DISABLED PERSONS (ATTENDANCE ALLOWANCE) (Hansard, 27 July 1971)

§ Mr. Dick Taverne (Lincoln)
I want to raise briefly a matter of some importance that is entirely different from the last issue raised by my hon. Friend the Member for Penistone (Mr. John Mendelson). It concerns the administration of the constant attendance allowance, the introduction of which was seen by hon. Members on both sides as a much-needed measure. At the same time, I think it was realised by many of us that there were difficulties about defining those who were to be helped, and that inevitably many people would be disappointed when they found that the allowance did not come to them because their circumstances, however sympathetically viewed by anyone else, did not qualify under the tests laid down.
But a case has arisen in my constituency which suggests that the allowance provisions are being given an interpretation so narrow as to have become an absurdity. I have written to the Minister giving the facts of the case, which I shall briefly outline to the House now. It concerns a Mrs. Crickmore, the wife of a fireman. She suffers from multiple sclerosis, and her condition has gradually worsened over the years. Her husband has looked after her for over 25 years. She is now quite unable to help herself, and needs constant attendance. I have seen her, and all she can do is move around with difficulty in her wheelchair. For everything else she needs help—to get up in the morning; to get washed and dressed; for cooking, eating, drinking, and medical attention; to clean her house; and to read. Someone else has to open the newspaper for her. The one thing she can do without turning over the page is the Daily Telegraph crossword, which is laid out in front of her. She needs help for the wireless to be turned on or off, and, although she can lift up the telephone, she cannot reach it before it ceases ringing, because of the difficulties of getting there in her wheel chair, and she cannot dial.
She receives assistance from a district nurse and a voluntary help, and, above all, from neighbours, while her husband is at work. She is blessed with very helpful neighbours, to whom I pay tribute. 531 There are lilting machines to help her get into bed, her husband has arranged for a hoist to help her get into their car, and the Multiple Sclerosis Society is helping to provide her with a constant alarm system at night.
This seems to me to be obviously a case of someone needing constant attendance. The only time Mrs. Crickmore does not need it is when she is asleep, and there must be very few people who are never awake. If ever there was someone who would appear to come within the definition of the need, she is such a person.
When I discussed the case with her husband previously I said that at least she would be helped when the constant attendance allowance came into operation. It would not be anything like enough compensation for all the expense which her husband had incurred, but at any rate I thought that there would be some compensation. We then learnt that the allowance had been refused. This was a bombshell not only to her husband and her doctor but to me, because I never envisaged that the provision could be so narrowly drawn that such cases would be excluded. Her doctor says that she is right at the top of the list of disabled and that if she were more disabled she would be a hospital case. So I cannot understand why the allowance has been refused. There is no appeal except on a matter of law. There is provision for a review if there has been a mistake of fact, ignorance of material facts or a change of circumstances.
I thought it important to raise this matter in the House because it puts a question mark over the whole scheme. I ask the Minister how many people have applied for the allowance; how many people are likely to be helped by the allowance; and what are the criteria under which a case like this can be refused assistance?

§ The Under-Secretary of State for Health and Social Security (Mr. Paul Dean)
I am grateful to the hon. and learned Member for Lincoln (Mr. Taverne) for raising this matter and for his persistence throughout the night in order to be able to do so. I will deal first with the general questions he asked and then say 532 something about the case to which he referred.
This is a new allowance. Incidentally, it is called the attendance allowance as opposed to the constant attendance allowance, which is somewhat different and which exists in the War Pensions and Industrial Injuries Schemes. This is a new venture in dealing with the disabled. It has been supported by both sides of the House, and I think it can be fairly said that the preceding Government and the present Government are joint authors because a great deal of the preparatory work was done by the previous Administration.
We regard this as a very hopeful first step in providing more help for those who are badly disabled, the civilian disabled, than is now available. We have estimated—it can be no more than an estimate—that up to 50,000 of the most severely disabled people will be drawing £4.80 a week from December on top of any other benefits to which they may be entitled. Therefore, for the first time the disabled people outside the War Pensions and Industrial Injuries Schemes will be getting a benefit of their own. I emphasise that this allowance is a start. We hope that, having felt our way and having dealt with the most severely disabled, we shall, in the light of experience gained, be able to extend the allowance.
What are the criteria on which the allowances are based? There are two mainly. The first—and here I quote from the Act—is that a person must be so severely disabled physically or mentally that he requires from another person, in connection with his bodily functions, frequent attention throughout the day and prolonged or repeated attention during the night. However, this requirement, clearly would not cover all severely disabled people, particularly the mentally disabled. As a consequence, an alternative requirement is that a person must be so severely disabled physically or mentally that he requires continual supervision from another person in order to avoid substantial danger to himself or others". The hon. and learned Gentleman asked how many people and what sort of people are likely to qualify. The sort of people expected to qualify correspond approximately with those described in the inquiry carried out on behalf of the Department and others by the Social 533 Survey Division of the Office of Population Censuses and Surveys as falling in the two top categories of most disabled people. The results of the inquiry were published in "Handicapped and Impaired in Great Britain." The survey suggested that there were 24,000 such people over the age of 16 living at home. To these have been added children from the age of two and adults living in residential accommodation—possibly up to 50,000 people in all.
There would, however, be severely disabled people needing a lot of help by day who would not qualify. Some would require some help at night, but not enough to satisfy the requirements of the Act. We have been working on the basis that up to twice as many people might claim—100,000 in all. So far—and I emphasise that these are early days and the allowance does not come into payment until December—there have been some 30,000 claims, and the process of assessing them is in its early stages. Therefore, it is not possible for me to give the House any relevant figures of the number of successful claims that we are likely to have by December of this year.
I come to the way in which the procedure is working on the initial work by the patient's general practitioner and the way in which the Attendance Allowance Board itself is proceeding. The Act provides for the medical requirements to be decided by the Attendance Allowance Board set up under the Act. The Act provides for up to 10 members; at present there are eight members, including one lay member. A board of this size could not cope with all the claims expected in the six months which we have allowed to deal with them before the first payments go out in the week commencing 6th December. The Act gives the board power to delegate its functions in individual cases to medical practitioners.
The board has appointed as delegates medical officers of the Department and medical practitioners experienced in war pensions and industrial injuries boarding work. It is not possible for these doctors to see the claimants, and, in general, they rely on a report given on a comprehensive report form by the disabled person's doctor. Where the board or the board's delegates are not satisfied that 534 the requirements of the Act are met the insurance officer has no alternative but to disallow the claim.
I come to what follows from that, and this is directly relevant to the personal case raised by the hon. and learned Gentleman. The claimant's right to apply for a review or to appeal are set out on the notice of disallowance sent to him. Against the insurance officer's decision there is a formal right of appeal to a local tribunal, but the tribunal has no power to award an attendance allowance where the board is not satisfied that the medical requirements of the Act are met. There is no right of appeal on the medical issues themselves.
A board consisting of the best qualified people, medical and lay, having been set up, it would not be possible to appoint a higher tribunal. However—this is the significant point—there is a wide-ranging right of application for a review. The Act provides for review on the grounds, usual with benefits of the National Insurance Act, of relevant change of circumstances, or ignorance of a material fact, or mistake as to a material fact. Additionally, however, the board may review on any ground—for example, mistake as to law or error of judgment—within three months of the original determination.
Mrs. Crickmore was advised of her right to apply for a review and we assume that she wishes to do so. She will be visited as soon as possible by a doctor, not her own, and she and her husband will have the opportunity to make their observations to him. Her case will then be re-submitted to the board. If the board is unable to make a decision in her favour, copies of all the documents will be sent to her and she and her husband and other representatives will have the opportunity to make further observations upon them before the board makes its determination. I am sure that the hon. and learned Gentleman will appreciate therefore, that it would not be right for me, now that this case is being reviewed by the board, to comment further on it.
In this short debate, I hope that I have been able in the first place to reassure the hon. and learned Gentleman about the working of the new allowance. Equally, I hope that I have been able to assure him that the case of Mrs. Crick-more, for whom and for whose family we 535 all have the utmost sympathy, is being examined with care and sympathy.

§ Mr. John Biffen (Oswestry)
On a point of order, Mr. Speaker. We learned from the "tape" last evening that, in the view of my right hon. Friend the Home Secretary, we are now engaged in "open war" in Belfast. I wonder whether any indication has been given to you that our proceedings should be allowed to continue in order that we might debate the issue which the hon. Member for Belfast, West (Mr. Fitt) wishes to raise.

§ Mr. Gerard Fitt (Belfast, West)
Hear, hear.

§ Mr. Speaker
No such indication has been given me.

§ The Parliamentary Secretary to the Treasury (Mr. Francis Pym)
rose in his place and claimed to move, That the Question be now put.

§ Mr. Fitt
On a point of order, Mr. Speaker. I now have Tellers——

§ Mr. Speaker
Order. The Tellers' names must be put in before the Question is put a second time. So the Ayes have it.