CHRONICALLY SICK AND DISABLED PERSONS ACT

HC Deb 21 May 1971 vol 817 cc1663-758

11.4 a.m.

Mr. Lewis Carter-Jones (Eccles)

I beg to move, That this House calls on Her Majesty's Government and local and other authorities to ensure full implementation of the Chronically Sick and Disabled Persons Act, 1970, at the earliest possible date, particularly in view of the report on impaired and handicapped people in Great Britain. It is now about 12 months since what has become known as the Alf Morris Bill went through this House, following which it went to the other place. In my view, not enough progress has been made on it in the past year. It would not be an exaggeration to say that progress has been abysmally slow.

During the Bill's various stages, its supporters gave the House estimates of the number of disabled people. We were told constantly that they were too high. However, it is significant that on what is almost the first anniversary of the Bill receiving the Royal Assent, we have available a report entitled Handicapped and Impaired in Great Britain, about which we heard a great deal during our debates on the Bill and which shows the true position. It is clear from that report that our figure was a gross under-estimate and that the problem is more severe than we realised.

The second difficulty that we faced inevitably was the financial one. We were told that this would be an extremely costly exercise. I agree. I have said for some time that the Chronically Sick and Disabled Persons Act is a time bomb which is ticking away in our town halls. At the same time, I am not as pessimistic as some right hon. and hon. Gentlemen opposite about the total cost. The trouble with Government Departments is that they always talk in terms of cost. They never seem to look at the other side of the balance sheet.

We are delighted to see the Secretary of State in his place this morning. I know that his presence indicates the measure of his interest in the subject.

When the right hon. Gentleman is told by Treasury officials and other sour souls what a costly business it is to help the disabled, perhaps he will draw their attention to a Stationery Office publication which I have brought along this morning. It is one of a series of C.A.S. occasional papers entitled "Current Issues in Cost-Benefit Analysis". If cost-benefit analysis methods were applied properly, in my view it would become clear that the total cost of taking care of the disabled is far lower than has been made out to be the case. Those of us who said when the Bill was passing through the House that the numbers of disabled persons were high have been proved right. However, I hope that the right hon. Gentleman will accept that, if a careful study is made, what we are asking for will not be as costly as he may think.

Perhaps I should begin with the local authorities, the people who will be mainly responsible for the implementation of the Act. In some parts of the country, we see a pleasant picture. In other parts, we see a bad picture. Good local authorities should be praised. But the bad local authorities really are abysmally bad, especially when it comes to identifying the chronically sick and disabled. The position is even more disgraceful when we consider the sort of money that they spend.

It has become clear, from replies that I have received from the right hon. Gentleman's Department on the money spent on disabled people, that the record of some local authorities is bad year in and year out. When the right hon. Gentleman comes to consider issuing another Circular to local authorities, I hope that he will not give what I regard to be a shocking inducement to them by telling them that they need not get 100 per cent. identity. Local authorities which are not doing their best must not be allowed to get off the hook. They need to be chased and chased until they implement the Act.

Authorities like Oldham and Surrey consistently and progressively spend more and more on their disabled people. Surrey now tops the record for the county councils and Oldham for the county boroughs. This is good. They should be encouraged; they should be praised.

Unfortunately, authorities like Salford, on the one hand, and the Isle of Wight, on the other, are consistently at the bottom of the list. They seem to have no appreciation of the real suffering which is going on. From time to time I am told that voluntary organisations are working in this area. What makes people think that there are no voluntary workers in Surrey or in Oldham? The voluntary society argument cannot be accepted. The voluntary societies still have an important part to play, but the local authorities must accept the major responsibility for tackling the problem.

The saddest thing of all is where a local authority seems to be becoming more aware of the problem, spends more money, and then suddenly says that it will cut the rates, and the best way of cutting the rates without anyone knowing about it is to cut the services for the disabled. This is an absolute tragedy. This is the worst case of all, because one feels that a break-through has been made, but then they turn their back on the problem.

The classic case is Oxford which was setting a first-class example to the country in caring for the disabled by the amount that it was spending on them. Oxford's expenditure rose to the magnificent figure of £12,000 per 100 disabled people. Then there seems to have been a rush of blood to the head or a massive economy campaign because the next year the figure fell to £4,000 and if that was not bad enough, the following year it fell to £2,000. It is disgraceful to save money at the expense of the weakest in our society.

When it comes to implementing the Act we are told by local authorities, "We have not been given any money for this special purpose" They are hiding behind the anonymity of the rate support grant. I believe that the right hon. Gentleman's major duty today is to spell out to local authorities that in the rate support grant this year he has allocated money for the implementation of the Chronically Sick and Disabled Persons Act. Local authorities ought to be told loud and clear that when the rate support grant was calculated the implementation of this Act was taken fully into account.

One reason given for the Act not being implemented has been the reorganisation of the welfare services into social services departments. It is like saying, "We cannot send the lifeboat out to save people, because we are painting it this week." That is how bad the situation is. For local authorities to say that they will not implement the Act because of reorganisation is absurd and unacceptable.

I remind the right hon. Gentleman that we had a fairly large Committee on what was a substantial Bill, but there was no Division on it. Therefore, it was accepted by the then Opposition and the Government of the day, and I hope vice versa now. If we have legislation which we do not want to sec implemented, we should vote against it. If we do not vote against it, if no Whips are put on and it gets on the Statute Book. 'then, without doubt, it should be fully implemented as soon as possible.

In reply to a Question about how much money was being allocated, the Under-Secretary of State said: No proportion is so allocated, though the Rate Support Grant Order as a whole allowed for appreciable development, over the next two years, of services for the chronically sick and disabled."—[OFFICIAL REPORT, 30th March, 1971; Vol. 814, c. 333.] My plea to the right hon. Gentleman is that, when he sends out his next circular, he should insist that local authorities fully appreciate what is going on and what has been done.

It might entertain—"entertain" is hardly the right word—it might reveal to the House the indifference and lack of imagination which can sometimes be shown if I mention two cases which have been given to me this week.

If a local authority is asked to provide a ramp for a disabled person because he cannot get out and that ramp is not provided, then, in my view, it is guilty of imprisoning him without trial. If one person was imprisoned who had not been sentenced properly or was found to be innocent, no doubt all hell would be let loose. But we have hundreds of thousands of people tucked away in their houses who cannot get out because of the lack of ramps.

I will illustrate a simple classic case. A lady has written to me saying that she has a spastic girl of 14 and a mentally handicapped girl of 19. Her problem is that the spastic child cannot get out. The Warrington local authority has said that it will put in a ramp for her, but that it will cost £45. This is a reasonable assumption. It is possible for wealthy families with mentally handicapped and spastic children to afford that sum. The tragedy is that this lady's husband had been unemployed for 11 months, because he broke his leg in seven places. He had gone back to work only three to four weeks previously. Yet the local authority concerned, knowing the provisions in the Act, insists upon imposing this tremendous burden on this family.

I will illustrate another example of lack of imagination. I pay tribute to certain civil servants in the right hon. Gentleman's Department. The right hon. Gentleman knows that for some time I have been taking an active interest in the application of advanced technology for the disabled. The officials in the Department have been absolutely first class and done everything within their power to help.

The second case I wish to illustrate concerns a severely disabled man living in Huddersfield who has a Possum unit which has been provided by the Department. That man, who is completely immobile, is anxious to take a degree in English, but he needs a radio. The Possum unit has an interface to take a radio but the local authority has refused point blank to provide him with one for what, on the face of it, seems a good reason. The local authority has pointed out that he has a radio. So he has, but he cannot operate it because he is completely paralysed. He can only use his radio for his studies if it is connected to the Possum unit.

Mr. Laurie Pavitt (Willesden, West)

Will my hon. Friend explain what a Possum unit is?

Mr. Carter-Jones

It is the application of technology in such a way as to enable someone with a minimum amount of residual movement to operate a machine and control his environment. If any hon. Members have seen this equipment in action they will know that a very severely disabled person can control his environment and be at an advantage over those of us who are fit and able.

Perhaps I had better deal with the cost-benefit part of the argument now. The cost of providing this equipment to a disabled person and thereby getting him or her out of an intensive care unit will be met within a month because the rate for intensive care units is between £125 and £150 per week. If we can get these people home, which is what they want, we not only do that which is morally right, and technically possible, but, in the long run, we save ourselves a considerable sum of money.

I mentioned voluntary organisations, and perhaps those who have worked in this field for so long would like to pay tribute to all the organisations which from time to time feed us with information and keep us up to date with general trends. We have all had a brief—a very good and full one—from the Central Council, which could keep the House going all day. We have had information from the Disabled Living Foundation, from our old friend Mary Greaves from D.I.G., from Peter Large, and from the Mobility Council. They have all made sure that we have received the fullest information, and as a result we realise that there is an urgent need to do something for these people.

We are not able to cure the disabled. The problem is not always a medical one. It is a problem of welfare, and of understanding welfare. If we can bring about an increase in understanding, in appreciation, and in sympathy, we shall, in the long run, go a long way towards improving the quality of life in this country as a whole. We talk about fall-out. The fall-out of good will resulting from the implementation of this Act will do the moral fibre of this country a lot of good.

I turn for a moment to the problem of the employment of disabled people, and here I make one plea to the right hon. Gentleman. He will find that his Department has a rehabilitation officer in only one hospital. He is at Stanmore, but his job is under risk because it looks as though there will be a take-over bid for his services from the Department of Employment. He is doing a job of work which, in the long run, saves the country a vast sum of money.

When someone meets with an accident, or suffers a severe illness, the first thing that has to be done, apart from giving him medical treatment, of course, is to reassure him. If an employment officer immediately visits the patient and says to him, "You have this illness, but we have had no end of cases like yours, and the people concerned have gone back to work", and he then visits the man's employer to see that everything is all right from that angle, very often it means that the patient can be discharged from hospital much more quickly than would otherwise be the case, and he can again become a real, lively working element in our society. I ask the right hon. Gentleman to try to extend the service to more and more people.

Mary Greaves says that we ought to try to provide education opportunities for children who are disabled early in life so that they can earn a living when they grow up. It may be said that this is a problem for the education service, but it is not, and I hope that the hon. Member for Ipswich (Mr. Money) will have an opportunity to take part in the debate, because I think that he can cite a particular case. If a severely disabled person is to be able to earn his living and to be educated, he has to rely on local authority welfare services, and the part of the Act dealing with that aspect of the problem must be implemented.

Lady Hamilton was kind enough to produce some information for me which illustrates some of the difficulties faced by the disabled. Of the 74,000 people involved, 4 out of 10 who are employed say that their disability has forced them into a job in which their qualifications are not used. They therefore have the double handicap of being disabled and being unable to get a job commensurate with their attainments. This problem should be pursued by the right hon. Gentleman. He may say that 'to do so would bring him into the realm of other Departments. That is true, but his right hon. Friend the Prime Minister clearly told me that there would be co-ordination between all Departments for the purpose of dealing with this problem, and that is why I have raised the matter today.

Perhaps I may now turn—my hon. Friend the Member for Willesden, West (Mr. Pavitt) anticipated me a little—to consider the possibility of solving the problems by means of technology. The Central Council for the Disabled has set up an Orthopoedic Equipment Research Centre at Stanmore to study the use of newer materials to help crippled people. It is a tragedy that leg irons of the kind which some of us saw being used by children when we were at school, and which our grandfathers before us saw being used, are still being used, yet we can put a man on the moon. We have all sorts of gadgetries, but nobody has got round the problem of producing and using new light-weight boots for supporting the leg. This is a matter which has so far been ignored, and perhaps the right hon. Gentleman will agree that it is the voluntary societies who have made a great contribution towards trying to solve this problem.

The report from Amelia Harris raises a difficulty which we often tend not to discuss, but I intend to speak about it today. There are in this country about 200,000 disabled people who live in houses which have outside toilets only. My hon. Friend the Member for Liverpool, Walton (Mr. Heller), with his interest in building, will no doubt say that the answer is to build more houses and thereby relieve the unemployment problem in the building industry. I agree with that, but that solution is bound to involve a time lag.

It may be said that we should modernise the houses and put in an inside toilet. The difficulty, however, is that many of these houses cannot take an inside toilet. That being so, we should realise that the technology of chemical lavatories has advanced, due mainly to people taking caravan holidays, and that, for a very small sum of money, it is possible to provide a perfectly good toilet inside a house, one which is acceptable by all the standards laid down for public health, and thus prevent the unfortunate tramp outside which disabled people have to undertake to perform their ordinary natural functions. It is as simple as that. The problem requires only imagination and a sense of purpose to solve it.

Earlier on I spoke about ramps. It is always assumed that one needs a concrete mixer and four labourers to lay down a ramp at great cost, and that the ramp has a great degree of permanence about it, with the result that when the disabled person has passed away, or been admitted to hospital, another bunch of men have to go down to the place to tear up the ramp. In fact, all that is necessary to solve the problem is a little imagination. New materials are available, and the cost of providing a ramp tan be reduced. All that is necessary is to use expanded metal. It can be put clown in 20 minutes and, if it is necessary to take it. Up again, it can be unscrewed and taken away to where it is required for someone else.

I now propose to refer to the possum unit, because I think that if we can demonstrate to society that the most severely disabled can live at home with their families, can continue to be educated, and in many cases can go to work, we may well crack the biggest problem relating to the physically disabled. It is here that the Possum unit has a great part to play, but again we come up against the problem of communication.

A population of 3 million or 4 milion is bound to be reasonably homogeneous. In London, we have four regional hospital boards. If one lives in the South-West Metropolitan area, one has a four times better chance of getting advanced technological help than in the north-west area. But if one lives in Wessex, tough luck. In that area, serving nearly 2 million people, it has not dawned on them that this equipment can play a vital part in helping the severely disabled. Only title machine has been prescribed in the whole of East Anglia.

The lack of information can be overcome, and the right hon. Gentleman can assist with publicity and money. I should know about these items, because I have been working on research in this field for about four or five years. Yet I sometimes talk to doctors who do not know the items to which I refer. The Disabled Living Foundation has a unique permanent exhibition of aids for the disabled, where professional people can see what is available. There is also an information retrieval system by which instant solutions to difficulties can be provided. We need many more of these centres so that the knowledge of what is available is made more widely accessible to the public.

I feel like a bowler who has been pushed up by his captain in the batting order. I am not having to open on a sticky wicket, because I hope that the Secretary of State will respond to us. I would pay tribute to everyone who helped to get the Bill through, particularly the captain of our team, the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris).

If there is a recipe for the disabled, it is a touch of sympathy, a dash of understanding, a lot of imagination, and the whole thing topped off with immediate positive action. The Secretary of State can play a very important rôle in this field. I hope he will.

11.33 a.m.

Mr. Ernie Money (Ipswich)

Every hon. Member would wish to pay tribute to the hon. Member for Eccles (Mr. Carter-Jones) both for his good fortune in the Ballot and for the obvious sincerity, skill and knowledge with which he has presented this matter. Equally, we are all delighted to see in his proper place on the Front Bench the hon. Members for Manchester, Wythenshawe (Mr. Alfred Morris), the originator of this important legislation.

I hope that I shall not embarrass the hon. Gentleman by mentioning the occasion when he was the first recipient of the Harding Award for services to the disabled, when he made a statement of great importance in the interesting paper which he presented on that occasion: There is no saving of public money in failing to provide adequate local services for the severely disabled. Those in local government who think otherwise confuse apparent cost with net cost. By attempting to save small amounts of ratepayers' money they waste a far greater sum of taxpayers' money. A severely disabled person who is not assisted to live in his own home often has to be institutionalised at a far greater cost to public funds. The hon. Member for Eccles referred to a case in my constituency, a girl called Sally Baker, who is 10 years old and severely paralysed. She attends a special school in the Eastern Counties and, through the foresight of the Medical Officer of Health for the county borough of Ipswich, it has been possible to acquire for that child a Possum typewriter at a cost of about £500. The difference which that typewriter will make to her future life is unimaginable. If we were to approach this in the most selfish terms, the difference that it will make to the taxpayer is many thousands of pounds.

That typewriter means that Sally Baker, instead of being a charge on the State for the rest of her life and a potentially institutionalised person, someone who would never be able to fulfil herself, now has the alternative of learning to express herself and fulfilling a proper rôle within the incapacities which the hand of nature has laid upon her.

This is basic to the whole approach—that this generation are starting to learn that there is no difference between the disabled and ourselves, except that we are fortunate enough to have all our physical capacities. It is against that background that we should approach the problems of finding full expression and opportunity for the large number—estimated at as high as 3 per cent. of the entire population—of disabled who face these difficulties.

Employment is one of the most essential factors in this whole problem. The most important thing, which is dealt with in Section 18 and other Sections of the Chronically Sick and Disabled Persons Act is identification. In dealing with this problem, an adequate register of disabled people, and adequate training and training opportunities for those dealing with registration and resettlement, are absolutely vital.

I should like to pay tribute to the work done by disablement resettlement officers in many individual cases, but these are simply members of the staff of the Department who are put into that job for a certain length of time and are likely to be promoted into another job as soon as possible. How can they build up a specialised knowledge which is so often necessary to deal with problems of this kind? How can they acquire an insight into disabled persons' problems?

In my following remarks I am in no sense criticising the holder of an important office in my constituency. The resettlement officer's office is situated at the top of a long flight of shiny stairs which it is impossible for the disabled to ascend. The disabled must either make an appointment and be visited in their homes or ring the bell at the bottom of the flight of stairs and be interviewed in the corridor of the building by the resettlement officer.

I have been disturbed by the results of my inquiries into the facilities available for training youth employment officers. During the full-time course of training for the youth employment service at Swanky in Kent, some reference is made to, among others, the deaf pupil as part of a one-day session, and there is also reference to the needs of the handicapped person. There is some further reference to this aspect in discussions. The other full-time courses at Manchester, Reading and Birmingham provide no more than this in their syllabuses. How, with the best will in the world, can any youth employment officer deal with the special problems involved in placing the physically handicapped, and particularly the deaf, on that sort of training?

Even more serious is the situation of the handicapped boy or girl who is leaving school or university and seeking entry into a profession or white collar job. Time and again in the past it has been found that the mere existence of a disability has proved a bar to entry into such a job. The presence of the hon. Member for Stoke-on-Trent, South (Mr. Ashley) proves how little of a bar it really is.

Unemployment among the disabled in Britain is in what can only be described as a critical condition. Despite the admirable work that is done by the Disablement Employment Register, it is unable to cope with the situation. Although there are 600,000 names on it, many other disabled people now feel that it is not worth applying, as they have no prospect of work even though their name is on the register.

It is a tragedy that disabled people always seem to be the first to be dis., charged or made redundant when there is a cutback in staff. In a debate of this kind, when hon. Members in all parts of the House are so closely allied in their interest in the subject, I do not want to introduce a political note. I must, however, point out that S.E.T. undoubtedly had side effects on the employment of disabled people. Tragically, in many instances those who-find it most difficult to find employment are the first to lose it, often because they are doing light work and other tasks which employers consider they can do without when they have to make financial restrictions.

We tend to forget how desperately important the mere fact of employment is to the disabled. People with their limbs intact overlook the psychological importance of the disabled having a job to do, so being able to feel that they are playing a full part in society. Indeed, we also forget the converse; how desperate the disabled feel when they are unable to find employment and are constantly seeking work.

One of many letters received by the Central Council, from a war pensioner in the West Country, dealing not with pensions but with finding a job, brings this point home. He wrote: When it comes to seeking some light part-time employment to supplement my income, this is no joke. To tell any employer in this area that you are a registered disabled person is like signing your own death certificate. In January 1970, owing to my disability, I had to go into hospital for a general check up, with promises galore from my employer of my job always being safe, and that I had no fear of not having a job to come back to. I had been in hospital for five days when my wife received by post my insurance cards and income tax form. I had been dismissed—not even a letter giving me a week's notice or any pay. I was dismissed because I was ill and disabled. The letter went on: I do not ask for charity in any shape or form, but just for a chance to do a job of work, and this requires employers to relent and say 'Yes' when people like myself apply for a job, instead of giving the same answer all the time, which is 'No'. It is right to pay tribute to the work that is provided both by Government organisations like Remploy and the special sheltered workshops provided by local authorities. These are admirable institutions but one must consider how few of them there are and how much more scope exists for them.

In my constituency we do not have a Remploy factory. Indeed, one is not available between Southend and Norwich. Thus, for the whole area of central East Anglia the only form of sheltered work available is in the excellent sheltered workshop at Granville Street in Ipswich, which I have visited on a number of occasions. My hon. Friend the Under-Secretary of State for Employment told me in a letter: What you say about the limitations imposed by the present premises entirely accords with the latest report of our Inspector. Quite clearly, the premises are unsuitable for development and restrict the number of severely disabled people who can be employed there. In fact, only 30 can be employed in this institution, and there are insufficient car parking facilities near the premises.

The constant problem facing organisations of this sort is their dependence on sub-contract work and the difficulty of finding work for even the number of people for whom they have room. It is in this context that one must remember that on 4th December of last year the number of unemployed registered disabled persons in the Ipswich and East Suffolk area was 306. In other words, 306 disabled people were queueing up to try to find work from an organisation which can take at the most about 30 and which, even then, is not necessarily always in a position to give them full-time employment because of the absence of sub-contracting work. I hope that I shall be excused using the opportunity of this debate to urge my right hon. Friend to reconsider the question of Ipswich having a Remploy factory.

There are two other aspects of this problem with which I must deal, although I appreciate that many hon. Members wish to take part in the debate and that time is short. First, I hope it will be possible for the law officers or the Home Office to take a careful look at what I consider to be one of the meanest and cruellest frauds—I call it a "fraud" deliberately—to be practised on this section of the community. I refer to the number of manufacturers and marketers who are employing small numbers of disabled persons, groups of two or three, to help in packing their own commercial goods which are then sent round via door-to-door salesmen in various parts of the Eastern Counties giving the impression that the goods are being sold for or on behalf of the disabled. It would be hard to think of anything more despicable, and I hope that something can be done about it very quickly.

The other aspect refers specifically to access. There is here so much that depends on good will, because although Section 8 of the Act was able to provide for future buildings, it is impossible so to provide, except in certain specific cases, for the provision of proper access to existing buildings. We have here a situation in which, in some curious way, local authorities, which are in many cases sensitive about these matters, seem to forget that disabled people pay the same rates as the rest of us but who are yet, to adopt the simile used by the hon. Member for Eccles, imprisoned by the difficulties of vehicular access. I hope that local authorities will turn their attention in this respect to their museums, their existing libraries and their theatres.

One of the things that touched me on this matter was what was said by a disabled lady who came to see me about specific problems in Ipswich which have now, I am happy to say, been dealt with. She started by saying to me: "I hope that one thing I may be able to persuade you about is that we are not a race apart: we do not appreciate or enjoy the arts any less than those who have their legs."

As we are fortunate today in having with us the Secretary of State, I add the plea that as soon as possible this matter can be reconsidered so as to give more opportunities for the use of four-wheeled vehicles, on the basis both of humanity and of the nightmare that some of us have had at the back of our minds ever since, in a recent Adjournment debate, we heard of the plight of the haemophiliac in the three-wheeled vehicle. Road safety, commonsense, and long-term advantage to the Exchequer are also involved.

I began by quoting a happy case in my constituency—that of the child, Sally Baker. I end by quoting another case, very well known to me personally, which is less happy. There is in my constituency a young man of considerable intelligence, in his mid-twenties. He holds O levels in mathematics and bookkeeping. He has the misfortune of being a spastic, and has very bad muscular co-ordination. Although I would place this particular friend, Brian East, among the more intelligent people I know, the best that society has been able to provide for him has been work in the spastics work shop cutting up firewood or filling bottles with liquid.

There are times when the conscience of a whole generation becomes suddenly very shocked by what it finds in its midst. The last member of my family who sat in the Commons sat at such a time. He was the hon. Member for Wooton Bassett, and sat in the period of William Wilberforce. I hope that I shall be fortunate to sit in a House which, having taken up the torch that was lighted by the hon. Member for Wythenshawe and other hon. Members who sponsored his Bill, will see that in future a further degree of justice goes to people like Brian East.

11.55 a.m.

Mr. Jack Ashley (Stoke-on-Trent, South)

It is a pleasure to follow the hon. Member for Ipswich (Mr. Money). I am particularly glad that he dealt with the problem of the unemployment of disabled people, because this is a subject close to my own heart. He quite rightly underlined their plight, and it is particularly important that this debate should emphasise that aspect of disablement.

The number of disabled people who are unemployed is five times the national average, and it is of paramount importance that the 50 per cent. of British employers who are failing to employ their quota of disabled people should fulfil their obligation. Fair too many permits are being distributed to allow employers to continue without employing their 3 per cent. quota. I endorse the view that in this respect there should be much closer liaison between the various Ministries involved.

I do not want to pursue that theme too far, but I am firmly convinced that the time has now come for a complete reassessment of the whole system of subsidies in respect of disabled unemployed people and whether the subsidy should be given to all unemployed disabled people. No one would be dogmatic about the solution, but I believe that a thorough-going and deep-seated Government inquiry should be made into the whole problem of subsidies for the disbled.

I congratulate my hon. Friend the Member for Eccles (Mr. Carter-Jones), not only on initiating this debate but on displaying in speaking of the human problems of disabled people that eloquence which we have all come to expect from him. Personally, it is always a delight for me to listen—if I may use that word—to my hon. Friend on the problems of disabled people. He sees the disabled, he feels for them, he respects them and he understands them. There can be no substitute for this kind of concern. He has done us a great service this morning, not only by initiating the debate but by presenting his case with reasonableness, moderation, conviction and great persuasion.

It is quite obvious that some of the euphoria which followed the passage of the Act has now been dissipated, and we should frankly recognise that fact. Euphoria has been replaced by anxiety and, regrettably, by recrimination. It would be unreal to expect the unanimity displayed by us all when the Bill was passing through the House to continue. The great virtue of this debate is that it offers us an opportunity of hammering out differences of opinion.

There is good will on all sides of the House, but there are clear differences between back benchers and Government and between individuals as to the solutions. We all want to do all that we can for the disabled. This is our opportunity to hammer out these differences and to create some kind of unified approach to implemehting the Act. It is in that spirit that I want to offer some constructive criticisms to the Minister.

I hope that some of the answers we get will be different from those I received from the Under-Secretary, who I am sure is listening attentively, when I sent him a number of letters from disabled people a little while ago. The main burden of the hon. Gentleman's answer was that they were out of date. I know that there were other explanations in the hon. Gentleman's answer, but if that is to be the attitude of some of the Ministers I propose to offer some up-to-date criticisms and not criticisms which are one or two months old. I hope that careful consideration will be given to the criticisms, which will be levelled in a co-operative and constructive spirit.

To be fair to the Secretary of State and to the Under-Secretary, they have always given the most careful consideration to the objections which we have raised to the way in which they are implementing the Act, although we must acknowledge that there are differences between as.

On the key issue—that of the 100 per cent. register—the Secretary of State and the Under-Secretary have given the most careful consideration, although I regret to say that they have given disappointing replies. The question of 100 per cent. registration is tremendously important. The Secretary of State will recognise this, because when I attended a deputation to the right hon. Gentleman as Chairman of the All-Party Group on Disablement we put our case to him very forcibly for the 100 per cent. registration of disabled people. Since then, in correspondence with the Under-Secretary the case has been made time and time again, but we have got no further.

Yet the case is profoundly important, particularly as some local authorities are registering only two per 1.000 disabled people as compared with 12 per 1,000 by some other local authorities. This underlines the need for a 100 per cent. register.

Further, some local authorities are allocating less than £1 per disabled person, although other authorities spend £70 per disabled person. These discrepancies should be taken into account.

The Government have made the important pronouncement that the 100 per cent. register is as much their aim as it is ours. This is an advance on what the Government said before, and I warmly welcome it. But the Government said in a sense that the disabled need and want to be registered. The proviso is added that the Government regard a 100 per cent. register as a difficult, expensive and time-consuming exercise, and unfortunately they have emphasised to local authorities that a 100 per cent. register is not a requirement of the Act and that identification is not a requirement.

I have told the Under-Secretary that the youth leaders of Stoke-on-Trent have assured me that they can compile a 100 per cent. register of 250,000 people in Stoke-on-Trent in less than six months relatively free. This is a clear categorical offer which has been made by responsible people. This offer should be placed against the Government's claim that it would be a difficult, expensive and time-consuming exercise.

I put that offer to the Government. In his reply the Under-Secretary put forward some arguments which I believe that the House should take carefully into account. I hope that the House will also take into account the rebuttals of the Government's argument. I recognise that there are no magic wands to be waved and that the whole exercise will take time. We must be realistic and understand the Government's difficulties.

The Government's first answer to this wonderful offer, which -I hope will be taken up and repeated in every city and town in the land, was that there would be considerable problems using voluntary effort in mobilising and deploying voluntary workers and in giving them guidance so that they could make an accurate assessment of the difficulties involved.

There is little substance in that objection. I believe that the Stoke-on-Trent offer was typical of the youth officers of many towns and cities, so I do not believe that there would be any great difficulty in mobilising voluntary effort to undertake this exercise.

I believe that the question of guidance is not a difficult one. Simple guidance could be given to the voluntary workers. They could take groups of people in simple but clear categories. First, they could get the category which is completely confined to their beds or to their chairs—people who are almost totally immobilised. Second, they could get groups of people who are confined to their homes. Third, they could get the rest of the disabled people. These would be three clear categories not requiring substantial or sophisticated guidance. So I do not believe that the first objection has any validity.

The Government's second objection was that each identified disabled person would have to be visited afterwards by someone from the social security—by skilled workers, in other words—and that, because there is a shortage of skilled workers, this would involve depreciating the efforts made for the disabled who are at present recognised by the Government.

I do not think that an impossible burden would be imposed if the method I have suggested were pursued, because, providing that the Government went for the top priority groups of the most severely disabled people, there would be no disproportionate call on resources.

The recent survey referred to by my hon. Friend the Member for Eccles has underlined the urgent need for registration; because, although 16 per cent. of the very, severely disabled, who are registered receive no services from the health and welfare authorities, which in itself is a shocking figure, 41 per cent. of those who are not registered receive no help at all from the service. This is a disgraceful figure. Forty-one per cent. of those who are severely disabled and not registered receive no help primarily because they are not registered.

The Secretary of State for Social Services (Sir Keith Joseph)

Has the hon. Gentleman any evidence to support his contention that the reason these people receive no services is that they are not registered? I do not know of any evidence for that proposition.

Mr. Ashley

I was hoping to draw the Secretary of State on that. The evidence is circumstantial. If it is a fact, as he will acknowledge, that 16 per cent. of those who are registered receive none of the health and welfare services, and if it is also a fact, which I assume that he will not deny, because it is in the OFFICIAL REPORT, that 41 per cent. who are not registered received no health or welfare services, it is a reasonable assumption that those who are registered have an opportunity of enjoying the services nearly three times better than that of those who are not registered. That is a logical deduction from the official figures which have been quoted.

I want to move on to a completely different category of objections by the Government to the question of the 100 per cent. register. They say that to register people would be to raise false hopes which could not be sustained. I do not accept that argument for a moment, because hopes have been raised already by the passing of the Act. The only reason why all the disabled people did not toast the passing of the Act in champagne was that they could not afford champagne. They are members of low-income groups. Only people like Ministers could afford champagne, and it was with them that those of us who helped with the passing of the Act celebrated. By and large, disabled people could not celebrate in that way, but they were delighted with the passing of the Act, so the hopes have already been raised.

Even more important, an explanation that the Government have limited resources and will be allocating them to those in greatest need would mean there would be no raising of false hopes.

I hope that the Government will think again about the vital problem of registration. Despite the Secretary of State's view, I am totally convinced that it is only by discovering all the disabled people that we can assess our priorities. When we have done so, we can be certain in our own minds that the Government resources are being allocated in the best possible way for those in greatest need.

Other hon. Members wish to speak, and I have no desire to take a disproportionate amount of time. But I should like to speak for just a few minutes about specific Sections of the Act in which I am particularly interested. The House will know of my interest in Section 24, dealing with an institute of hearing. I am not interested in it because it would benefit me personally, because unfortunately I am beyond the help of the medical profession. But the Section may help future generations, and I believe that it can be one of the many memorials to the Act. When I first proposed the Clause, it was strenuously opposed, even by some of my hon. Friends. It was represented to us that perhaps the Medical Research Council would object, that perhaps the Government would be establishing an unacceptable principle. So I discussed the then Clause, as I discussed every Clause, with my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris). He urged me to press ahead with it because of its value, and after those careful consultations the Clause was pressed and was accepted by the Government.

I am now delighted to find that the Government are consulting all the authorities and individuals that are interested, and are collating evidence. That is a tremendous step forward. I urge the Government to make the evidence available to the Medical Research Council as soon as possible, because only then can the M.R.C. come to a reasoned conclusion on whether such an institute is advisable. The sooner that matter is settled, the sooner we shall end the uncertainty in the minds of those working on research for the deaf.

The Secretary of State for Education and Science has been less energetic than the Secretary of State for Social Services in implementing Section 25, concerning the provisions for deaf-blind children. A circular was sent to local authorities last July asking for information about their provisions for deaf-blind children. Today, 10 months later, the evidence is still not complete. This shows a lack of a sense of urgency by the Secretary of State for Education and Science. I remind the House of the figures about deaf-blind children I gave in the Committee considering the Act.

Eight years ago, of 208 children with this dual disability only 92 were in a special school or a unit, and only 17 of them were in units which cater for the dual disability. The Secretary of State should show a greater sense of urgency for those with perhaps the greatest disability of all, children who can neither see nor hear. A delay of 10 months is intolerable. I hope that the right hon. Lady will get a move on to ensure that the evidence is completed before the first anniversary of her circular.

On Section 26, which deals with autistic children, the right hon. Lady has not even got an anniversary to look forward to. She told me last November that she was considering asking for information about autistic children, but local education authorities are still awaiting guidance about them. That means that children who are deprived of normal education facilities are still awaiting specialised help. It is unbelievable that children disabled in that way can be compelled to await the Minister's pleasure. I hope that the right hon. Gentleman will make urgent representations to her on this very difficult problem.

I am glad to say that although the Secretary of State for Education and Science has not implemented Section 27, dealing with children suffering from dyslexia, she announced on 6th May that she is referring the question of the need for guidance to the Advisory Committee on Handicapped Children. That is a major step forward, and I welcome her willingness to seek authoritative advice. I am delighted that she has given an assurance that she will listen both to the experts and to the parents of dyslectic children.

The Act was piloted through the House under the skilled and tactful guidance of my hon. Friend the Member for Wythenshawe. At that time we were all drinking very heady wine, because we were placing on the Statute Book something of immeasurable value to the disabled. But I am afraid that we are tending to fall into the trap of the regarding the "disabled" as a group of people—which they are not. I ask the House to bear in mind that what we are discussing is a number of disabled individuals, each one with a disability of his own. When one reflects on disability, one realises that we are all disabled. Some are deaf; some are blind; some are stupid; some are arrogant; some are selfish. Each individual has a disability of some kind—only, some are more easily recognisable than others. The heart of these debates, which are so valuable, is the recognition of the individuality of the problems.

I hope that, when the Government consider the representations made by right hon. and hon. Members, they will bear in mind that, although we require action on a broad general front, the vital consideration is that they should help individual people who are disabled and that the provisions of the Act are to ensure that, in effect, the disabled shall be given their dignity and self-respect and helped to help themselves.

12.22 p.m.

Dame Joan Vickers (Plymouth, Devonport)

I want to say to the hon. Member for Stoke-on-Trent, South (Mr. Ashley) how much we appreciate his speech and how much I agree with many of the points he put forward, particularly on the question of the register. I am not certain that his solution is the right one, but on the other hand I feel that, with the co-operation of doctors and, in particular, the health visitors, we might be able partly to solve the problem.

I congratulate the hon. Member for Eccles (Mr. Carter-Jones) on his luck in winning the Ballot, and I also congratulate the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris) not only on his Act but on his understanding speech at the Harding Award, which I read with interest.

I think we should remember today Mrs. Megan du Boisson.

Hon. Members

Hear, hear.

Dame Joan Vickers

If it had not been for her, we might not have been having this debate; we might perhaps see that she has a posthumous award. Her vision, her patience, her perseverance and, if I may so put it, her diplomatic bullying won thousands to her cause. The only occasion I have ever spoken in Trafalgar Square was on behalf of the disabled, when I was divebombed by pigeons, which added to the enjoyment of the occasion. Undoubtedly, great progress has been made both in legislation and in voluntary effort, but we must remember that the Seebohm reorganisation is in progress and that this may have impeded the quick action we were all hoping for.

I want to quote what Michael Flanders said: Given enough slaves very few places are totally inaccessible to the disabled but it would be of help if the people and bodies concerned could take steps to make life easier for us and preferably remove them. That is a rather clever suggestion—remove the steps that make life difficult.

I hope that my hon. Friend the Member for Edinburgh, South (Earl of Dalkeith) will be able to return to this House—

Hon. Members

Hear, hear.

Dame Joan Vickers

—and that we shall ensure that the steps are made easy for him, when the occasion arises.

A great deal of work has been done in the Plymouth area. We have a motto there, "Help us to help ourselves". This we do. I challenge any city of comparative size on the work done for the disabled. Not only do we have a home for the disabled—Astor Hall—with flatlets, which cater for 40 people in all, but an hotel on Dartmoor which takes people from all over Britain; we also have a Cheshire home, whilst the Royal Navy provides excellent transport vehicles and takes parties out to sea. Rotarians and others collect disabled people twice a week and bring them to our major centre, where they have concerts or lectures or play bingo and so on. I mention these matters because there must be co-operation between voluntary organisations and local authorities and I realise that the Plymouth local authority has been perhaps a little dilatory, because it spends only 7½ pence per head.

I turn now to the position of the deaf. One of the great tragedies for people who cannot hear is that because they look, as the hon. Member for Stoke-on-Trent, South does, so fit and well, they do not perhaps get the understanding and help that other disabilities call forth. We should press on as hard as we can for consideration of the points the hon. Gentleman put forward.

Housing for the disabled is one of the most important aspects. The hon. Gentleman mentioned the question of lavatory accommodation. One of the difficulties is that this is tied up at present with other measures for house improvements, with the result that if a person puts in a lavatory and bathroom, up go the rates. If the necessary improvements are made to the houses of the disabled, they should not be penalised in this way.

We should also press on with the provision of telephones, as only about one in eight disabled persons has a telephone, yet a telephone is a necessity for people who are housebound. Again, over 50.000 women over the age of 75 live alone and better accommodation for many such people is therefore a very important consideration.

The Disabled Living Foundation has this philosophy: The principal philosophy is that careful study will invariably ameliorate bad conditions"— I think that we must realise that careful study can and will do so— and that in the case of the disabled, study of their environment in the widest sense and subsequent action can return very often opportunities in life which have hitherto been lost to them. That was one of the points brought out by the hon. Member for Stoke-on-Trent, South.

I want now to speak of the position of professional people who are disabled. One is sometimes apt to overlook them. I do not think that they can really be catered for by disabled registered officers. These officers have many duties in other ways and very often are not sufficiently qualified to do this task. I heard the other day of a man qualified to go to university who had written to 14 of them but had found that only four were willing to accept him. The others did not have adequate accommodation. Clause 23 of the Finance Bill says that the amount of tax for a blind person in personal reliefs is reduced by seven-ninths of tax-free dis- ability payments on £100, while under the heading of Amount to be deducted from total income on £130 there is a reduction by tax-free disability payments.

I should like to see for all handicapped persons in the professions who are earning sufficient to pay income tax the same facilities as are afforded to the blind. I was fortunate enough to introduce an Amendment to the Finance Act, 1963, concerning the position of the blind, and I think that the facility would also be of advantage to professional people who are disabled because they, too, have high expenses in their daily life, especially if they wish to travel about.

Travelling is actually becoming more and more difficult for the disabled owing to the improvements in travel conditions. When we had open carriages on the railway which opened straight on to the platform, it was easy to put in a stretcher. Now, we have long carriages with different sections and compartments, very often with tables between the seats, and it is difficult for stretchers to be accommodated in such carriages.

A great many people in wheelchairs have to travel in guards' vans which invariably are unheated. I suggest that where it is possible to notify such journeys in advance the railway authorities could make some particular arrangements. At the moment special access for disabled persons is confined only to the inter-city trains, otherwise travel arrangements are extremely difficult for disabled people. I hope that corisideration will be given to providing one carriage at least in a train from which the seats can be removed and the space made available for the individuals concerned.

I know that my right hon. Friend the Secretary of State for Social Services, who takes a great interest in these matters, has visited the Aids and Information Centre. I feel that too few people know where these aids can be obtained, and it would be a great advantage if this exhibition could travel round the country so that people could be aware of the facilities which are available.

I am also very keen that there should be far more recreational facilities for these individuals. It is an enormous advantage if local authorities and voluntary associations can be encouraged—and there are special organisations such as Task Force to undertake this work—to take individuals out for the day. If it were known where such people lived, by means of a central register, Mrs. Smith or Mr. Jones could be taken out for a drive once a week or every fortnight. We know that in the mental hospitals this is done through the League of Friends. There are always people who do not want to join a club or go to an evening meeting or a handicraft class, and a personal contact such as this with them in their home would bring them in touch with the outside world.

My hon. Friend the Member for Ipswich (Mr. Money) mentioned the West Country in regard to difficulties over the employment of disabled people, and I can assure the House that he was not including Plymouth. We have been fortunate that the Royal Naval Dockyard at Plymouth has taken more than its 3 per cent. of disabled which has been a great asset and also we have Remploy and three sheltered workshops. What worries me is that a number of people—and two or three cases have been brought to my notice recently one involving a nearly-blind person and another who is physically handicapped—have not been able to obtain a job after they have been trained. This is a cruel thing to happen. It is no good training a person if there is no hope of them obtaining a job in the neighbourhood. Therefore, I hope that the employment situation may be looked into before a person is entered for a form of training.

If the Government are not moving as quickly on autistic children as the hon. Member for Stoke-on-Trent, South would like, I am happy to tell him that we in Plymouth are opening a school for these children on a voluntary basis.

We know that the grants are going up as the Government give a block grant known as the rate support grant. I understand that in 19717–2 this will amount to 57 per cent. and in 1972–73 to 58 per cent., the remaining expenditure having to be found by the local authority. The agreed estimates for 1971–72—my right hon. Friend will correct me if I am wrong will be £99 million, just under 12 per cent. higher than those for 1970–71, and there will be a further 12 per cent. increase in 1972–73. The Secretary of State intends to give loan sanction of £3 million for the building and engineering of homes and centres in 1971–72. This is an increase over the figure for 1970–71 which amounted to £2.7 million.

I should like to congratulate my right hon. Friend on increasing the grants, and indeed for taking the trouble to come to the House today for this debate. I know that he is doing all he can to persuade the local authorities, in conjunction with the voluntary organisations, to make what we hope will be a new life for the disabled in the future.

12.25 p.m.

Mr. David Weitzman (Stoke Newington and Hackney, North)

No subject demands to a greater extent the utmost parliamentary pressure than the cause of the chronically sick and disabled person. It is a demand which I am sure is supported by all political parties irrespective of political bias. Members of all parties demonstrated their approval of the provisions of the Chronically Sick and Disabled Persons Act when it was piloted through the House so ably by my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris). He was rightly given the Harding Award for his splendid work.

The Act came into force on 29th August, 1970. The Government issued a circular on 17th August, 1970, in which they stated inter alia, It is not a requirement of the Section"— that is, Section 1— that authorities should attempt 100 per cent. identification and registration of the handicapped. Not a very persuasive remark, particularly to the neglectful local authorities.

In December last year I raised on the Adjournment the necessity for the implementation of Section 1, and I was told by the Minister that it was intended to make the order shortly after 1st April. I naturally assumed that that meant that the provisions of Section 1 were to be brought into effect shortly after 1st April, but on 23rd February last the Under-Secretary stated in answer to a Question that an order would be made shortly after 1st April bringing Section 1 into effect on 1st October. Why did he not say so in December? Why the delay? This means that 13 months will have elapsed before the requirements of Section 1 are made compulsory—a clear invitation to laggard local authorities to do nothing. The excuse appears to be that the Government were awaiting publication of their Social Survey, but the facts in that survey show how dangerous such dilatory action has been.

The Government have been invited again and again to draw the attention of the disabled to the provisions of the Act by radio and television, and through the Press, but there is no doubt that many of the disabled were, and still are, ignorant of their rights under the Act. On 23rd February last the Minister, in answer to a Question, stated that apart from the issue of the circular no money had been spent on publicity. Such publicity and the help of voluntary organisations would undoubtedly have brought to the notice of the disabled the provisions of the Act and assisted local authorities in registration. There is no excuse, I submit, for this dilatory action on the part of the Government. They should have mobilised the assistance of voluntary bodies and engaged in the maximum of publicity. When pensions were introduced for the over-80s I understand that £60,000 was spent on publicity, and my recollection is that the Secretary of State himself went on the television to announce what was being done. Why is this not done for the disabled?

It is all very well talking of the big back-load to be caught up, the help from National Insurance benefits, or the help from the hospital services, but what is needed is that immediate steps should be taken to see, first, that the register under Section 1 is completed and dealt with with as little delay as possible; secondly, that the disabled are informed of the services provided; and third, that at the earliest possible moment the Secretary of State gives general guidance and makes the necessary order so that the provisions of Section 2 of the Act may be brought into effect.

There are many other points which I should like to touch upon, particularly in view of the wealth of data in the Report, but I know that there are many other hon. Members desiring to speak, so I will conclude by urging upon the Government—I know how sympathetic they are, and I am sure they are anxious to help—to take immediate action.

In the passage of the Bill, all Government Departments did all they could to assist and the Labour Government made sure that it became the law of the land before the General Election. But it is one thing to have a charter for the chronically sick and disabled enacted, and another thing to see that its provisions are carried into effect. I am sure that the Minister appreciates the gravity of the problem, and that he sincerely desires to alleviate the difficulties of the disabled. But, again, appreciation of the problem and the desire to help are not enough if they are not translated into effect. In my view, the Government had done too little and taken too long to do that little. My hon. Friend the Member for Eccles (Mr. Carter-Jones) has done a real service in choosing this subject for debate and in drawing the Government's attention, particularly in the light of the Report on the Handicapped and Impaired, to the need for urgent action. That publication supplies us with very valuable data.

First of all, I wish to pose the question: what is the number of disabled? There are varying figures. The Department of Health and Social Security has given a figure of 1¼ million, the disabled group 1½ million, and the Spastics Society 2 million. The Government's social survey now estimates that there are 3 milion impaired over the age of 16 and not in residential care. Of these, 1¼ million are so handicapped as to be need of some support. Some 2,000 very severely handicapped live alone without welfare services; 90,000 in the handicapped groups live in similar circumstances. A further 15,000 very severely handicapped rely on husband or wife, mainly elderly, for support. It is further to be noted that the figure of 3 million does not include those under 16 and those in residential care, which means that another million should be added.

Obviously these are very disturbing figures. It is true that many may well be receiving some form of welfare service; but clearly many are not, particularly when one notes that of 500,000 needing considerable support, only 18 per cent. are registered by the local authority.

Section 2 of the Act was designed to make compulsory the provision of welfare services for those disabled in need of them, practical assistance in the home, recreational facilities, help with regard to work, holidays and the use of the telephone. But local authorities are required under the Section to exercise their functions under the general guidance of the Secretary of State and in accordance with regulations made by him. The local authority must know who are the disabled who require their help. Section 1 is the base, since it puts the duty on the local authority to keep a register of the disabled and to inform them of the services provided. Here again, I remind the Secretary of State, it only comes into operation when he makes the order. It is, therefore, clear that the Secretary of State has a great responsibility, if the duties under Sections 1 and 2 are to be carried out, to make sure that such an order is made as expeditiously as possible. Has he done so?

12.44 p.m.

Mr. John Hannam (Exeter)

I am most grateful for the wealth of constructive advice which we have heard from so many hon. Members, and especially for the admirable speech of the hon. Member for Eccles (Mr. Carter-Jones). He works painstakingly in the cause of helping the physically handicapped by the maximum use of modern technology. It cannot be doubted that he has proved again and again the case for increased investment in research and development of artificial aids for the disabled and handicapped. Not only can millions of pounds be saved but we can enable people to return home and to work so that life can be made more bearable for the injured and stricken.

I should like to return later to some of the other points which the hon. Member raised but I would first particularly mention a family in my own constituency of Exeter, the Hardie family, who are extremely well known to the Disablement Income Group, and, indeed, to the Minister, for I have written many letters on their behalf to all concerned with the welfare of the disabled.

My constituency of Exeter is one of those with a very proud record of service to the sick and disabled, and, indeed, I am grateful for the help and assistance given to me by the local social services department in my own efforts to help the disabled. Exeter lies in the top ten of the list of county boroughs, showing an expenditure of over £50 per head during 1969–70 under the 1948 Act, and in the implementation of the 1970 Act Exeter is fully advanced, and yet even in one of the better areas of the country one is conscious that we are only just starting in finding those needing help and actually providing facilities and finance for them.

I quote the Hardie family as an exceptional case, in that of a family of four, two parents, two children, three are disabled, or semi-disabled. Yet, despite the difficulties and hardships, Mr. Hardie, with tremendous independence of mind, has insisted on continuing full-time employment, rather than fall back on the State. Yet, when I visited this family nearly a year ago, I found them deeply distressed at the constant struggle of trying to run a house which was totally unequipped for a disabled family —for example, with one open fire to heat the whole house and the water. The total income of that working man is £20.62 a week, and after paying tax and insurance contributions there is left £17.23, and this has to cover rent of £4.26, diet and prescription costs for the three disabled people in the family, and the living costs of the family of four.

I consider it hard indeed for him, that such a man should be paying income tax out of a low income of that amount of just over £20, and I also consider it hard that he should not be receiving a disability allowance or pension, and it is even harder that he should still be waiting—over 10 months now—for an immersion heater or night store heater.

If this is the situation which exists now for a family of four with three disabled members, in what is considered to be a good local authority area, if these delays and hardships are occurring in this instance, how many more serious cases must there be, hidden away in our towns and cities, of people reading and hearing of the Chronically Sick and Disabled Persons Act and yet still waiting, and wondering when someone will call or something will happen?

It is no good expecting them to come forward and identify themselves when it is likely that they do not yet understand the Act or what it can do for them. Surely it is our responsibility to seek them out and offer them help. When we hear of 1¼ million physically handicapped people over the age of 16 living in private households and hear that one in five is living alone, and that the highest proportion of women with physical impairments is to be found in my own region, the South-West, then my own fears are confirmed, that until local government changes one word—one important word—in its interpretation of Section 2 of the 1970 Act, and Section 29 of the National Assistance Act, 1948, that the local authority "may" make arrangements for residents in the area, we shall continue to see these disparities. It is the interpretative use of the word "may" which bothers me, and I should like to have it changed to "shall", so that local authorities shall make the necessary provisions to fufil the Act. I know that there is a lack of available finance, and that puts a hold on the rapid build up of the provisions of the Act.

I know that the Government are gathering momentum in their efforts to help the sick and disabled. I welcome the "declarations of intent", to use what I believe to be the "in" term, made by my right hon. Friend the Secretary of State. However, I regard this urgent sector of need as the No. 1 priority in our social services programme.

One asks oneself what can be done now. First, as the hon. Member for Stoke-on-Trent, South (Mr. Ashley) stressed, I believe that we should initiate the drawing-up of a detailed 100 per cent. register of the sick and disabled in each locality. Notices should be isued by the Ministry for display in all public places. I have in mind doctors' and dentists' surgeries, post offices, bus stations, and other places where people congregate. The notices should draw attention to the Act and give details of the method of registration being adopted in the locality. Then, the local voluntary organisations should be enlisted. In Exeter and other areas of the country, local branches of the Child Poverty Action Group have been working in conjunction with local social services departments, and they are performing this extremely worthwhile rôle of contacting those people who are in need of help. So far, all the evidence points to a general ignorance on the part of many disabled people of the need to register their names and of the provisions of the Act itself.

Secondly, local authorities should be required to carry out as an urgent priority the house conversions and adaptations for the physically handicapped to which we have heard reference today. I include such work as the installation of immersion heaters, night store heaters, handrails, and interior lavatories. The disabled have special physical needs and require different accommodation from the able-bodied. However, in most cases rehousing is not necessary. Only minor alterations and improvements to their existing accommodation are required.

As my hon. Friend the Member for Plymouth, Devonport (Dame Joan Vickers) said, the installation of telephones is another urgent priority under Section 2 of the Act. Only one in eight of housebound people living alone has a telephone. With 50,000 severely handicapped women over the age of 75 living alone, it is small wonder that we hear so often of the tragic discoveries of lonely deaths days and sometimes weeks later. In many cases, a telephone might have saved life.

Thirdly, I support the call for four-wheeled vehicles instead of the standard three-wheeled one-person vehicle, which condemns many families to be split, with children separated from their mothers and husbands from their wives whenever they wish to travel anywhere.

Finally, I refer to the desperate need for a disability pension and allowance. The costs of special clothes and special foodstuffs for diets, the lower income which is paid to the working disabled person, and the incidence of taxation could all be alleviated by the introduction of such a pension or supplement.

I am sure that we are all concerned about the high unemployment level amongst our disabled. Much could be done to help in terms of retraining and rehabilitation. A great deal is being done. Many hon. Members will have visited schools and colleges for the disabled in their constituencies, and they will have been as impressed as I was with the dedication and devotion shown by the staff of such establishments. Jobs have to be found. But, if they are found, financial assistance may still be necessary. A disability pension is badly needed.

The hon. Member for Eccles, in his fine, detailed introduction to the debate, referred to the hospital rehabilitation officers, of whom I think there are two. I believe that they were appointed 20 years ago by the Royal National Orthopaedic Hospital to provide in-patient advice, job analysis and liaison with industry. This position in our hospitals, especially at our regional centres, seems to be worth developing on a national scale. When an injured and newly-handicapped patient has received medical attention, the next major concern is his or her return to work. The questions then arise of what he or she can do, where is the best place to work, what retraining is required and who will find the new job. Sometimes, there is no problem. The patient can be assessed as being able to return to his or her old job and the employer can be informed. On other occasions, when it is obvious that the patient will not be able to return to the old job, the rehabilitation officer has to find alternative work, preferably with the old employer, and the hospital rehabilitation programme will be modified to include an educational retraining programme, with the patient actively co-operating.

The work is extremely valuable in many ways. It gives reassurance to the patient. It helps with contacting employers and keeping jobs open, and in modifying hospital programmes to suit the new training programme. The result of the work of these two officers over a period of 20 years is reflected in the high proportion of patients returning to full and progressive employment. I should like, therefore, to endorse the hon. Gentleman's recommendation that my right hon. Friend should consider the establishment of such a rehabilitation position at our major regional hospitals.

I apologise for raising so many points. Many others have been raised by hon. Members. I do not censure the Government for inactivity in our social services. I am proud of the measures which have been taken already to help the severely sick and disabled and the mentally handicapped. This is just the beginning. The stone has just begun to roll. It is rolling slowly. I want to see the Government give it a hearty shove. I believe that my right hon. Friend cares deeply about this problem, as does the whole country.

I congratulate the hon. Member for Eccles, and I have great pleasure in supporting his Motion.

12.56 p.m.

Mr. Reginald Freeson (Willesden, East)

The Report on Handicapped and Impaired People in Great Britain shows how pressing is the need for housing for the disabled. It is on this subject that I intend to concentrate my remarks.

When the Chronically Sick and Disabled Persons Bill was in Committee, I introduced what later became Section 3, under the heading "Duties of housing authorities". That Section says: Every local authority…in discharging their duty…to consider housing conditions in their district and the needs of the district with respect to the provision of further housing accommodation shall have regard"— not "may"— to the special needs of chronically sick or disabled persons; and any proposals prepared and submitted to the Minister by the authority under that section for the provision of new houses shall distinguish any houses which the authority propose to provide which make special provision for the needs of such persons. In introducing that Clause, I made a number of remarks about the housing position in many local authorities, and I believe that they bear repeating today in equally strong terms.

I said at that time that there was no doubt that local authorities needed to have a clearer, deeper and more detailed understanding of the housing needs in their respective areas and that it was not enough for authorities to cater for general housing needs without looking at the detailed make-up of those needs in their areas. I stressed that in far too many cases the housing lists, which had always been conventionally maintained, did not reflect in sufficient detail the needs which had to be met in local authority areas.

When I was at the Ministry of Housing and Local Government, I made a broad calculation which revealed that housing lists in the stress areas throughout the country reflected only about 25 per cent. of the real need in the worse parts of our cities. The figures do not relate simply to the housing position at large. They have a special relevance to the chronically sick and disabled who, for a variety of reasons, tend to live in larger numbers and in greater difficulties in precisely those social stress areas where the worst housing conditions exist. That does not mean that there are not problems elsewhere. There are. However, there is a larger concentration of problems for the chronically sick and disabled in our older twilight areas. These are the areas of multiple social stress, and chronically sick and disabled problems are part of the stress to be found in them.

It is important that local authorities do not continue to stick solely to the use of the housing waiting lists as a guide for meeting housing needs in general or in particular, such as the needs of those with whom we are concerned today. There is a need for local authorities to have house-to-house surveys geographically and not wait for applications to come to them to join the housing list and then to undertake rehousing more slowly or more quickly according to priority for houses available to people on the waiting list. Local authorities should not wait for needs to be brought to their notice; they should find them out by positive inquiry on the ground.

It seems that few authorities have embarked upon this process. Some have embarked upon it to a degree, but they are very few out of the total number of housing authorities. This is particularly important concerning registration, which has quite rightly been harped upon time and again today and on many occasions in Questions to the Minister during the last six to eight months. I am sure that we all wish to have 100 per cent. registration. However, it is often said that this is too great a burden to accomplish at any great speed. This view does not take account of the other responsibilities and duties of local authorities under other services which they should be providing.

I suggest that there could be a good deal of worth-while collaboration in this respect, not only at Government level, but more so at local authority level. Whereas there may be a serious shortage of survey workers and specialist public health inspectors within housing and planning departments, if the local authorities with the greater stress areas, covering the problems of the chronically sick and disabled and others, were to establish teams of survey workers interdepartmentally, it would be possible to embrk on the kind of house-to-house surveys to which I have referred and, in the course of them, establish a more detailed register of individual needs in specified areas within local authority districts. These needs and priorities could be established fairly simply by looking at the existing geographical knowledge within boroughs, urban districts and counties. On that basis local authorities could start earmarking districts for house-to-house survey for housing as well as casework purposes under the other provisions of the Act.

I am concerned specifically with housing, but it is important to stress this point. If there was closer teamwork and integration we should not have to stand back until we had enough public health inspectors, social survey workers, housing survey assistants and staff in the housing and planning departments to carry out their own individual departmental responsibilities.

I suggest that there is a serious need for detailed advice and circularisation by the Government. When I held a junior Ministerial position in the Ministry of Housing and Local Government, partly responsible for the handling of the Act with which we are concerned, I had very much in mind the preparation of advice and information to get the Act implemented as speedily as possible in the most difficult areas. I believe that the Government should send out this kind of advice. Not sufficient has been put out so far. It needs to be inter-departmental both nationally and locally if it is to be effective.

The figures which have been produced in the report give clear evidence of the need for more detailed study even by the Government. I suggest that the Secretary of State for Social Services, in conjunction with the Secretary of State for the Environment, should consider pursuing the policy embarked upon by the previous Government, after the completion of the national sample of condition of property survey in 1967, of a series of conurbation studies to establish whether the national statistics which had been produced by the first national sample survey were valid on the ground. These conurbation studies, virtually completed in succeeding years, have proved immensely valuable to the Department of the Environment and to its regional offices in their contact with local authorities dealing with housing generally.

I suggest that the estimated figure of 200,000 households containing severely or appreciably handicapped people in need of rehousing or improvement in their accommodation needs to be followed up to get clearer information on the largest conurbations rather than that it should be left as a broad national figure. On that basis, the Government could more adequately say to local authorities: "You are part of such-and-such a conurbation for which, by careful study, we have produced these figures of housing conditions. It seems that by extrapolation your problem is such-and-such a figure. Will you please embark upon house-to-house surveys in the most difficult parts of your area to place these figures in their real down on the ground perspective so that your housing, planning and health and welfare departments may embark upon the provision of the kind of services which need to be provided, and in particular so that the housing and planning or the development departments may embark on a methodical improvement of property and housing accommodation generally within which provision can be made for the chronically sick and disabled."

This figure of 200,000 households—I will not bore the House by repeating that many other figures which appear in the report on the housing side—is sufficiently worrying to warrant this kind of exercise. It is the only way that the Department, in conjunction with local authorities, can embark on the progressive policy which is needed to tackle the housing problems of the chronically sick and disabled.

Mr. Bruce Douglas-Mann (Kensington, North)

It is not solely a question of ascertaining the facts. Does my hon. Friend agree that many local authorities, even when they are well aware of cases of extreme disability within their areas, do not make and are not making any provision to meet them? There is one case in my constituency, with which I have been concerned, involving an acutely disabled couple. The husband suffers from multiple sclerosis; the wife has only one leg and she has numerous other disabilities. They were living in a fiat, in which they could not use wheelchairs, which was heated by fires for which the wife had to fetch coal from a store outside. The local authority, having been well aware of this case for many years, took no action until great public pressure was generated after the Act came into operation. There must not only be surveys, but a will on the part of local authorities, which has been sadly lacking. In fairness, I should say that this case has now been dealt with.

Mr. Freeson

I agree with my hon. Friend. In fact, the last part of my observations were to be directed to that issue.

Having established the kind of information on a more detailed basis at Government level by these conurbation studies, the Government should press local authorities to embark upon their own studies. As the conurbation studies are completed the Government are in a better and stronger position to pursue the process with local authorities. But information is not enough. The Government, through the Secretary of State for the Environment, should use their powers—and they do exist—to require local authorities to carry out their housing responsibilities.

The hon. Member for Exeter (Mr. John Hannam) laid great stress on the question of permissiveness, compared with compulsion, from the point of view of local authorities undertaking certain responsibilities. Under current housing legislation, local authorities are "required" to do certain things. What is necessary is that the Government, having satisfied themselves, after a sufficient length of time, that local authorities are not using their powers as they are required to do, should move in and, by persuasion, by pressure, and, if need be by using reserve powers—which I admit have rarely been used, but they exist under the 1957 Housing Act—make sure that local authorities carry out their responsibilities.

When discussing this part of the Chronically Sick and Disabled Bill in Committee, I indicated that the Section of the Act placing on local authorities the responsibilities for surveying housing conditions and taking action also gave the Minister power, which was held in reserve and not used regularly, to require proposals to be submitted to him in respect of the needs of specific areas, and other Sections of the 1957 Act empower the Minister to move in should his directive not be complied with.

I said in Committee: … wherever it is appropriate, the power to require proposals to be submitted will certainly be used to meet the needs of the disabled, as well as other special needs."—[OFFICIAL REPORT, Standing Committee C, 4th February, 1970, c. 162.] That was a considered statement. It was an undertaking to the Committee. It was part of a series of policy statements which I took the opportunity of putting on the record. I realise that even now it is early days, but to date no further steps appear to have been taken on that score.

I urge the Minister to consult his right hon. Friend the Secretary of State for the Environment on the housing section of the report before us. I suggest that serious note be taken of these figures. I suggest, too, that the kind of conurbation studies which I have discussed should be embarked upon. The necessary circulars and, if necessary, directives, should be issued, either to a large number, or to a specified small number, of local authorities, as appropriate, requiring them to undertake these house-to-house surveys in the most seriously stressed areas of the older parts of our cities so that proposals shall be submitted to the Minister in order to deal with the housing needs of those areas.

I shall not labour the point for polemical purposes, but I cannot conclude my comments without drawing attention to the serious fall back generally in local authority housing during the last two or three years. It has dropped back by about 40 per cent. nationally, and most noticeably in the most seriously stressed parts of the country. Urgent steps must be taken to reverse that process and, as part of reversing the process, the kind of recommendations that I have put to the Minister should be taken account of and applied.

Unless there is an upping generally of local authority housing in our worst cities, unless there is an increase in the number of housing starts, and unless there is a house-to-house geographical survey, or series of surveys, in the worst city areas, we shall only pretend to deal with the housing needs of the chronically sick and disabled. What is more, we shall not be able to undertake the kind of moves towards the 100 per cent. registration of the needs of disabled persons that is absolutely essential if local authorities are to go ahead and provide the necessary houses and services in the future. Those steps must be undertaken as a matter of urgency if we are not to be faced with the same kind of figures in five or ten years from now.

1.16 p.m.

Mr. John Cordle (Bournemouth, East and Christchurch)

The hon. Member for Willesden, East (Mr. Freeson) touched upon another facet in this important and serious debate. I hope that the question of housing will be looked at, not only in the great conurbations but also in the provincial and country areas. The need for a survey into the housing needs of the chronically sick and disabled in all areas of the country has been highlighted by the Bill introduced by the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris), and I congratulate him on getting it on to the Statute Book. It has been said that "The rent for your room while on earth is service". The hon. Gentleman has rendered a great service to the country and to the disabled and chronically sick by piloting that Measure through the House.

I congratulate the hon. Member for Eccles (Mr. Carter-Jones) on initiating today's debate, because there is no doubt that more and more people in our constituencies are becoming in need of more sympathy, understanding and help, and the Bill passed last year sets out to provide those things.

The hon. Member for Stoke-on-Trent, South (Mr. Ashley) referred to the euphoria that came in when that Bill was going through the House. As he said, that euphoria has been somewhat dissipated and, instead of the rapid action that we had hoped to see, we realise that there are still many things that have to be caught up with, and I should like, therefore, to draw attention to the fact that local authorities need jogging along, although my constituency is getting on very well with the work.

There are cases which fall between the Act and the national service for the disabled and chronically sick. There are two cases in my division to which I should like to draw the Minister's attention. This has been a wide debate. We have debated telephone requirements, employment, television needs, vehicles, the vital question of registration, and the problems of identification. I pray that local authorities will take the matter seriously, and push on and comply with the Act. The Minister must issue directives. He can try persuasion, but he must, if necessary, get down to making sure that local authorities take action under the terms of the Act.

Most of the points that I had hoped to make have been made by other hon. Members. The two cases which I wish to highlight are known to my hon. Friend the Under-Secretary of State. The first is that of a young man in my division who is virtually house-bound and deprived of any pleasure, as a result of an accident that befell him in April, 1968. He is now a severe paraplegic. He has a wife aged 22, and two small daughters. I propose to read two paragraphs of a letter which I have received from a social worker in the welfare department of the Hampshire County Council in respect of this young man. I pay a tribute to our welfare and social workers, who seem to have endless sympathy and humanity for these good people who have suffered such serious tragedies in their lives.

The report says: On one or two occasions this year it had been hoped to arrange transport for Andrew to attend the Day Centre … but unfortunately he became ill with an infection and it has not been possible to implement this. Andrew is extremely sensitive about his disabilities and is not over-keen to attend the Day Centre. Because of this sensitivity, and in an endeavour to give you a proper appraisal of the situation, I have discussed the more personal aspects with his wife. Mrs. Graham tells me that her husband is able to dress as far as the waist down, whilst she deals with the remainder. She has been trained to deal with changing an in-dwelling catheter three times a week, his evacuation, urinal, and bathing, and she carries out all these tasks unaided, and without complaint.' The question which I am dealing with is the question of providing suitable transport or a vehicle for this young man aged 25.

The letter goes on: I understand that Andrew has been assessed for the provision of an Invacar, but that he has turned down this proposition partly because of his wish to have a specially adapted Ministry car in which he could take his family for outings, and partly because he feels an invalid car would draw attention to his disabilities. There is a tendency to treat a disabled person and his family as separate entities, and in this particular case I feel it is essential to consider them as a family unit. The eldest child, already attending school, is an intelligent little girl but far too solemn and quiet for her age and in all probability this is due to her environment and the fact that, due to lack of transport, she is precluded from simple family pleasures such as going to the beach, into the country, or to the shops. I am greatly impressed by the manner in which Mrs. Graham shoulders the responsibilities of caring for her husband and two engaging little girls, and this despite her own nervous asthma. A less sunny personality than hers would be easily daunted with such a bleak future. As the next step, I would be most grateful if you could see your way to approaching the appropriate Ministry, as a special case, for the provision of an adapted motor car for this family, rather than an invalid carriage. So I got into touch with the Under-Secretary of State, who replied: Cars are provided through the National Health Service only to those groups of disabled who are described in the Note at the end of the enclosed leaflet. Unless Mr. Graham qualifies in one of these groups, and as far as we know he does not, we could not provide a car for him. I am afraid we could not make an exception for Mr. Graham. But this is an exceptional case. The local authority cannot help, so it seems that the Minister should be able to help in this very sad case and make it possible for this young man to have an adapted car. He has been divided from his wife and family and the one pleasure of taking them out together.

A further report says: He spends most of his day in a wheelchair which he is able to push himself, albeit very slowly and laboriously, round the house but is quite unable to do so out of doors and his wife cannot push him far due to asthma and therefore he remains completely housebound. I hope that the Minister will look at this case again and treat it with haste and urgency, and give this young man the opportunity he seeks.

In the last report on the case, I was told: To summarise the three main points which could make life more tolerable for himself and his family are:—

1. 1. Saloon car with Reselco controls
2. 2. TV Channel change facility
3. 3. Telephone for emergency purposes."

There is another case which I should like to mention because it relates to a very unfortunate 1914–18 war disabled pensioner. He thanks me for my efforts on his behalf in trying to secure him an invalid chair and writes: The whole point is I am unable to drive any vehicle which is intended for use on a road. There is available a type of electrically-propelled chair which can be used on the pavement. Its speed is just about walking pace. In special conditions they have been supplied to disabled persons. I am a limbless man, a 1914–18 disabled person, and I find now … that months elapse without me being able to go out. I do not expect you to be able to do much now, but your colleague, Mr. Alfred Morris, has wasted his time with the Chronically Sick and Disabled Persons Act. It just does not work. I hope that there will be an opportunity to review this case and make it possible.

Of course one thanks God for local voluntary associations, which might come to the assistance of both these men. The Round Table is interested in the case of the Graham boy and other organisations have been brought in on to the case of the war veteran. I should like to leave those two cases with the Minister.

1.26 p.m.

Mr. Christopher Mayhew (Woolwich, East)

My hon. Friend the Member for Eccles (Mr. Carter-Jones) made a positive and interesting speech in opening the debate and said that he felt like a junior member of the team who have been put in to bat by the captain, the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris). This is my maiden speech on the Chronically Sick and Disabled Persons Act, and if my hon. Friend felt modest, I feel much more modest. I should claim the indulgence of the House in the light of the hardened campaigners who have spoken on both sides.

I will not be controversial, but I should like to put some questions to the Secretary of State on one aspect of the Bill, where I am sure both the Government and the House will agree—mainly that we must be sure that the benefits which the Bill can confer on the physically handicapped are enjoyed to the maximum by the mentally handicapped and the chronically mentally sick. I am sure that that is the view of my hon. Friends, and the Minister has already shown himself very sympathetic and informed about the problems of mental handicap and mental sickness.

This is a very difficult question. We were all glad to see the reply which the Under-Secretary gave my hon. Friend the Member for Wythenshawe on 6th April, when he asked about the application of the Act to the mentally handicapped and chronically mentally sick: When Section 1 of the Act comes into force on 1st October authorities will be under a duty to publicise their services for disabled people, and they will, I am sure, in this publicity, make it clear that, where appropriate, the services extend to mentally disordered people of any description."—[OFFICIAL REPORT, 6th April 1971; Vol. 814. c. 64.] I should like to know a little more of what the Secretary of State envisages.

He has talked about publicity and the fact that the mentally disordered of all kinds should be told of their rights under the Act. But I should like to hear his thinking about how far the Act should apply to the mentally disordered. Obviously, not all its Clauses do so. One must face the fact that the Act was born in a climate of concern for helping those who had some particular locomotive disability, a physical handicap.

Sir K. Joseph

Would the hon. Gentleman be rather more precise? I presume that when he refers to the "mentally disordered" he is using that ambiguous phrase to mean the mentally handicapped, which is the phrase we normally use when talking about the mentally ill or mentally handicapped.

Mr. Mayhew

I have been using the ambiguous phrase "mentally disordered" because the Minister of State used it in his Answer. I am speaking about the mentally subnormal and those who are chronically mentally sick. These are the categories to whom I feel the Act should apply, in part or in whole, as I will show.

It is obvious that some parts of the Act—those relating to outings, television, transport, holidays, meals and so on—can and should apply to the whole range, but how is the registration of these people to be effected? How are the definitions to be made and, in particular, how far can the Act help the appalling problem, to which the Secretary of State has shown himself sensitive, of the overcrowding and understaffing in mental and subnormality hospitals? Does the Act lay duties on local authorities, particularly in relation to Sections 2(1)(a) and 3(1)?

Some definitions were given in the Report of the Social Survey Division on the Impaired and Handicapped in Great Britain, but the attempts to reach final definitions only showed the great difficulty of doing this. "Impairment" was defined in what might be considered a strongly physically orientated way, when it said: For the purposes of this study the following, definitions have been used: 'Impairment' is, one, lacking part or all of a limb or having a defective limb, or, two, having a defective organ or mechanism of the body which stops or limits getting about, working or self care. At first sight that might seem to exclude the mentally handicapped and the chronically mentally sick. But no. If one looks further into the report one sees that it lists the causes of impairment according to definitions which are given, and categories 5 and 16 are plainly of the type about which I am talking. Category 5 is given as: Mental psycho neurotic and personality disorders. Category 16 is given as: Senility and ill-defined conditions These represent 220,000 people. It is a strange way to go about the definition of impairment of a mental type, but even on that definition one sees that there is a major problem for over 200,000 men and women in private houses suffering impairment as the result of either mental handicap or chronic or severe mental sickness.

Perhaps we can consider three categories and how far the Act can help each category. First, the mentally disabled elderly. Here the importance of registration is great. Of the over-65s with relatively severe psychiatric disorders, more than three times the number are outside mental hospitals than are inside, which means that when one has deducted those who are looked after well by families or local authorities, there are still many in the community who do not seem to be connected with any institution or helper and who urgently need to have someone registering them and taking some responsibility for them. I ask the Secretary of State to assure us that the Act will be of help for this category.

Can the Act help to remove the appalling overcrowding and understaffing in the geriatric wards of mental hospitals, by, for example, requiring local authorities to give assistance in homes to people of this sort, to pay particular attention to the housing needs of handicapped people and to report on the proportion of their housing which goes to the disabled about whom I am speaking?

Can we prevent mentally disabled elderly people finding their way in to hospital when, with a bit of support from the community, they could live, perhaps in their own homes, a happier life, so unquestionably saving ratepayers' and taxpayers' money and, of course, making life very much easier for those who must be in hospital? The Act should cover these people.

Much the same applies to the second category, namely, the mentally subnormal. How can they be helped by the Act? If the Act were properly implemented, it would, I believe, prevent the mentally subnormal from going into hospital not because they need treatment but because there is nowhere else for them to go. If the Act and particularly Sections 2 and 3 and the provisions relating to housing were properly implemented, we could cut off the flow of people to subnormality hospitals and so make life a lot more worth while for these poor folk who are at present obliged to live in overcrowded and understaffed hospitals.

I am sure that, like me, a number of hon. Members have visited hospitals of this kind. I have gone round them. I visited Farleigh a few weeks ago. The Secretary of State has shown, by the amount of money he has made available—it is not enough but it is a considerable advance—that he is anxious to help these hospitals. It is clear that this is part of our society of which we should feel most ashamed. I refer, of course, to the overcrowded wards of mental subnormality hospitals. Can we assume that the Act will be of help in this direction?

The third group of people, and perhaps the most difficult, is comprised of the chronic mentally sick. Here we have greater difficulties of definition and the need to register in a human way—in a way that is efficient but does not invade privacy. We must face the fact that while many illnesses can be cured or cure themselves, there will be some which will leave their sufferers with a residual disability. The Act should be of help to these people and local authorities should be required to give more help.

How are we to discover and define these people? Having done that, how are we to provide for them? At this stage I merely ask the right hon. Gentleman these questions. I am sure that he will consider this matter carefully because I know that the House and the Government do not want these people to be overlooked just because it is difficult to help them. Indeed, this is all the more reason to take great care to see that they are helped.

Volunteers and voluntary organisations are absolutely vital and are increasingly important. When we look at this aspect of impairment and see what is done by unpaid volunteers, we realise that it would be impossible to do without them.

Here, I draw attention to the work of the national societies: the National Society for the Mentally Handicapped; and the National Association for Mental Health with which I am connected and which has 83 local associations, the great majority of them actively working to help impaired and handicapped people. These bodies, together with the local authorities, can make a real contribution under the Act. I hope and believe that the support given by the Secretary of State to these associations will be continued so that they can go on helping local authorities and the Secretary of State himself in the work we all want to see done.

1.40 p.m.

Mr. David Lane (Cambridge)

I welcome the debate, and congratulate the hon. Member for Eccles (Mr. Carter-Jones) on his constructive speech. It is good to see my right hon. Friend here as well as my hon. Friend the Under-Secretary of State. I apologise to them and to the House if I have to leave just before the very end of the debate, for reasons which I have given to them.

Like the hon. Member for Woolwich, East (Mr. Mayhew), I cannot claim the expert knowledge of sickness and disability which many hon. Members have, but I want to add my voice to those who are urging the Government and the local authorities to keep the momentum of progress as fast as is practicable.

We often say, quite rightly, that handicapped people need both cash and care. They also need hope, and we should keep this in mind as a very important third element of the whole problem. Hope is growing among these people, partly because of the commitments and actions of Governments of both parties and the efforts of hon. Members on both sides. Better understanding is leading to more action, and I hope that in the House we can keep this as an all-party effort.

I hope, too, that we can keep the problem in perspective. We should acknowledge what has already been excellently done by the Government. I think particularly of the new constant attendance allowance, and I am glad to pay tribute to the tremendous work done by many people to bring forward by a few months the envisaged date of its introduction. Further help for the chronically sick was also announced a few weeks ago.

Nevertheless the Government are not complacent, nor are we. We know that as a nation we are still not doing enough, and of this we have recently had two reminders. First, a survey of what is being done in other European countries was recently published by D.I.G. This is not the occasion to argue the Common Market with the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris), but I am sure that from that publication he will have taken to heart the fact that, by and large, countries on the Continent are already doing more than Britain to help the disabled.

In passing, I should like to pay tribute to the work of D.I.G., not merely as a noisy pressure group, although it likes to be called such—

Mr. William Molloy (Ealing, North)

The hon. Gentleman has mentioned the very relevant fact that the Common Market countries appear to be doing more than we are in this respect, but I am sure that he would not accept that before we can do anything to improve the lot of our chronically sick and disabled we have to join the Common Market.

Mr. Lane

I am grateful to the hon. Gentleman for giving me the opportunity to say that one of my reasons for hoping that we shall soon join the Common Market is that we should thereby enjoy greater prosperity out of which to do still more for the chronically sick and disabled.

When I was interrupted I was saying that I welcomed the pressure being kept up by D.I.G. for a national disability income, while stressing that a number of other desirable steps still need to be taken, particularly in the improvement of facilities for looking after disabled people in their own homes. That aspect cannot be emphasised too strongly.

The second reminder was contained in the recently published and invaluable social survey. This contains a vast amount of material bearing on the problem, a lot of it new. One fact that struck me vividly is that while in the whole country there are only 200 or 300 very seriously handicapped men living alone, the number of very seriously handicapped women living alone is no less than 8,000. The survey is full of facts like that, of which many of us may not previously have been aware.

Today we are talking of what more can be done to make the Chronically Sick and Disabled Persons Act effective. The timing is reasonable. There has been some criticism of the Government and of local authorities about timing, but I doubt whether there would have been any gain in trying to rush the implementation of certain parts of the Act, notably the compilation of the register, before the local authorities' new departments were properly established and, incidentally, before the survey was available, although that is a secondary point.

In mid-Anglia, the Cambridge City Council, which has until recently been responsible for a number of services for disabled people, is well to the fore in excellent work. A new department of the county council is now getting to grips with the problem. According to a report in the Press a few days ago, the subject was debated at a full meeting of the county council, which discussed the Government's announcement of October as the appointed time for bringing Section 1 into force.

According to the Press report, the chairman of the council's social services committee stated that … they had not been asleep' in preparing for the Government's announcement, and already provision had been made for engaging the extra staff and contacting the voluntary welfare organisations. In this area of the country we are spending a higher-than-average amount per head on helping the disabled, but I very much support what was said by the hon. Member for Eccles. How sad it is to discover the enormous variations in what is done by one local authority and another. Let us hope that the searchlight of publicity which the Act will help to play on the local authority services will quickly bring some of the more laggard authorities up to the performance of the rest. Whatever our views may be on the timing of bringing Section 1 into effect, this is certainly the moment to put more steam into carrying out all the provisions of the Act at national and at local level. I hope that today's debate will help in this respect.

We are here dealing with a very large field but I have four suggestions that I want to put briefly to my right hon. Friend. First of all, I hope that he will soon announce—today may not be the time for this—an outline of the Government's longterm plans for doing still more for the chronically sick and disabled. I have already spoken of the great importance of hope amongst disabled people. What would encourage them more than anything would be to know that, in addition to what is already being done, the Government have in mind a series of further steps, a coherent programme to be fulfilled over the next three or four years, or at least in the lifetime of this Parliament. If the Government can do that this year it will greatly encourage these people. Among other proposals, we we should like to have some idea of the Government's attitude towards a national disability income.

Secondly, publicity is partly covered by the Act, which puts on local authorities the duty to make known to disabled people the services available to them, and their rights to those services; but I hope that my right hon. Friend will not overlook the positive value of further Ministerial broadcasts, The need to make all that is available better known is underlined by two other facts in the recent survey. The first is that only one person in five of those wanting adaptations to their homes has ever tried to get them made. There is here some failure in communication. The second fact is the exceedingly high proportion of handicaped people who both listen to radio and watch television. It is stated that 85 per cent. of impaired people have both radio and television. So there is an audience waiting to learn in that way, and not simply through the newspapers or from local authority announcements. Ministerial broadcasts about the new arrangements would have a great impact on that audience.

Next, although unemployment is not strictly the responsibility of my right hon. Friend, he pays close attention to this problem. In the present situation of relatively high general unemployment the disabled have been even more hard hit. All hon. Members are sadly familar with cases of rebuffs, disappointments and despair among our constituents who have been trying to obtain and then retain jobs in difficult circumstances.

Not long ago in Cambridge one-quarter of the total number of registered unemployed were disabled. This problem cannot be minimised. I was very glad to read the announcement by my hon. Friend the Under-Secretary of State for Employment at Question Time on 25th March that a fundamental review of services for the disabled was being conducted by his Department. I hope that this review will be carried out even more urgently in view of the general unemployment situation, and that my right hon. Friend the Secretary of State for Social Services will give all the support of his Department to any new measures which may prove to be desirable in employment services.

Lastly, there should be still more encouragement of the voluntary services. Today we have very much in mind, because of the subject of the debate, the Government's responsibilities and those, above all, of the local authorities. We must not overlook the tremendous help in tackling this whole problem that voluntary organisations and individuals can provide. The survey has highlighted the difficulties which the disabled, especially disabled housewives, have with shopping. In this respect voluntary help, especially by young people, could do much to make the shopping problem more manageable for households of disabled people.

Another example of the scope for voluntary help is in removing the sense of isolation felt by many disabled people. There is room for more visiting. Another survey which I studied recently discovered that only 7 per cent. of all those interviewed had no social contact with their neighbours or friends in the community. Among the handicapped under-20s, however, the proportion who had no social contact was no less than 33 per cent. One in three was living virtually a life of isolation, with no regular social contact. Here is a tremendous opportunity, especially for able-bodied young people, to develop more contacts with the disabled, thus making disability more endurable.

All this must be, as it has always been, a combined operation by the Government, local authorities, voluntary bodies, and individuals. The Government must give a vigorous lead. My right hon. Friend and his colleagues have started very well. I am confident that they will keep up the good work.

1.54 p.m.

Mr. William Molloy (Ealing, North)

My hon. Friend the Member for Eccles (Mr. Carter-Jones) not only drew attention to the situation of the chronically sick and disabled but in his superb and knowledgeable speech he stressed that it seemed that Parliament's will was being thwarted by the lack of alacrity on the part of local authorities in getting cracking and implementing the admirable Act which was piloted through this House by my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris).

The hon. Member for Cambridge (Mr. Lane) rightly paid tribute to the role of voluntary organisations. I stand second to none in my admiration for the work of these bodies. However, we must not fall into the error of saying that, because there are not sufficient voluntary organisations, it is not incumbent upon the State and local authorities to do the fundamental work which they have to do; for if they do not do it there is little effective scope for the work being done by voluntary organisations. I hope that the Secretary of State will take to heart many of the points which have been stressed this morning. The overwhelming responsibility is that of the State.

The Under-Secretary of State for Employment gave me an assurance recently that he would institute a thorough investigation into the question whether the quota of disabled was being taken up by firms and organisations in industry and commerce. I hope that a statement will be made to the House very soon so that a realistic assessment can be made.

I have known the Secretary of State for Social Services for many years. Although I have not always agreed with his political philosophy, I was one of those on this side who felt very heartened when he was appointed to his office. I know that he has as much feeling as anyone in the House for the problems of the sick and the disabled and has a proper regard for the great responsibilities he carries as Secretary of State for Social Services. I have had no reason to complain on the few occasions when I have had to take up matters with the Under-Secretary. From all the Ministers in this Department we have had examples of real and genuine concern; they have exhibited humanity to a most praiseworthy degree, as did their predecessors.

The way in which we treat the sick and disabled reflects the moral structure of society. If we neglect the chronically sick and the disabled we also cause grief to their families, we upset the medical profession, and we impose unnecessary burdens on hospital staffs.

One reason for this debate and for our apprehension on the question of the chronically sick and disabled, whether we are talking from the point of view of hospitals, the nursing service, the voluntary organisations or whatever it is, is that we have lost the vision of Aneurin Bevan's creation of the Health Service. If we had retained that vision greater strides would have been made in ensuring that there were compassion and understanding throughout the country for those in pain, for those who suffer, and for those who are chronically sick and mentally handicapped.

The Health Service was created a few years after the greatest war in history. Europe was destitute. The world was still shattered. Britain launched a magnificent concept. I am not enamoured of the argument that we should hesitate before going further because of our possible entry into the Common Market. We have made some progress towards the tripartite foundation required for both social security and the National Health Service, but local government welfare is still lagging behind the other two—not that the other two are right up to scratch. Until there is an efficient fusion of the National Health Service, social security and local government welfare, we shall always have problems.

It is a year since my hon. Friend the Member for Wythenshawe got his Act on to the Statute Book. It was a humane Measure. One of its fundamental features was the co-ordination of Departments of State and local authority departments. We have heard this morning about lack of enthusiasm in some local authorities. I have a suspicion that more prodding could have been done by the Department of Health and Social Security. Much of what my hon. Friend envisaged in his Act is being ignored. When the responsibility for carrying out legislation passed by this House falls on local authorities, we have a right and a duty to see that they carry it out. If a local authority failed to appoint a medical officer of health, town clerk or borough engineer, the Minister concerned would take immediate action. Let us have a little bit of action over the Act as well.

Some people say that the Act has been going for only a year, and that it takes time to become effective. But a chronically sick or severely disabled person will have very little patience with someone who tells him, "We passed the Act, but it will take a couple of years before what we intend sinks through to those who adminster the local authorities." We have a responsibility to see that what we intend through legislation is put into effect at whatever level we have decided on.

The Act laid a responsibility on local authorities to seek out disabled people and then, when the register had been compiled, to see that the needs of the various types of disabled people were properly related to the local authority welfare service.

Perhaps one of the most poignant facts about disablement was that fewer benefits were available for the disabled. The Act did a great deal to remove that nauseous reality.

Another important feature of the Act was that it had a preventive as well as a curative function. It is possible that someone who is disabled by a severe accident or a dreadful illness may recover to some extent if he has constant attention. The history of disablement, which I have studied, shows remarkable progress where there has been constant attention or where someone has reported to a medical authority or a hospital the condition of a disabled person. The local authorities could see to this, and contributions could be made to remarkable cures. This important aspect of the Act is being neglected.

We are trying to ally our compassion with maintaining the dignity of the disabled, which is very important. The desire of the disabled to fend for themselves is apparent to all of us who know them and who visit them in our constituencies. We can feel nothing but admiration for them, and we have a responsibility to see that everything we can provide for them is provided efficiently.

The disabled suffer handicaps additional to the actual disablement. Sometimes a disabled person must have special clothes. A person who has to use crutches often finds that his jacket wears out much quicker than that of an able-bodied person. Sometimes special gadgets, which may be very expensive, need to be installed in homes. In numerous ways, it is more expensive for a disabled person to live. In modern society he or she suffers an additional punishment for being disabled. Various Acts have attempted to alleviate the situation, and my hon. Friend's Act made a big contribution.

There is an urgent need for special facilities, like toilets in public places, for disabled folk. Many disabled people cannot use public telephones, because their wheel chairs will not go into the boxes. These may seem trivial problems to all of us who enjoy good health, but they are serious setbacks to the disabled, and they are not insuperable problems. The normal communications that science and technology have brought to the rest of us are denied to the disabled person simply because his wheel chair will not go into the telephone box.

Mention has already been made of the problem of access to Ministry offices. It is appalling that this happens. I know of cases of Ministry offices—not in my constituency—which constituents of mine have to visit because they are disabled and where they find difficulty in reaching the civil servants concerned because the office is on the second or third floor, and their wheel chair will not go into the lift. We must pay attention to these matters. When we are modernising our railways and streamlining our buses, let us give a little thought not only to the comfort of the able-bodied person but to the problems facing the disabled person.

There is the further need for practical help in the home. Adaptations such as ramps, handrails and hoists have been mentioned. I remember visiting the secretary of my local Disablement Income Group, who does not live very far from me. She had two or three children. I had never been in her home before. I hope that the House will understand me when I say how the difficulties of the disabled were driven home to me when a number of us left the meeting to use the toilet. When the moment came for that lady to use the toilet herself, we suddenly realised just what a courageous effort it meant for her. What was a perfectly simple human function for us was a major endeavour for her.

These are the sort of things we must give thought to if we are considering giving help to people—and the conditions for a disabled person must be quite gruesome if there is no internal lavatory in the house. I hope that the point made by my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) on this aspect will be taken up by the Secretary of State, who, I hope will discuss with the Secretary of State for the Environment the question of perhaps devising a purpose-built house for families which are suffering permanent disablement in some way or other.

I have specific proposals to put to the right hon. Gentleman. In my branch of the Middlesex Disablement Income Group, we have Mary Grieves, a valuable and courageous fighter for the disabled not only in Middlesex but throughout the country. We have devised what we regard as a charter which, together with the social services, could make a massive contribution in meeting the needs of the disabled and making the quality of life better for them. The charter contains six points which I want to draw to the attention of the right hon. Gentleman. 1. The families of all contributors to the National Insurance scheme are entitled to all the benefits of the health services. This principle should be extended to cash benefits for severe disability. If it were, disabled housewives and disabled children could become entitled to benefit regardless of their means on reaching the age when family allowance ceases. 2. The benefits available to severely disabled people who totally lose their capacity for work but whose disability is not incurred at work should be brought up to the level already available to those whose disability has occurred at work (e.g. through industrial injury). 3. To encourage disabled people to work and employers to provide work, benefits should continue, although at a reduced level, to disabled people who regain or retain a limited capacity for work but do not qualify for industrial injury benefits. This level should be assessed by reference to the disabled person's residual earning ability as compared with the earnings of the average able bodied person and not by reference to his or her loss of physical mental faculty as such. 4. A family with a disabled breadwinner should not receive lower benefits than it would if the breadwinner had died. This is particularly relevant to the proposed fall-back pension scheme. If this scheme is to provide a pension to the widow of a man who dies before retirement age, it should also provide an invalidity pension at a corresponding level. 5. Whether or not a severe disability causes any loss of working capacity, a graded tax free allowance for extra expenses (including those incurred in getting to and from work) should eventually become available. This should be developed from the new Attendance Allowance and from the special allowances available under the Industrial Injuries scheme. 6. If these principles are adopted their costs will be offset by

1. (a) a saving in means-tested supplementary benefits;
2. (b) few disabled people being cared for in long-stay institutions and fewer of their children being in the care of local authorities;
3. (c) the increased used of the working capacity of disabled people."

Running throughout these proposals is the theme not of the disabled constantly asking for something but urging us as legislators to see that they can make their contribution and give of their best both for the nation and for themselves.

Mention has been made of the cost of these proposals. Here we run up against the remarkable Jekyll and Hyde attitude of quite ordinary good folk. Dr. Jekyll is proud of what we do for the dis- abled and proud of the National Health Service. Then up pops Mr. Hyde, who complains of having to pay for it. I hope that we as legislators will always be on the side of Dr. Jekyll. Let us not forget that many disabled people are both tax payers and rate payers.

I want to say something on behalf of disabled drivers, to whom motoring is not a luxury but an essential lifeline between them and society. Motoring taxes are a tax on their mobility. The vehicles of the disabled should not be subject to increases in purchase tax, petrol tax or road tax. If we ensured that, we should be making a genuine contribution to those who want to make a great effort to help themselves and to make their own contribution to the nation's economy.

I hope that one day soon we shall move towards exempting from any form of road tax disabled passengers as well as disabled drivers who own their own vehicles. Perhaps we might even consider a mobility grant to disabled passengers between school leaving age and retirement. I understand from the Disabled Drivers' Association that this would be acceptable in lieu of the tricycle they are entitled to but cannot drive.

Here we have an absurd situation. Apparently, we can say to a person, "You are entitled to a tricycle. We will pay for it and provide it but if you cannot drive it, hard luck. We will not give you a copper for anything else." That is absurd. We should also seriously consider the free provision of a car for the disabled mother to be able to take her children to school and bring them back again.

All the great voluntary organisations like the Disablement Income Group and the Disabled Drivers' Association, have met the challenge of refusing to accept the dictum that silent pain evokes no response. They have not been silent, and rightly so, and because of their agitation and endeavour a remarkable amount has been achieved for disabled people. I believe that preventable pain, anguish, and neglect of the sick and disabled are a blot on our society.

I hope that the few things I have been able to say are acceptable to all hon. Members. I hope that they will be noted by the Secretary of State and the Under-Secretary of State. I know them to be men of great compassion, just like one of the Secretary of State's predecessors, Kenneth Robinson. We have had many Ministers of Health and Ministers of Social Security who, if not quite in the mould of the great Aneurin Bevan, have at least sought to continue to build up what he started. We are in this predicament today, however, because we lost the idea of that great vision. But I have confidence in the right hon. Gentleman and believe that he and his colleagues at the Department will endeavour to restore the ideal. I want to see us adorning our public life with sensitivity for the chronic sick and for the disabled by showing the concern and compassion which a civilised society should show to them.

2.20 p.m.

Dr. Anthony Trafford (The Wrekin)

I am sure that all hon. Members share the compassion and sentiments expressed by the hon. Member for Ealing, North (Mr. Molloy). I should like to take up one or two of his points. There is, first, the question of the disabled not getting a good hearing with the authorities. One of the reasons for this was expressed to me by an aged and very crippled lady who told me she suffered from the agony of being unattractive. This, quite apart from any physical disability, caused a certain amount of embarrassment in the people whom she met and it was one of the reasons for her tragic isolation. The hon. Gentleman also spoke about Dr. Jekyll and Mr. Hyde, and it is unfortunate that this is not, in some ways, the most attractive field in which high skills are to operate. This is an unfortunate fact but it has to faced.

All too often the disabled person suffers some extra disability—for example, an acute illness on top of a chronic illness. Such a person is kept in hospital, even though there are pressures on the beds, since it is realised that it would be difficult in present circumstances to return such people to the community. A recent survey showed that some 60 per cent. of people in acute hospitals were not there for the reason that they were acutely ill. About 15 per cent. were there simply for the reason that they were not able to get around entirely unaided. They were not completely disabled in the sense that they could not move or could not go out somewhere, but they could not be left in the isolation of their home. It is usually a small item, such as a rail in a lavatory, that is not provided at home which means they are unable to be discharged with safety to the care of the community.

I congratulate the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris) on steering the Act through the House, which is making a great contribution. However, this is a difficult field in which to work and it is extremely difficult within the community to create those services that would make a significant difference to the chronic sick. Many of the things that need to be done seem to be unable, in practice, to be done.

I was impressed by what was said by my hon. Friend the Member for Cambridge (Mr. Lane) about the sense of deprivation and isolation suffered by the chronic sick. When I visit patients in their homes, I am often humbled by the courage, endurance and sheer persistence they display in the face of appalling disability. I often think of this when, having examined such patients, I help them to put on their night attire and realise what a monumental task it is for an unaided person. Then one realises the contrast when one merely turns on one's heel and leaves the house under one's own steam.

I was horrified to see in the report that about 72 per cent. of impaired people do not have a telephone. In other words, they are incapable of communicating with the outside world and, in the event of a simple disaster, cannot be helped. For example, this applies even to the simple instance of knocking over a glass of water on a bedside table and being unable to get out of bed to retrieve it in order to use the glass for further refreshment. Even this simple function cannot be undertaken unless someone calls at the houses and sees what has happened. Many impaired people would not have a telephone to make such a simple request. I should also point out that some 4 per cent. of these people would be unable to use the telephone even if one were installed. When I see some of these cases I am amazed at the adaptability and endurance of human nature.

There are one or two suggestions which I wish to make which would help such people. I should like to draw my right hon. Friend's attention to one simple matter that could make a great deal of difference—not so much to the disabled person as to the families of the disabled. It would encourage their continued devotion and give them a certain amount of relief from what is an extremely arduous duty. The suggestion is that for a period of each year the disabled member of the family could be admitted to a hospital bed to allow the rest of the family to take a holiday. It would not be particularly onerous for the disabled person since at the same time he could undergo a check on his physical disability. It would certainly be of great benefit to the family which for the remaining 50 weeks of the year will be responsible, and will be encouraged to be responsible, for the care of that particular person.

There are a number of anomalies which arise on the matter of cost. It has always interested me that it is more expensive to admit a chronically bronchitic patient for a period of six weeks to a hospital than to install the cheapest form of central heating throughout that patient's house. Nevertheless, under the present regulations and laws, it is impossible for one to prescribe central heating rather than a visit two or three times per year to a hospital, as so often happens. For this reason, I hope that my right hon. Friend will encourage the new social service departments to exercise the widest discretionary powers they can in dealing with the individual problems with which they are faced. I have mentioned the matter of family health and have indicated what can be done in simple inexpensive ways in houses.

The hon. Member for Woolwich, East (Mr. Mayhew) raised the point about large numbers of these people being crowded into geriatric hospitals, which is a deplorable situation. When Aneurin Bevan introduced the National Health Service he did so believing what the Beveridge Report had indicated, namely, that in the course of time following the introduction of a comprehensive health service there would be less sickness rather than more. Every one of Aneurin Bevan's successors as Minister of Health or Secretary of State for the Social Services could tell him that the demand, far from decreasing, has escalated, as indeed has the cost. My right hon. Friend the Secretary of State is well aware of this, and I am glad to see that already he has made a considerable contribution by increasing the amount of money to be spent on services for the chronic sick, which are so essential a feature for the future of the National Health Service. This must happen if the service is to operate as a health service and not merely as a warehouse for the sick and if it is not to depend on a particular lobby catching the ear of a particular Minister at a particular time.

The implementation of the Act in full would be of massive benefit to nearly 3 million people. I know that my right hon. Friend has this matter at heart and I have complete confidence both in his judgment and compassion. Above all, I urge him to remember that, when he turns to tackle these extremely expensive areas of the services for which he is responsible, he will always tilt towards the side of expenditure on the chronic sick, the old and on services in the community rather than on the side of the attractive, the dramatic, the technological and the new. In that way he will serve our people better than if he were to take the contrary view.

2.30 p.m.

Mr. Frank McElhone (Glasgow, Gorbals)

I should be failing in my duty if I did not begin by paying a tribute on behalf of the disabled people of Scotland to my hon. Friend the Member for Eccles (Mr. Carter-Jones) for initiating this debate today, especially when we find from the recent Government Report that in Scotland there are 270,000 disabled people. I would say to the Minister at the outset that that is an underestimate of the number.

We also have in Scotland this peculiar difficulty that many local authority people are under the misapprehension that the Chronically Sick and Disabled Persons Act, especially Sections 1 and 2, does not apply to Scotland. I have faced this misunderstanding time and time again, and I hope that the Scottish UnderSecretary—I am glad to see him on the Government Front Bench—will try to get across to the local authorities the truth of the matter and the fact that, apart from Sections 1 and 2, the Act does apply to Scotland, all the other 27 Sections. I may tell him that they are not being applied at the present time.

I was told at Question Time that although Sections 1 and 2 do not apply in Scotland that does not make any real difference because what is embodied in them is also embodied in Section 12 of the Social Work (Scotland) Act. That Act, however, is not being operated in Scotland. I stress that to the Minister at the outset of my remarks. I hope that at some time in the near future my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris), who sponsored this wonderful Act, and the Minister will get together to initiate an amendment to the Act to allow Sections 1 and 2 to operate in Scotland. That would clear up all this ambiguity.

I come now to one or two points arising out of the Act, and the first is housing. I recently put a question to the Secretary of State for Scotland about how many local authorities had, under Section 3, plans for houses for disabled persons, and I discovered to my horror that not one single local authority in the whole of Scotland has any plans this year for constructing under Section 3 one house to suit a disabled person. This is a most serious problem.

Section 8 is about access to educational establishments, and I find that little or nothing has been done about that. In an answer by the Scottish Secretary to a Question I was told that he was sending out circulars. I should like to have a progress report on that. One thing is certain, that disabled people are in greater need of skills, greater need of further education, even than other people so that they may have opportunities to take their place in our community and to take it as normally as others.

As to Sections 9 to 15 regarding advisory committees, I have a strong suspicion that disabled people are not being consulted and not being assisted to take part in those committees, especially in considering transport. I see my hon. Friend the Member for Rutherglen (Mr. Gregor Mackenzie) on the Front Bench. He also has been deeply involved in getting for disabled people subsidised fares on public transport. I gather from him that so far we have had no assurance yet of getting them.

I have had many letters about badges for disabled persons' cars. I have had many letters about that, especially from crowded cities where there is real difficulty for disabled people in getting about. They ought to be able to do so and we should always encourage them to do so, as part of the larger object of enabling them to take their place as normal persons in our society.

Then there is the question of research and development. My hon. Friend the Member for Eccles, in his very fine address, spoke of this being the age of technology, and of the expertise which could be used to give a greater degree of freedom, and a greater degree of dignity to disabled people, and this could be done if more money were spent. I am surprised and sorry to learn that in England and Wales we are spending only £375,000 this year, a really paltry sum, but what angers me even more is that in the whole of Scotland last year we spent only £55,000. With the present rises in prices and the inflation, we do not get anything for £55,000. I hope the Scottish Under-Secretary will bear this in mind. Scotland is being frustrated in trying to implement the provisions of the Act.

I raise again a matter already mentioned this morning—adequate publicity. I have raised questions with the Secretary of State and the Scottish Secretary of State about a Press and television campaign, and the replies I got were that that was not necessary because publicity for the Act was adequate.

I can tell the House that I am fortunate in having in Glasgow a team of volunteers who turn out every Saturday on a door-knocking campaign, in a door-to-door survey in my constituency, and this survey will take in 5,000 people. I cannot praise too highly the members of that team. They represent a wide cross-section of the people of Glasgow. They would turn out every day if that were possible. I can tell the Scottish Under-Secretary and the Secretary of State that their estimates of the number of disabled, and of the knowledge which the disabled have of the Act, are pitifully poor.

Going round the houses from doorstep to doorstep I have found cases which would make one feel ill. To recount one or two examples, there was one person who was incarcerated for three years in a house in a multi-storey block. The mere fact of getting that person a wheel chair in which to bring him back to civilisation saved that man's mind. Some young people had the distressing experience of seeing and stopping an attempted suicide by a woman who was frustrated because of being incarcerated in her home 24 hours a day seven days a week. It is for reasons like this that there is anxiety and there is agitation among Members on both sides of this House, and it has been well expressed today.

The Under-Secretary of State has responsibilities for hospitals. As I understand it from my researches, we do not have one hospital unit for the young chronic sick, and it is distressing that young chronic sick people have to be put in geriatric wards. That is a poor thing in the year 1971.

I accept that this Government have been in office for only one year, and one cannot expect them to have done everything in that time. What I question is their priorities. We can nationalise Rolls-Royce in a day and we can find £400 million from corporation tax and we have surtax rebates for the political tallymen who returned the Conservative Party to office, and yet we can find only £55,000 for research and development for the disabled in Scotland and only £375,000 for research and development for the disabled in the rest of the country. That is why I question the Government's priorities.

Another question is the very important service of home helps. I am told that there has been a 25 per cent. increase in rate support grant, and when one examines that one finds it means £5 million and that £5 million has to last till the end of 1973. What was not told to us was that £1.1 million of that £5 million is to go to the children's panel service, and I work it out that the actual expenditure allowed by the Scottish Secretary through rate support grants will not benefit one single disabled person in Scotland up to 1973. There again, I question the Government's priorities.

Tributes have been paid to the compassion of the Minister, and I would not disagree about that. But he must accept that he is a member of the Government and, as such, that he must accept their responsibilities. So far, their attitude has been one of callous indifference.

The Under-Secretary of State for Health and Education, Scottish Office (Mr. Edward Taylor)

That is not true.

Mr. McElhone

The Minister says that that is not true. In that case how does he justify the Government's handing back £400 million in corporation tax and surtax rebates to the political tallymen who paid for his Government to come to power? That is where the question of priorities arises.

I want answers to my questions. I gave an assurance that I should limit my remarks, in view of the fact that the debate is nearing an end, and we want to hear the Minister and also the the Opposition Front Bench speaker. But I must stress that there is a real problem in Scotland. The figures that we have had from the Report are an under-estimate. I hope that the Under-Secretary or the Secretary of State can tell us what the disabled people in. Scotland may expect.

2.41 p.m.

Dr. Tom Stuttaford (Norwich, South)

I shall be brief. I want to talk about practical problems, just as did my hon. Friend the Member for The Wrekin (Dr. Trafford). Speaking as a doctor, I submit that we need a practical approach to this problem. I have been impressed by the speeches made by hon. Members on both sides of the House and I congratulate everybody who helped to get the Chronically Sick and Disabled Persons Act on the Statute Book. The Ministry is pushing the Act as hard as it can with the local authorities.

We must overcome the long-standing inertia among local authorities. In municipal affairs, for a long time money has represented power, and power has represented money. The social services have come well down the municipal social hierarchy. Social service committees have never been prominent ones; they have always had a smaller share of municipal budgets.

I congratulate my right hon. Friend the Secretary of State on not showing callousness. The reverse has been the case. In the last few months we have given local authorities more money to spend on the chronically sick and disabled. We have tackled the problem of the young chronically sick, and the geriatric wards. We have made more money available for chronic cases. There has been a big step forward. The effect of this step forward has already permeated the medical profession, and is appreciated by it.

I want to talk mainly about housing. The house is the secret of the life of the disabled. Disabled people spend a much longer time in their houses than do other people. If a disabled person lives in a reasonable house within the community there is a good chance that he will not develop the secondary psychiatric symptoms that we so often see in the chronically sick and disabled. A danger that is rarely mentioned but was touched on by my hon. Friend the Member for The Wrekin is that disabled people tend to become isolated, and as they become isolated they become slightly paranoid and withdrawn. We must provide houses for the disabled—not secluded houses, in some corner, like the almshouses of the past, but specially adapted houses in the community, so that the disabled people can feel part of the world at large.

In Norwich we have adapted the ground floors of some council houses for completely disabled people, and this has been very effective, because it has not only given happiness to the people concerned but has saved money. It is much cheaper to keep a disabled person in an adapted house than in a home. The trouble is that we cannot adapt enough houses fast enough. There are not enough ground-floor adaptations, or bungalows, to go round. Therefore, we must see what we can do to help the people who cannot be given an adapted house.

The first thing to do is to provide them with some form of chair with an elevated seat—something that operates like a Citroen car. When such a car stops at the traffic lights its body moves up and down. We need a hydraulic lift-type chair. No such chairs are available from the social services at the moment. In 1968 there was such a chair, known as an Anderson chair, with an elevated seat. This was extremely helpful. It had a seat movement of about 12 inches, and it meant that a women could propel the chair to the washbasin, wash her hands, move the seat to a different level to get to the cooker, and to a different level still in order to reach the light switches. She could exist by herself that little bit more effectively. That is a fundamental requirement in the household. The disabled person must be enabled to do as much as possible for himself or herself. Once such a person has been relegated to the role of a childlike member of the household, being cared for physically, he or she tends to be treated as if they had childlike mentality. That is bad for morale.

Let us make some of these chairs available once more. The Stanmore Orthopaedic Centre has had a design for some years. It manufactures the chairs individually. It now wants the Ministry to take over the manufacture, and to develop the chairs further. I hope that the Secretary of State will examine the possibility of doing this. If we could provide a chair with an easily operated elevated seat we could achieve a lot, because it would mean that we would not have to carry out so many minor alterations to houses.

My next point concerns the older person who becomes disabled. We often think of the disabled as being those who are born disabled, with congenital diseases, but many older people become disabled. They have families, and if we move them into custom-built houses we must ensure that they have at least two bedrooms. They will be isolated anyhow, and we do not want to isolate them further by making it impossible for other members of their families to stay with them. In these days of greater mobility, members of a family often live great distances from each other. We must ensure that other members of a disabled person's family can come to spend a few nights with them. Let us provide houses that are in the community and that have two bedrooms.

Every hon. Member—certainly every doctor—will have come up against the question of costs. Doctors recommend a supply of telephones for disabled people, but they are nearly always met with the same reply, "There is not enough money." A telephone is a disabled person's link with the outside world, especially if that person cannot move outside the front door. A telephone enables such a person to talk to the rest of the world. I should like to see a great expansion in the supply of telephones whose receivers do not need to be raised before they can be used. Such telephones are now available, and they are of enormous value to disabled people who are confined to wheelchairs.

Mr. Carter-Jones

There is one point that I have tried to make, namely, the concept of cost-benefit analysis. The L.S.T.—the loudspeaking telephone—has made an astonishing difference to handicapped people. Does the hon. Member agree that if it is supplied the disabled person can remain on his own, thereby saving money for the State? He can look after himself for that much longer.

Dr. Stuttaford

I agree. I know of one household where a patient of mine—a woman—was completely paralysed. She could only move her hands very slightly. With the aid of a telephone, and a very devoted husband, she had been able to bring up two children. When she had the children she felt that because of her gross incapacity she must have one of these telephones in order to prevent disaster overtaking the family. It meant that she could summon help when necessary. In our social work we constantly come across old people who, although disabled, would not have to be moved into an old person's home or hospital if they could be given the kind of help that I have mentioned. They could remain at home, which would save the State money and would create happiness for them.

My next point concerns cars. This is something for which I fought long before I became a Member of Parliament. Doctors believe that the regulations concerning cars are too tight. There is one special group of people that I want to mention in this connection, namely, those who work at a work centre. It is not full-time work; the work is done partly for therapeutic reasons and partly because the disabled people concerned want to contribute something to the world. At the moment, they are not allowed cars.

A disabled person who can work full time in a normal job can have a car, but anyone doing part-time work for valuable therapeutic reasons cannot have a car. In my view, this is quite wrong. What is more, I want, too, to underline the difficulties of the young housewife who has children. She must have a car. It is not merely a matter of getting her children to and from school and shopping A car is a means of keeping the family together. Her children will have been born with a disadvantage. They will be that much better off if there is a car in the family.

Greater encouragement should also be given to increasing the facilities for employment at home. There are training schools, but they are quite inadequate to cope with the numbers involved. As my hon. Friend the Member for The Wrekin said rather courageously, a great many of these people are unattractive, and they are not always a success in a factory. Many of them could do useful work in their homes. We need more grants to enable that sort of work to be developed.

2.52 p.m.

Mr. Hugh Dykes (Harrow, East)

I apologise for what will be a brief intervention, since I did not hear the beginning of the debate.

There are a number of splendidly bipartisan occasions in this House, of which this is one. The old American political maxim was that foreign policies should be bipartisan. In this House, a number of subjects are of a non-controversial nature, and certainly this is very much a bipartisan matter. There is much good will on both sides of the House. In that sense, it was rather a pity that the hon. Member for Glasgow, Gorbals (Mr. McElhone) injected a slightly abrasive note.

The 1970 Act has been welcomed by hon. Members on both sides of the House, and I add my voice to the congratulations. However, I shall be grateful if my right hon. Friend the Secretary of State will consider the suggestions that I wish to make.

First, I echo what has been said about motor cars. There should be a much more flexible approach. In addition, the discretionary interchange of drivers of disabled persons' vehicles should be permitted. This could be achieved without detriment to other road users.

My second suggestion concerns discretionary grants by local authorities or the Government of money for house conversions and improvements. We are only at the beginning of the crucial process of working out a sophisticated system of assistance. One example not referred to by my hon. Friend the Member for Norwich, South (Dr. Stuttaford) is the provision of lifts in houses. They are expensive pieces of equipment and, in any event, many houses are too small for them. But I know of cases in my constituency of disabled people who could well contribute to the cost of a lift and to whom a grant from the local authority for the balance of cost would be very welcome. To many people, a lift would make all the difference between their living as near a 100 per cent. normal life as possible and their not being able to. Although my hon. Friend referred to ground-floor residences, one has to bear in mind the normality of going upstairs to bed at night, and that is lacking in the cases to which my hon. Friend referred. This has had a considerable effect on a number of disabled people in my constituency.

Perhaps my right hon. Friend will be able to find time to consider the possibility of making grants towards the provision of private enterprise control panels. Some disabled people have been able to afford them, but they are expensive pieces of equipment. They operate windows, lights and so on and enable disabled people not to have to leave their beds. As I say, the panels are very expensive. I shall not embarrass the manufacturers by referring to their names. But it would be of tremendous assistance if the Government could look into the possibility of providing some contribution towards their cost.

I hope that the Government and local authorities will be able to promote more energetically the standardisation of slot-in equipment for the disabled in kitchens, bedrooms and bathrooms. All these items are essential.

A great many important suggestions are being considered by the Department. I am glad to have been able to take part in the debate, since it has enabled me to add my own.

2.56 p.m.

Mr. Alfred Morris (Manchester, Wythenshawe)

My hon. Friend the Member for Eccles (Mr. Carter-Jones) is to be congratulated warmly on his superb introduction to this important debate. Everyone knew that his success in the ballot meant almost inevitably that we should have this further opportunity to debate the problems of the long-term sick and severely disabled. My hon. Friend's speech was a most felicitous one. It was extremely well documented and it maintained the very high standard that we have come to expect from him in these debates.

With my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley), and the hon. Member for Newbury (Mr. Astor), my hon. Friend the Member for Eccles played a distinguished part in the enactment of my Chronically Sick and Disabled Persons Bill. It has been pleasing to me that we have also heard today from my hon. Friend the Member for Willesden, East (Mr. Freeson), who made a very important contribution to the making of the Bill as a Minister in the previous Government.

From both sides of the House, we have had informed and constructive speeches expressing deep concern and understanding. The House is often at its best in debates of this kind. For all of us are seeking to help our fellows who lie chronically sick or severely disabled.

We are now approaching the first anniversary of the Royal Assent. It is, therefore, timely to review the progress which has been made since May, 1970, in translating precept and law into administrative practice and social revision.

Inevitably, perhaps, most public attention has been directed to the response of local authorities to the mandatory charter of local services provided in Section 2 of the Act. That is the section which ensures the availability of practical assistance in the home; housing adaptations; telephones and any special equipment necessary to enable the disabled person to use a telephone; holidays; meals in the home or elsewhere; transport to and from services outside the home; and many other forms of help.

In the last full year before the availability of these services became mandatory, the amounts spent by local authorities per registered disabled person varied, among county councils, from £41.99 in Surrey to £5.77 in Oxfordshire, and among county borough councils from £70.83 in Oldham to £3.08 in neighbouring Salford. In such a range, clearly there were many authorities in which marked improvement was both essential and urgent for the proper discharge of their duties under the new Act.

It is impossible today to catalogue all that has been done by local authorities since Section 2 came into force on 29th August, 1970. Much that has been done is wholly admirable and worthy of our warmest approval. Not only have all the provisions of section 2 been readily and humanely implemented by many local authorities, but the same authorities have widely publicised the availability of their new services and thus encouraged a larger number of handicapped people to participate.

While these local authorities have been leading the way, others have been somewhat noisily dragging their feet. In some localities even leading public representatives have professed ignorance of the Money Resolution by which Parliament gave financial backing to the availability in every locality of the services set out in Section 2. They have also argued that it would have been "more convenient" if the Act had been given the Royal Assent at the beginning of a financial year. This sounds much like saying that administrative convenience is preferred to social progress, even in the discharge of legal duties to the severely handicapped.

Nevertheless, our purpose now should be to praise the good, not to castigate those who could have done very much better. It was, of course, too much to hope that full implementation would be achieved in every locality simultaneously. But that the new provisions can be applied in exactly the way we intended has now been clearly demonstrated by local authorities in widely differing parts of Britain. We are no longer dependent on precept. What many local authorities have already done is equally attainable elsewhere, indeed everywhere. Our aim now must be to publicise the sucess which has been achieved while continuing to insist on raising the general standard of local services even above the level of the existing best.

The hon. Member for Ipswich (Mr. Money), who speaks with great sincerity and authority on this subject, has kindly recalled my recent statement that there is no saving of public money in failing to provide adequate local services for severely disabled people. Those in local government who think otherwise are confusing apparent cost with net cost. Many outstanding experts have argued, in sup- port of what is now Section 2 of the Act, that improved domiciliary care can lead not only to increased happiness for the severely disabled but ultimately to a net saving of public expenditure.

It was urged upon me again and again that even a modest improvement in welfare services provided by local authorities could help to relieve at least some of the strain on the hospital service. The truth of this could easily be illustrated by the cases of people who have been enabled not only to live independently, but even to take paid work following the provision of adequate services by their local authorities. Clearly, and indisputably, the fullest possible implementation of all the provisions of Section 2 of the Chronically Sick and Disabled Persons Act in any particular case would not involve anything like the cost of long-term hospitalisation.

I am grateful to the Secretary of State for removing a misunderstanding concerning the financing of the Act. Answering oral Questions in the House on 6th April, the right hon. Gentleman stated that the Act … carried with it no finance whatsoever and that it …had no finance connected with it."—[OFFICIAL REPORT, 6th April, 1971; Vol. 814, c. 219.] The right hon. Gentleman knows that, on the initiative of the previous Government, the House as a whole approved a Money Resolution covering those parts of the Measure requiring financial provision. If this had not been done the Bill could not have made progress, although it was not, of course, necessary at that stage to make any precise estimate of its cost. The right hon. Gentleman is also aware that the Bill did not receive the Royal Assent until the final day of the last Parliament-29th May, 1970. It is the wish of all of us—certainly not least the right hon. Gentleman—that this new Act should wholly succeed in its purpose. Thus it did not help for the impression to be given that the Act was one which somehow reached the Statute Book without the enabling provisions of a Money Resolution. The right hon. Gentleman now readily concedes, as he has confirmed in his letter to me of 5th May, 1971, that the Money Resolution gave the necessary statutory cover for any additional expenditure arising under the Act. The House as a whole will, I am sure, congratulate the right hon. Gentleman on the success that he has had with the Treasury in making available increased sums of money for spending in the localities under the provisions of the new Act.

In the rate support grant negotiations, it was made very clear that a substantial increase in services was envisaged. It is always useful to give as much guidance as possible to local authorities, and to the voluntary organisations working with them, on the somewhat complicated questions of financing the legislation we enact.

Section 2 is, however, but one of 29 Sections in the new Act. There is now a need for much more attention to be concentrated on the other provisions that we have made. Section 1 still awaits implementation by the Secretary of State. Its provisions place a new mandatory duty on each local authority, first, to find out how many handicapped persons live in its area and, second, to ensure that every such person is informed of the services available to him or to her. Subject to the principles of confidentiality and voluntarism, this requires the full identification of all who are severely disabled in Britain today.

Section 1 is the master key to the main problem in the whole field of social provision for Britain's disabled. From the important surveys commissioned by the Central Council for the Disabled in Exeter and Edinburgh, it became clear that the number of permanently and substantially handicapped people in this country was well upwards of two million. But when these surveys were published recently, only 600,000 cases were known to public authority. It followed, therefore, that until Section 1 was fully implemented about two-thirds of Britain's severely handicapped people might be denied the benefits of other provisions of the Act.

We have now received the sombre, and, in many respects, deeply shocking report of the Government's own survey, which shows that about 200,000 households which include handicapped people need rehousing or improvements to accommodation because of the lack of an inside toilet. Another 150,000 very severely, severely or appreciably handicapped people were found to be living in inadequate accommodation with inaccessible rooms, or where the handicapped person has to sleep in the living room because of his or her disability.

Two-thirds of all handicapped people are women. A large number of them were found to be living alone without the help of welfare services, and the Report says: One in five handicapped persons is living alone and even one in 20 of those who need special care has no one living with her, having to bang on walls to attract the attention of neighbours, provided they are at home. Very few of these people use a telephone to call for help. One in five impaired people living alone has a telephone, but only one in eight housebound people living by themselves has a telephone. Under the provisions of the new Act there is now no justification for any housebound disabled person to be isolated in that way, or for the other deprivations which are detailed in this Report. The survey did not include either disabled children under the age of 16, or the large number of elderly people who are severely handicapped. Even so, its figures reveal that there are three million people lacking part or all of a limb, organism, or mechanism of the body. Again excepting those under 16 and many elderly handicapped people, the survey revealed 1.25 million adults with even more serious handicaps. As has been emphasised by Mr. James Loring, the Director of the Spastics Society, the survey shows how very seriously the size and gravity of disablement problems have been underestimated in contemporary Britain.

The survey's findings also argue the compellingly urgent need now to implement Section 1 of the new Act. Most severely handicapped people need help. How on earth can we help them without first knowing who they are and where they live? That was the gravamen of the case made by my hon. Friend the Member for Eccles and others who have spoken about Section 1 in this debate.

Against the background of the Government's survey, the task now facing public authorities may seem daunting, even intimidating. Certainly it will not be tackled successfully without maximum co-operation between the statutory and voluntary organisations. But let no one have the merest doubt that the voluntary organisations are ready, indeed deeply anxious, to play their full part. In this regard, I welcome the current trend towards increasing co-operation among organisations representing all kinds of disability.

Ministers and most of the new directors of social services will accept the need for close liaison with the voluntary organisations to discuss the implementation of the Act, but such liaison is made easier if the voluntary organisations can be seen to be working together and speaking with one voice. This is also important for the purpose of Sections 9 and 14, which seek to ensure adequate representation for the disabled and their organisations on councils and committees advising Ministers and the public services on major questions of policy.

Co-operation in the localities is no less important if we are to take full advantage of the provision in Section 15 for co-opting disabled people and their representatives on to the committees of county and county borough councils. The local authorities will obviously find it easier to make their co-options if they can be certain that the persons invited to serve are seen to be representatives of all disabled people in their areas. The need for every local authority to use Section 15 is increasingly urgent. In extending and improving local services, the social service committees of county and county borough councils cannot but benefit from the knowledge and first-hand experience of those who know the realities of life for disabled people.

The implementation of Sections 25 to 27, which refer to the special educational needs of deaf-blind, dyslexic, autistic and other children suffering from early childhood psychoses, would clearly be hastened if the voluntary organisations locally can work together for a co-option of suitably representative people by local education committees. As my hon. Friend the Member for Stoke-on-Trent. South has reminded us, these sections are deeply important. I agree that the Secretary of State for Education and Science should be urged as quickly as possible to do everything she can to ensure the fullest possible implementation of Sections 25 to 27.

There are as many autistitic children in Britain as there are blind children. Some of the most distressing and desperate problems for the parents of disabled children are those presented by the difficulties encountered by really disturbed autistic children. I have heard recently from J. K. Wing. Professor of Social Psychiatry at the Institute of Psychiatry and London School of Hygiene, about the problems of autistic children. He points out that, because of his central difficulty in understanding the world, the autistic child becomes withdrawn and often very difficult in behaviour. He adds that although many families do not receive help, it is nevertheless possible to weather the storm and keep the child at home. The outlook then is quite hopeful. At the very least, the child grows up to enjoy life and remain outside an institution. I know that we are all deeply concerned that, wherever possible, the disabled child should be in his own home and not in an institution.

There is, of course, a far bigger number of people involved in the problem of severe disablement than any of the estimates to which I have referred. For we must endorse the concept of the disabled family. If one member of a family is disabled then, by definition of the word family, the family as a whole is disabled. This was well illustrated by a letter that was sent to me while I was preparing my Bill. It came from a schoolmaster with a severely disabled daughter. He had been offered a headship in another town but could not accept it because the local services for the disabled in that town were so much worse than in the area in which he and his family were then living.

This seemed quite wrong, but I knew it to be a problem of growing importance. The incidence of severe disablement is increasing rapidly as medical science both extends our life span and improves the surivival rate among children with the more grievous congenital afflictions.

Many of the provisions of the new Act are designed to help families as much as the disabled themselves. This is because we can help many disabled people only if we are prepared to help the family as a whole. The logic of this is to accept that there are not 2 or 3 million, but perhaps upwards of 6 million people who are personally involved in the problems of severe disablement in Britain today. When we are discussing the welfare and status of the disabled, we should also remember that potentially we are all disabled.

The access provisions of the new Act have received far less attention than Sections 1 and 2, although they are of fundamental importance to improving the social life of disabled people. In drafting my Bill, I was convinced that what hurt the severely handicapped more than loss of any faculty was the thought that they were regarded, even sometimes treated, as if they were a separate species.

Physical disability still invited severe social penalties. The disabled were not told to keep out of town halls, art galleries, libraries and all sorts of other public and social buildings. But they might just as well have been. Most of our public and social buildings were designed exclusively for the able-bodied. Sharp, twisting staircases, narrow corridors and awkward doorways can bar a chairbound person just as effectively as locked and bolted doors.

Even university buildings have been mostly designed on the assumption that dependence on walking aids or a wheelchair implies a lack of scholastic ambition and merit. For this reason we argued strongly in our debates on this subject that it would have been useful if every architect had been obliged during his training to spend a week in a wheelchair. Only then would he have been able to see the world from the point of view of severely disabled people. Five Sections of the Act are concerned with improving access to every kind of public and social building. The most important of these, Section 4, ensures full access and facilities for disabled people both to and within almost every new building or premises to which the public are to be admitted, whether on payment or otherwise.

Section 8, which amends the Education Act, 1944, as well as the Education (Scotland) Act, 1962, is also of real significance for the future. In the interests of the young disabled, and of disabled teachers, the provisions of this Section specifically extend the new philosophy to universities, university colleges, and colleges, including teacher-training colleges, and schools and other educational buildings.

But these are provisions about new buildings. Adaptation of existing buildings is not always easy. But nor is it as difficult as many would have us believe. I am pleased to acknowledge today the lead given by the authorities of the two Houses of Parliament both in making the Palace of Westminster more accessible to disabled people and in providing here the facilities they need. Those responsible for many other important public and social buildings, including the British Museum, are to be congratulated on their recent decisions. We must now hope that others will follow their lead in adapting existing buildings.

Amongst the most sensitive problems we set out to tackle in drafting my Bill were those of the young chronic sick confined to geriatric wards and of the young and homeless disabled living among very elderly residents in local authority welfare homes. It is a sad comment on these problems that in a report last week from the South East Metropolitan Hospital Board, some 15 of its geriatric units were described as … perfect examples of 'human warehouses'. Some very challenging cases affecting young people in geriatric wards were brought to my attention. They were all very sad cases in which mental anguish was gratuitously added to chronic sickness and physical disability. The Act deals very fully with this problem. Not only is it necessary now for every regional hospital board to inform the Secretary of State of every case of a young person who is in a geriatric ward. The board must give the reasons why the young person is there and also explain why more suitable accommodation cannot be found. It will be necessary further for the Secretary of State to lay before Parliament annually a report giving full details of every case where a young person has been kept in a geriatric ward. It would be of help if the regional boards could report any progress in this very sensitive field today. My hope is that there will be no necessity for many such reports, and that before long we shall have a nil return from regional boardsabout the incidence of young people in geriatric wards.

Briefly stated, our intention in drafting what is now Section 17 was to ensure that geriatric wards are used for geriatric persons. Simple as that proposition may seem, it was very far from being easy to sustain. Here I must pay tribute to the action already taken by the Secretary of State and the provision he has made for spending £3 million for special units for young chronic sick for the purposes of Section 17. I know that he fully shared our assessment of the cost in human terms of failing to tackle this problem. Even one young person who is wrongly placed in a geriatric ward is too many, for to place young people in geriatric wards is to add the possibility of mental handicap to other forms of illness and disability.

Several sections are concerned with improving the mobility of disabled people, but the provisions of Section 20, which deals with research and development, are widely held to be most far-reaching in their importance. Their principal aim is to improve both the indoor and outdoor mobility of disabled people. Under the provisions of this section, the Secretary of State now has a statutory ditty to lay before Parliament an annual progress report on reserch and development undertaken by or on behalf of any Minister of the Crown for the purpose of … increasing the range of activities and independence of well-being of disabled persons, with particular regard to equipment for improving the indoor and outdoor mobility of disabled persons". There will thus be opportunities now in both Houses of Parliament for an annual review of what all Ministers have done in previous years to increase the independence, wellbeing and mobility of disabled people.. The intention of Section 20 is not merely to report progress but to stimulate progress. From now on technological progress in the service of the disabled will come under constant parliamentary scrutiny and review. Again, it would be helpful if the House could hear from the Secretary of State when the first report will be presented and also whether it will be informed by full consultation with the organisations with which my hon. Friend the Member for Eccles is so closely in touch.

I am hoping that Section 22 will very soon lead to a wider availability of four-wheeled vehicles for the severely disabled. There will undoubtedly be determined Parliamentary pressure for this. With Mr. Graham Hill and others who have discussed the present position with me in recent months, including motor car manufacturers, I am convinced that we could provide a suitable four-wheeled vehicle at no greater cost than the three-wheeled vehicle which today does so much to disrupt the family lives of countless disabled people.

Quite apart from disrupting family life, the three-wheeler can sometimes be a highly dangerous vehicle. The vehicle is dangerous, for example, to haemophiliacs, for whom twists and jolts bring on internal haemorrhage. There have been a number of cases of three-wheelers, in which the disabled person must travel alone, being blown off the road in high winds. In one such case the disabled driver was trapped in a ditch in a three-wheeled vehicle for 12 hours. His disability was paralysis from the waist down and he could not get out of the vehicle to summon help. If he had been a haemophiliac, he might very well have died from bleeding.

Why, then, is there so much official reluctance to provide four-wheeled vehicles? I am sure that it is not based on the cost per car. I have seen figures which show there to be little, if any, difference in cost per car as a result of replacing the three-wheeler with a four-wheeled vehicle. Official reluctance to go for a four-wheeled vehicle seems to have much more to do with the fear that this kind of vehicle would substantially increase demand. While we have three-wheelers, many of those entitled to them simply do not apply because of the unsuitability of these vehicles. The offer of a four-wheeled vehicle would certainly increase the number of entitled applicants, and I believe it to be this aspect of the cost of replacing the three-wheeler which really disturbs Whitehall.

Ministers appear to be continuing an unsatisfactory service on the ground that it invites fewer applicants at lower cost than would a satisfactory service. As I have said elsewhere, it is rather like offering distasteful sweets, not because they are cheaper, but because fewer people will want them.

Here again, there is more concern with apparent cost than with net cost. The fact is that there are disabled people who could think in terms of taking some form of employment if their mobility were improved. There are many highly capable disabled people, men and women alike, who desire nothing more than the dignity of being able to work. They yearn to cease being supplementary pensioners and to start being taxpayers.

Lack of mobility is not their only obstacle. The incidence of unemployment among the employable disabled at 12½7 per cent. is tragically high at the present time. What is more, the attitude is much too widespread that disabled people, even if they are considered to be employable, are capable only of menial work.

These problems were debated at length in the parliamentary proceedings on my Bill and it was pointedly stressed that at least part of the unemployment problem of employable disabled people is due to the inaccessability of most places of employment.

The provisions of the Act to help war pensioners have been widely welcomed by the organisations representative of the war disabled. I trust that the right hon. Gentleman will be able to tell us that these provisions are working well.

Section 21, which is of benefit not only to disabled drivers but also to drivers of disabled passengers, is to be made effective in the very near future and will improve the mobility of disabled people. There has, however, been very little reported progress so far under Section 24 of the Act which has to do with the need for an institute of hearing research. That is a Section with which my hon. Friend the Member for Stoke-on-Trent, South was deeply concerned during the passage of the Bill through Parliament. Like many other hon. Members, he is keenly concerned to see it translated into meaningful action.

There is one other matter on which progress should be reported today. It has been re-emphasised in recent Ministerial statements that the Act covers the mentally handicapped, where appropriate, just as much as the physically handicapped. I am very grateful to my hon. Friend the Member for Woolwich, East (Mr. Mayhew) for making the points which he made on this important matter.

It would be helpful if the Secretary of State could comment on the important memorandum sent to him by Ann Shearer and Sandra Francklin recently, in which they and others proposed a programme of reform which will lead to the abolition of hospitals for the mentally handicapped within 10 to 15 years and a commitment to the financing of a full programme of community care which will make this possible. As Ann Shearer and Sandra Francklin say: These may sound bold demands, but we feel that only in this way will retarded people get the rights accorded to every other citizen of the country. Cardinal Heenan in his Lenton Pastoral, speaking of the mentally handicapped, said: These are our brothers and sisters no less dear to us than the bright, young and healthy. That is the way we should approach these problems. There are other provisions to which I should have referred, but I must conclude. The new Act has been welcomed by all the voluntary organisations working among handicapped people. By the Bulletin of the British Polio Fellowship it has been called a Bill of Human Rights for the handicapped. The assessment of the journal of the Royal National Institute for the Deaf is that it is as momentous for many severely disabled people as the National Health Service Act, 1948.

There is still much to do if we are to turn law and precept into administrative practice and full social provision. The House as a whole recognises the right hon. Gentleman's problems. All of us want to help, without any party animus, in emphasising their high importance and priority. None of the very wide fellowship who made and enacted the new Act doubts the size and gravity of the task ahead. Yet I trust that by working together we changed the status quo for Britain's disabled and also removed the serene satisfaction and complacency by which they were oppressed.

3.32 p.m.

The Secretary of State for Social Services (Sir Keith Joseph)

I think that every hon. Member would like me to say how grateful we are to the hon. Member for Eccles (Mr. Carter-Jones) for choosing the subject of the Chronically Sick and Disabled Persons Act for debate. He has given us all a chance to review the position of the chronically sick and disabled in the light not only of the Act but of the momentous survey by the Government of the handicapped and impaired and the initiatives the Government have taken on various aspects.

The House has shown itself deeply interested in the subject and, as usual, very well informed. I congratulate hon. Members on both sides on doing their homework so thoroughly. My only regret is that the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris) whom we all respect, has taken far more than the time he expected. I asked for at least 35 minutes, and preferably 40, in which to reply. I have just 26, and I shall have to scamp some of the answers to questions. There is an immense amount of ground to cover.

My hon. Friend the Under-Secretary of State for Scotland for Health and Education has been present for part of the debate, and my hon. Friend the Under-Secretary of State in my own Department has been present nearly all the time. I have been particularly asked by my right hon. Friends the Secretary of State for Education and Science, the Secretary of State for Employment and the Secretary of State for the Environment to say that they will individually study all the points relative to their Departments made from either side in today's debate. I am especially asked to emphasise that my right hon. Friend the Secretary of State for Employment has already put in hand a study of the employment services for the disabled.

I do not think that the hon. Member for Eccles need have any doubt about one of the points that he made in that very practical and powerful speech with which he opened the debate. He bade us bear in mind the lessons of cost benefit. Here, in this work, the lessons of humanity and cost benefit both preach the same doctrine—that the ideal that we should aim at is to keep people at work, whether it be paid work or housework, and to keep people at home. We believe that these should be our objectives because as my hon. and—saving your presence, Mr. Speaker—medical Friend, the Member for Norwich, South (Dr. Stuttaford) said, a person who is allowed to become inactive can often suffer even worse troubles than physical disability. The House will, there, force, not be surprised, after that introduction, when I say that I hope that the Motion will be accepted.

The House will not expect me to pause long on specific subjects within the responsibilities of colleagues in the Government. I want to acknowledge the speech of the hon. Member for Willesden, East (Mr. Freeson), which will I know be studied by my right hon. Friend, and I also acknowledge the points made by my hon. Friend the Member for Norwich, South, based on the simple proposition that housing is even more important for the disabled than it is for others because the disabled spend more time in their homes than most of the rest of us do in ours. In the same way, I must pass over the employment issues raised so powerfully by my hon. Friend the Member for Ipswich (Mr. Money), who cannot be present for the reply. He showed a crusading concern for the employment interest of the disabled and I know that my right hon. Friend will study what he says. Similarly, my hon. Friend and I will study seriously the points made about vehicles. The whole issue of vehicles for the disabled is under study by the Government and there will he a statement as soon as we have completed our decision making.

My hon. Friend the Member for Plymouth, Devonport (Dame Joan Vickers) made a number of valuable points to which I shall recur. In particular, she brought out, as others did, the importance of travel and access for the disabled. I, too, hope that we may soon welcome our hon. Friend the Member for Edinburgh, North (Earl of Dalkeith) back to the House, where he will have a chance to test our improved arrangements. [HON. MEMBERS: "Hear hear."] I want to speak about finance.

I am grateful to the hon. Member for Manchester, Wythenshawe for his courteous clarity and the graciousness with which he acknowledged what the Government have been able to do. In brief, we have accepted bids from the local authorities in the rate support grant negotiations which will add to their agreed expenditure 12 per cent. in real terms this year over last year and 12 per cent. in real terms next year over this year. This is not perfect but it is progress, and it is an increase in real terms. On top of these agreed bids, I was authorised by the Government to add an extra £11 million, spread over two years, specifically for the improvement of the welfare services of local authorities, and a share of the extra money, in addition to the appropriate parts of the basic sums, will go to the elderly, many of whom are disabled, the chronic sick and the handicapped.

In addition, there has been the extra £110 million over four years for the neglected sectors of the National Health Service, particularly for the geriatric, mental handicap and mental health services. The money is being spent relatively impartially between hospitals and community improvements. I am grateful to my hon. Friend the Member for The Wrekin (Dr. Trafford) and to my hon. Friend the Member for Norwich, South for recognising the importance of these improvements to the neglected sectors.

I do not think that politicians as a whole can be very proud of our earlier reactions to the needs of the disabled. Individual politicians among us have been very active indeed, and there have been lobbies for the war disabled and the industrial disabled over decades and generations. When it comes to disability in general my hon. Friend the Member for Ipswich was right when he spoke of a relatively new awareness. There were no debates on the subject between 1959 and 1964. There were no references at all in the 1964 Conservative and Labour Manifestos. In the 1966 Conservative Manifesto there was passing reference to severe disability, and in the 1966 Labour Manifesto no reference to disability at all.

I make this no matter of reproach. Individuals have been pioneering for a long time; while we have been laggard, voluntary societies and local authorities have been in action for decades and generations. We should not assume that, because we have come to the subject late and enthusiastically, all is to be done.

This is where the work of Ann Armstrong and Megan du Boisson and the creation of the Disablement Income Group sparked off Parliamentary interest. The focus of D.I.G. was primarily on those of working age, and in particular on the work of the disabled housewife. I do not know for sure, but perhaps it was D.I.G. that provoked the previous Government to commission this report. If that were so, the commission was undertaken with the primary thought in mind of working-age people. What comes out of this two-volume report—and there is a third volume on finance to follow—is the enormous proportion of disabled and handicapped who are old people. This is a report more about old people than about working-age people, though both are equally important.

The hon. Member for Wythenshawe was right. The figures, taken raw, are daunting and intimidating. But I would remind the House of three thoughts which will give us the spirit in which to tackle the task. The first is that, individually, disabled people show a wide variation in capacity to cope with their disability. What is misery for some is endured stoically by others. Certainly no community can hope to pay for all the work that has to be done to help the disabled. The prime burden must fall on the family. The function of the paid staff—and I am not suggesting, of course, that they are mercenary staff since most are dedicated and enthusiastic—is to supplement the work of the family, to help to relieve its burden, and to help those with no family either because they are widows with no children living near them or because they are single and have no family within reach. This is brought out on page 49 of Volume 1 of the Report.

The third piece of comfort I would give is that, despite our new recognition of the problems the foundation of a superb service is in existence. There is an enormous amount still to be done, but we have evidence from these reports how much' local authorities and voluntary bodies and families are already tackling.

I turn now to a few statistics. The Report shows that 1.1 million people need substantial help to get through ordinary everyday life. To this figure of 1.1 million over the age of 16 living at home we should add perhaps 300,000 more adults who are not included and who are mostly in hospitals and institutions, and about 80,000 children. Of the 1.1 million, some two-thirds are women. Of the 1.1 million, one third are over 75, one third are between 65 and 75; and the remaining third are under 65. Half a million of the 1.1 million are either very severely handicapped needing special care or severely handicapped needing considerable support. A further 0.6 of a million are appreciably handicapped needing some support. About 20 per cent. of this total of 1.1 million live alone, and that percentage of those living alone is increasing. About half of those living alone in this group, the very severely disabled, the severely handicapped and appreciably handicapped, are helped by relations.

Let us look particularly at how local authorities' services reach them. Of the very severely handicapped three-quarters are getting one or more local authority services; 40 per cent. of the entire group of 1.1 million are getting one or more local authority services. If I have time I will come back to the question of the hon. Member for Woolwich, East (Mr. Mayhew)—the mentally handicapped—but I can answer by Parliamentary Question and answer, if I do not have time today.

Services clearly exist; families are in action; but services need expansion to reach those who need them but are not getting them, and we need to increase the services to those who receive some but not enough. What are the needs and what are the provisions?

We all know that there is need for both cash and care, and I want to recognise two particularly trenchant speeches, those by my hon. Friend the Member for Exeter (Mr. John Hannam) and my hon. Friend the Member for Cambridge (Mr. Lane). I quite accept the argument by my hon. Friend the Member for Cambridge for a strategy. I would remind the House that the Government are injecting £30 million net of extra money a year for the chronic sick and the very severely disabled. Some 65,000 households will receive either an increase in children's allowance, or an increase for working wives, or both—from this September. I am ignoring nearly 350,000 households who will get invalidity allowance.

There will be another 30,000 households who from December will receive attendance allowance for very severely disabled members needing attention. Thus about 95,000 households will receive, some with supplementary benefits offset, substantial extra weekly cash from September or December this year, quite apart from the invalidity allowance.

The needs for care vary immensely. I will not list them. That will only take time, and we all know the range, the catalogue. There is immense scope for families, for neighbours, for voluntary bodies. The spectrum of care ranges right across family, neighbour, voluntary bodies, local authorities, health authorities, and cash. The hon. Member for Ealing, North (Mr. Molloy) abundantly stressed the crucial importance of cooperation between them. If I had a magic wand and had one wish, which was not cash, I think it would be for multiplication of home helps. We recognise that these are a prime aid for those in this sort of need. Secondly, there are the district nurses.

We recognise the demand for increased telephone facilities. But I ask hon. Members to accept that telephones are not a panacea for those in emergency.

I come to what, I think, was the principle thesis of the hon. Member for Eccles who moved the Motion, and that is that technology and ingenuity can provide a great deal of assistance for the disabled. The fact is that the disabled need, as it were, a parallel world of adapted facilities. I have been to the Disabled Living Foundation this morning. My hon. Friend the Member for Plymouth, Devonport spoke glowingly of it, and she is quite right. My right hon. Friend the Prime Minister went to see the exhibition recently, and he told me how impressed he was by what he saw. I shall study the prospects and the scope of this admirable institution. In particular I shall study the proposal of my hon. Friend the Member for Norwich, South and my hon. Friend the Member for Harrow, East (Mr. Dykes) on the subject of aids. I am coming a little later to some of the suggestions of the hon. Member for Eccles.

For lack of time I must turn now to the question of Section 1 of the Chronically Sick and Disabled Persons Act. There is to be a survey of needs, starting in October. It is common ground that there should be no compulsion to register. Some people do not want to be labelled—particularly the mentally ill. Short of compulsion, and subject to confidentiality, our aim is a comprehensive and up-dated register. I stress the word "up-dated" because an out-dated register is about as useful as an out-dated canvass return—and we all know how useful that is!

Hon. Members must accept that we cannot leap straight to a comprehensive up-dated register. It is our aim, and we shall reach it. Meanwhile, I must tell the hon. Member for Stoke-on-Trent South (Mr. Ashley) that it may be that people are registered because they are getting services rather than getting services because they are registered.

Anyway, the first need is to assess the scale and type of help in each locality. We know from the reports that there is great regional variation. We do not need a survey for local authorities and the Government to recognise the need to expand home helps, meals on wheels, day centres and the adaptation of houses. We know that however fast we go we shall not catch up with the need in a hurry. What we need to know from the survey is what, in the list of factors, is needed in each area. We shall be advising local authorities how to carry out these surveys. Part of the job under the Act is for local authorities to give publicity to the services that are available locally. We know that needs far exceed supply, and are likely to do so for a while yet.

I am discussing with local authorities the strategy that they should follow. There are, broadly, two alternatives. Local authorities can go for a comprehensive service for the disabled but they cannot cover their whole areas at once with such a comprehensive service, so they will have to have pilot schemes in parts of their areas. That is one alternative. The other is for local authorities to provide a first-class service for particular priority needs over their whole areas. I am discussing with them which of the alternatives, or a mixture of both, should be adopted. It may be best to have different pilot schemes in different local authorities and to try out each of them. I am having discussions with them about that.

I apologise to the hon. Member for Glasgow, Gorbals (Mr. McElhone) for not having time to deal with his questions, but I am sure that my hon. Friend will write to him about them.

Mr. McElhone

On a point of order. Scotland has been treated in a shabby fashion on this occasion.

Mr. Speaker

That is not a point of order. It is a comment.

Mr. McElhone

May I be guided by you, Mr. Speaker, on the question of an English Minister speaking for a Scottish Minister.

Mr. Speaker

That is not a point of order. It is a comment. I am afraid that the Chair has no control over these matters.

Sir K. Joseph

The House would like to know what immediate action we have in mind—it is only provisional action; we have had this report only a few weeks and we must consult local authorities. It cannot be dramatic. The work is going on. It is not enough, but it is going on. The House knows of the many improvements that have been made in caring for the mentally handicapped. The Government are about to issue comprehensive policy guidance. At the moment I am discussing with local authorities their plans and I am arranging a system of feedback and progress reports.

Meanwhile, the House would expect the Government to try to attack some of the greatest avoidable miseries revealed by the reports. I believe that some factors behind these figures are not generally recognised—factors that we should try to alleviate. I believe—I do not know whether I am correct—that, oddly enough, incontinence is a source of massive misery, leading in many cases to such a sense of insecurity that isolation is the only refuge of the person concerned.

I have been asked about the scope for research. I am told that the King Edward's Fund had a seminar on the subject last year. I shall see whether there is scope for more sharply focused research on the medical aspects of incontinence, and perhaps I shall have a chance to report to the House what I learn at a later stage.

Meanwhile, and related to incontinence, there is the problem for the disabled of access to lavatories. I do not mean access to public lavatories, important though that is, but to private lavatories, which is even more important. We know, alas, that many disabled people live in homes where they are separated either by stairs or by having to go outside their houses to get to lavatories. I am told that, medically, it can be very important to leave a motive for the disabled person to move and that, therefore, we should not jump to the conclusion that the provision of a lavatory conveniently, as we all enjoy, is necessarily good for such a person. I should have thought that it was good for such a person I am sure that we all would take that view. But it may be that the stimulus to move is necessary for some.

I propose that we should try an experiment. The hon. Member for Eccles has reminded us, and the point has been reinforced by my hon. Friend the. Member for Cambridge, that, as a byproduct of the growth of the caravan industry, there are now decent, seemly chemical closets. I think that we should arrange for them to be tried to see whether they improve life for the disabled who are not within easy reach of a lavatory. The local authorities have a great deal to do. I should dearly like to help them test out this idea so that, if it is found satisfactory, they can from their own resources embark upon the widespread use of chemical closets.

Before the hon. Member for Willesden, East accuses me of giving up hope of better housing, let me say at once that I am talking about the months and years which must flow before all houses in the country are improved. Let us help those who cannot conveniently reach a lavatory, if chemical closets will be of assistance. I propose, therefore, to buy 1,000 immediately and to make them available to local authorities for a piece of research to try them out in 1,000 homes. I shall obtain reports within as few months as possible. In this way, local authorities can learn whether it is a wise policy to follow in a more wholesale manner. We need an intermediate stage before jumping to hasty conclusions.

Then, my hon. Friend the Member for Cambridge rightly referred to isolation. The Government are disturbed to find from the tables in these reports that there are 8,200 in the most seriously disabled categories, very severely or severely disabled, living alone. Of those 8,200, 8,000 are women. They are mostly old. There is reason to think that most of them, probably 6,000, receive local authority services. Though they live alone, many have families who are within reach. But it may be that 2,000 or so have no services at all, at least from local authorities, although they may from their families.

I propose to ask local authorities at once to search for these 8,200 by consulting their own departments, general practitioners and voluntary bodies, so as to make sure that these very severely or severely disabled people who are living alone have all the help that they need. Surely we can at least see that those 8,200 people are found and helped. I appeal to hon. Members on both sides: if in their constituency correspondence they come across evidence of very severely or severely disabled people without adequate services from local authorities, families or neighbours, they should let their local authorities know. I know that the local authorities will be anxious to help.

In our anxiety to do better, we must not forget the huge aggregate of current efforts by families, local authorities, voluntary bodies and, above all, the disabled themselves, who are coping and enduring. The needs are certainly as great again. The Government are determined to secure progress. I said to the hon. Member for Woolwich, East at a conference which he chaired that the motto should be, "Impatience, but realistic impatience". That is the Government's attitude. It is my own attitude. With that attitude, I commend the Motion.

Question put and agreed to.

Resolved, That this House calls on Her Majesty's Government and local and other authorities to ensure full implementation of the Chronically Sick and Disabled Persons Act, 1970, at the earliest possible date, particularly in view of the Report on Impaired and Handicapped People in Great Britain.