HC Deb 16 April 1970 vol 799 cc1705-12

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

10.0 p.m.

Mr. David Winnick (Croydon, South)

Recently the House debated the Chronically Sick and Disabled Persons Bill. I am glad that that Measure received the unanimous approval of the House, and I hope that it will soon become an Act of Parliament.

I wish tonight to speak about one family in my constituency, the Carter family. I want to set out the details of their difficulties. For some years Mr. Albert Carter has been completely disabled. He is unable to drive a vehicle of any kind, and his wife needs assistance. They have four young children. What I want to bring to the notice of my hon. Friend is the need for the family to be given a car, or assistance towards the cost of running a car. I emphasise that the car will not be for Mr. Carter's use. It will be for use by Mrs. Carter who needs assistance. The Carter family live on a large council estate in my constituency, some distance from the centre of Croydon, and my hon. Friend will appreciate that is relevant to the point that I am making.

I first took up the Carter case about four years ago. I wrote to the Minister of Health, who explained to me that, while he appreciated the difficulties of this case, his Ministry was not in a position to help. I continued to write to the Ministry, and last year I wrote to the Secretary of State for Social Services. I should like to read part of the reply which I received from my hon. Friend who is to reply to the debate. He said: Any extensions to the service, such as the more general issue of cars instead of three-wheelers which would result in an increase in the total cost, will I am afraid, have to wait until the economic climate permits. It would be misleading, however, to suggest that the provision of cars through the National Health Service for persons who, like Mr. Carter, would be unable to drive themselves is likely in the foreseeable future. My hon. Friend concluded his letter by saying: Mr. and Mrs. Carter's circumstances certainly command a lot of sympathy and I am indeed sorry I cannot help. I do not for a moment doubt that my hon. Friend and my right hon. Friend the Secretary of State are genuine in their feelings of sympathy and concern. I am sure that they would both very much like to help. But it does not alter the situation that assistance is not being given, and is unlikely to be given for some time. My point is that a car should be supplied for the use of Mrs. Carter or, if that is impossible, that some assistance should be given towards the upkeep of a car. Mrs. Carter is rather fortunate in that she has a car, thanks to the generosity of her sister. Were it not for that she would be in a very difficult situation indeed. However, though she has a car, she receives no financial help from the Department towards its upkeep.

The position is quite clear. If Mr. Carter was being looked after outside the family circle, if he was in some kind of home, if there was no family to support him, the total amount of money which the community would have to spend would be far more than is being spent now.

Mrs. Carter is in special difficulty, with a disabled husband and four young children and living on a council house estate some distance from the centre of the borough. I am, therefore, right in pressing this case, but I appreciate that there are many more people like the Carter family where the husband or the wife is disabled and a car is needed.

As I said, I wrote to the Minister in 1966. I wrote again last year, and I decided to raise the matter again tonight because it seemed that there was hardly any chance that the circumstances in the Ministry would change. My hon. Friend's letter seemed to offer hardly any hope that in the foreseeable future assistance would be given. The time has come for the Department to review its policy. It may be that the Department itself is in difficulties and that we need on the front Bench someone from the Treasury.

I have looked at the Health Services and Public Health Act, 1968, which gave the Minister greater powers. During the passage of that Bill many hon. Members pressed for a wider category of people to receive motor car assistance from the then Ministry of Health. I hope my hon. Friend will be able to say that the 1968 Act is sufficient for this purpose without the need for new legislation. The Department needs money to be able to apply the provisions of that Act.

There are many people who are in the same position as my constituents, and no doubt their Members of Parliament are pressing their cases, but I feel that we do not pay enough attention to disabled people and their families. The Chronically Sick and Disabled Persons Bill dealt in general terms with the disabled, but particular difficulties exist in families where one partner is completely disabled. If there were no Mrs. Carter to look after her husband, the total cost to the community would be far greater.

The House of Commons has an obligation to understand these difficulties and should be willing to spend money to enable them to receive the assistance which they require. The difficulties of a man who is chairbound for the rest of his life will be obvious to us all. If we really want to show sympathy and consideration let us supply the money, so that Mrs. Carter can be assisted with a car or with the cost of running a car, so that her problems can be considerably eased.

10.08 p.m.

The Joint Under-Secretary of State for the Department of Health and Social Security (Dr. John Dunwoody)

I am grateful to my hon. Friend the Member for Croydon, South (Mr. Winnick) for having raised the difficulties of Mr. and Mrs. Carter and for the chance that he has provided to discuss them tonight. The fact that he has done this is an indication of the conscientious way in which he fulfils his constituency obligations and represents his constituents here at Westminster. As he has said, he has been in contact with my Department about this very difficult case since a few weeks after being returned as the Member of Parliament for Croydon, South.

Perhaps I might begin by expressing my admiration for the able way in which Mrs. Carter has looked after her husband and young family for so long. I may say that my Department has been in touch with this family for many years—since the start of the National Health Service, and there are a number of ways in which I am glad to say we have been able to help them. As my hon. Friend knows, Mr. Carter had a powered single-seater road vehicle from us while he could use one, although he can, unfortunately, no longer do so. We have supplied him with any wheelchairs that have been necessary, and the local authority welfare services have also helped the family.

The problem which my hon. Friend has described is ultimately not one of failure to meet our commitments, but rather that the commitments themselves need to be widened; this raises the problem of resources and priorities. I endorse the implication of my hon. Friend that we are discussing primarily a question of resources and priorities.

I always find it depressing to be unable to give something which we could give if the resources available were greater. It is one of the paradoxes of progress that, as we learn more and more, acquire greater skills and provide more help for the disabled, we find that, because of the cost, we have to make a choice between one possibility and another. This is, of course, especially and increasingly true with the Health Service. Technological advance has led to a large number of developments which promote health and welfare, but the better the development the more expensive it often is to provide. There is a consistent improvement in the scope and achievements of the service, but we would all be glad if it could go faster. It is no consolation to the individual who needs help now to be told that his turn will come and that he must be patient.

Our provision for the disabled exemplifies the problem, and when I talk about "the disabled", I am not, of course, talking about some special group, apart from the rest of us, but about ordinary people who just happen to have been denied some of the advantages of life which the rest of us enjoy. We naturally want to do all we can to compensate them and help people like the Carters.

But this brings me to one of the crucial difficulties, that if we do something for one person we must be prepared to do the same for all in a comparable situation. We cannot be selective, because this would, of course, be palpably unjust. This is my answer to many of my hon. Friends who ask that an exception should be made for a deserving case.

Within the context of limited resources, we have to decide which groups of people most need help, and how far we can go to help them. We then have to devise criteria for identifying the groups concerned, and this means that there will be people who are excluded under the criteria. We have to say "no" to some requests for help, because it would be unjust to admit some exceptions and not others, and because in their totality these requests would add up to a greater demand on our resources than we can bear at present.

The present Health Service arrangements for providing powered road vehicles for disabled persons—or for giving some other assistance in lieu—all depend on the disabled person himself being able to drive the vehicle. It is not difficult to understand why this condition should have prevailed from the beginning of the scheme; the concept is that of restoring to an individual as much person physical mobility as it is possible to provide.

I am well aware that this criterion is not perfect, and any criterion inevitably involves a certain amount of hardship for those just outside a group whenever it is defined. But it is a worthwhile ideal and its adoption put Great Britain well to the fore as an enlightened provider for the disabled.

However, I do not want just to talk about the theory behind our objectives and how they should be defined. The practical situation is this: we are able to support our substantial and continually increasing commitment to provide vehicles for the disabled who can drive them but the extension of such issues to people who cannot drive would cost many millions of pounds, at a time when there are a growing number of important developments and pressing demands for other new and better facilities for the sick and disabled.

My hon. Friend underlined the increasing interest that exists in this House in this subject when he talked about the valuable Private Member's Bill which at the moment is being considered in another place.

It has been suggested that we might help the Carter family by exempting their vehicle from excise duty. This sort of exemption is provided under the Finance Act, 1964, which is really not primarily the concern of my Department, but, like the invalid vehicle service which we operate, the exemption is limited to those disabled who themselves drive the vehicle.

The matter has been discussed on a number of occasions in this House and always attention has been drawn to the serious administrative difficulty in extending exemption to vehicles in which the controls are perfectly normal and have not been converted for use by a disabled person.

My hon. Friend has also suggested that we should consider paying a grant towards the Carter's transport, and, although I cannot make exceptions, I think that the general possibility of paying grants in certain cases is a matter which deserves serious consideration when we are thinking of ways to improve the service. I am anxious for all the advice I can get from those personally acquainted with the problems suggesting what improvements they consider desirable. I shall bear them seriously in mind. We can confidently claim to be well ahead of other countries in the provision of free vehicles to the disabled.

Mr. Winnick

I appreciate that this must apply in all cases. I am not arguing that only the Carter family should be assisted, and I went out of my way to make that point. I was interested and encouraged in what my hon. Friend said about grants. Could he say whether it would be possible to make progress reports in two, three, four or five months to give us some hope of progress in the near future?

Dr. Dunwoody

I will be able to answer my hon. Friend's point as I continue my speech, because I want to say a word or two about some of the investigations being undertaken by my Department. I think that we can be proud of our record.

Over the years since 1948 we have seen the vehicle provided for our invalids graduate from a wheelchair with a motor attachment to the present closed purpose-built machine capable of taking its proper place on the highway. The present vehicle is specially designed for the use of invalids not only so that they can enter and leave it with comparative ease, but also so that their personal needs for control devices can be readily incorporated so that many who could not drive an ordinary small car can still be mobile in one of these vehicles.

The prospect improves further as we approach production of the new vehicle which we are to produce with a more powerful engine and automatic transmission. I myself have driven one of the prototypes of this vehicle and like others, have felt that it is another important step forward in seeing that the disabled people have a vehicle which is suitable for their needs.

The vehicle service commands an ever-increasing proportion of our resources. Over the last five years the expenditure on the service has doubled and now runs at £5 million a year. This rate of increase well exceeds, of course, that applicable to health provision generally, and our record in the Health Service as a whole is a good one. It illustrates our deep concern for the needs of the disabled. None the less, I know that improvements are possible, and it was for this reason that I asked for a review of the service within my Department to see what progress could be made, and I know that it is now nearing completion. One must decide to what extent the vehicle service should command additional resources in competition with other parts of the Health Service, but even within the vehicle service itself there are competing demands and priorities.

Apart from the claim that we should provide transport for the disabled passenger, there are other demands to improve the vehicle for those who already benefit from the scheme and the claims of those who receive no help whatsoever at the moment but who are only marginally less disabled than those who get the full benefit of the scheme. Again others ask that we provide cars instead of three-wheelers to those who would be able to use them, but as this must increase the total cost of the service it could only be at the expense of those who at the moment get no help a all.

This is the dilemma that we face. If we extend the service, shall we be able to give a better service to those who have the service already or shall we extend it to those who have no provision at all at present? As an example, one could cite people who are virtually unable to walk not because of something wrong with their legs—an amputation or something like that—but because of some other disability such as a heart or lung condition. We do not at present help these people unless they are working, and yet many of the very worst disabled of them, who are unable to work through no fault of their own, would benefit immeasurably from the mobility that a vehicle would give.

There are other anomalies, too, all of which we shall consider in the course of this survey of the vehicle service which we are at present carrying out. This is a most complicated subject, and I intend to investigate fully all the proposals that have been put to me from many sources before reaching a conclusion.

I am grateful to my hon. Friend for raising this subject and for putting his views so that I can take them into consideration. It gives me no pleasure to repeat that we cannot offer Mr. and Mrs. Carter a vehicle under our vehicle arrangements. I can only hope that they will find some satisfaction in the knowledge that their experience has enabled this House again to recall the obligation and privilege laid upon all of us to ensure that everything possible is done to ameliorate the life of those whom disablement has robbed of basic enjoyments which the rest of us all too often take for granted.

Question put and agreed to.

Adjourned accordingly at twenty-one minutes past Ten o'clock.