different parts of the services for handicapped people. During the summer the Report of the Seebohm Committee was presented to Parliament. The Government are carefully considering the Committee's recommendation that services now administered separately should be brought under one unified control and administered by a single new local authority department. The views of the local authority associations and others are being sought. Only last week the Department of Health and Social Security was created by merging the Ministries of Health and Social Security, thus bringing together two of the most important facets of assistance for the disabled, and giving formal recognition to the fact that disabled people and their families very often need help not only from one source but from a number. It is the Government's policy to make it easier for people to get the help they need without going to half a dozen different places.

My hon. Friend finished by more or less implying that there are out-of-date hearing aids which do not have multidirectional reception. I agree that some public buildings are being wired with a loop induction system for use with hearing aids fitted with an induction coil. National Health Service "Medresco" hearing aids do not have this facility, except one model provided specially for children being educated in establishments wired with the loop system. Because the number of public buildings so wired is increasing, the new "Medresco" aid now being developed for general issue will incorporate this facility.

If I was perhaps a little terse or dogmatic in replying to my hon. Friend about invalid tricycles, it is because I have given considerable thought to this problem. As I said earlier today, my right hon. Friend the Minister of State is receiving a deputation from the Joint Council on Mobility for the Disabled shortly, and I have suggested certain problems that might be raised. There must be limitations, because of the limitations of resources. We must be certain that people can use the vehicles, and not all disabled persons can get into an ordinary car.

I am very grateful to my hon. Friend, in spite of my rather quick reaction to his criticisms, for raising this point, because it is important to put on record certain things about tricycles and to elaborate the Government's plans about co-ordination.

Question put and agreed to.

Adjourned accordingly at ten minutes past Twelve o'clock.