HC Deb 21 November 1968 vol 773 cc1683-94

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

10.6 p.m.

Mr. Lewis Carter-Jones (Eccles)

It gives me great pleasure to have the opportunity of raising this subject on the Adjournment, because it is very near and dear to my heart.

One of the most remarkable features about this subject is that the people who stand to gain most seem to be those who are prepared to give the most and who think that the Ministry is compassionate. However, they would like the Ministry to be a little more compassionate and to have a long cool hard look at some of the newer technologies which can be used for the benefit of the disabled. Secondly, the disabled would like the Treasury to have a long cool hard look at value analysis, because these people are being called a burden on society when they can make a great and vast contribution.

Before I develop my theme, I should say that I have done a fair amount of research work on it. I pay tribute to the Library of the House of Commons for the information which it has given me, but I am dreading tomorrow morning and subsequent mornings because since the subject for this debate was announced I have been inundated with material. It was Confucius who said that it was better to light one small candle than to grumble about the dark. What I am after tonight is an extension of the number of candles and more effective candles to assist people in need.

I put this matter under three broad headings. First, nobody in the House would argue the morality of it. Everyone would accept that it is morally right to do something for these people. Secondly, I know that it is technically possible to give far greater assistance to them, but I do not think that as yet the technologies are fully understood by the Ministry concerned. The design of some of the devices in the engineering sense is to say the least, out of the Ark. They may well be functional, but they are nowhere near as good as they should or could be. However, I shall leave that for a future discussion.

The next aspect of the argument with which I should like to deal is the one which will probably cause most trouble: from where is the money to come? I shall strongly argue that we should not be worrying about where the money will come from but analysing how much money society will save if this matter is dealt with effectively and positively. If we assist the disabled, young and old, we may well be surprised at the saving to the Exchequer. My great worry is the absence, as far as I can make out, of any real attempt by the Treasury to make a value analysis of this field of social welfare. I know that my hon. Friend the Minister of State is a great believer in helping the underdog, no matter of what colour or creed. I hope that he will persuade his right hon. Friend the Minister and the Treasury to look at this matter carefully.

The first class about whom I want to talk are those people who can use sophisticated techniques to overcome the most severe handicaps. I hope that my hon. Friend will bear with me while I say to him that in the Gallery tonight we have a paraplegic who cannot move—

Mr. Speaker

Order. The hon. Member must not call attention, even indirectly, to the presence of strangers, otherwise, as he knows, I shall have to take drastic action; although I am in complete sympathy with the case that he is advancing.

Mr. Carter-Jones

I apologise for that lapse, Mr. Speaker; I am sorry.

The person referred to, however, is far from being a liability to society. Far from drawing on public funds, he is contributing to public funds even though he is completely paralysed. This is the far end of the range where people use the most sophisticated techniques to assist them, but there are some extremely simple devices which can enable all sorts of quite humble people who want to live alone, but who are too severely handicapped, to be able to do so.

I should like to quote a few examples. It is possible for deaf people to communicate by telephone by writing. The transcription takes place immediately and deaf people can communicate by telephone. If they are happy in these circumstances, why not extend the system? There are some wonderful examples of people who are both deaf and blind and want to live alone who are able to do so because of simple technical devices.

I will not bore the House with details beyond saying that the device in question consists of a bell-push system; instead of operating a bell or a light, it operates a magnetic field. The ordinary simple deaf and dumb person carries with him something small, weighing ½ oz., around the wrist; vibration is set up and he is in touch with someone. This is at the simple end of the range. At the farthest end of the range are the totally handicapped, from one of whom I would like to quote They are not asking for sympathy or indulging in self-pity. They want as far as possible to look after themselves and make a contribution.

I had a rather hard time last week and I was extremely tired. I travelled back via Aylesbury and Stoke Mandeville and added considerably to my journey, but I arrived home a very much refreshed person when I realised the manner in which disabled people, with the assistance of dedicated technologists, were able to overcome their handicaps. I realised how lucky I was with two arms, two legs and two eyes. We, the able-bodied, should have the pleasure of giving to the disabled in the form of a thanksgiving to help them, but it would be a thanksgiving which would be returned many times to us.

The man in question is completely paralysed. His throat is pierced to enable him to breathe. One would have said that here was a man who could do nothing. He cannot move, he is paralysed, he cannot breathe adequately and he has to be assisted. If that man were in hospital that would cost the Ministry between £80 and £100 a week to keep him.

The disabled say we are a compassionate society. We sometimes misapply our compassion. That man is not in a home. He is looking after himself—and he is delighted to be paying Income Tax to help other people. One would have thought that in him there would have been a lot of self-pity. Not a bit of it. Here is his letter, and this was the basis of his complaint: I do approve of the Queen's Award to Industry for firms who export, but I do wish the Government would not start giving the Queen's Award to all the big firms. What about people like myself who have increased our exports by 65 per cent. this year? That would take care on the I.C.I.s and have them beaten. The moment we encourage this sort of person we are well on the way to recovering self-respect in the community.

I take another section of these people, and here, too, we can save money. There are people who want to live alone. Many, because of disability, have to decide to leave their homes and go into institutions sooner than they would like. If an ordinary telephone or a modified telephone at a reduced rate will allow a disabled person or an old-age pensioner to live a little longer where he wants to live, in his home, I think the Ministry and the Treasury ought to value that, because it is very costly to keep people in institutions. If we say that nurses and doctors are valuable people and scarce—and they are—then we can save on their skilled services in nursing and looking after the sick and the aged who could look after themselves, but for those who go into institutions and homes and hospitals, why not, by the application of technology, enable them to do certain things for themselves? If we do that we give them a sense of independence, and we give them a sense of belonging, and we shall save a considerable amount of money, but, above all, we shall, in the economic sense, use scarce skilled labour more efficiently and more effectively.

We are not talking about the year 2,000. We are talking about here and now. We are talking about instruments, we are talking about gadgets and devices which are here now. If we were to use the principle and take advantage of large scale production the Ministry could do very well on this.

I ought to quote, as I meant to quote, a sentence which sums up part of my philosophy. Sir Ludwig Guttmann, former director of the National Spinal Injuries Centre, speaking of his work at Stoke Mandeville, defined its aim as turning the physically disabled into taxpaying citizens. And a wonderful aim it is. We should add to it by enabling the aged and the disabled to cope a little longer for themselves in their own homes when they can, and so make more effective use of limited nursing and doctoring facilities.

I end as I began. This is morally right, it is technically possible, and, what is more, it makes economic sense.

The Minister of State, Department of Health and Social Security (Mr. David Ennals)

I thank my hon. Friend for having raised this subject this evening. It is a subject in which I have a great interest, both because of the responsibilities I now hold in the Department and also because I have a very close and dear relative living in my home who is paraplegic. She spent many months at Stoke Mandeville and during that time I had many opportunities of visiting her.

Mr. Speaker

Order. It will help reporters if the hon. Member addresses the Chair.

Mr. Ennals

I had the opportunity on many occasions of visiting Stoke Mandeville while she was there, and I have the greatest admiration for Dr. Guttmann and all his staff, and for all that has been done in Stoke Mandeville.

I will take this opportunity of explaining some ways in which we are applying technology, imagination and skill to assist the aged and disabled. "Aged and disabled" can sometimes mean separate classes of people, but in most spheres with which we are concerned they are closely associated with each other.

Only yesterday I was at Roehampton, the limb fitting centre, where many of the patients were amputees. Over 60 per cent. of those who have lost a limb are over the age of 60, and one realises that the provision of artificial limbs, particularly of legs, affects them very closely. We have recently established at Roehampton a bio-mechanical research and development unit which I visited yesterday. It is charged with the responsibility of itself undertaking and sponsoring officially a programme of research aimed at producing arms and legs that can be provided and fitted more quickly, operated easily and worn with more comfort. One of the major items of equipment of the unit is a computer installed in a laboratory with devices for measuring the way that people walk and the loads which bear on limbs when people walk on the level and up and down stairs. The unit is at present involved in some 20 projects.

Its own most important project, which I was looking at yesterday, is the development of a prefabricated leg which we know as the modular assembly prosthesis, and the main object of this is to allow the production and fitting of a new limb within a very few days in order to prevent the sort of delays that can be disturbing between an amputation and the arrival of a new limb.

The unit is also making progress in the design of total contact and total bearing sockets, aimed at producing a more comfortable fit and a more even distribution of the body's weight on the patient's stump. Perhaps its most important external project is the development of a myo-electric hand, which I was also looking at yesterday, which is operated electrically from tiny signals transmitted by muscles in the patient's arm or elsewhere in his body, and it works automatically when the patient's brain tells the muscle what to do.

Nor must we overlook the research efforts of the major artificial limb contractors with whom we are working. Each one has a small research and development department producing in many respects imaginative and forward looking inventions which the bio-chemical research and development unit is evaluating. One firm has its own prefabricated leg at the stage of patient trials.

A number of techniques are designed to increase the mobility of the disabled. Modern methods and materials allow the construction of buildings in which disabled people are moved about with greatly reduced inconvenience. I remember when my mother-in-law came to live at our house some of the changes that we had to make in order to make it possible for her to move about the house without the difficulty of doors which opened the wrong way, and so on. But we cannot always utilise every device in every building. For example, in a residential home it is generally better to ensure the adequate provision of guide rails which enable the handicapped to achieve the dignity of doing as much as possible for themselves, rather than to indulge in expensive but relatively inessential things like mechanical self-opening doors. Very often with a little thought we can do much to increase the mobility of handicapped people without resorting to the expenditure of large sums, and without relying on complex machinery. Features such as ramps, which are constructed in front of my own front door, can be incorporated in new public buildings at comparatively little cost, but the convenience which they afford to wheel-chair users or the semi-ambulant is immeasurable. The same is true of specialised mobility for particular groups.

The development of the sonic torch for the blind seems to be a wonderfully compassionate use of techniques originated for other purposes. I am following the trials of its potential use with great interest.

A great many people are so disabled that they require either wheel-chairs or powered vehicles to move about. My hon. Friend will know that the powered vehicle generally provided is the three-wheeler, with special categories of people given the choice of a small car. It is true that some invalids are able to drive adapted cars with safety to themselves and others. But what is often overlooked is that many of them cannot. That is why the three-wheeler has been specially designed for the purpose. The very light steering is a characteristic which is unobtainable when two wheels with a space between them have to be turned. This is not a problem when a driver has powerful arms, but is of paramount importance when the arms are weak. Furthermore, the large interior unimpeded by a transmission tunnel permits a person with severe leg handicaps to enter through the large door and settle himself conveniently inside the vehicle.

Mr. Carter-Jones

One of the complaints that I have had is that certain technologists are not particularly happy about the car and the way in which it is controlled. Many of them feel that it can be improved by using some of the new techniques.

Mr. Ennals

That is quite true, and I am glad to tell my hon. Friend that we are making some improvements in the next issue of the three-wheeler. It was only last week that I was looking at the mock-up of the new vehicle which is to come into service. It includes automatic transmission and a number of other developments which will make it a more effective vehicle for the majority of the disabled.

We have made significant advances in the design of wheel-chairs. Inevitably, these are bulky and heavy articles, and our efforts have been directed towards making them lighter, without loss of strength, and easier to control. A new type of metal tubing has permitted the introduction of light-weight chairs, and we have introduced electrically-powered indoor chairs which the patient can manoeuvre with his fingertips—a great boon to many. Last week, I opened a new limb fitting centre in Oxford and I had the opportunity of manoeuvring one of these mobile chairs which can be moved about the house by the lightest touch of the fingertip.

My hon. Friend has referred to an experiment conducted by my right hon. Friend the Postmaster-General in Manchester with the help of the local authority. This is fine to provide a telephone link. It was to assess the useful-nes of the device which we call the Portaphone, which can connect two points simplest by plugging the instrument into the main, so providing a link between a disabled person and a friend or relative. Unfortunately, mainly for technical reasons, the experiment did not have the success for which we hoped. Partly for that reason, but also to gain wider knowledge, my right hon. Friend has asked Essex University to make a study of the need of elderly people to communicate in this way, with special reference to the possibility of a low cost telephonic device.

Meantime, the Supplementary Benefits Commission, in calculating benefits, will take into account the cost of a telephone where one is regarded as essential. Similarly, in some cases local welfare authorities may be prepared to help with the cost of a telephone.

There are devices aiding communication which are of the greatest value and which can be provided for all who need them. They range from the simple call bell to the electronic communication and door-bell device for the deaf-blind. My Department has provided some of the equipment for this latter device and participated in trials of it which I believe have enabled most of those likely to benefit from it to do so.

Taking communication in its wider sense, there are the marvels of the computerised production of embossed literature for the blind, the photographic enlargement of print for those with reduced sight, and the so-called "talking book" for those with or without sight who are unable to make use of ordinary books. These open the world of literature and knowledge to very many people.

Many aids for the disabled are relatively simple. As regards appliances, ranging from splints to calipers, I have only to mention the word "caliper" to recall a period of nine months when I had to use a caliper on one of my legs at the same time as I had to wear my arm in an aeroplane splint for two years, giving me an opportunity of learning something of the difficulties of people who are permanently inconvenienced. They range from splints, calipers and footwear to surgical corsets and hosiery. We recognise that we must ensure that these share in the general technological advance. Probably the greatest progress has occurred through the substitution of new materials for old. Many appliances are now made of perspex and polythene instead of blocked leather and stainless steel.

Over the past year or two we have been experimenting with the newer plastics in such appliances as toe-raising fitments. There are also experiments in using plastics for surgical footwear, moulding it around plaster casts on patients' feet to give a more comfortable fit and a speedier delivery.

Some people above all others, perhaps, deserve our compassion and help—those who are almost totally disabled. It was with some of these in mind that my hon. Friend raised this subject. There are some who, a few years ago, could not do anything for themselves. Many of them are not old. Perhaps they have become paralysed from poliomyelitis—as has one very distinguished and courageous young woman who lives in my constituency—or through an accident. Because of their comparative youth, they have been filled with a burning determination to show their independence.

A quite remarkable invention called Possum has made this possible. It is an electronic device which is operated by the patient's mouth. By sucking or blowing through a tube connected to the Possum machine the patient can operate a number of household articles. He can switch on an electric fire or the television or radio set. He can open or close an electrically-controlled door, dial a telephone number, operate a book page-turner, use a tape recorder, and so on.

This person, long totally immobile, is able, simply because he has breath in his lungs, to live again. There is a standard arrangement for him to sound an alarm buzzer if he is in trouble. It is difficult to imagine what a blessing this device is both to the patient and to those who care for him.

The equipment is provided centrally by my Department, and with the ready co-operation of local welfare authorities, who consider the needs of the patient in his or her home, over 100 very severely disabled patients have so far been provided with such equipment. There is no reason why anyone who is in need of such a device should not have one. It would enable him to make actions that he cannot now make.

We have been considering this evening the compassionate application of technology, and I hope that I have shown that we are conscious of the need to apply the fruits of technological advance to assist the disabled, and that we have made much progress in that direction. I do not want to suggest, because I have listed so many of the things in which we are involved, that we are for a moment complacent. When, yesterday, I was at the institute and laboratory at Roehampton, I was excited by the enthusiasm with which the doctors and those assisting them were applying not only their technology but their compassion and their knowledge of the patients to see that incapacitated people could lead a fuller life.

With all its faults, the service provided in this country for the aged and disabled rivals, if not surpasses, that of any other country. I assure my hon. Friend, to whom again I express thanks for his compassion and the work which he has done on this subject, that we will continue our efforts to improve it and that I regard it as one of my responsibilities in the new Department in which I have the honour to serve to try to carry forward the cause of the aged and the disabled in the best way that we can.

Question put and agreed to.

Adjourned accordingly at twenty-five minutes to Eleven o'clock.