CHRONICALLY SICK AND DISABLED PERSONS

HC Deb 21 February 1972 vol 831 cc913-1034

Mr. Speaker

Before calling the hon. Lady the Member for Halifax (Dr. Summerskill) to move the Opposition Motion, I should inform the House that I have selected the Amendment standing in the name of the Prime Minister and other right hon. Members.

4.9 p.m.

Dr. Shirley Summerskill (Halifax)

I beg to move, That this House deplores the long delay in implementing important provisions of the Chronically Sick and Disabled Persons Act 1970, the restrictive rules of entitlement to the attendance allowance, and the continuing lack of provision for the chronically sick and disabled. We are moving this Motion not to seek party gain but in order to shed light on the inertia of the Government concerning the chronically sick and disabled. It is not enough that there should be general agreement about what should be done for the disabled. A sense of purpose and positive action are needed, and these we have not had during the 19 long months that the Government have been in power. This is what we are debating today.

A recent Government social survey on the handicapped and impaired in Great Britain revealed a grave situation. Even in 1968–69 35–40 per cent. of the handicapped were in receipt of supplementary benefit, and on the whole their incomes were lower than for the general population. Over 12 per cent. of the housebound living alone had no telephone. and only 5 per cent. of the handicapped were living in purpose-built accommodation.

It is well-known now that there are 3 million people in Britain who are handicapped in one way or another. Of these, 1.2 million are very severely disabled, severely disabled or appreciably handicapped. One million of them are over 50. Many thousands of families are struggling to help them.

We do not want any more surveys. We now want positive action. It was to help such people to be more independent, more mobile and less lonely that the Chronically Sick and Disabled Persons Act was piloted through the last Parliament. It was a proud achievement of my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris). The Act was urgently needed to deal with a serious situation. It has often been said that we have a first-class health service for acute illness but that it is deficient in coping with chronic sickness and disability. We are examining this afternoon whether that Act has taken effect in practice. The Government have a duty to see that it is fully implemented locally. They cannot sit back and feel that they are relieved of responsibility now that the Act is on the Statute Book. The Act imposes a statutory duty on local authorities to find out how many chronically sick and disabled people are living in their areas and to determine what services they need; they have an obligation to ensure that the disabled know about these services and that they are provided with them.

I should like the Secretary of State to clarify the Government's attitude to registration of the disabled and chronically sick. His attitude has been ambiguous. We should like to know whether he considers it an expensive and time-consuming exercise, whether he considers registration unnecessary, whether he considers that the disabled and chronically sick do not wish to be registered, or whether all three descriptions apply to his attitude.

We appreciate that a register of the disabled is not a requirement of the Act, but many hon. Members, myself included, feel that keeping such a register indicates the conscientiousness of a local authority in applying the Act, and I consider it indispensable to efficient implementation of the Act. Failure to keep a register can be used to cover up inefficiency. If local authorities are given the impression that they do not have to have a register, there is no deterrent to such inefficiency.

I appreciate the confidentiality aspect, the voluntary aspect, which must be retained, but the disabled and the chronic sick by their very nature are not always able or willing to seek out help. The whole point of the Act is that we go to the disabled and the chronically sick and offer them help, and we cannot do that without some register or identification. We already have registers for the blind and the deaf, and we do not consider that that is interfering with their liberty or confidentiality. We know that it is essential if we are to give efficient help. General practitioners already have records of their chronic sick and disabled. That is not regarded as interfering with their confidentiality.

Yet when the right hon. Gentleman was asked as recently as last November what further steps he intended to take to ensure that all local authorities which had not yet done so proceeded to the speedy preparation of registers of local disabled persons, his reply was that all the responsible local authorities already had such registers. That implied that those which have not got such registers are irresponsible local authorities, and that is what we are concerned with. We are concerned with the lazy local authorities, the under-staffed local authorities, the mean local authorities. Every hon. Member knows that there are many such authorities.

What steps is the right hon. Gentleman taking to enforce the Act and ensure that local authorities do not make excuses not to carry out their obligations? We should like to see him exerting every possible pressure, giving every possible form of guidance and help to errant local authorities. Circulars and leaflets are not enough. They have been distributed in abundance. It would be admirable if the Act could be advertised with the same zest as that with which the Government advertise the family income supplement or pensions for the over-80s, on television and in magazines and newspapers, circulating G.P.s, local authorities, clergymen, dentists and the disabled themselves, everyone they can possibly contact.

We all know that there are striking disparities in local responses to the obligations imposed by the Act. Some authorities are moving slowly; some are not moving at all. Several councils have told disabled inquirers that they are simply not operating the Act. Some give excuses like finance and local staff shortages.

Which? magazine discovered in a remarkable analysis at the end of last year that 66 per cent. of the disabled were not registered with their local authorities and were unaware of the services which the councils offered free. Yet 93 per cent. of those people were in touch with their local doctors, who could assist with compiling registers. Harrow, Ealing, Liverpool and Manchester are a few examples of local authorities that are making active and successful efforts to implement the Act, to inform the disabled of their rights and to provide the services to which they have a right. We want to see the Government ensuring as a positive duty that local authorities large and small, rich and poor, Labour and Conservative controlled, are actively engaged in carrying out the provisions of the Act.

The Government have specifically refused, for reasons best known to themselves, to reveal the number per thousand of registered physically handicapped for each local authority. The Minister's reply to a request for that information in a Question was that since registration was no measure either of services provided or of the incidence of handicap, and the practice of local authorities with regard to registration therefore varied widely, the publication of the figures requested was liable to be misleading, and he would not be justified in giving them. By not giving them, the right hon. Gentleman is himself being misleading because failure to give them is interpreted as a concealment of figures that people would like to know. If such figures are not revealed, some authorities can conceal their inactivity behind them. Surely, if there is any misleading information it can be explained and the misunderstanding removed?

Mr. James Scott-Hopkins (Derbyshire, West)

On the question of registration, is the hon. Lady suggesting that it is the doctors who should inform the local authorities, and that they have a duty to do so, in order to compile the register, or does she say that local authorities should ask the doctors for information? It matters from the point of view of the doctor's workload which way round the hon. Lady puts it.

Dr. Summerskill

I suggest that there should be mutual co-operation. With the patient's permission and agreement, of course—which is important—the doctor could give information to the local authority, and the local authority should make every effort to get it from the doctor. Obviously, there would have to be mutual co-operation.

Mr. Lewis Carter-Jones (Eccles)

Is my hon. Friend aware that 12 months ago, almost to the day, I received this very information from the right hon. Gentleman and that it was classified in numerical order? I am now being told that the information is misleading. If it is misleading, ought not the House to have been told? Has not the right hon. Gentleman been subjected to great pressures from had local authorities to get him not to give this information in future?

Dr. Summerskill

I think that the right hon. Gentleman will take that point, and we hope that he will answer it. We appreciate that there are difficulties, and we hope that he will have some suggestions to make concerning these difficulties and something positive to say on the policy he puts forward. I mentioned that recalcitrant local authorities have been known to offer financial difficulties as their excuse, but it is strange that other local authorities do not have financial difficulties as an excuse. There is a wide variation.

No doubt the right hon. Gentleman will remind us that expenditure on the disabled will rise by 25 per cent. in the next few years, which should be reflected in the biennial rate support grant from the Treasury. Yet, as we know, rate support grant is calculated on a national basis. When councils get their apportioned share, they are not compelled to earmark money and spend 12½ per cent. or more on the disabled, so that facilities for the disabled will show wide variations. The extra money may go in one place on drains and libraries and in another place on the disabled. For instance, the social services committee of Cumberland County Council has just asked for another £20,000 to spend on telephones, television sets, aids and adaptations for the handicapped.

Meanwhile, the Government are unable, as my hon. Friend the Member for Eccles (Mr. Carter-Jones) has pointed out, to give the House figures of total expenditure by local authorities on services—indeed, we are told that these are not available. Here again, local authorities which want to can hide behind unavailable figures, and their apathy will remain undetected. Yet in the long run the economy can benefit from efficient implementation of the Act because caring for patients in hospitals and institutions is a higher cost to public funds than caring for them in their own homes.

There should be effective co-ordination, too, between the many Government Departments involved, with the Department of Health and Social Security given the ultimate responsibility of overseeing the implementation of the Act. It is a complex task to supervise an Act which, as well as amending 39 other Acts, makes provision where previously there was no legislation. Perhaps the right hon. Gentleman could consider the appointment of an Ombudsman for the disabled, who could investigate local complaints, but we realise that he is thinking day and night about the appointment of an Ombudsman for other parts of the National Health Service and we do not want to add to his contemplation of that matter.

We would also like to see greater co-ordination between the voluntary organisations, on which the Government rely greatly for the implementation of the Act. We want to see them in far better and more efficient liaison with the local authorities than many of them are at present. Many voluntary organisations have great pride, and they like to feel that they can stand on their own feet, but it is essential that they should cooperate with the local authorities.

I come now to the question of the attendance allowance. The right hon. Gentleman is well aware, from the Parliamentary Questions he is asked, of the dissatisfaction among hon. Members on both sides of the House about the criteria of eligibility for the allowance. These criteria are far too rigid, in that the disabled person must require not only attention throughout the day but also prolonged or repeated attention during the night. Again and again it is being revealed that patients are drugged at night so that relatives can get some sleep. They are then disqualified from receiving the allowance. Is this not a totally discriminatory, unrealistic and, indeed, inhumane way of looking at these cases? Not only that, but it is economically unsound, because the present criteria prevent many able-bodied men and women from going to work, because they are house-bound and unable to qualify for the allowance for disabled relatives.

The extent of the need for the attendance allowance was seriously underestimated by the Government when they set their target at 50,000 attendance allowances. I do not blame the Government for that. They now discover that over 95,000 people have applied.

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

One hundred and thirty thousand have applied.

Dr. Summerskill

Even more. Such great demand only serves to emphasise the urgent need for help in caring for these people. It is interesting to contrast the response in applications for the attendance allowance with the response to the much heralded and much advertised family income supplement, when the Government greatly over-estimated the number of potential applicants. Although at the end of last year 44,000 attendance allowances had been paid, by 25th January this year as many as 38,000 had been rejected. Can the right hon. Gentleman explain why these applications were rejected? Why were only 69 per cent. of those who applied for the allowance for looking after disabled adults successful? Were the other frivolous claims, or were they, as I believe is more likely, very hard-pressed disabled people who did not satisfy the strict statutory conditions for the present attendance allowance?

We ask the right hon. Gentleman to re-define and extend the qualifying conditions and broaden the scheme to include night or day attendance or both rather than restrict it to night and day attendance. This would entail a very simple alteration of the rules. If not, would the right hon. Gentleman consider a two-tier system whereby a person needing only day time or only night time attention would qualify for a portion of the allowance? This would involve up to 250,000 further disabled people—a clear indication of the need. The right hon. Gentleman has told us that this job must be tackled in stages. We suggest to him that the second stage has arrived. Mistakes must be admitted and progress made.

There are two other aspects of the attendance allowance that I ask the right hon. Gentleman to consider. A high proportion of the applicants who apply for a review of the board's decisions are successful. I believe that it is as many as about 80 per cent. Does not this indicate some deficiency in the first selection procedure, and are not all these appeals, which number about 4,000 at the moment, an unnecessary administrative waste of time, trouble and expense? Will the right hon. Gentleman also bear in mind the unfair situation which arises from varied standards of criteria applied by general practitioners to the attendance allowance in different areas of the country? Will he consider amending the form to cover all varieties of circumstances and permit far more information to be given about a particular case?

I should like the right hon. Gentleman to give careful consideration to the possibility of introducing a national disability income. Any disability or chronic illness makes living not only harder but more expensive. The disabled usually have low incomes if they go out to work, and they often need special food and special clothes. The Disablement Income Group advocates the introduction of a disability pension for all disabled men, women and children regardless of the cause of their disablement, not only men who have been injured in the war or at work. It would be similar to that already available in Sweden, Norway, Denmark, the Netherlands, West Germany and France.

Medical science increasingly offers the prospect of prolonged disability as a substitute for death. Governments should ensure that the extra years are not accompanied by prolonged financial hardship. We know that the disabled do not ask for pity and sympathy, but they ask for and need practical help and assistance in the form of cash as well as care.

I know that every hon. Member would greatly welcome a statement from the right hon. Gentleman concerning the invalid vehicle service. This would increase the mobility of the disabled, and enable many to go out to work who now stay at home, and make it possible for a disabled person to take a friend or family out in the car. These seem very simple problems to solve. In an age which boasts the hovercraft and Concorde, surely it is within the ingenuity of our scientists and engineers to design a range of safe, reliable, economic invalid cars with either three or four wheels.

I would not underestimate the need for housing for the disabled, and provision for ensuring that is contained in Section 3(1) of the Act. It is a shocking fact that thousands of disabled are now living in deficient, inappropriate accommodation with inaccessible rooms, outside lavatories and baths too low or too high. Yet disablement inevitably means struggling to cope within four walls most of the time, out of sight but, one hopes, not out of mind.

I am aware that the right hon. Gentleman's Department is co-operating with the Department of the Environment in a study to establish the extent to which the housing needs of the disabled person may best be met by adapting his existing dwelling, by providing him with a new house, or by providing him with a new dwelling especially designed for him. Could the Minister tell us when this important study will be completed, and would he assure us that it is not being used as an excuse for delay by local authorities and as an excuse for inactivity?

On this side of the House we must deplore the inflexible atitude of the Government to the problems of the chronically sick and disabled. I should like to explain in what way the attitude is inflexible, and I choose that word with great care. First, prescription charges for the chronically sick; "chronically sick" are words which defy definition, as the Government have found. If, Mr. Deputy Speaker, you have Parkinson's disease, or schizophrenia, or chronic bronchitis with asthma and you need a constant supply of prescriptions, you are not classified as chronically sick and you do not get exemption from prescription charges.

Mrs. Jill Knight (Birmingham, Egbaston)

Would the hon. Lady tell the House whether this was exactly the situation under the previous Government?

Dr. Summerskill

Yes, it was, but that does not make it any better for the people with Parkinson's disease, schizophrenia, or chronic bronchitis.

It is an inflexible attitude that can keep one list of one type of disease and patients having exemption from prescription charges and another list of those who are not exempt. The Government have undertaken to review this situation with the B.M.A., and I shall be interested to know the results of those discussions.

Secondly, there is inflexibility in the allocation of the attendance allowance. Here, too, some disabled may have it if they satisfy certain criteria while others may not because they do not satisfy certain criteria. With invalid vehicles there are the haves and the have-nots among the disabled. I do not sympathise with the type of means test which involves money but the extent to which a person is ill. It is a divisive policy; it creates two nations among the sick and disabled.

I have tried to deal broadly with the features of the Act, but I know that hon. Members on both sides of the House will be dealing more specifically with their own constituency cases, of which there are thousands, and more specifically with different sections. Tonight we shall vote on the Motion because the chronically sick and disabled and their relatives and friends who care for them have no trade union, no power to strike, but look to Parliament to represent their interests. We believe that the Government have not exerted themselves to ensure the legal rights of the disabled and that inertia has been responsible for a continued lack of provision for millions of chronically sick and disabled people.

4.37 p.m.

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

I beg to move, to leave out from "House" to the end of the Question and to add instead thereof: 'welcomes the present Government's introduction of the Attendance Allowance for the very severely disabled, the invalidity benefits for the chronic sick and their families and the rising provision for buildings and for the facilities and aids for the disabled; and commends the Government's realism in encouraging local authorities to implement the provisions of the Chronically Sick and Disabled Persons Act as fast as increasing staff and increasing resources allow'. The hon. Lady the Member for Halifax (Dr. Summerskill) is a very engaging person and a very engaging speaker, and if she had been truly angry, I expect that she could have made a three-line speech. But the speech she has just made was not even an attempt to indict the Government for anything deserving a three-line Whip tonight. Nevertheless, the Government are given an opportunity, which I for one warmly welcome, to explain the progress that has been made and the vast range of things still to be done in connection with the disabled.

The hon. Lady's criticism would have been a little more morally effective if she had been able to point to six years of progress under the late Labour Government. In fact, except for one moment when her argument was entirely punctured by my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight), she failed to refer to any activity under the Labour Government. She mentioned the Private Member's Bill, but no Government legislation, no extra services and no specific benefits for the disabled. I shall not in general make a party speech, but that needs to be put on the record.

Mrs. Barbara Castle (Blackburn)

Before the right hon. Gentleman becomes even less partisan, may I point out that the Labour Government warmly welcomed my hon. Friend's Bill and gave it time and a Money Resolution, thus putting the authority and the finances of the Government behind it?

Sir K. Joseph

The right hon. Lady knows that that is playing with words. There was not a penny of extra money connected with the Bill, and we know it. But I do not want to pursue that. It needed to be put on the record as a background to the hon. Lady's speech. [HON. MEMBERS: "Why?"] Because the hon. Lady failed candidly to reveal it as I for one would have revealed it in her position.

The hon. Lady made a broad indictment that there was a continuing lack of provision for the chronically sick and disabled under the present Government. I propose to deal far more widely with the conditions of the disabled than did the hon. Lady in her entirely justifiable and legitimately selective manner. Both sides must start with the following background.

Mr. Alfred Morris (Manchester, Wythenshawe)

Before the right hon. Gentleman leaves the question of finance, does he recall that my right hon. Friend the Member for Birmingham, Stechford (Mr. Roy Jenkins) was in correspondence with him on that point? The Money Resolution provided Parliament's support for the spending of money on the Act. He will do a major disservice if he keeps on saying that there is not one penny associated with it.

Sir K. Joseph

The right hon. Member for Birmingham, Stechford (Mr. Roy Jenkins) is unable to show that any extra money was voted for this Act. A Money Resolution was passed. That simply entitled local authorities to spend money on the purposes of the Act, but no extra money was provided to enable them to do so, and the whole House knows that. I have said time and again from this Dispatch Box that until Megan du Boisson and Anne Armstrong awakened the conscience of Parliament as a whole no Government began to face up to the problem. In the 1966 General Election the Tory Party had one reference in its manifesto to the severely disabled and the Labour Party did not have a single one. It is only recently that the House and the country have woken up to the needs of this group, and there is no credit to be gained to either party through looking backwards.

I am glad that in her introductory remarks the hon. Lady emphasised the degree to which the disabled are elderly. The D.I.G. campaign, splendid and effective though it was, largely concentrated on the disabled of working age and disabled children. When Amelia Harris produced that monumental survey to which the hon. Lady referred, initiated by the right hon. Member for Coventry, East (Mr. Crossman), it showed that two-thirds of the disabled—severely, very severely and appreciably disabled—are over 65 and one-third over 75. There has so far been no campaign for the elderly disabled, and yet they are just as poignant as the disabled of working age and disabled children. It is the Government's job to try to improve conditions for all. As the moment the disabled depend enormously upon themselves, their long-suffering families and neighbours. There is an infinite range of handicapped with needs requiring help and service.

The first subject with which I must deal is the difficult one to which the hon. Lady referred of identification and registration. I very much welcomed the relatively objective manner in which she dealt with the subject. It is rather more complicated than hon. Members on either side appreciate. The background does not start with the Chronically Sick and Disabled Persons Act but rather with Section 29 of the National Assistance Act, 1948.

That Act imposes upon local authorities the obligation to bring help to those who were: …substantially and permanently handicapped by illness, injury, or congenital deformity or such other disabilities as may be prescribed by the Minister.' Later it lays down the obligation to maintain a classified register of persons to whom help under the section has been given. We have an obligation to help and to register those who are helped, but that is a register which will not include those who do not want to be registered, those who have not been helped, those who have not been identified. It is a limited register, not necessarily covering all who need help.

Now we look at the Act introduced as a result of the efforts of the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris)—the Chronically Sick and Disabled Persons Act. Section 1 of that Act lays upon local authorities a duty to inform themselves of the number of persons who require help because of disability or handicap. It is a very valuable Section, but it contains no requirement to register. Along come a number of hon. Members doing their duty and asking for details of registration and spending on registration. There has crept in a confusion between the overlapping requirements of Section 1 of the 1970 and Section 29 of the 1948 Act.

I propose to try to sort this out in as objective and effective a manner as I can. I am about to embark on consultations with all interested bodies, and I shall welcome individual discussions with hon. Members who wish to put their points of view to me so that I can give advice to local government about the statistics which successive Governments will require to monitor performance of policies for helping the disabled and seeing where further help may be needed. I hope that that objective statement of intention will be acceptable to hon. Members. In the meanwhile, I have to say that statistics derived from the numbers registered under Section 29 of the 1948 Act as applied to the expenditure that can be identified under later Acts will not give a meaningful record of local authority performance.

I intend that there should be a meaningful record but I cannot promise that such a record will be available effectively before next year and the year after as a result of the improved statistics for which we shall be asking. In the light of that, I hope that the hon. Lady will allow me to carry on with the assurance that I shall be consulting all interested bodies and will gladly have individual talks with interested Members.

Hon. Members will be interested to know that a veritable fever of activity now characterises the social service departments of local authorities. Quite apart from the priorities that have to be given to those who need caring for as a result of the coal dispute, the departments have experienced an avalanche of demand for their services—in both the traditional needs and the newly identified needs that the last Government and this Government have exposed in connection with the mentally handicapped, mentally ill and physically disabled. The social service departments are coping with an almost overwhelming demand and are having to build up staff and expertise.

The House may like to have a few details of the sort of cases which the search to identify the handicapped under Section 1 of the Chronically Sick and Disabled Persons Act has yielded. Here are four cases that demonstrate the benefit of the Section and the service which social service departments are offering. The first is of a 16-month-old child suffering from a double gangrene amputation after a spina bifida birth. This child was not known to the social service department until the search was undertaken. A mentally ill man, suffering from agoraphobia has been found. He had not gone out of his house for 17 years. The social service department is now helping him overcome his disability. A skilled engineer had contracted meningitis abroad and had become totally deaf and lost all his friends. He had become completely socially isolated, but has now been rescued from his isolation by the social service department and placed in work in a sheltered workshop. A man who was deafened in the war and had reached such a desperate stage that he had thought of becoming a tramp was found by the department and is now organising an angling club and a rambling club and being assessed for sheltered work.

Mr. Carter-Jones

I must preface my intervention by saying that every time I have asked the Secretary of State for help it has been readily forthcoming. I could not have asked anyone for more help at any time. I freely pay that tribute to the right hon. Gentleman. He has just quoted four dramatic cases and has argued that the statistics may be misleading. He has referred to Amelia Harris. I am not concerned about whether the statistics are misleading. Amelia Harris is concerned with half a million very severely disabled people. I would rather have misleading statistics of identification than the four cases, genuine though they may be, and one of which will not come under Amelia Harris' jurisdiction because the child concerned is under 16 years of age—

Mr. Deputy Speaker (Miss Harvie Anderson)

Order. I hope that the hon. Gentleman will remember that a number of hon. Members wish to speak.

Sir K. Joseph

I take the hon. Gentleman's point. What I object to is the use of statistics with a limited validity to indict local authorities which perhaps are performing as well as they can.

I move to the question of the broader services. If we can get it from the Chancellor of the Exchequer, it is far easier to distribute money than it is to provide services. Therefore, I deal first with the question of cash benefits. The attendance allowance has been far more effective in its first stage than we expected. We expected to achieve about a 50 per cent. success rate—that is, awards totalling about 50 per cent. of applications—and we expected the awards to total 50,000. We started on the basis of a £4 tax-free, in general disregarded, weekly benefit. In fact, with 2,000 claims a week still coming in, we have made 74,000 awards and achieved a 63 per cent. success rate. The benefit is now £4.80 a week, and instead of spending the expected £10 million a year we shall be spending £20 million a year.

The hon. Lady the Member for Halifax said that we have a far too narrow-eligibility test. I must throw her words back in her teeth. It is the only practical eligibility test for the first stage because it identifies the most severely disabled—those most urgently in need of help. It is precisely the same—word for word—eligibility test as that which the Labour Government put in their National Superannuation and Social Insurance Bill, which fell at the election.

I have said, and I repeat, that the Government intend to extend the attendance allowance as soon as they can, subject to the financial and administrative implications. Meanwhile, I hope that the House will relish the relative effectiveness of this award, which has already been made to 74,000 people—and there will be many more awards since not all the claims have been dealt with.

I turn to a matter which the hon. Lady the Member for Halifax did not mention—the invalidity package. In 1970 the Government introduced the first set of systematic benefits for the chronically sick—for those who had been sick for more than six months. There are benefits for the sick wage earner, depending on the age at which he first became chronically sick. There is a much increased disregard for an earning wife, which is benefiting no fewer than 13,000 earning wives of invalidity pensioners. There is a sharply increased benefit for the dependent children of those receiving invalidity benefit. Over 200,000 households are receiving benefit totally over £18 million a year.

The result of these two packages together—the attendance allowance and invalidity benefit—is that this year £40 million more will be paid to the disabled than was paid in the Labour Government's last year of office. That is a significant improvement, even if there is much more to do.

Mrs. Castle

If we are to tackle these problems, is it not ridiculous that there should be anomalies such as that which arose in the case which I sent to the right hon. Gentleman recently concerning one of my constituents who qualified for invalidity benefit and promptly lost his entitlement to free prescriptions? Is it not time these problems were considered more comprehensively?

Sir K. Joseph

I will look into that case. I will find out from the right hon. Lady about it, but it sounds a very special case.

Mrs. Castle

The right hon. Gentleman has sent me a reply.

Sir K. Joseph

I will look into the case again. It seems a very odd and unusual case.

What has been done is not enough. I am much stirred by the point made by the hon. Lady the Member for Halifax that many Western European Governments seem to be able to provide for the partially disabled and the disabled housewife in a way which we have never found practicable. That is why I undertook last year to send a mission to those countries to find out how they did it. That mission has returned, and I hope to have its report in a few months, and see what the Government can learn from its discoveries.

I turn to the question of services for the disabled. First, I should like to deal with the local authority finance question. The Government have made provision for an average annual growth in revenue spending by local authorities on the health and personal social services of over 7 per cent. in England and Wales during the five years to 1975–76. The comparable figure in real terms for the last five years of the Labour Government's term of office was under 5 per cent. Therefore, there has been a decisive real improvement.

Taking the personal social services by themselves, revenue expenditure by local authorities in England and Wales is planned to grow by an average annual rate of 9 per cent. in real terms between this year and 1975–76. Annual capital expenditure on the personal social services is planned to grow from £41 million in 1971–72 to nearly £65 million in 1975–76. With regard to local authority welfare services for the handicapped, the forecasts of relevant expenditure made in the rate support grant negotiations for the current two years provide for annual growth rates of about 12 per cent. in real terms.

There is, therefore, finance for improved services, but there is nothing like enough for all that needs to be done. As the hon. Lady the Member for Halifax freely conceded, there is a 25 per cent. growth rate in real terms over the current two years. I have no reason to think that local authorities generally are not playing fair by the personal social services. I believe that finance committees and finance chairmen and treasurers are co-operating very closely with their social service committee chairmen and directors. There may be exceptions, but in general the reports which I have had are of very fair play by these nationally suggested standards. But I admit that an enormous amount more will need to be done to ensure that the services meet the identifiable needs.

Dr. Summerskill

I believe that a survey of London boroughs revealed by my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) showed that 10 out of 32 of the boroughs did not intend to implement the Act.

Sir K. Joseph

Which Act?

Dr. Summerskill

The Act we are discussing.

Sir K. Joseph

I beg the hon. Lady's pardon, but we are not discussing the Act. She has indicted the Government for, as she says, a continued lack of services for the chronically sick and disabled. Across the whole front of services—and I shall deal with many others which the hon. Lady has not mentioned—the finance is available for improvements. For instance, in the vital domiciliary services provided by local authorities, the number of home helps was increased by nearly 8 per cent. last year. In the equally vital home nursing service, the numbers in effective action were up by over 5 per cent. in the last year. This means potentially better services for the disabled and the elderly and all those people who need attention at home.

I should like to tell the House about some improvements on the hospital side for the disabled. For the first time the Government have approved finance for no fewer than 38 new assessment centres for children's handicaps at a total cost of over £800,000. This is only the beginning of what needs to be done. The House already knows that about £5 million has been set aside by the Government to increase the number of units for the younger chronic sick. We have doubled over three years the number of places for the younger chronic sick in suitable hospital units. At present the Government are engaged in a comprehensive review of services to the blind, and for the deaf.

We recently announced our acknowledgment of the Reid Report on epilepsy. There is to be a national conference, called by me, this July for those concerned with epilepsy. We have agreed to finance the cost of three special centres for epileptic cases. My Department has made grants of £10,000 to the British Epilepsy Association both last year and for the current year.

The House may have seen that in a recent speech I drew attention to the whole range of what I called afflictions which, in medical terms, have not yet been able to be cured. These are borne, above all, by the elderly, and are afflictions such as arthritis. There is an enormous difference in the individual cases, dependent upon the quality of clinical treatment. A very small improvement in clinical treatment can make a very great difference to the life of the person concerned, and it is the intention of the Government to make it practicable to narrow the gap between the best clinical practice and normal clinical practice. Busy doctors cannot keep individually in touch with every improvement and every development in their skills, and the Government are helping to finance a number of demonstration centres for the best practice for the treatment of arthritis and the care and rehabilitation of the elderly.

I must now move on to those services which depend upon co-operation between hospital and local authority services. The House is aware that in the definition of "disabled" goes mental as well as physical handicap and also that the Government have found considerable resources for the improvement of treatment for the mentally handicapped and the mentally ill and the elderly—the elderly, many of whom are also disabled. There is going on, and will increasingly be going on, a great surge of upgrading and improvement, extra staffing, improved multidisciplinary management, more day hospitals, and more provision for the mentally ill, the mentally handicapped and the elderly in the hospital services—once again, not enough; but a beginning.

I would like to tell the House that joint discussions between the regional hospital boards and local authorities are going on now to co-ordinate the services for the mentally ill and the mentally handicapped. Local authorities in preparing the 10-year plans, which I am shortly going to ask from them, can collaborate with the hospital services in providing extra homes, hostels, day centres, sheltered jobs and clubs—and transport which is going to be needed for many elderly with the improved services for the mentally handicapped and mentally ill and elderly.

I would like to pay a special tribute again to the voluntary bodies in supplementing this vital work, and in particular to the services performed by the Spastics Society, the National Association for Mental Health, of which the hon. Member for Woolwich, East (Mr. Mayhew), who is sitting with us today, is Chairman, the Mencap Association, the Royal National Institute for the Blind—this cannot be a comprehensive list, but it is a list of just some of those with which I have been in contact—the Royal National Institute for the Deaf, the Central Council for the Disabled, the British Council for the Rehabilitation of the Disabled, the Royal British Legion, the Red Cross and St. John—and there are many other similar groups.

I should like to make special mention of a substantial class of the disabled who are not generally mentioned in this connection—the alcoholics. The Government have set aside £2 million for community and hospital services. A number of hospital projects have been approved. I am in discussion with a number of voluntary bodies and the National Council on Alcoholism to try to set in hand a national plan which the Government will help to finance.

I should like to give the House the latest figures of projects for the physically disabled. These are projects for which loan sanction will be recommended between this year and 1975. They number no fewer than 156 residential homes for the physically handicapped, day centres, hospital centres and combined day centres for the physically and mentally handicapped. This is 17 up on the figure I reported six months ago.

I turn to the hon. Lady's reference to telephones. I know that a number of hon. Members on both sides strongly believe that telephones would be a great blessing to the disabled. I am sure that it is right that they would be a great social blessing. What I am not convinced about is that, at the vast cost which would be involved in providing telephones virtually wholesale they would be a proper priority, bearing in mind all the other priorities for the disabled that we have to consider. The evidence is that, socially valuable as the telephone is, it is not nearly as much a lifeline as people imagine. There is, above all, the problem that an elderly or disabled person cannot necessarily get to the telephone when he or she needs help, let alone reply to the telephone in isolated cases if and when it is rung.

The Government, therefore, are working with several research groups, in particular with the Post Office-Essex University research team and also with the National Corporation for the Care of Old People and the National Research Development Corporation research team in examining other alternatives for making it possible for a disabled person not in contact with a mechanism to give an emergency signal. I hope from time to time to report progress to the House. It is not that we under-estimate the importance of contact. It is that we are not sure, even in spit of Michael Young's study of Hull, that the telephone facility, expensive as it is, would be an effective lifeline.

I would like to tell the House that the Government intend to distribute later this year 3 million copies of a special booklet for the disabled describing benefits and services and facilities which are available. We shall try to get them into the hands of all those interested. The disabled have a need of a parallel world of adapted facilities, and access to them, in their own homes. I should like to turn to a subject of especial interest to the hon. Member for Eccles (Mr. Carter-Jones), and that is aids for the disabled.

The hon. Member will be aware that we recently made a grant to the Disabled Living Foundation. I have been baffled, frankly, by the sheer number and variety of gadgets and aids which are on offer. The House knows, but perhaps would like to be reminded, that I have set in hand a reviewing team which is studying at this moment the needs for aids and equipment, and I hope it will be reporting back to me this spring. I hope that when that reports we shall know what our priorities are and how best we can get the information and evaluation into the hands of the key people, the prescribers and hospitals.

The hon. Lady referred briefly to housing. I can assure her that the Department of the Environment is conducting its study of facilities as fast as possible. One of the greatest miseries of the elderly disabled is that in many houses lavatories are not conveniently installed, and, sometimes, are not in the houses at all. The House will remember that the Government bought 1,000 chemical closets and distributed them to 20 local authorities. I hope this year to learn the lessons of the application of these palliative measures, pending improvement of the housing stock. Fast as the improvement of housing is going, it will take many years, and many of our elderly people will have to live in unimproved houses still.

The hon. Member for Eccles will be interested to know that the use of Possum is increasing fast. He was right in saying that the more knowledge there is of these gadgets the more will the take-up tend to be. They are growing increasingly fast.

The hon. Lady was right in saying that facilities for the disabled must include consideration of transport. I would like now to turn to the proposals the Government have in mind for the invalid vehicle service. I should like in particular to pay a tribute to my hon. Friend the Member for Banbury (Mr. Marten) who has been, I was about to say, "a plague" to Ministers about invalid vehicle services. He has had the support of my hon. Friend the Member for Oxford (Mr. Woodhouse) and the hon. Member for Wythenshawe, and others on both sides of the House.

My Scottish and Welsh colleagues—I see my hon. Friend the Under-Secretary of State for Health and Education, Scottish Office with us today—and I have just completed a review of the invalid vehicle service. As a result of this, we are making changes which, although accomplished within the limits of present expenditure, together enable us to secure important improvements. In trying to make better use of the existing money, it has been necessary to introduce a few savings in order to permit the improvements. The changes are these.

Persons qualifying for a vehicle will in future be able to forgo it and receive instead an allowance of £100 per annum to run a vehicle of their own which is registered and insured in their name and which they hold a full licence to drive. These allowances will be introduced with effect from 1st April, 1972, and I understand that the Chancellor of the Exchequer will be making arrangements for this allowance of £100 per annum to be tax free.

Vehicles will continue to be issued to people with some, though severely limited, walking ability if they need them to get to full-time work, but on cessation of employment the vehicle will be surrendered instead of, as hitherto, left with a person permanently once he has qualified for it.

Future recipients of cars issued by the Department will not be required to garage them. In consequence, the cash assistance accompanying the vehicle will be reduced by £25 per annum to £35 for each of the first two years after first issue of a new car, to £55 for each of the two succeeding years and to £65 per annum thereafter.

Future recipients of three-wheelers will not receive the £5 per annum petrol allowance.

Those unable to walk because of a heart or lung condition have hitherto had to show that they needed a vehicle to get to work in order to qualify for one. This employment condition will be removed.

Mothers who qualify for a vehicle will be able to have a car instead of a three-wheeler if they have the care of young children. The requirement that they must be in sole charge of the children will be removed.

Persons living alone in their own households, whose disability is such that they would normally have to be in full-time employment in order to qualify for a vehicle, will be able to have one even if not employed if they need it to carry out their household duties.

Persons whose walking limitations qualify them for a vehicle and who suffer from haemophilia may have a car instead of a three-wheeler.

Any vehicle issued by the Department or run with the assistance of the new allowance will be exempted from vehicle excise duty with effect from 1st April.

These changes will remove a number of anomalies that have developed over the years, introduce a desirable flexibility, meet many of the requests that have received a strong measure of support and increase substantially the number of beneficiaries, notably the unemployed "heart and lung" sufferers. Altogether we hope that about 10,000 people will benefit under the new arrangements.

We recognise that these changes do not solve the problem completely and we are already starting to think about possible future improvements. Before deciding the next priorities for any further help to those who are immobilised by severe disablement, we must consider the alternative ways of helping them, and the proportion of the resources that should be devoted to particular groups of severely disabled people.

We shall therefore within the next few weeks invite somebody from outside the Health Departments to study the subject and give us unbiased advice about further changes it would be useful for us to consider. We shall make it clear that the money available will be limited by competing claims on our resources. For this reason the inquiry will pay particular regard to the needs of people of working age. The resources of the Health Departments will be made available to the person conducting this inquiry, who will be asked to receive evidence from responsible bodies concerned with disablement, and I will ask for this work to be completed within a year. In due course I will inform the House of the main features of the advice received and the Government's intentions regarding it.

Mr. Neil Marten (Banbury)

I ought to be upstairs in the Select Committee, but I should like to thank the Minister for what he said about the all-party Disabled Drivers' Group, which has been running a long campaign. We shall study carefully what my right hon. Friend has said. I thank him, the Under-Secretary of State and the Prime Minister for the personal interest they have taken in the problems of disabled drivers.

Mr. Alfred Morris

Will the Secretary of State also say a word about the disabled passenger? What help does he see coming for the person who is too grievously disabled to drive himself or herself?

Sir K. Joseph

Before I answer the hon. Member for Wythenshawe, I should like to emphasise the point brought out by my hon. Friend the Member for Bambury. The statement I have been able to make this afternoon was very much the result of the intense interest taken in this whole subject by my hon. Friend the Under-Secretary of State, the hon. Member for Barkston Ash (Mr. Alison), and also the great interest shown by the Prime Minister personally.

In answer to the hon. Member for Wythenshawe, there must be some limit to the degree to which transport for disabled passengers can be treated as a priority, but the subject which he has raised will be one of those which will be studied by the inquiry which I have announced today.

I hope that I have said enough to show that the phrase in the Motion— …the continuing lack of provision for the chronically sick and disabled. is a complete denial of the truth.

It is natural that the House and the vast numbers of interested persons outside the House should be impatient for more progress. I understand and welcome this impatience provided, at least in this House, that it is realistic impatience and takes into account the other priorities which the Government must recognise.

No matter how fast the benefits spread—and they have spread and will spread more; no matter how the services for the disabled sprout—and they are sprouting and will sprout more: no matter how determined the Government are to improve conditions for the disabled; no matter what the evidence is that we are succeeding; the cry will still be "more and faster". I welcome the pressure and I welcome the impatience, provided it is realistic.

The Opposition have no moral right, after their ineffective six years of government—six years in which they did nothing specifically for the disabled—to press their Motion on this reforming, improving and active Government. I ask the House to reject the Motion and to carry the Amendment.

5.17 p.m.

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

I congratulate the Secretary of State on his great skill in making a feast out of the crusts which have been offered to the disabled by this Government. I welcome the limited advances which have been made, but I do not suppose that even the Secretary of State would pretend that they have kept pace with the advances made by the rest of society.

The Secretary of State's speech must be seen, first, against the sombre background of the disabled people in Britain today, and the way in which they are regarded and treated as second-class citizens in our society. Secondly, the Secretary of State's speech should be seen in the context of the poverty of disabled people. There can be no doubt that for every disabled millionaire there are a million disabled paupers. The poverty of the disabled must be recognised against the claims put forward by the Secretary of State.

We must also bear in mind that nearly two years after the Chronically Sick and Disabled Persons Act went on to the Statute Book it is still by no means fully implemented. That is a scandalous state of affairs that should concern this House. We should also take account of the shocking variations in treatment accorded to disabled persons depending on how much they are disabled. There are some indefensible anomalies between people with different types of disability. Then there is the scandal of the disabled housewives who are disgracefully neglected.

That is the context in which we must see the Secretary of State's rather euphoric statement. I was surprised that the right hon. Gentleman did not safeguard his comments, with his usual modesty, by explaining in some detail that this is only a start, although, to be fair, he was careful to embellish some of his points with this reservation.

We are dealing with a group of people who have no powerful trade union to fight for them. There is no eloquent spokesman to order a picket line on their behalf. Most of them have a restricted capacity to earn a living and many of them are prevented from earning high salaries, yet these are the people who have very high expenses.

This combination of the restrictive power of earning together with high expenses turns the poor disabled into paupers. They are relying on the Chronically Sick and Disabled Persons Act and the Government to help them, but so far they have been deeply disappointed, even to the point of bitterness.

When the Chronically Sick and Disabled Persons Act was passed under the skilled and compassionate sponsorship of my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) our hopes were high for what I then called a charter for the disabled. Many of us said at that time that it would revolutionise the provision for the disabled of Britain. However, its implementation depends largely on local authorities, among which we find the very good and the appallingly bad.

The House will be familiar with the Answers to Questions tabled by my hon. Friend the Member for Eccles (Mr. Carter-Jones) last February and March in which he asked, among other things, how many disabled people per 1,000 were registered by local authorities and what amount was spent on each of them. The House will, I hope, recall the information that was given in reply.

It was clear that some local authorities had registered as many as 11.9 per cent. per thousand while others had bothered to register only 1.5 per cent. Glorious Canterbury had registered only 1.5 per cent. of the disabled. In terms of the amount spent on the disabled, some local authorities had spent as much as £70 per disabled person whereas, for example, Great Yarmouth had spent only £2.85. Since those answers were given one might have thought that changes would have come about and that more local authorities would have been responsive to the appeals of hon. Members on both sides of the House for more action.

The Secretary of State refused to give me up-to-date figures. His refusal was backed by the Prime Minister who, when pressed by me, also refused to give up-to-date figures. An odd thing happened after our exchanges in the House. Following the refusal of both the Secretary of State and the Prime Minister to give this information to me, the details of which appeared in the Press, I received a letter telling me that the figures had already been published, and my correspondent wrote: These figures were revealed in a Welfare Services Statistics Report published by the Institute of Municipal Treasurers". I have a copy of this report with me, and, as one would expect, some local authorities have shown a vast improvement, and every credit to them for so doing. Whereas Great Yarmouth had earlier been one of the worst offenders with a commitment of only £2.85, its expenditure has gone up to £13.59, which represents a wholly admirable increase which deserves every credit.

The figures still show a great discrepancy, first between the amounts of money spent and second between the numbers registered per 1,000 by local authorities. Dear old Canterbury is still near the bottom, registering only 1.5 per cent. per thousand.

The Secretary of State knows that I have been arguing for a long time for registration. He also knows my view about the value of the register and my anxiety to see 100 per cent. registration.

Leaving the question of registration aside for a moment, the figures published by the Institute of Municipal Treasurers prove conclusively that there are grave deficiencies in the amounts of money spent by local authorities, irrespective of the register.

For example, whereas average expenditure per 1,000 disabled people by county boroughs is £305, Oldham spent £678, making it top of the list, and I pay credit to it; Rochdale spent £645 as against the national average of £305, while Canterbury spent only £93 and Coventry £79.

In the light of these figures, with Oldham and Rochdale spending six times as much as Canterbury and Coventry, it is clear that the aldermen and councillors of Canterbury and Coventry are a disgrace to local authorities in that they are denying the disabled people of their cities what is being given to them six-fold by other cities, and I cannot see any defence for this state of affairs.

I ask the Secretary of State to turn his guns on these people at the conclusion of this debate. He can act as a great lever on indolent local authorities. I also want him to approach the Treasury with a view to getting a far greater amount of money spent on the disabled, for we are about to see unfolding a vast reservoir of human misery. I say that because the Chronically Sick and Disabled Persons Act is now becoming fully operative. We are, therefore, about to see revealed the suffering of thousands of disabled people about whom we have not known.

This piffling increase of 12 per cent. in the rate support grant is wholly inadequate. I appreciate that, like any other Minister, the Secretary of State must fight the Treasury. One example of what will be revealed is shown by Stoke-on-Trent, which has been conducting a city-wide pilot scheme and will undertake a city-wide survey. It expects the number of disabled people in the area to rise from 2,500 to 12,000, which is a 500 per cent. increase in the number of people who have to be helped.

This is why I say that an increase of 12 per cent. in the rate support grant is wholly inadequate. We must stop thinking in terms of traditional peanuts. We need a revolutionary approach to this grave national problem of those in need.

We need a strikingly new approach, also, to the anomalies between the industrially and the civilian disabled. There is no justification today for the historic differences between those who are injured within the walls of a factory and those who are disabled outside. To illustrate how differently they are treated, a man with two children who is disabled inside the factory, if he is really totally incapacitated, can receive £38.20, and he needs every single penny of it. A man in similar circumstances who is disabled outside or has an accident just outside the factory walls which results in the same disability and responsibility and the same amount of pain receives only £21. By any standards, there can be no justification for that anomaly, and I know that the Secretary of State will be only too glad to do what he can, because the House is not prepared to allow this state of affairs to continue without strong protest.

The main reason for the discrepancy is that the man who is industrially disabled receives a £10 disability benefit for loss of faculty. The other man gets nothing. The man who is industrially disabled receives £12 constant attendance allowance, whereas the other man receives only £4.80 attendance allowance.

It would be churlish not to recognise and welcome the limited steps which have been taken by the Government, but it would be foolish to pretend that they are adequate. My hon. Friend the Member for Halifax (Dr. Summerskill) has argued the need for a change in the criteria for attendance allowance. I hope that sooner rather than later the Secretary of State will fight to establish that the attendance allowance may be paid in cases where attendance is required by day or by night rather than restricting it to those who need attendance day and night. I hope that the right hon. Gentleman will look closely at the possibility of a significant increase in the amount of the attendance allowance, especially in the light of the figures that I have given concerning the industrially disabled.

People who receive the attendance allowance, low though it may be, are allowed to keep it. However, that is not the case with the invalidity allowance. I find it incredible that a third of those who receive the invalidity allowance have it docked from their supplementary benefit. This is a very shabby conjuring trick: now you have it, now you don't; now you see it, now you don't. The Disablement Income Group has received many letters from people all over the country who cannot understand why those who are better off are able to keep the invalidity allowance whereas those in greatest need are deprived of it. This is another matter which I hope the Secretary of State will look at carefully.

The people who are treated most shabbily are housewives. This is an outrageous anomaly which we have endured for a very long time under successive Governments. There can be no excuse for it. Apart from qualifying for the attendance allowance, the disabled housewife is entitled to no State benefit. It is scandalous that housewives should be treated like this. It is an insulting anachronism that a housewife is not regarded as being "gainfully employed". The time is long overdue for her value to be recognised fully. She is not excluded from the National Health Service, and I see no reason why she should be excluded from disability pension. A housewife could be made eligible on her husband's insurance, and I hope the Government will act on this as soon as possible. Housewives and congenitally disabled people are called by the Disablement Income Group "the outcasts of society" and are the under-privileged. I hope that they will be dealt with by the Government in the near future, brought in from the cold, and have adequate provision made for them.

What we require is a firm commitment by the Government to help disabled housewives and the congenitally disabled by giving them a disablement benefit as of right. The disabled do not want crusts from the Government. What is required is a comprehensive policy on income for all the disabled.

5.35 p.m.

Mr. John Astor (Newbury)

I am very happy to be called immediately following the speech of the hon. Member for Stoke-on-Trent, South (Mr. Ashley). We all respect the contribution that he has made to promoting the cause of the disabled. He is perhaps unique in this House in speaking from personal experience.

I always welcome debates on the problems of disablement and any attempt to promote the well-being of the disabled. However I find the terms of the Motion a little harsh, to say the least. Apparently it seeks to condemn this Government, which have already done more to recognise and make provision for the difficulties of the disabled than any of their predecessors. The Government's Amendment gives a far more realistic and balanced picture of the progress which has been made so far.

This criticism comes rather ill from an Opposition which, when in power, resisted a number of Private Members' Bills designed to help the disabled and the elderly and possessing objectives similar to those which, presumably, right hon. and hon. Gentlemen opposite now advocate. I readily concede that the then Government gave a fair wind to the Chronically Sick and Disabled Persons Bill, introduced by the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris), which will prove to be a worthwhile and beneficial piece of legislation.

My right hon. Friend the Secretary of State does not need any defence from me. He has outlined the achievements of the Government, and he has shown that they have made a very good start. The representatives of organisations concerned with disablement recognise already my right hon. Friend's great understanding of the problems involved, and they welcome the steps that he has been able to take.

That is not to suggest that there is not a great deal remaining to be done. I share the feeling of impatience that the Government have not been able to go even faster and further. But it must be borne in mind that the difficulties have been aggravated greatly by the almost total neglect of the problems by previous Governments of both political parties. We have to make up for lost time and overcome all the collective problems which have been allowed to accumulate over the years.

I remind right hon. and hon. Members opposite that when their Government were in power they found that it took much longer to translate good intentions into effective legislation than no doubt they would have wished. I can remember asking the then Minister of Pensions on 12th July, 1965, whether she would introduce an attendance allowance, which was one of the schemes which we had been led to believe previously were ready to swing into instant operation. I also asked her whether she would do so as a matter of urgency ahead of the general review being carried out at that time. The Minister replied, "Certainly", and added, fairly enough, that more should have been done already in previous years. My point is that, although she had this sense of urgency, and although, I am sure, her intentions were of the best, it was not until 1970 that her Government were able to introduce firm proposals. I am pleased to say that my right hon. Friend has moved much faster than that and introduced an attendance allowance scheme at an earlier date and at a higher level than had been proposed by the Labour Government.

The attendance allowance has got off to a good start, but most of us will accept the criticism which is being levelled against it that experience shows that the qualifications for eligibility are too restrictive. We all have constituency cases of people who do not at present qualify but of whom any commonsense assessment would say that their disability is such that they need a substantial degree of attendance. I therefore hope that my right hon. Friend will pay special attention to the request which has been made to him on a number of occasions that he should consider relaxing the requirement that attention must be required by both day and night.

It is arguable that if my right hon. Friend were so to widen the scope of the allowance those who would then become eligible would need rather less attendance than those who are already qualified. I do not think that the present allowance is over-generous, and it probably seldom meets the full cost. I hope that my right hon. Friend will take up the suggestion made by the hon. Lady the Member for Halifax (Dr. Summerskill) that he should consider—at least initially—a second tier of allowances at a slightly lower level for the new category which would be made eligible. If this suggestion would enable him to extend the eligibility earlier than might otherwise be possible, it would be welcomed by disabled people as a further step forward.

My right hon. Friend will remember the survey which was carried out by the Disablement Income Group into the various forms of financial provision which European countries make for their disabled citizens. After the publication of the report my right hon. Friend undertook to inquire further into this matter to see what lessons could be learned from the experience of our European friends. Is my right hon. Friend yet able to report his findings? If not, when does he expect to be able to do so?

I hope that when he is framing legislation my right hon. Friend will constantly bear in mind two principles which are fundamental. First, where it is medically possible disabled people should be encouraged and enabled to live at home with their families rather than in hospitals or other instutions. Second, they should be given every encouragement to take jobs and pursue careers. Those two principles are right, not only on human and social grounds, but also on economic grounds.

The cost of keeping a patient in a National Health Service hospital in the year 1969–70 was £2,839. We must recognise that usually disablement causes high living expenses, extra warmth, extra food, wear and tear on clothes, special equipment, or extra home help. However, these expenses are modest when set against the figure for keeping a disabled person in hospital for a full year. If there is no medical need for a disabled person to be in hospital, he is preventing a patient who may require medical treatment from occupying a bed.

Although I say that these expenses are modest compared with the cost of hospital accommodation, for the families affected they are significant and often intolerable. The attendance allowance has been welcomed because it is a useful step to meet the expenses partially, as indeed is the supplement to the long-term sickness benefit. But neither of these benefits goes far enough, and I hope that my right hon. Friend will give further consideration to introducing an invalidity pension to cover the costs of disablement.

Under the industrial injuries scheme a severely disabled person may in certain circumstances receive up to £22 per week compared with the £4.80 of the attendance allowance which may be the only benefit to which a civilian disabled person is entitled. I agree that there may not be many receiving £22 but there are some. This gap is too wide. As the Disablement Income Group points out, it is not the cause of disablement which is significant; it is its results and effects, and the life of a person who suffers disablement is equally transformed regardless of whether the disablement arises at home or at work. I hope that my right hon. Friend will consider closing this gap.

Everybody will agree that disabled people should be encouraged to take jobs, where practicable. I hope that my right hon. Friend will give further consideration to providing greater facilities for training, making special equipment more readily available, and relaxing the earnings rule so that there will be a greater incentive for disabled people to return to employment. I understand from the announcement that my right hon. Friend made today that he proposes to relax the restrictions on the provision of invalid carriages or converted vehicles for those disabled who find great difficulty in getting to their place of employment by public transport but are not at present eligible for invalid cars.

Right hon. and hon. Members on both sides will support the view that disabled people should be enabled to live in their own homes and take employment. Money spent in this direction would not be wasted and would probably be saved. Every disabled person who was enabled to live at home rather than in hospital would be a money saver. Many potentially employable disabled people could be transformed from net receivers of State benefits into taxpayers, as was pointed out very convincingly by the hon. Member for Eccles (Mr. Carter-Jones) last May.

In advocating expenditure on these two matters I am not seeking any special privilege for the disabled. I do not think that they would ask for special privilege. All they ask for is that they should be helped to overcome their handicaps so that they can live and work in near equal terms with their fellow citizens, which is surely a fair proposition.

I believe that disabled people have benefited from the all-party approach which has been brought to bear on these problems. Although I regret that hon. Members opposite who have been working with my hon. Friends and myself to help the disabled will be in a different Lobby tonight, I am sufficiently charitable to believe that the debate is prompted only by a desire further to promote the wellbeing of the disabled, and I look forward to our being able to continue to work together.

5.50 p.m.

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

I am very glad to see that the Secretary of State is now back in his place. He started his speech with an attack on the Labour Government, suggesting that the Labour Government had done nothing. A minute or two later he referred to Section 29 of the National Assistance Act, 1948. This is a very important Measure because almost for the first time it dealt with schemes of assistance to the chronically sick and disabled—something which had never been done by a previous Conservative Government.

The years passed from 1948 until my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) introduced his Bill. Up till then not a single piece of legislation had been introduced by any Conservative Government to assist the chronically sick. When my hon. Friend the Member for Wythenshawe introduced his Bill, every Department affected gave assistance, and, indeed, leaned over backwards to assist to make the Bill practicable. The General Election came, and the Labour Government took the precaution of seeing that the Chronically Sick and Disabled Persons Bill was made an Act of Parliament before Parliament dissolved. Therefore, I hope we shall have no more talk of what the Labour Government have not done.

I listened with great interest to the wonderful things which are supposed to have been done by the present Government since the Act came into force. Let us see what they have done. They have provided a certain amount of money and put in hand a number of schemes. Two years have passed and we have seen very little practical result.

I wish to refer to the Minister's comments on Section 1 of the Chronically Sick and Disabled Persons Act, because I had something to do with the drafting of that Section. The Minister has criticised our desire that a register should be kept. If he reads the words of Section 1 he will see that it is the duty of every local authority to inform itself of the number of persons to whom Section 29 of the 1948 Act applies. When the Bill was in Committee we wanted to devise a practical way of obtaining information about the number of disabled persons. We did not know how many there were. The information was very inadequate and, therefore, it was not possible to devise schemes or to apply assistance.

Let the Minister answer this question What have the local authorities done to obtain this information, whether by means of a register or otherwise? I agree that some local authorities have done so; others have not. But Section 1 not only requires a register; it also requires that information relating to the services provided shall be published and that the information is given to the disabled. Clearly some local authorities have done this, but some have not. We on this side of the House have repeatedly asked the Government for such information but it has not been forthcoming. If local authority resources are not available, steps should be taken to see that the considerable voluntary assistance which is available is mobilised to enable this Section to be fully implemented.

I repeat the criticism that was made by my hon. Friend the Member for Halifax (Dr. Summerskill). Surely the Minister should have made known to the disabled, on radio and television, the contents of this Section so that they would be aware of the duty placed on the local authorities and so that, if necessary, they could bombard the local authorities and say "Give us this information". Why has this not been done? Ministers very often speak on the radio and television; indeed, they very much like doing so on certain occasions. Here is a very good object. Why not appear on television or speak on the radio and tell the disabled of their entitlements and what the local authorities should do?

Let us now consider Section 2 which sets out in detail—summarising it quickly—that services should be made available such as practical assistance in the home, recreational facilities, meals, telephones and so on. Why has this not been done? How many authorities have provided these services or stated for the benefit of the disabled what services are available? It is all very well for the Minister to say "We have increased the amount to be paid to local authorities by 7 per cent.". But have the local authorities been advised, by circular or in some other way, that they ought to devote this money to implementing Section 2?

I have mentioned telephones. The Minister says that he is not at all certain that telephones would be helpful. I do not agree with him. Telephones would be very useful to the disabled in many cases. The fact remains that local authorities are not carrying out these provisions. In a recent article in The Guardian reference was made to a pilot scheme in Hull which showed that the death rate among elderly persons had been halved by the provision of telephones.

I put down a Question asking what was happening about the provision of telephones for the chronically sick and disabled. The answer I got was very interesting. I was referred to an answer given to the hon. Member for Birmingham, Edgbaston (Mrs. Knight) as follows: We will consider what further advice to give when we have received the findings of several current studies into means of emergency communication generally."—[OFFICIAL REPORT, 4th February, 1972: Vol. 830, c. 223.] What an example of an answer to a serious question about the provision of telephones! Have steps been taken to see that telephones are provided for the disabled where this is essential? Is there a means test? Is it not a fact that some local authorities have done almost nothing in this direction?

I now turn to Section 3 which requires a local authority to pay regard to the special needs of the disabled in the provision of housing accommodation. The Department of the Environment has an overall responsibility for housing. It is all very well to give a general answer, but I want to know what proposals the Minister has for providing such accommodation and what steps he has already taken. The House is entitled to that information. As an example of what the Department did under the Labour Government, when the Bill was in Committee we were very anxious to ensure that when buildings to which the public were admitted were erected provision should be made for access, parking and sanitary conveniences for the disabled. It was difficult to draft such a provision—I tried hard myself—and we had the assistance of the Department. Now we have Section 4, which requires provision to be made for access, parking facilities and sanitary conveniences for the disabled.

Again, the Department of the Environment has some responsibility. What information does it have about plans for buildings and premises to which the public are admitted where these facilities are, or are to be, provided? We are entitled to know.

Next, the question of education. I dare say that the Secretary of State cannot deal with this now, but we want to know what is being done to provide special educational treatment in certain respects for disabled children under Sections 25, 26 and 27 of the Act. Replies have been given to certain Questions, but the House is entitled to detailed information showing how the requirements of those Sections have been met.

The Chronically Sick and Disabled Persons Act went on the Statute Book before the Labour Government left office, and much of it came into force, if I recall aright, on 29th August, 1970. Nearly two years have elapsed since then. We are entitled to know what practical steps have been taken to achieve its objects.

I have with me a letter from the Hackney Association for the Disabled: The Hackney Association for the Disabled is deeply concerned at the—

1. "(a) ever-increasing cost of spares, repairs and petrol to the disabled driver;
2. "(b) non-existence of special parking places for the disabled driver;
3. "(c) ever-growing conversion to self-service by petrol stations using petrol pumps which cannot be handled and used by disabled drivers;
4. "(d) shortcomings of the three-wheeler invalid car.

We are, therefore, of opinion that (a) special concessionary garages could be opened by local authorities in order to do service and repairs and sell petrol to the disabled driver; and "— this is extremely important—

1. "(b) there should be special parking places for the disabled driver close to shopping centres, theatres and sports grounds, and in close proximity to beauty spots;
2. "(c) that self-service petrol stations should make arrangements for an attendant to be on duty or for a special pump for disabled drivers' use only;
3. "(d) that the three-wheeler be replaced by a four-wheel Mini, which will enable the disabled driver to enjoy the companionship of his family and friends and thereby lead a full social and enjoyable life".

Mr. Ernle Money (Ipswich)

The hon. and learned Gentleman has twice referred to the provision of special parking facilities for disabled people, a problem which has worried a great many of us. My local authority has made precisely that provision, but the difficulty is that members of the public deliberately use spaces which have been reserved for disabled drivers. Has the hon. and learned Gentleman any suggestion as to how we could persuade the public to keep such places free for the people for whom they are intended?

Mr. Weitzman

I do not suggest that there is a perfect remedy. I am urging that the problem be gone into and that steps be taken to try to deal with it. I am obliged to the hon. Gentleman for raising the matter. I have here a letter from a disabled constituent, who writes: At the present time disabled persons are very frequently unable to participate in public activities because there is no parking space reserved for their cars. For example, during the summer months I like to spend some leisure time in Regent's Park, but I am prevented from doing so on most occasions as parking space is already occupied. I cannot leave my car and walk a distance. This also applies to sports activities which I should very much like to attend, such as football and cricket matches. It is most disappointing that after making the effort and looking forward to the outing, I have to return home just because I cannot park my car". He then makes this suggestion: It would be a great help to all disabled drivers if a few places reasonably near entrances to public activities could be allotted for cars belonging to disabled drivers, as we are unable to make use of public transport as an alternative. I dare say that the Minister read the article in yesterday's Observer headed "Mental Health Scandal". Referring to the report on the Whittingham Hospital it said, inter alia: How many more bewildered and frightened mental patients in other places are suffering torments in enforced silence? It goes on to condemn society because, as it is said, Such behaviour was and is only possible in an area of social neglect. The right hon. Gentleman did not deal with the point, though my hon. Friend the Member for Halifax made it in opening, that one of the steps which must be taken now is to appoint as soon as possible a health ombudsman. The whole problem ought to be studied carefully to see in what way there can be some amelioration of these conditions.

I acknowledge that the Secretary of State is extremely sympathetic to the cause of the disabled and is anxious to do anything he can to assist. But we have in the past week seen how much discomfort can be suffered as a result of restrictions on heating and lighting among the population generally. How much greater must be the misery and discomfort suffered by the disabled as a result of their disabilities.

I welcome this debate. It is our duty to press the Government as strongly as we can to see that the maximum effort is made to do everything possible to assist the disabled. I do not wish to be too scathing in criticism of the Government, and I recognise that these things take time and the problems are difficult, but I remind them again that two years have elapsed since the Act went through the House. During those two years, much more could have been done. There is a duty laid upon the local authorities. The Minister can do a great deal to see that those authorities which are lagging get on with the job and make a real effort.

Mr. Speaker

Order. There are nearly 180 minutes left for back-bench Members. I know that there are 18 hon. Members who wish to catch my eye. The arithmetic is simple.

6.7 p.m.

Mrs. Jill Knight (Birmingham, Edgbaston)

The hon. Lady the Member for Halifax (Dr. Summerskill), for whom I have a great regard, was served a most shabby trick by her right hon. and hon. Friends when they asked her to put this matter before the House today. Clearly she was uncomfortable. She knew very well that it was a shabby manœuvre, and her moral indignation was as phoney as a plastic penny. I am not surprised.

The hon. Lady charged the Government with inflexibility. We learned all about inflexibility towards the disabled when the Labour Government were in office and when she herself, I believe, voted at least three or four times against pensions for the very elderly. I vividly remember the occasion when we attempted to ensure that the Labour Government did not impose selective employment tax in respect of the blind and the disabled. The inflexible response of the Labour Government to that suggestion was unbelievable.

The hon. Lady admitted that there had been some inflexibility on the Labour side, and she was plainly most unhappy at having to argue that the present Government were in some way deserving of censure because of failure to do certain things, remembering, as she does, that her Government did nothing at all.

I felt that in adopting a moderate approach to the matter my hon. Friend the Member for Newbury (Mr. Astor) was wiser than some hon. Members who have spoken. I am certain that we achieve far more in a positive way for the disabled when we work together. In this context, I commend what was said by the hon. Member for Stoke-on-Trent, South (Mr. Ashley) about disabled housewives. It is not my right hon. Friend the Secretary of State who is deserving of censure on that score. All of us ought to be concerned, for instance, about the way taxation militates against disabled housewives. This is not within my right hon. Friend's ambit but I am sure he is aware of the needs of disabled housewives and the fact that they are given an unfair crack of the whip. I am certain that he, being the man he is, will do all he can.

In the few moments that I intend to speak I want to make one or two suggestions for helping the disabled which should be looked at with sympathy from all sides of the House in a genuine desire to help and not to waste time in attacking. We are to have better hospitals for the mentally ill and I am glad that this is to be the case. May I put in a small plea for the staff? I know after last week that all of us felt very bitter about the Whittingham Hospital, which has already been referred to, and some of the things that the staff did there. By and large, however, the staff in these hospitals do well and patiently an incredibly heavy and difficult job. In planning better hospitals for the mentally ill we should bear in mind the tremendous task we ask these men and women to undertake in looking after the patients and we should give them the greatest possible facilities.

I was delighted on 11th November last year when my right hon. Friend the Secretary of State approved proposals for 50 new residential homes for the chronically sick and disabled which, I understand, are to be finished by 1974. This is excellent. I believe that 72 more day care centres are to be set up, and I suggest that we should apply ourselves to this task with all possible speed.

I vividly remember, when I was a member of a local authority some years ago, receiving a letter from a lady in her 70s asking me to call and see her. I went and found that she had a son in his 40s who had been hopelessly mentally disabled from birth. She was unable to go out without him and she had never left him alone in all the 43 or 44 years of his life. The interesting thing was that she did not want to see me to complain but she wanted to ask me what would happen to Jack when she died. I was tremendously impressed with the selfless devotion which that woman had given for so long. If only there had been more day care centres to which Jack could have gone, it would have made such a difference. I am conscious of the concern my right hon. Friend has for this matter and I urge him to see that these day care centres are provided with all haste.

I believe there are to be 31 combined centres for the elderly and physically handicapped and I am not altogether happy about them. I recognise that a great many handicapped people are elderly but I hope that the disabled and elderly will not be lumped together too much. Many disabled people are young and very active, as far as they can be, and it is not perhaps a good thing to have them shut up too much with the very elderly. I hope this will not happen in these combined centres.

I would also like to make the plea that more local authorities should be asked to give more help in the provision of simple things like baths and lavatory accommodation downstairs for the disabled. I have a constituency case of a young man who was injured in a motor cycle accident. He has become progressively worse because he gets heavier and heavier through being unable to move about and his mother finds it impossible now to bath him. There has been the greatest possible difficulty in obtaining help to fit a bath downstairs. The house is rented and the landlord cannot afford to put in the bath, yet he is quite willing to do what he can within the limits of his financial capabilities. May I ask that the local authorities should be urged to give the greatest possible help in providing facilities of this sort and in advancing money for mortgages? This would help many disabled people who are anxious to help themselves.

The local authorities could adopt a more sympathetic attitude towards moving elderly people, who have become disabled because of their age, nearer to sons and daughters. Frequently one finds a daughter or daughter-in-law for whom it is difficult to cross a city to keep in touch with an elderly parent. When one raises the matter with the housing authority, however, one hears the same old cry about the difficulty of getting one-bedroom accommodation.

We have heard a good deal about the attendance allowance and I quite understand what my right hon. Friend says about this matter being treated as a priority. He is clearly thinking in terms of taking another step on the attendance allowance as soon as it is possible to do so. It seems to me that he is being thoroughly realistic in helping first those who need help most. This is the right approach and I hope we would all agree with it. But if people are unable to get their sleep at night it is impossible for them to look after a disabled person during the day. The hon. Lady the Member for Halifax mentioned that disabled persons were often under sedation at night. I would not like to think that they were not put under sedation when they could be for fear of losing the attendance allowance. This might possibly happen and I would not wish this to be the case. I feel we are pushing at a half-open door here and that my right hon. Friend is willing to give help.

Mr. Carter-Jones

I understand the problem of sedation at night, but one of the dilemmas of sedation is that the patient who has been disabled for a long time lies in the same position. The question of sedation could be made a lot easier if equipment like ripple mattresses, which would allow the fit person a full night's sleep without worrying about bedsores, was supplied.

Mrs. Knight

That is an excellent suggestion for which I am grateful and I have no doubt that my right hon. Friend and his junior Ministers will take it on board.

I come next to telephones, in which I have been interested for a long time. The Minister felt that it was not proved so far that telephones were the best way of helping the disabled although he is clearly examining this very closely. Although the flashing light method of attracting attention is worthy of careful consideration, and is probably cheaper, the benefit of a telephone is that relatives can ring the disabled person. This happens in a case I know, where the daughter rings from a telephone box at a certain time every day. She will therefore know that something is wrong if the telephone is not answered. An old or disabled person cannot be contacted with a flashing light in the same way as is possible when a telephone is installed. I have tried two or three times without success to have telephones installed where I felt there was a clear need. I hope we can come around to the wider provision of telephones.

I should like to make a plea for a little more to be done in rehabilitation centres for those with head injuries. So far as I know, there are only two such centres in the country. The sad thing is that so often the injured are young people who have come off their motor cycle. They have suffered head injuries at a stage in in their life when everything was in front of them. I visited one rehabilitation centre and saw that although it is possible to teach such people to do simple things, all too often they cannot then go out and earn anything for themselves, even in a sheltered workshop. Therefore, they remain and the place is rather too static to help in their training. More might be done in that regard.

I would also ask for more sympathetic help for disabled people who do not qualify for a free car but buy their own, with some difficulty, and then find that the cost of conversion to hand controls is another burden they have to bear. Perhaps we could make help available to such people, many of whom are war-disabled. It is very hard for them to find that they have to pay an extra £30–£35 to convert their cars to hand controls, and they are not allowed to drive them unless they have hand controls.

Occasionally disabled people do not want to be put down on the register. I know how important it is from our point of view—from the point of view of authority, of people trying to help the disabled—to have a real picture of how many of them there are, but I would regard it as a very retrograde step if an elderly or disabled person with a rooted objection to being on any register were forced to have his name included. I hope this will not happen. Some people think that they must be included on registers, but it would be anathema to us all if people were put on them against their will.

I cannot support the Motion in any way. I can most warmly and wholeheartedly support the Amendment.

6.23 p.m.

Mr. Tam Dalyell (West Lothian)

I should like to express myself gently and quietly to the Secretary of State on behalf of one group of the chronically sick, the 2,000 or more people who die each year because of kidney disease and who, between the ages of 15 and 55, might well be saved if our laws were a little different.

It is known to the Secretary of State that I have tried to introduce a Bill on transplants of human organs which was objected to on Friday by the Government Whips. I make no particular complaint about that, because we understand these matters very well. The Under-Secretary of State, the hon. Member for Barkston Ash (Mr. Alison), gave me a very courteous interview, as one would expect, and had obviously gone to some trouble to inform himself of the issue. So I make no complaint against the Under-Secretary. But it is my view that the Government are being wrongly advised in their lack of action on the MacLennan Report, published in 1969, on the whole issue of transplants.

The present situation is exceedingly unsatisfactory. I have had a letter from Roy Calne, Professor of Surgery at Addenbrooke's Hospital, which says of my Bill: If it were passed as stated, it would be extremely helpful and I am sure would more than double the number of people to be treated by kidney transplantation, thereby saving many lives. Professor Calne possibly does more of those operations than any other surgeon in the country.

I was told by the Under-Secretary that whereas the doctors involved in transplant surgery wanted the implementation of MacLennan, many other medical bodies advising the Government were doubtful. I can understand that great harm was done to the case for transplants because of the way in which a patient was transferred across London before he was dead so that he would die in the right place. I do not attempt to defend that. All I say is that that was an exceptional and scandalous case. On the whole the British medical profession does not do that sort of thing. I am very doubtful about where the Government are getting their advice, because since my interview, and since the Bill was objected to by the Government Whips, I have gone to some trouble over the weekend to discover those sections of the medical profession which are likely to have objected. With the best will in the world, after some effort, I have been unable to do so. I hope that the Minister who replies will state specifically what advice the Government have had, and from where, against the kind of Measure I have been seeking to introduce on behalf of many surgeons. Soon my right hon. Friend the Member for Cardiff, West (Mr. George Thomas) will be presenting a great petition from McCabe-Wilkinson and his colleagues in Wales.

In going around the hospitals, has not the Secretary of State been told of the awful situation at present when the hospital authorities have to ring up the next-of-kin of someone who has suddenly and, by definition, unexpectedly died and ask them at the point of maximum grief, "Can we have the organs of your loved one?"? It is a terrible thing to do. I am glad that there are present the hon. Member for The Wrekin (Dr. Trafford), one of the sponsors of my Bill, and another sponsor, my hon. Friend the Member for Halifax (Dr. Summerskill). They must have experience such as I have not had, though I have seen it done, of a hospital ringing up at the point of maximum grief and asking that terrible question. I see the hon. Gentleman nodding his head. It is the worst possible moment to ask that question. Relatives have told me that perhaps they would have made a different decision—either they would have been against the organs being taken, or they now regret that they were not taken—if it had had to be made 24 hours earlier or later. The time of maximum irrationality is certainly not the occasion to pop that question.

Therefore, there must be a change in the law. If the Government do not want to tinker with the law along the lines of my Bill, something that can be done fairly urgently is the introduction of a medical identity card. The great majority of the organs needed come from fatal accidents, and I believe that the majority of fatal accidents involve road vehicles. Therefore, while we are arguing about the implementation of MacLennan and changes in the law, would not it be sensible to think of introducing a medical identity card giving the blood group, details of certain allergies to penicillin, records of diabetes, allergy to steroid therapy, for instance, history of coronaries, and so on? In case anyone has doubts, as the hon. Member for Birmingham, Edgbaston (Mrs. Knight) has, about people being forced to go on a register, I would point out that there is advantage not only to possible recipients of organs but to the potential donor, if he should suffer a motor accident and be critically ill. It would be far easier to save him if that kind of identity card existed. [Interruption.] Did the right hon. Gentleman want to intervene?

Sir K. Joseph

I was very tempted, because I am deeply interested in the subject, but I only wanted to ask whether the hon. Gentleman agrees that despite the difficulties to which he draws attention there are 200 kidney transplants a year where those difficulties are overcome. I doubt whether anything like as many as 2,000 would be medically saved if kidney transplants were available for them. The 200 kidney transplants a year are a small but important number, and it is clear that the law does not prevent them occurring.

Mr. Dalyell

Let us give credit to what is done, but speaking as a lay Member of Parliament I know that it is the opinion of those who know this subject better than I do—Sir Michael Woodruff, Roy Caine and others—that this could be changed.

Dr. Anthony Trafford (The Wrekin)

I take it that my right hon. Friend the Secretary of State was referring to renal transplants. The hon. Member for West Lothian (Mr. Dalyell) will be aware, as I am from personal experience, that in nearly all those 200 cases those concerned were put in considerable difficulty through problems of sentiment and maximum bereavement, as well as legal problems and all the other difficulties which he has raised.

Mr. Dalyell

I think the point has been taken by the Secretary of State. He has said that he is deeply interested. If he says that he is deeply interested, let us leave it at that, because it is his interest that we really want.

6.30 p.m.

Mr. Christopher Woodhouse (Oxford)

Although I appreciate the disappointment felt by some hon. Members concerning the implementation of the Chronically Sick and Disabled Persons Act, I am exceedingly sorry that it has been decided by the Opposition to divide the House on the Motion, because if there is one subject which has benefited from all-party agreement it has been the care of the disabled. It seemed to me, although I shall want to study his speech very carefully, that my right hon. Friend the Secretary of State made very important announcements today. I am particularly grateful to him for the announcement that the right to four-wheeled vehicles in place of three-wheelers under the National Health Service will be extended automatically to disabled haemophiliacs.

I am grateful for this extension, partly because I have been campaigning on this issue for 10 years, partly because there are so many haemophiliacs in my constituency because of the quite exceptional medical facilities available there, particularly in Churchill Hospital, partly—although this is a small point—because the vehicles they will be issued with are manufactured in my constituency and partly because haemophiliacs are a special case which is easily identified and they are especially vulnerable.

I have had a number of examples given to me by a doctor in my constituency who has specialised in this subject for years. He told me of a recent case of a young haemophiliac who, on getting into his Ministry-issued tricycle, sat down heavily on the metal frame of the seat, which caused bleeding. He was in hospital for a week and the cost of transfusions and drugs, not counting the cost of the occupied hospital bed, was £250. This sort of case can be multiplied many times and demonstrates how right it is to make this extension in the issue of four-wheeled vehicles.

Without wishing to be churlish I ask my right hon. Friend, since one always wants a Minister to go further when he has made a concession, to look into the further question of whether the three-wheeler really is a suitable vehicle in any case. In a letter to me the same doctor to whom I have referred calls these vehicles "tin coffins", and there is much evidence to support that view. I can give a few examples from in and near Oxford. There was the case, for example, in November, 1969, of a 26-year-old paralysed man, Mr. Keith Smith, who was blown off the road at night in his three-wheeler and fell into a ditch 8 ft. deep in which he stayed 14 hours before being found.

Then there was the case in July, 1970, of a spastic, Mr. Lyndon Bower, whose vehicle was blown into the course of a lorry on the A40, hit and thrown into the ditch. Fortunately he was rescued at once. If he had not been, he would have been burnt to death in his vehicle. There was the case only a week or two ago of a more elderly disabled driver, Mr. Jack Fisher, who was blown into the path of an oncoming lorry near Witney and killed. I cannot say any more about this case because the inquest is continuing.

These cases and much other evidence, including my personal experience of driving these vehicles, underline the very serious defects to which they are liable The steering is extremely difficult; the gears are also extremely difficult to operate; it is impossible and, indeed, illegal to carry a passenger; most serious of all is the instability of any three-wheeled vehicle, which all these cases illustrate.

The doctor I have quoted suggests that these vehicles would be more stable if the third wheel were at the back instead of at the front. I know that my right hon. Friend's advisers tell him that for some disabled people this type of vehicle is the best and the only suitable one. For others, however, it certainly is not. I think it rather striking that disabled ex-Servicemen are all automatically entitled to four-wheel vehicles and I have never heard anyone saying that in their case a three-wheeler is the more suitable. At least further help should be given to those for whom it is not suitable to acquire a mini-car instead. I hope that I have rightly understood my right lion. Friend's announcement today as opening the door some way in that direction.

As we all agree, most of the disabled who can do so want to go to work and lead a normal life, and they should be enabled to do so. I hope that my right hon. Friend will consider other ways of making it easier for them—for example, by arranging with my right hon. Friend the Chancellor of the Exchequer for exemption from value-added tax of equipment specially designed and made for disabled people. My right hon. Friend said that he was baffled by the number and variety of aids. I hope that he will give his attention to an article which will be published in next month's issue of Action, the journal of the National Fund for Research into Crippling Diseases, by Mr. Donald Guthrie, which will show further examples of equipment which can be used only by disabled people. There is no difficulty in discriminating in favour of these items in the value-added tax because no one else could want or use them.

My right hon. Friend has also been urged—and I endorse the plea—to look carefully at the operation of certain recent measures by both local and central authorities because of the rather restrictive interpretation which is put upon them. I was struck by the revelation of the hon. Member for Halifax (Dr. Summerskill) that in the case of the constant attendance allowance about 80 per cent. of the appeals against rejection are successful. This suggests that extremely severe—indeed, unduly severe—criteria are being applied in the first place.

I will not go over the matter of telephones again because this has already been the subject of considerable comment. But there is another Section of the Act to which I want to draw attention. Section 15 provides permissively for the inclusion of disabled persons on appropriate committees of local authorities. This is not being sufficiently implemented. When one puts down a Question about this kind of point, it is also disappointing that one gets an answer not from my right hon. Friend but from the Department of the Environment. I cannot help feeling that the Department of the Environment is not temperamentally or by experience the best-equipped Department for dealing with matters of this kind.

Moreover I foresee difficulties in future over the application of some Clauses of the Housing Finance Bill, and I hope that my right hon. Friend will discuss this with his colleagues concerned. For example, will allowance be made for the special needs of the disabled with specially designed houses? Will their needs be taken into account in fixing a fair rent? Can special provisions relating to the severely disabled as well as the blind be included in Schedule 3 to the Bill which deals with the subject of needs allowances? Clause 23(2) provides for advisory commitees, and I suggest that my right hon. Friend recommends to the Department of the Environment that these committees should be empowered to co-opt disabled people in exactly the same way as is provided for by Section 15 of the Chronically Sick and Disabled Persons Act.

Finally, I hope that my right hon. Friend will sympathetically consider the argument of the Disablement Income Group that it is essential that financial help be available as of right to those severely disabled who are simply incapable of being self-supporting. The public are becoming alert to these problems. A few weeks ago I attended the inaugural meeting of the Oxford branch of the Disablement Income Group, and it was without exception the largest public meeting in my constituency that I have ever addressed. As this case shows, public opinion is alert now and when public sympathy is enlisted on behalf of a special case, as the Government learnt last week, it is not lightly to be ignored.

6.40 p.m.

Mr. Laurie Pavitt (Willesden, West)

I hope that the hon. Member for Oxford (Mr. Woodhouse) will forgive me if I do not comment too closely on what he said. I join him and the Secretary of State in paying tribute to the work of his neighbour the hon. Member for Banbury (Mr. Marten) for his work on behalf of disabled drivers.

I wish to take up three features of the debate. The hon. Lady the Member for Birmingham, Edgbaston (Mrs. Knight) intervened in the speech of my hon. Friend the Member for Halifax (Dr. Summerskill) on the subject of prescription charges. I remind her that when the Labour Government imposed prescription charges many of their backbench Members were in revolt, and I led them into the Division Lobby, so that at least we made our protest.

The meanest thing the Government have done is to tax the chronically sick by increasing the cost of the "season ticket", for which only the chronically sick have to pay. from £2 15s. to £3 10s., an increase of 15s., which brings in the infinitesimal sum of £25,000 to £30,000 a year in a budget of £2,100 million. I cannot see how the Government can possibly justify that.

The hon. Member for Newbury (Mr. Astor), who does so much for the disabled, spoke of the problems of employment. I wish to draw the attention of the House to the blind who are unemployed, for 10 per cent. of blind persons are now unemployed. That is the sort of rate which causes the House serious concern when it occurs in a geographical region like Northern Ireland or Scotland. This poses special problems, because for years Governments of both parties have been trying to get the blind, the deaf and other disabled into the ordinary run of work in the community and not necessarily having to be put on one side in sheltered workshops. But the consequence of this policy is that they are the first to fall the moment there is an economic blizzard. It is urgent that the Secretary of State for Employment should negotiate now with the Secretary of State in order to help blind persons who are unemployed by finding them jobs.

As an example of the art of brevity I commend the speeches of my hon. Friend the Member for West Lothian (Mr. Dalyell). I was able to do so in a recent speech I made in Standing Committee C. I wish to follow him by commenting on the use of kidney machines and renal dialysis as an adjunct to transplants. I should like the Secretary of State to pay special tribute to the nurses involved in this work in the last five weeks when there has been a tremendous work load because of power failures. Patients receiving home dialysis have had to be fully supported by hospital units, and it would be most appropriate if the Secretary of State sent a special letter of commendation to the nurses concerned. If I may introduce a personal note, my daughter worked 70 hours last week on maintaining patients needing renal dialysis.

This Government are learning very slowly—and with painful consequences to the rest of the nation—that a boardroom balance sheet is not the way in which to run Great Britain and that £.s.d. is not the only factor to consider. I exempt the Secretary of State from that charge, because the Health Department is a great educator of all its Ministers and the right hon. Gentleman in particular learnt very quickly, though he has the Chancellor of the Exchequer breathing down his neck. I congratulate him on having moved occasionally in the right direction.

But the Government have not yet shown that leadership which is demanded by the Chronically Sick and Disabled Persons Act, 1970, introduced by my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris). More drive and not just vague exhortation is required. Most of all, they have to find the cash. I differ from the Secretary of State, as have others, about the provision of telephones for old and disabled people. It would not be all that expensive, and a try-out should be given priority.

It is especially urgent for old people living alone and for old people who are disabled, for many of them do not have too long to live and to enjoy the amenities with which they ought to be provided. The right hon. Gentleman ought to cost the exercise, prepare plans and then give the House some idea how much it would cost to provide telephones, first, for old and disabled people and, second, for old people living alone. It is ridiculous to expect the Post Office to mount this exercise as a kind of commercial proposition. It is a community responsibility and, therefore, the concern of the Government and not just a problem for the Post Office. It is time that the Government faced the implications of the Act and realised that the chronically sick and disabled have the whole-hearted support of the community.

An economic problem which the right hon. Gentleman has yet to face is the shortage of manpower, and it is time that he considered having a Royal Commission to investigate manning the kind of services which the Act demands. It is time to consider, with the present unemployment problem, how people could earn their livelihood by giving service rather than employment always being geared to production. It is a revolutionary concept, but for more than 10 years we have talked solely of more productivity and more automation, but the consequence has been a million unemployed, and the Government must now start to think seriously about not only economic power and the production of goods but how to man services. We must find people to provide help for the chronically sick and disabled, to give only one example. The probation service is another.

As a matter of urgency, the right hon. Gentleman should consider the needs of mentally handicapped children, and negotiate with the Society of Physiotherapists the possibility of doing what is done in Denmark—that as part of their training course physiotherapists should spend three months with mentally handicapped children. It would give them an insight into that sector of the service, and it would benefit the nation as a whole.

Finding more manpower by making manpower more mobile is a Cabinet responsibility, and it is time that the right hon. Gentleman and his colleagues discussed the possibility of men and women being able to change their employment at the age of 50 after a career of, say, 25 years, but taking with them accrued pension rights. The Government should initiate a scheme so that people who wish could work in health services, social welfare, or the probation service, any service which was short of staff. There are hundreds and thousands of people in industry who, after 25 years in one career, would be prepared to engage in a compassionate service for the last 15 or 20 years of their working life, if only they could keep their accrued pension rights and undergo training at Government establishments with maintenance grants for the term of their re-education.

I ask the right hon. Gentleman again to consider a suggestion which the Opposition have hammered at the Prime Minister for some months—that there should be one Minister responsible for the chronically sick and disabled. At present one disabled person can have his needs looked after by nine different Government Departments. If it was possible for the Labour Government to have one Minister responsible for sport and shift the same Minister from one Department to another, the present Government ought to be able to have one Minister responsible for the chronically sick and disabled and able to cut across the Departments and thus provide these men and women with the service which they de-verve and which the community thinks they ought to have.

I pay tribute to my own local authority in terms of implementing the Act—the London Borough of Brent. For some years under the previous Tory Administration it has been notorious because of its conduct in many affairs, and my ward of Neasden has been referred to in every edition of Private Eye as being the kind of place that everyone can have a joke about. I pay tribute to the way in which the Director of Social Services in my borough has, with full support of the present council, grappled with the Act in spite of the problems that other hon. Members have mentioned, including the shortage of manpower.

I pay tribute to the way in which social workers in Willesden have been dealing with old people during the last five weeks, in terms of the fuel crisis and other problems.

Our difficulty has arisen in terms of Section 1 of the Act—finding those who are most vulnerable and in the most need. We are grateful for the voluntary organisations and the kind of co-ordination that we are receiving from bodies like the Knights of Columba which are helping us find these people and ascertain exactly what kind of help they need.

We must accept the point made by my hon. Friend the Member for Halifax, that 90 per cent. of all cases are known to their general practitioners, and that there must be a mutual two-way traffic between local health authorities and the general practitioner service. I ask the Under-Secretary of State to ask his Department why we could not have a crash programme during the summer, employing and paying students who are always looking for work during the long recess. Why not attach them to local authorities and general practitioners in order to implement Section 1 of the Act?

I pay tribute to my Borough's Department of Development in relation to the provision of ramps in buildings and devices and conversions in the homes of disabled persons. One fact that the Government have entirely ignored is that in places like this Chamber we could have an induction coil enabling people like myself, wearing hearing aids, to hear more effectively. This sort of thing could be done in many public buildings. It would cost only about £250 for a Chamber like this. Why is the Department of Health and Social Security not using its research facilities which produced the Medresco hearing aids? It has the Dollis Hill Research Station at its disposal, and it could produce and sell the electrical equipment needed to cope with bad acoustic properties of cinemas and public buildings. The acoustic properties of most cinemas are 10 times worse than those in Committee Room No. 14 upstairs; and that is saying something. It is very difficult to hear what is going on. This mechanical device, which is technologically possible, should have the drive and incentive of the Secretary of State behind it, because it is possible to carry out a nationwide scheme within the provisions of the Act.

In the East End, where I was brought up, we had a saying, "It's the poor what helps the poor." I pay tribute to the fact that in many local authorities it is the old and the disabled who are making a reality of the Act. In my area a joint leaflet issued by the local authority and the Brent Association for the Disabled has been successful. Thanks to the co-operation of the Union of Post Office Workers in Brent we are able to reach immediately people who need help. The whole of the postal services in my area, jointly with the social services, operate a system of the "card in the window"—the scheme that was pioneered in Cambridge. An elderly or disabled person needs help, and the postman knocks to find out the need. This sort of scheme could be extended if there was more drive by the Department, but what is happening? Practically nothing.

I conclude by referring to the section of the Act which I drafted and which still needs to be implemented—Section 24. This provided for the Secretary of State to report on the establishment of a national research institute into the problems of deafness. At the moment, in research, there is the chance of a positive breakthrough. For the first time it may be possible to prescribe an aid for a deaf person in the same way as it is possible for any optician to write a prescription for a pair of glasses which can be dispensed by any other qualified optician. In hearing this is not possible.

The reasons that I gave when I first drafted the Section remain valid, after two years. I invite the Under-Secretary to whisper to his Parliamentary Private Secretary asking him to get some information from his officials so that he can deal with this point. He knows that his Department has done a lot in terms of homework on what is needed to establish a centralised research institute as an apex organisation. We have heard nothing about this for two years. I hope that when the Minister replies he will give us a progress report. At the moment research is carried out by ardent individuals scattered throughout the country. Since the passing of the Act there has been an upgrading of the work at the National Hospital by the Medical Research Council, on which I have the honour to serve. A full unit is there under the direction of Dr. Hood. There are many other research projects, but there is no co-ordination. There is a need for team work between doctors, audiologists, engineers, physicists and technicians. We need an apex institute that will attract the best brains and scientists of the highest calibre to give weight and authority and a focal point for all research into deafness.

The problem that we face today arises to some extent because of the slow reaction of the Government, but I accept that they are all men of good will—and those with responsibility in the localities are doing what they can with the resources at their disposal. But they are not doing half enough. The object of this debate is to increase pressure upon them to persuade them to do a little more. We cannot salve the social conscience on the cheap. If we want to help the chronically sick and disabled we shall have to accept increased taxes and increased rates hills. We should thank God that we are not blind, deaf, disabled or chronically sick and be prepared to pay for the needs of those who are. Only thus can we discharge our responsibility.

6.55 p.m.

Mr. Charles Simeons (Luton)

This debate began in a mildly controversial way, and no doubt it will end true to form. In between we have got down to the facts of life. Hon. Members on both sides have been exchanging information, which is as it should be. I support the hon. Member for West Lothian (Mr. Dalyell). It is either that I reflect him or he reflects me, as is borne out in Early Day Motion No. 4 in my name, supported by the hon. Member for Halifax (Dr. Summerskill), my hon. Friend the Member for Plymouth, Devonport (Dame Joan Vickers) and the hon. Member for Stoke-on-Trent, South (Mr. Ashley), among others. One cannot say that this is a party Motion; it is an all-party Motion.

If there are those who wish to become kidney donors—and there are—let the fact be made known much more easily. Until we permit it to be made known, we are putting a bar in the way of human happiness. We are stopping people being given a chance of becoming independent. We are saying that they should remain tethered to a kidney machine.

Whatever we may say of South Africa, at least it has the right idea in this respect. It does not produce more kidney machines; it tries to eliminate them by enabling people to be given transplants, so that they can continue to lead useful and active lives. I went to Hammersmith Hospital and saw a whole series of these processes, including a transplant, which I found all the worse for being in glorious Kodacolour. It was remarkable to see a girl sitting in bed waiting for a transplant, to see the transplant carried out and then to find her sitting behind me, hale and hearty. I asked her how she was getting on and she said, "They think that we are sick because we have only one kidney, but not a bit of it. I am working as a hairdresser and I do my job every day." She had been made independent; we had stopped tethering her. That is what the hon. Member for West Lothian and those who support the Motion to which I have referred have been endeavouring to achieve.

Dr. Trafford

I support my hon. Friend on the question of transplants but I do not go so far as he does on the question of tethering. Home dialysis is superior over a five-year period compared with a transplant. It is right to press for transplants, but I plead with my hon. Friend not to overdo it. The figures are 66 per cent. against 80 per cent., which is something that my hon. Friend ought to bear in mind before pleading too strongly for this form of treatment.

Mr. Simeons

I accept what my hon. Friend says. If he talks to those who have been on a machine and have undergone this discomfort three times a week and who have then gone for five years with a transplant, I think he will soon see which course they would prefer. I accept what he says and the warning should be given. I am only asking that people be given the opportunity to become donors, not forcing them to have transplants.

It is the progressives who always have the greatest hopes but, as we know from experience, this hope is usually unfounded and life becomes progressively more difficult.

My hon. Friend the Member for Newbury (Mr. Astor) mentioned employment. No doubt Luton is typical of the rest of the country. The percentage of disabled unemployed there is rising. In Luton 18 months ago it was a fraction of the total unemployed. Today it is 10 per cent. This means that these people cannot use their limbs, they have to stay at home and if they are men it means that they are getting under their wives' feet, causing great dispute.

Even though firms are told that they have a responsibility to employ disabled people we know that many do not discharge this responsibility. There would be merit in saying that firms above a certain size must pay a reasonable wage for one, two or three disabled people irrespective of whether they are employed. If they did not employ the people the money would go into a central fund. These people should be paid a proper wage, not a notional figure. They are putting far more effort into their work than fit persons. It means an enormous amount to them even if it is a great sacrifice for them to go out.

While it is vital to have definitions for constant attendance allowance, I hope we will move beyond that. It is not only those who are totally incapacitated who need constant attendance; there are vigorous people who need it just as much. People who are totally blind probably need more assistance than anyone else. Imagine a blind man dropping a cigarette. He does not know where it has gone. I know a blind man who has had most things happen to him. He has been in hospital for a long time and has applied for a constant attendance allowance. He has broken both ankles and both wrists, suffered a double hernia and set the house on fire more than once. If anyone needs an attendance allowance it is this man, because his wife's life is made a misery. I hope that we will look outside the element of incapacity and examine those who may appear to be vigorous but who need looking after.

My hon. Friend the Member for Oxford (Mr. Woodhouse) spoke about the problems of the three-wheeler. This vehicle has a chain drive, generally operating in the gutter. It is probably one of the worst possible forms of propulsion. In snowy weather all that happens is that the vehicle skids out to the middle of the road. Another problem which some of my disabled friends experience in travelling about in these vehicles is that they cannot get out of them. They are stuck at the side of the road and wave to oncoming motorists who think that they are merely enjoying the summer sunshine and wave back again. No one takes any notice. We need some sort of distress signal. There is great difficulty in getting the machines serviced when the service stations are many miles distant.

Electrically-propelled chairs involve a long delay in delivery. I am told at the factory that there are plenty of chairs but that orders are awaited from the Ministry. I hope that this position will be investigated. If long delays occur, in cases of progressive disability by the time these vehicles arrive they are useless.

Coming now to television sets, I am told by the Cheshire Foundation that aged persons in a home do not need a television licence.

Mr. Fred Evans (Caerphilly)

I believe the hon. Gentleman will find that that is true only where there is a communal lounge. Many authorities which have old people's flatlets with no communal lounge have discovered that it is necessary for the individuals to hold television licences.

Mr. Simeons

I am grateful to the hon. Member. I was thinking of homes where old people want to have television sets in their rooms. I understood that they do not have to pay for licences, whereas the chronically sick do have to pay. When the Minister was written to about this he was far more interested in making the elderly pay than in giving free television to the disabled. I hope that this position will be looked into because while it can be done under the auspices of the local social services I feel that it ought to be recognised by my right hon. Friend.

The hon. Member for Willesden, West (Mr. Pavitt) raised the question of prescription charges and pointed out that there are instances such as heart complaints when people have to pay for their prescription charges if they go to work. A man suffering from a heart complaint may stay at home on his doctor's instructions and in that case can obtain his prescriptions free of charge. If he decides to take drugs and go to work he immediately has a financial burden imposed on him. My right hon. Friend has shown that he is not inflexible and I hope that he will reconsider this.

Many right hon. and hon. Members have spoken about the things which have not been done but it is worth while pointing out what has been done. In my constituency a survey was carried out. To begin with the survey contacted every tenth house because it was felt that writing to every house might be considered an intrusion. The response has been remarkable in that neighbours who were written to have spoken about other neighbours and a large amount of information has been collected. Among the things that have been done are the provision of parking space and telephones—although there are not enough of these—television sets and licences, and a geriatric hospital runs a daily laundry service for the disabled. This is not enough but it is a start. If we want to get the message across, no group of persons is better placed than ourselves. How many times do our words appear in local papers? How many times do we mention the Chronically Sick and Disabled Persons Act? If every time we spoke we mentioned the Act, there would not be a soul in our constituencies who did not know about it.

7.8 p.m.

Mr. Lewis Carter-Jones (Eccles)

I suppose I am the person who is called a dreamer and an idealist on this subject in the House but I claim to be the realist. Let me make one plea at the outset. As I walked from my room near the Grand Committee Room off Westminster Hall I saw that someone is spending vast sums of money on an exhibition showing what our extension will look like in the fullness of time. Will the Under-Secretary think in terms of getting the Department to mount a massive display showing what can be done for the severely handicapped to help them overcome their disabilities? That hall would never, in its history, have been put to better use. We have all seen the possibilities. We are talking not about dreams but about realities.

The hon. Member for Luton (Mr. Simeons) said that we should refer to these matters in our constituencies. I thing we all do. But we are nowhere near realising the possibilities. I speak as an economist turned assistant to disabled people. I am not a medical man. I have been privileged to meet a large number of dedicated disabled people and dedicated politicians who wish to make a contribution, but the trouble is that the pace of progress is all too slow. Let me repeat what I have said over and over again. I must be careful not to identify strangers, but I can see people whom I should not see who in their capacity as civil servants have helped me considerably to advance the cause. They have done their best, but we have a major communication problem.

I am not suggesting that there are diseases which can be cured, but no matter how badly disabled, anyone with a residual voluntary movement, even if it is a winking of the eye, given the application of known technology, can control his environment and live an independent life, which is what we are aiming for.

I am deligted that the Secretary of State has returned to the Chamber because I wish to pay him a further compliment; no doubt he will be embarrassed by this. He took the trouble, at seven o'clock one morning, to travel with me to Aylesbury to see a piece of equipment and a research unit which may affect the lives of countless hundreds of thousands of people. Somewhere down the line we have slipped up, not because we do not want to help, but because we do our sums the wrong way round. The hon. Member for Newbury (Mr. Astor), whom I count as one of my hon. Friends, pointed out the cost of keeping people in hospital. He, too, has taken the trouble to see what can be done, not by one unit, but by many.

The trouble is that frequently we take people from their known environment and put them in places where they receive very expensive help when they should be with their loved ones. I can point out case after case in which it is not the disabled person who dies but the fit person who did the nursing, the loved one who was prepared to make the sacrifice of keeping the family together. This is the tragedy.

I am sure that the Secretary of State and the Under-Secretary of State will know the three Sections of the Act of my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) to which I shall refer—Sections 22, 1 and 2. Section 22 was primarily intended to show people what developments were taking place. A document has been produced, but I do not think much of it. It is better than the situation we had before, because we never had a document before, but it can be improved. It should be produced in two editions. The first edition should be produced in a form which laymen and disabled people can understand; it should be brief, to the point and illustrated. The second edition should be published in some detail, using perhaps the esoteric language of the technologist and the medical man so that they, too, may understand what is said.

A large number of voluntary societies to which the Secretary of State paid great tribute collect money with considerable skill from the public and do tremendous research work. None of it appears in the publication primarily because the Act deals with what the Government are doing. However, when the Bill was going through the House we were given an assurance that if the voluntary societies wished to say what they wanted to do and what they were doing it would be published. The voluntary societies raise their money with great difficulty. They sponsor research, and reference to their research projects should be made in this document.

I urge the Secretary of State to ensure that the voluntary organisations are consulted. It may surprise him to know that when serving as a layman on committees dealing with the question of aids for disabled people I have heard organisations asking for tens of thousands of £s for solving problems which I knew had been resolved. No voluntary society or Government can afford to squander money in this way. I implore the right hon. Gentleman to make sure that research projects are not duplicated and that money is spent in the right direction. I am not speaking for or against Rothschild, because that is another argument.

Sections 1 and 2 of the 1970 Act cause me the greatest anxiety. My hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) and myself have urged the Secretary of State time and again to tell us how much each local authority spends and how many people are registered. He has said, rightly or wrongly, that figures in respect of this matter are misleading. For the sake of the argument, I will concede that they are misleading. But I have never known misleading figures to produce so many results. When they were published 12 months ago, a large number of local authorities were frightened out of their wits. Many of them said, "In what sort of behaviour are we engaged?" Never have I known misleading figures to produce such dramatic results. May I ask the right hon. Gentleman to produce some more? May I ask him to shake the complacent?

Let me give him one simple example. I am not making a party point. The right hon. Gentleman's Government talked about setting the local authorities free. In 10 seconds fiat let me mention the Education (Milk) Act whereby the Government tied their hands. Because some of the backward authorities moaned and complained and were bitter about the figures because they were ashamed of themselves, the right hon. Gentleman's Department gave in to them. I ask him to look at this again. I ask him not to give in to people who are completely ashamed of their behaviour. The next time I table that Question about the numbers, if I can get it past the Table—even Mr. Speaker has had to look at it and to say that he regretted it could not be accepted—the next time I table it, if I can find a formula by which to do so, will the right hon. Gentleman quell his anxieties about the figures being a bit misleading? They will produce results for disabled persons.

Many other hon. Members want to speak, and so only briefly will I make my next point. When we were discussing the "Alfred Morris Bill" some of us, on both sides of the House, were saying that in this country there were roughly 1 million to 1.25 million disabled people. When we said that, we saw eyebrows raised at the Dispatch Box. I had never before seen eyebrows raised as high. "Nonsense. Ridiculous. Exaggeration. There is nothing like that number." That was the response from the Box. Then Amelia Harris's report came out. If we were wrong, we were wrong on the right side: we had underestimated. There were three times as many disabled people as were were talking about, three times the number that Ministers at the Box quibbled about.

I come now to a category I want particularly to mention to the right hon. Gentleman, for whose work in this field I have very considerable regard. I ask him to consider category 4 mentioned on page 17, table 8, of the Amelia Harris report. There are nine categories of disabled people. I conclude by mentioning the fifth. Remember, this number does not include those who are already in homes, and it does not include those under 16. Even so, there are 512,000 people in this category of very severely disabled. This is the point I want to make. This is the category of those who find it difficult to tell us they are disabled. It is the category of those who are housebound, who are immobile. The right hon. Gentleman mentioned four cases today. I appreciate them. But there are 200,000 people who are severely disabled who are not receiving attention. If somebody wants to challenge that figure I hope he will get up and start doing so now.

I quote a single figure of the severely handicapped which the right hon. Gentleman himself conceded in a debate when he recognised that there were 8,000 severely disabled people who live alone. If they were taken into hospital it would cost a considerable sum of money indeed. If we use haste, if we use compassion, if we use real drive and initiative, and if we find them, we do our souls a power of good, we do those people a power of good and we do a lot for the quality of life in this country.

I end with four appeals. The problem of the disabled is one of communication: please do not despise the telephone. There is the problem of immobility. That is not insurmountable. There is a case of a well-known paralysed polio victim who, on his back, drives a vehicle. He has passed his driving test with care and efficiency. He lives in Horsham. I am not talking about curing the disabled, but there is no disability, where there is any voluntary movement left, which cannot be relieved and which cannot be alleviated. I have permission to mention one case mentioned in backchat in debate with the Prime Minister, who took it up, the case of a man who for 29 years had lived happily with his wife but who regrettably had an illness which meant that for the latter part of his life, he would not communicate because all the mobility he had left was the ability to move his chin sideways slightly. Equipment was quickly and efficiently supplied for him. His wife has written a most delightful letter. The man died, but they had six very happy months together before the end of his life, because they communicated. They had that last-minute happiness because of that equipment. The equipment remains for the next person. I make this plea to the right hon. Gentleman not to let the reluctant, the backward local authorities pull the wool over his eyes. If the figures can be misinterpreted slightly, they can be put right. I urge him to insist that Section 1 of the Act shall be fully implemented.

7.28 p.m.

Mr. Ernle Money (Ipswich)

The hon. Member for Eccles (Mr. Carter-Jones), who has just made so powerful and compassionate a speech, spoke of the need for a major exhibition to show what has been done and is being done in the field of disablement technology, and I support him in that. No one has done more than he has to draw the attention of the House and of a large section of the general public to these matters.

One of the things which has given me most pleasure in the brief period I have been a Member of the House has been the bipartisan and crusading attitude which there has been in all parts of the House on the question of the disabled. In the circumstances, I am particularly glad to see that the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris), who after all, as a Private Member, brought in the Chronically Sick and Disabled Persons Bill, now the Act, with all-party support, will be winding up for the Opposition tonight.

I regret, therefore, that the Opposition have seen fit to divide the House on this issue tonight, but I hope indeed that in no way will any Division we have tonight serve to loosen the very real friendship and the very real bipartisan achievement which there has been by committees like the all-party Committee on Disablement and the all-party Committee on Disabled Drivers.

I was deeply moved by the plea made recently in my local paper the Ipswich Evening Star that what caused grave distress among disabled people was the thought that they might be used as a potential political plaything. I hope the House and all those who are involved in politics will keep that very much in mind.

The real future here lies in co-operation between the Government, who have to provide most of the money, the local authorities and the voluntary organisations. To give one example of what is happening in my constituency, the recent development of a new civic centre in Ipswich enabled a large, fine Georgian house in the middle of the town at present used by the corporation to become available. The local authority in 1969 decided to plan to co-ordinate there the work of all the voluntary organisations under the aegis of the Ipswich Council of Social Services. I very much hope that the availability of all those services under one roof, together with an adequate citizens' advice bureau, will serve both the disabled people and those who wish to do voluntary service.

I hope that some of the good will and co-operation which have been shown during the difficulties caused by the miners' strike in individual care, help and service for the elderly and disabled, and the arrangements for day centres made by the Churches and other voluntary bodies, will be kept in being during the next few years and not just during the next few weeks.

I believe that social benefits in the Common Market countries are very much better than they are here, and that is one reason why I am a convinced supporter of the Common Market. I look forward to the day when the ambition of the Disablement Income Group for an effective disablement income will be realised. I hope my right hon. Friend might be able to consider what on the Continent is a real act of social justice, and that is an extra family allowance for a disabled child, a special family allowance which compensates the mother for some of her difficulties.

I am delighted that my hon. Friend the Member for Oxford (Mr. Woodhouse) has won his battle for the haemophiliacs. This is a door which is already ajar and which will, with the willing and enlightened help of my right hon. Friend the Secretary of State, be pushed still further open.

My hon. Friend the Member for Luton (Mr. Simeons) made a variety of interesting points on the employment of the disabled with which I have been deeply concerned. He suggested, in effect, a disablement tax for firms which did not take up their full complement. This happens already in the Federal Republic of Germany and I ask my right hon. Friend the Secretary of State to ask his right hon. Friends to consider a similar method here. I also ask my right hon. Friend to consider the possibility of extending the Remploy service to parts of the country which do not have it to help those who cannot be found adequate employment in the open sector.

Many hon. Members have concerned themselves with the constant attendance allowance. Concern has been expressed about cases which one would have thought would obviously qualify and which have not, but I am sure my right hon. Friend and his Department are paying the greatest attention to this.

I conclude by mentioning two problems which I have found to be of great concern in recent months. One is essentially not for my right hon. Friend but for the Chancellor of the Exchequer. I hope that the purchase tax on pet foods regrettably introduced by the previous Labour Government will be done away with when value-added tax comes into force, particularly in the interests of the blind who rely on guide dogs.

The second matter is a more general problem, the position of geriatric wards in old hospitals. With the introduction of some new hospital schemes the patients and their relatives are concerned that they will be moved outside the ambit where they are known, where they are used to the staff and are within easy distance for visits. I hope that these changes in our hospitals will not bear too harshly on individual cases and that those geriatric wards concerned will be run down rather than moved wholesale. I hope that further consideration can be given by my right hon. Friend's enlightened Department to the question of keeping elderly married geriatric patients together in the same hospital.

7.35 p.m.

Mr. Pardoe (Cornwall, North)

I do not wish in any criticisms I make of the Government to speak in bitterness. As one of the three all-party vice-chairmen of the Disablement Income Group I have long learnt that one gets far more done for disabled people by a non-partisan approach than by bitter criticism. I am thankful for what has already been done, but since the job of an Opposition hon. Member is to push the Government, of whatever political persuasion, along it is in that spirit that I shall vote against the Government tonight.

The Chronically Sick and Disabled Persons Act provides theoretically very well indeed for the disabled. It has had a great deal of effect, but its failures perhaps were inevitable and to a certain extent built into the Act. Many local authorities have ignored large sections of the Act and claim that they are ignoring them through lack of funds. Local authorities are perfectly entitled to plead poverty. Although it has been said that the Act is backed by the authority of the Government, unfortunately it has not been backed with any considerable amount of cash, and it is this lack of hard cash that has been the problem. This is a general problem which we face in imposing responsibilities on local authorities without giving them the money to carry them out. We take our responsibilities in the House too lightly in this respect.

Only this week I have received a plaintive cry for help from the director of social services for the County of Cornwall. He says that he has been embarrassed lately by statements to the effect that the Secretary of State has made large sums of money available to local authorities to expand the social services. The Chronically Sick and Disabled Persons Act is merely one means by which the Government have imposed responsibilities on local authorities.

A great deal has been made recently of the £228 million which is apparently available for improving social services generally. The Government have accepted that, for rate support grant purposes, expenditure by local authorities on social services will expand by 10.4 per cent. within an overall increase in local authority expenditure of 4.9 per cent. The director of social services points out: When it is remembered that the local authorities, in addition to their existing duties and services, are required to implement the Children and Young Persons Act, 1969, Sections 13 and 15, newly brought into effect, of the Health Services and Public Health Act, 1968 and the Chronically Sick and Disabled Persons Act, 1970, it will be seen that 10.4 per cent. cannot be expected to go very far. Parliament must will the means. It is no good hon. Members and Governments believing that they can impose a burden on the rates because the rates are simply another form of taxation. Rates are an inefficient form of taxation on which to impose social security and welfare burdens of this sort. They are, after all, neither a tax on actual income nor a tax on actual expenditure. They are a ghost tax.

I hope that the Minister recognises my view of the Government's performance in this whole sphere, particularly in regard to the attendance allowance, bearing in mind my response to his right hon. Friend when I asked him a Question on 21st December last. On that occasion I urged him to widen the regulations of eligibility and said: Is the right hon. Gentleman aware that thousands of people will be grateful for the attendance allowance…may I say that the right hon. Gentleman can claim credit for that and that I thank him for it?"—[OFFICIAL REPORT, 21st December, 1971; Vol. 828, c. 1284.] A number of questions arise in connection with this allowance. For example, there is more to it than widening the regulations. Is the interpretation of the present regulations in keeping with the spirit which Parliament intended when it passed the Act? In other words, whatever regulations we lay down must be interpreted by someone. Often they are interpreted by doctors, either the Department's doctors in respect of war pensions or a panel of doctors who presumably have special and, I imagine, secret instructions as to how they shall proceed.

Are not the Department's doctors and the doctors working in the panels making these tests too harsh? I believe that they are, and I fear that not sufficiently often do they give claimants the benefit of the doubt. Hon. Members come up against this when dealing with war pension cases. I feel that what I have said is particularly true of our treatment of Far East prisoners of war, towards whom we are behaving far more harshly than are most countries with a similar problem.

Many doctors have an unfortunate determination to abide by previous decisions. A recent case that was brought to my attention highlights this point, and the case was brought to my attention not by the individual concerned but by the doctor. Mr. X suffered a stroke five years ago, since when he has been paralysed down the right side of his body. In his doctor's words, he is entirely dependent on his wife for his most rudimentary physical needs. His application for an attendance allowance was refused. The doctor summed up what in his view were his patient's needs in these words: He is entirely dependent for even the most rudimentary physical needs. However, because she"— his wife— does not have to get up repeatedly every night, the claim appears to fall outside the strict interpretation of the regulations for Constant Attendance Allowance". The medical report on behalf of the Attendance Allowance Board stated: "it is noted in the first medical report…that attention at night is once or twice a week for help with urination or after taking laxatives, and with turning over in bed; viewing the evidence as a whole, therefore, it is considered that he does not ordinarily require prolonged or repeated attention during the night."

Hon. Members regularly come across cases of this sort. We appreciate that the line must be drawn somewhere. I am questioning not just whether the regulations are right but whether they are being interpreted in a way that is in keeping with the spirit which Parliament intended when the Act was passed. The Secretary of State needs to watch his doctors. It is extremely difficult for the layman to do this because doctors tend to stick together.

As my Question of last December indicated, I believe that the regulations should now be widened. When he replied to my Question the Secretary of State said that we had to go through the first stage before going on to the second. He referred to the first stage as being the experimental one. Very well. But when does the next stage arrive? When is the experiment sufficiently advanced for the right hon. Gentleman to be able to conclude that we can move on to the next stage?

I do not necessarily argue for the same sum to be paid. Perhaps the regulations should be altered to cover day or night attendance and, for example, not necessarily to pay as much as for day and night attendance. This is, therefore, not just a question of multiplying the existing allowance by the number of people whom we think will be brought into the net.

What of the future? We have been told that there are probably 3 million handicapped people. We must, therefore, consider two factors. The first is the extra cost of living which the disabled have to bear, and the second is the loss of income incurred by someone who is disabled. The hon. Member for Stoke-on-Trent, South (Mr. Ashley) developed this point extremely well and explained how unfavourably disability income and constant attendance allowance compare with the industrial injuries provisions.

In the Government's plans for reforming the whole of our social security provision we are told that they intend to make retirement Pensions and widows' pensions earnings related. I disagree with this, but we can develop this issue on another occasion. I recall developing it ad nausetam in the debates on the Grossman Bill, which were largely futile.

If the Government are to say that retirement and widows' pensions should be earnings related, can they deny that benefits for the disabled should not be earnings related? I believe that they should be so related, though from my reading of the Government's plans it seems clear that this will not happen.

We must accept that when a housewife becomes too disabled to carry on, either temporarily or permanently, her job as a housewife, her family suffers a substantial financial loss and that this must be made up within our social security provision.

Several hon. Members have referred to the problems faced by kidney patients, and in the recent electricity crisis their plight has been brought home to us.

There was tomorrow to have been a sale at Telford by the Ministry of Defence of a large number of Government surplus small portable generators. I note from an advertisement in today's Daily Express that the sale has been cancelled. Presumably it has been decided that the generators are needed for priority use in the Government service. I suggest that one priority which the Department should bear in mind is to have these generators on tap for the use of home kidney patients when or if there is a crisis such as the one from which we have suffered recently.

Much is being done to help the disabled but a lot more needs to be done, even under the present state of our law. I wonder whether the total effect of all our provision in this respect—Government, local authority and voluntary—is being effectively co-ordinated? We need a commission for the disabled to coordinate this effort and ensure that our total provision is used to the best possible effect for the disabled people of Britain.

7.50 p.m.

Mr. Robert Boscawen (Wells)

I intend to take up one or two of the points made by the hon. Member for Cornwall, North (Mr. Pardoe) later in my speech, especially his comments about the working of the attendance allowance. Before doing that, however, I wish to say what a privilege it is to take part in a debate where all hon. Members share the desire to help the severely disabled to live as far as possible an independent, reasonable and happy life. I am glad to have been called in such a debate.

There will never be enough money to do all that we want. Certainly there will never be enough resources or manpower. Despite that, I think that the speech of the hon. Member for Halifax (Dr. Summerskill) was a little unfair to my right hon. Friend the Secretary of State, especially when the hon. Lady suggested that my right hon. Friend had shown a degree of inertia and a lack of action. The very opposite is true, and that is shown by the fact that 74,000 people have taken up the attendance allowance under the Chronically Sick and Disabled Persons Act, and the fact that more than 300,000 have taken up the invalidity allowance.

The attendance allowance cash benefits have brought very valuable assistance to many people. But it would be foolish to pretend that all is well. We all have experience of individual cases where the Act has worked unfairly. There are fringe cases where individuals do not fit in. I have in mind what has been called the day and night qualification, certain qualifications for children, and so on. However, I hope that my right hon. Friend will not rush in to plug these individual anomalies. I should prefer to regard the allowance as an experiment in depth and to give it a thorough examination after it has been working for a year or so.

That is not to say that attention should not be given to the possibility of applying different rates to the allowance. Would it be possible, for example, to have percentage rates rather on the lines of those for disability pensions, so that someone who was slightly disabled got a smaller percentage of the allowance'? I hope that my right hon. Friend will examine the attendance allowance carefully after it has been working for a period.

My second point concerns the invalidity allowance, which, as I said, 300,000 people have taken up. I should like to hear a breakdown of the age groups among those who receive it. There are different rates for different age groups, and when this matter was being considered in Committee some of us were not convinced that this was the right way of going about it.

Then there is the cut-off point for those persons, within two years of their retirement, who do not get the carry-forward of the benefit throughout their retirement. May we be told how many have applied for benefit only to be told that they fall into that category and cannot have it? Those hon. Members who served on the Committee would like to see how the Act is working in practice in that respect.

We have heard a great deal about Amelia Harris in this debate. But there has not been much mention of the White Paper on Better Services for the Mentally Handicapped, which puts the emphasis on residential rather than on hospital care. This is a very remarkable report. It presents the social service departments of local authorities with an enormous challenge, and this relates to some of the comments which have been made about the directors of social services of the local authorities. A great many jobs are being pushed on to them. They need a very high degree of management skill. I hope that the Department will give them all the assistance possible to carry out the very full job of implementing all these various reports.

There is a danger that the local authorities may get some of their services out of balance. They may be spending too much on the mentally handicapped, for example. Heaven knows, there is enough to do. But if they put too much of their resources to this end, they will not be spending enough on the chronically sick and on the many other services that they have to run. I agree with the hon. Member for Eccles (Mr. Carter-Jones) about the need for some means of screening what the local authorities are doing in the social services. There is no test to ensure that they are carrying out what Parliament requires of them. Although I do not think that the figures asked for at the beginning of the debate necessarily are the right way to go about these matters, I believe that we should devise some scheme whereby we can test to our satisfaction what individual authorities are doing for the physically and mentally handicapped.

We ought to be looking more at the need for voluntary helpers. I wonder whether we persuade a sufficient number of our young people to go in for this type of voluntary work. I wonder whether schools and other education establishments do enough to show children what voluntary work exists, what jobs there are, and what the needs are. One hears too often in one's constituency that there are not enough people to do certain jobs. By that I do not mean necessarily the professional jobs, though I accept that they are very short of staff. I have in mind especially such voluntary jobs as home help, and so on. More needs to be done on the education side to tell children about the variety of jobs that they can do in their spare time when they go out into the world.

The Government are trying to do an enormous amount in the social services in every field, in terms of the extra requirements of widows, of war pensioners, of the chronic sick, community care, hostels for the mentally handicapped, community hostels and so on. It is all going on at once. In the past progress has not been rapid enough. But it would be less than fair of right hon. and hon. Members opposite to ignore all that is being done by my right hon. Friend.

7.59 p.m.

Mr. Fred Evans (Caerphilly)

The hon. Member for Cornwall, North (Mr. Pardoe) spoke about the necessity for this House, having once legislated, to see that the instruments to carry out its legislation perform those functions properly.

I begin my brief contribution by drawing attention to one organisation which has shown just how much compassion can go into the operation of this legislation. I refer to the Post Office Engineering Workers' Union in Wales, the members of which volunteered in their own time to install telephones for all disabled people who had been accorded this amenity by the county councils. They did it free of charge and thus cut the installation costs by half. If mat attitude can be instilled into all the instruments under this great Act, great progress will be made.

Reference has been made to the harshness of the Motion and to the fact that there is a three-line Whip, the implication being that the Motion reflects some of the deep and bitter ideological gulf that has raged between the two sides of the House recently. This is not so. I was fortunate enough to serve on the Standing Committee which considered the Act when it was a Bill. On that Standing Committee we were, for once, like a band of happy brothers and one relative happy sister. The Bill went through all its stages without the necessity of a Division.

The Motion, and the fact that there is a three-line Whip, arises from our deep sense of disappointment and frustration. Hopes in the House run very high, not only amongst those who were members of that Standing Committee but amongst many others. Those high hopes were shared by disabled people throughout the country, who looked upon the Act as a charter which would liberate lives which had been restricted for many years.

We on these benches, because the Bill was sponsored by my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris), felt this disappoint ment keenly. Like hon. Members opposite, we know that many of our constituents are plunging back into the slough of despair. This is hard to accept by anyone who has worked selflessly and idealistically for people who are in this unfortunate position.

This is particularly so in my area—South Wales—because, in addition to the normal incidence of disablement, we have the mining industry. In one year 83,000 reported accidents were sustained in the mining industry throughout the whole of Britain. Forty thousand men are drawing disability allowance for pneumoconiosis. Many thousands more are assessed at a very low level by medical boards for disability pension, but as they reach the age of 45 to 50 they become disabled to a considerable degree.

Some of us have lived closer to this problem than others. This is a matter of geography. We claim no virtue for being able to talk about the subject in greater depth or with greater compassion. It is just the fact that it is before our eyes all the time. For some curious reason, in my part of the country the general morbidity rate is higher than it is in many other areas. In the Welsh valley where I live the incidence of spina bifida is considerably higher than the national average.

I hope that those who have referred to the Motion as though it were couched in terms of bitterness will accept that for people like me it is framed in terms of frustration and disappointment.

Two things which emerge from the debate are, first, the non-activation of a proper system of registration. I do not accept that long-term sampling is the right method. I would rather there were a saturation study, even if it meant sorting out marginal cases by more detailed examination later. Why not, as was done in my area, use district councils as agents of the county welfare authorities and get them to use their monthly bulletins to bring these matters to the notice of all people in their localities?

Why not enlist the voluntary organisations to undertake a blanket study, making door-to-door calls if necessary? This has been done in many areas. In my area local councils have done all this amongst their council tenants and are now busily engaged on the rest of the population. In some areas it has been done by sixth forms. The hon. Member for Wells (Mr. Boscawen) spoke of the desirability of getting youngsters involved in these matters. This is a good way of getting the younger generation to do social field work and of bringing them face to face with problems which perhaps they did not know, even existed. It may be considered emotionally cruel to bring youngsters face to face with these problems, but in general it is a good thing.

The second point which emerges from the debate and which we on this side are very critical about is that there has been a failure to ginger up councils which have failed in their duty under the legislation. If we are not careful we may be in the situation which we were in with education, when grammar education depended on accident of birth or residence. In one town 12 per cent. of children went to grammar schools. In Wales 45 per cent. of children went to grammar school. In Gateshead a boy had a better chance than a girl of getting to a grammar school. In Oxford a girl had a better chance. Unless we are careful to vet what local authorities are doing, to publish what they are doing and to ginger them up, there will be a growing disparity between areas.

My hon. Friend the Member for Eccles (Mr. Carter-Jones) made a powerful plea for the voluntary organisations. Will the Minister consider supporting and encouraging—not through legislation—schemes such as that introduced by the South Wales Council of Social Services which formed a department for the physically handicapped? The remit of that department is to bring together into one authoritative body a convention of all the voluntary organisations, professional bodies and statutory bodies.

The hon. Member for Wells spoke of the need to bring more people into the social services. The education and training of such people can no longer be left to a good heart. Skill, encouragement and dedication are needed. Educated training is essential if voluntary effort is to maintain its fine record.

When the great Aneurin Bevan framed the National Health Service he did not see it other than as a solid base provided by the State to which the voluntary ser vices would attach themselves, gather strength from, and grow and flourish. I want the Act to be treated in exactly the same way. Let the Government provide the base. Let them do many of the things which have been suggested today. But let us not erode the tremendous function of the voluntary organisations. Let us give them the necessary base to make them much more effective.

I hope the Minister will encourage the kind of thing that has been done by the South Wales Council of Social Services. As we move into an age of greater material prosperity I hope that we shall also, this House giving the lead, move into an age of greater compassion for our fellow men.

8.10 p.m.

Mr. Nicholas Edwards (Pembroke)

I am glad to follow the hon. Member for Caerphilly (Mr. Fred Evans), who has shown that in Wales, too, there is concern about these matters. He spoke of a band of happy brothers, and I must say that the speeches from both sides of the House have confirmed the broad measure of agreement that exists among us, which makes the terms of the Motion more difficult to understand.

I have a great respect for the hon. Lady the Member for Halifax (Dr. Summerskill), who opened the debate, and who understands very well that concern in these matters is shared. I therefore find the hostile wording of her Motion difficult to understand and, in face of the immense steps that were taken by my right hon. Friend, hard to forgive. To complain about the shortcomings in the working of the attendance allowance system or the continuing lack of provision for the chronically sick and disabled in the face of my right hon. Friend's record is to divide the House on a question that should, and does, unite us.

The hon. Lady complained about inflexibility—strange language from a party that did practically nothing for these people during that party's term of office. One swallow in the shape of a Private Member's Bill really does not make a summer. It is equally strange to complain of inflexibility about the attendance allowance when we are still in the first year of its use, when so many of the earliest applications and appeals are still under consideration by the appeal board, and when my right hon. Friend has indicated his willingness to look sympathetically at the working of the Act and to extend it when we have something to go on.

Many of us acknowledge our disappointment at the way in which the Act is being implemented in some cases. I shall be saying a word about specific examples in a moment. The Secretary of my local Society for Mentally Handicapped Children fairly summed up the situation when she wrote to me in November: It is early days yet to say that action is needed for in all cases brought to our notice where the application is rejected, we strongly advise the applicants to request a review of their case. But it is not premature to alert all interested persons or bodies to the situation as we see it developing. The secretary is right; it is early days yet.

My hon. Friend the Member for Wells (Mr. Boscawen) was correct when he suggested that it is important when we come to alter the Act that we get it right and do not rush into changes which provide only a partial solution. The enterprising branch of the Society for Mentally Handicapped Children in my constituency, recognising that what is needed at this stage is information, sent out circulars to all its members. It is interesting, and, I dare say, not unrepresentative, to note that 53 replies to 80 questionnaires revealed that 25 had already received an allowance; 16 had not initially replied; four had been turned down, and the remaining cases had gone to appeal. Generally f find this encouraging.

The principal difficulties in the cases that I have seen arise in two main fields, and I think this is the experience of all hon. Members. First is the overnight definition. Some of us are a little puzzled why cases which do not get by under the phrase prolonged or repeated attention during the night do not none the less get in under the phrase continuous supervision in oder to avoid substantial danger…". Then there are the clear differences in approach by many doctors. A large number of the cases which have come to my attention where these two factors throw up distressing anomalies involve mongols. The variety of decisions in these cases is quite bewildering. There seems to be very little logic at all. One parent writes that the only thing that his boy is able to do is when food is put on a plate for him, he pushes it in his mouth with his hands, but other than that, it is not a case of helping him to do anything, but it has to be done for him. When he is put to bed at around 8 p.m., the chances are that he is still awake at 2 a.m., and probably sitting on the stair landing. This has not give my wife much chance to get some sound sleep in the last 20 years, and does not look very hopeful for the next 20. He goes on to say: I, like quite a large number of other people, have every reason to believe that this scheme is a national make-believe'. I think he is wrong. I do not think one can say that a scheme is a national make-believe when it has already given benefit to 74,000 people, or 63 per cent. of the applicants, although one can understand the feelings of someone whose son is described by a doctor on the application form as a low-grade mentally defective, a child for whom the local authority has recognised the seriousness of his condition by offering to take him into their hostel and care for him.

I have another case, again a mongol, classified as mentally severely subnormal, again with the habit of keeping his parents awake at night, who requires constant attention, and who, if they attempt to stay up with friends, tries to take action which endangers the household, but it is no more serious than the case to which I have just referred and which on appeal has been approved.

It is indeed difficult to understand why these discrepancies occur. Partly the trouble arises, as the hon. Member for Halifax pointed out, because of the variety of medical reports, and in particular, because of the inadequacy and shortcomings of the present form that is in use. It is important that we should give very clear guidance to doctors on this matter and produce a form that really gives a picture of the case as it is and does not request brief answers by means of a tick or a "Yes" or "No" to a number of summary questions.

The matter that requires the most urgent revision is this question of overnight attendance. My right hon. Friend promised earlier that he would move on to the extension of the scheme as soon as he could, and I am sure that it is in this area that we must move first.

I want to make two other brief points. The first is to emphasise the urgent need for an extension of the building programme for hospitals and hostels close to the families of patients. In rural areas such as my constituency the lack of these facilities is still acute. Parents may devote care to their handicapped children while they themselves are alive and well enough to do so. They dread the day when they will die. They fear that their children will then be taken away to some vast and remote institution far from their relatives, their homes and the countryside with which they are familiar. Even while they live they fear a temporary illness or an absence from home which will prevent their looking after their children. New short- or long-term hostels are, therefore, urgently required, as are the day centres referred to by my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight).

I greatly welcome the additional provision for the younger chronic sick to which my right hon. Friend referred, the increase in the number of units from 28 to 60, and the number of beds from 700 to 1,500. In particular, in my part of the world I welcome the new assessment unit in West Wales, as I welcome also the new 30-bed unit for adults in my constituency.

My constituents are grateful for the substantial improvements which my right hon. Friend has already achieved. They are in no mood to condemn but rather, recognising that they have a sympathetic Secretary of State who seems to have a magic touch with the Treasury, they look forward to more.

8.21 p.m.

Mr. Philip Whitehead (Derby, North)

I take up what was said by the hon. Member for Pembroke (Mr. Nicholas Edwards) only to the extent of saying that I, too, appreciate the difficulty, which he overcame by being partisan in declaring that this is not a partisan debate, of bringing matters of direct party concern into dispute.

We all agree that this is not a subject on which hon. Members should speak with the voice of party. Very largely, this is a cross-party debate, in which genuine social concern has been aired by almost all hon. Members who have spoken. The Secretary of State explained in opening why he feels that he must make haste slowly. We must all listen carefully to the case which he made and criticise carefully where it seems to us that haste could be made with rather more urgency and zeal than has been apparent so far. But we all accept what the right hon. Gentleman said in terms of the time span within which the general problem of disablement has come to be recognised; the period within which, in other words, the disabled have come to be seen as normal people with abnormal problems rather than as a problem group who must be shunned or ignored.

The right hon. Gentleman was right to pay tribute to the late Megan du Boisson, who made all of us so much more aware of the problem. In the Palace of Westminster itself we have only in the last few years come to recognise and cater for the problems of disability and the needs of those hon. Members among us who are disabled. I think that the right hon. Gentleman was, perhaps, a little less than fair to my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) and his Bill, which could not have passed into law without the generous help given to it in time and so on by the Labour Government in 1970.

The first two points which I wish to make go to the question of definition raised by my hon. Friend the Member for Eccles (Mr. Carter-Jones) in his brilliant and moving speech. He talked of the problems of mobility and communication. I should be the first to acknowledge that what the Secretary of State has said on the problem of mobility is to be widely welcomed. If a chronically disabled person wishes to get about and can get about, it is an extra limb to him to have a motor-powered vehicle; and the extra provisions announced today by the right hon. Gentleman are much to be welcomed.

I was, however, depressed to hear the Secretary of State being somewhat sceptical about the value, other than the social value, of a telephone. All of us have become aware in talking to our constituents of the extent to which the telephone is now regarded as a general facility to which people are far more accustomed than they were a few years ago. To dismiss it and say that its provision in this context is not appropriate or it may have little value apart from its social use is, I feel, harmful in two ways. Firstly, because those local authorities which are dragging their feet on Section 2(1)(h) of the 1970 Act will be discouraged, and, second, because it betrays in the Minister an attitude which one can only describe as that of "pre-electronic man".

We are living in an age of electronic communication now, when people accept the telephone almost as a replacement of the letter as a means for getting in touch with others. For the disabled, who often need to get in touch with medical help or with others who may be able to come to their aid in an emergency, the telephone is of special value. To dismiss the use of the telephone in the way suggested by the Secretary of State is, I believe. damaging.

Mr. John Golding (Newcastle-under-Lyme)

Is my hon. Friend aware that the Post Office engineers in Wales have offered to provide their services free of charge to fit telephones, which has made it possible for the Post Office to charge half the price to local authorities, but this development has been held up because the Secretary of State's Department has stated that there is no industrial injuries cover for the men who do that voluntary work?

Mr. Whitehead

Yes, my hon. Friend the Member for Caerphilly (Mr. Fred Evans) has already made that point. All of us have noted that the Post Office Engineering Union has shown a rather greater sweep of imagination than have the Secretary of State and his Department.

We can count the cost of such a provision only when we have the general register, which has often been discussed—it has been discussed again today—but which is still to come. Until we have a general register of the elderly disabled living alone—and, eventually, I hope, a register of all elderly people living alone—we cannot know how much it would cost to provide the telephone in the circumstances which hon. Members have described. I hope that the Minister will tell us whether he can at some stage put before the House his Department's estimate of the cost of providing telephones in this way. Only when we have such an estimate can we as a House properly decide whether it is the sort of priority which should come before other things which are now being provided.

All of us have difficult cases in our constituencies—the hon. Member for Pembroke has raised three—which show the limitations of the attendance allowance as at present defined to be far too narrow. If application is made for the attendance allowance, one has to be able to show that the person for whom the claim is made is so severely disabled physically or mentally that he requires from another person in connection with his bodily functions frequent attention throughout the day and prolonged or repeated attention during the night"— the word "and" is heavily underlined—and it appears to be that consideration rather than the consideration of disablement being so severe that the person requires continual supervision from another person in order to avoid substantial danger to himself or others which is applied.

All of us have cases of people dealt with in these circumstances on the basis of grievously misconceived assessments. I have three which I wish to put briefly to the House. First, I take the case of a constituent who came to see me the other day. He has cared for his severely mentally disordered daughter, now 38 years of age, who is crippled also and has been from birth, with severe problems of all kinds. Her claim for the attendance allowance has been turned down.

As the hon. Lady the Member for Birmingham, Edgbaston (Mrs. Knight) said, these are proud people; they do not easily make a claim for the allowance at all. Quite often they have looked after their children for a lifetime, in this case for longer than my lifetime. The father who came to see me realises now that, in his middle seventies, he cannot go on in this way. Simply to be told that his daughter, when she is asleep, is not likely to need the constant attention she has to have in every waking moment, and has had for 38 years, is not good enough.

I have had two other cases of ineligibility where the people concerned are very severely disabled indeed. In one case a lady, who has been deaf from birth and, therefore, has had only vestigial speech from birth, and is now blind, cannot get the allowance. Another case concerns a lady who is also deaf and blind. Her husband is partially disabled and has had to leave his job to look after her. He is a man of 60 who is try to cope.

The director of social services in Derby wrote to me about the second case, that of Mrs. O'Brien. He said: As you will know Parliament laid down the regulations governing the Attendance Allowance and this so far has been limited to those people who require repeated attendance at night'. It is our opinion that a person would not, therefore, be granted an attendance allowance simply on the ground that they were both deaf and blind, although I agree that you could very well argue that this is wrong…You are no doubt aware that there are many severely disabled people who do not qualify for the attendance allowance because of the very restricted criteria used in the assessment and I suggest to you, for your consideration, that the matter might very well be raised in the House of Commons. Most of us who have progressive directors of social services have had that kind of letter. Perhaps too much has been said tonight about those local authorities which have been dragging their feet and too little about the directors of social services who wish to do more but find the provisions of the Act as it stands unnecessarily restricting. If the provisions of the Act were widened the criteria of disability could be stretched to take in more of these cases. Even though, as the Disablement Income Group suggests, the price to be paid is perhaps that about 250,000 people will come within the scope of the Act, that is still an insignificant price compared to the institutional care that these people would probably require if in the absence of a satisfactory provision of the attendance allowance they were taken into hospital.

It is more important even than that, because these people not merely deserve to receive the attendance allowance but also deserve the right to live out the rest of their lives with as great a sense of their own independence and with as much human dignity as possible at home. That is possible only at home. To provide the allowance for them and for those who have been caring for them, and have grown sick and the old in their service at home would be a far better service for the Government to provide than hospital care could possibly be.

8.30 p.m.

Dame Joan Vickers (Plymouth, Devonport)

I am grateful for the opportunity to take part in the debate and to pay a special tribute to my hon. Friend the Under-Secretary, because most of the cases I have raised have come before him and I have had extremely sympathetic replies. It is extremely difficult to implement the Act and there will be differences which will have to be considered in the future, but these will bring a gradual understanding of the problem.

It is essential to realise, as I do, having once been an elected member of a local authority, that local authorities have different priorities in different areas. It is therefore extremely difficult to get comparable statistics for the whole country.

I was interested in the suggestion that disabled people were second-class citizens. We were told last week that women were second-class citizens, so we make a good group together, and so I do not feel that this is such a handicap as was suggested.

In spite of the unemployment in this country at the moment, as was stated in answer to a Parliamentary Question, in four weeks in November, 1971, 4,800 disabled people were found jobs. I would like to pay a special tribute therefore to the disablement resettlement officers who are doing a very good job. We must remember Mrs. Megan du Boisson, who was herself disabled and had to go about in a wheelchair, because if it had not been for her I do not think many of us would be discussing this matter today. I know two women who are both in wheelchairs. One is very successfully acting as a foster-mother and the other is looking after her five children, also very successfully, so if a little help is given this keeps the families together.

The question of the Disabled Living Foundation has been raised. The hon. Member for Eccles (Mr. Carter-Jones) suggested that we might have an exhibition here. There is already an exhibition and I suggest that hon. Members should visit it, because they would find there everything they want. I understand that my right hon. Friends the Prime Minister and the Secretary of State have already visited it. I hope it may be possible for more relations of disabled people and doctors and teachers to visit the exhibition, because they would find tremendous help in being able to tell the disabled what can be provided, and all without pressure from manufacturers. All are articles of genuine use to disabled people.

On the question of architecture, I was very interested in the book "Designing for the Disabled", by Mr. Selwyn Goldsmith, a very important document dealing with both public and private buildings. More architects could be trained along the lines suggested in that book.

It is worth considering how much is done by voluntary organisations in certain areas. In Plymouth, for example, we have a Cheshire Home and a voluntary home for the disabled. We also have flatlets for the disabled, where meals can be cooked for them, and we have special transport arrangements. One of our voluntary workers is embarking on the provision of a special public house just outside Plymouth where disabled people can go and feel quite at ease. It is to be called The Wounded Soldier. When they go there everything will be made convenient for them as disabled people want to be able to enjoy life and be independent.

I hope that when the new pensions are introduced there will be more connection between the pensions given to the disabled and those given to the ordinary able-bodied person. There is also a need for a congenitally-disabled person to have a pension of his own when he comes of age.

I had the pleasure not long ago of opening a hostel in Oxford for both mentally-handicapped and disabled people who work in a local factory, together with a number who do not need to live in a hostel. Some also live in a small house on their own with just daily supervision. I consider that we should aim for more such hostels and small homes from which people can go out daily to work.

Does the Sports Council yet have a disabled person among its members? The disabled have been asking for representation for some time.

The National Fund for Research into Crippling Diseases, which has had a grant of nearly £200,000, is doing excellent work and will report in March. Is the money it has received sufficient to carry on research? It is much better if we can prevent the diseases than wait until people have become crippled with them.

The Biomechanical Research and Development Unit is also doing an excellent job in providing a much better type of artificial limb. I hope that the work will be continued and that the unit has enough money to improve the mobility of those who have lost arms or legs.

There are many necessities and priorities to think of, but I want to mention only two points in conclusion. I begin with autistic children. Most of the work of educating such children is still done by voluntary organisations. I have heard of cases of the attendance allowance being refused in regard to autistic children. An autistic child is very restless. Often he wanders about the house at night and he can never be left alone in the house, day or night. The allowance has been given in some cases and not in others. Where is the dividing line drawn? Is it a question of age or the degree of disability? The matter is causing considerable worry to many parents.

Secondly, there is the question of children who will never grow up as physically normal people. I was very interested recently in a book by Dr. Joan McMichael about parents being told that their child was physically or mentally disabled. A great deal of skill is needed to integrate the child and the mother. Often parents cannot face looking after such children without help, and therefore there are far too many children in hospitals. It is very important that parents should be members of a therapeutic team of doctors, social workers and others contributing towards the decisions affecting their children's future. There would be fewer such children in the hospitals if this were so, and sometimes it would help parents not to reject their child.

The efforts of people in aiding the mentally handicapped are becoming more and more recognised, and I am glad that one of our organisers in Plymouth was included in the New Year's Honours List for her work. The more this type of work is appreciated by the community, the better.

We now have to consider our new links with the European Economic Community in the tying up of various matters like children's allowances and pensions. I think we need to hold a conference so that the member countries of the newly enlarged E.E.C. give the same money values in allowances for the disabled and so on. If people are allowed to move from one country to another within the Community, it will be difficult for them to budget if one country pays a certain amount and another pays less. This should be considered. The Health and Social Services Committee of the Council of Europe is to hold a conference shortly on the drug problem, and if the Government would agree it might be appropriate to have a conference to deal with the question of these allowances and pensions so that we will be on a par throughout.

8.41 p.m.

Mr. Frank McElhone (Glasgow, Gorbals)

I hope that the hon. Member for Plymouth, Devonport (Dame Joan Vickers) will forgive me if I do not follow her line of argument. Suffice it to say that I share her point of view with regard to the Sports Council and representation on consultative bodies. I know that my hon. Friend the Member for Oldham, West (Mr. Meacher), who takes a keen interest in this subject, also wishes to contribute to the debate, so I intend to concentrate on the problems of Scotland. There was a debate just before the turn of the year on this subject, and I am afraid that it turned into a rather heated and nasty debate because of the refusal of the Secretary of State to answer any questions about Scotland. I hope I can have an assurance from the Under-Secretary of State that, despite the presence of a Scottish Minister on the Front Bench, he will give use some replies about Scotland when he winds up the debate. My hon. Friend the Member for Derby, North (Mr. Whitehead) said that this subject should not be a party matter because there is concern on both sides of the House. I would agree if it were not for the shabby treatment to which Scotland has been subjected as a barren area in social work for the sick and disabled. When in opposition the Secretary of State for Scotland, according to a Scottish Office Press notice, had been pressing the Government to undertake a survey to help to identify and locate the disabled and chronic sick". He has said that there are about 108,000 substantially handicapped people in Scotland today.

I was lucky enough to have a team in my constituency which carried out a door-to-door survey which the Central Council for the Disabled said was the first of its kind in the United Kingdom. In a non-party spirit, I sent a copy of its findings first to the Secretary of State for Scotland, thinking that I could be of some help to him because I also took part in the survey. I wrote to him saying that together with my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) I would like to discuss with him the survey and its impact both for Glasgow and the rest of Scotland. In a letter on 11th November, 1971, the Secretary of State replied by referring to an early-day Motion I had put down, and said: I should add that after the intemperate terms of your motion No. 568 of the last session and its reference to me, I am not sure that I ought to agree to see you at all. That was because I was a signatory of a Motion, however intemperate, criticising the Secretary of State for his failure to give answers, and he has since refused to give the answers for which Scotland is waiting.

One might be forgiven for carrying on in that intemperate fashion, but, trying to be non-partisan, I wrote another letter to the right hon. Gentleman to say that I should like to discuss the situation with him, accompanied by my hon. Friend the Member for Wythenshawe. We went to see the right hon. Gentleman just before the end of the year and we put to him suggestions, including the use of unemployed people to undertake a door-to-door survey such as that in the Gorbals. We are now reaching the end of February and I am still awaiting a reply from the right hon. Gentleman. If that is not enough to make one partisan, I do not know what is.

There is a myth in Scotland that the present Secretary of State is deeply concerned about the disabled. As someone who was closely involved with a team investigating disablement, I can say that that is not so. On every provision of the Act as it applies to Scotland we have had virtually no assistance from the Secretary of State. That is true of research and development, for instance. Strathclyde University, the former Royal College of Science and Technology, is a first-class institution for research into technological help for disabled people, but the amount spent on general medical research in Scotland is £130,000 and of that only 19 per cent. goes on research for the disabled. I am not the best mathematician at this time of night, but I make that about £25,000 a year on research and development. One could not buy a decent back court wash house for £25,000.

The Secretary of State for Social Services spoke about the provision of assessment units and research centres. I sought to intervene to see whether we could have such a unit in Scotland, and one hon. Member said that he was glad one was already in Wales. I hope we shall be told tonight that we are to have an assessment unit in Scotland. I know of a hospital in Glasgow which is crying out for such a unit. According to the Government survey, out of 5 million people in Scotland 240.000 are disabled, a very high proportion that justifies Scotland having its own assessment unit.

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

I am sure that the hon. Gentleman would not wish to be unfair to my right hon. Friend the Secretary of State for Scotland, who has taken a personal interest in the disabled and played a particular part in the change in the transport arrangements for the disabled which was announced today. He is playing his full part in the increased expenditure on all the work in hospital and health services and so on.

Mr. McElhone

I am sorry that I gave way, because that intervention was no help to me or to any other Scottish Member, and it took up valuable time.

One of the most distressing features of this problem is that young chronically sick people are incarcerated in geriatric wards. According to the figures for Scotland, a total of 427 are in that position. It is a crying shame that people who are suffering physical pain should also be subjected to the mental torture of incarcerations in these wards for the elderly. I have no doubt that the position is similar in England and Wales, but I am concerned that a total of 427 people in Scotland—according to the figures available to 1970—should be trapped in these places.

I visited one of these establishments and found it most distressing. The Secretary of State quoted four examples; I shall quote one. It is the case of a paratrooper who has lost both his legs. His family found it impossible to look after him. I found this brave hero trapped in a ward for geriatric and senile people. To what greater torture could anyone be condemned than to live there year after year until he passes away?

I ask the Under-Secretary to have some regard to people who have the dual handicap of blindness and deafness. I do not see why Scottish children should have to go to Shrewsbury, in England, to be catered for. I am sure that with the money available from the Home and Health Department budget a place could be found in Scotland. In reply to a Question on 22nd November the Secretary of State for Scotland said that there were very few of this type of handicapped child. That is all the more reason for finding a place in Scotland for these people.

One thing that stood out from my survey was the sincere desire of people to look after themselves. That desire could be aided by the provision of home helps. I recently put down a Question about obtaining assistance in the shape of home helps, and the predecessor of the Under-Secretary told me that there had been a 25 per cent. increase in the rate support grant, which would help to provide home helps, but I found that that 25 per cent. increase amounted to £5 million to cover the next three years. Considering that the cost is rising by 10 per cent. each year, that figure does not represent many home helps.

I would not be partisan this evening if it were not clear that the Government—who are spending about £3,000 million a year on defence, and who gave £350 million in October, 1970, to the surtax payers and corporation tax payers—have their priorities wrong. We are entirely right in voting against them in the Lobby this evening.

8.52 p.m.

Mr. James Hill (Southampton, Test)

We are all grateful to my right hon. Friend the Secretary of State for the new provisions for disabled drivers. A paraplegic in my constituency writes to me regularly. He has a kind of love-hate relationship with his three-wheel vehicle. If those three-wheel vehicles can be phased out I know one constituent who will be very happy.

The Motion, which I can only regard as a censure Motion, refers to the long delay in implementing important provisions". When I read that I thought that the best person to ask about it was my own director of social services. I got on the telephone to Southampton and had a word with him. He was quite put out. He said "What do they mean by long delay'?" He then went through a long list of the things on which he had been working very hard and of which he was very proud. He particularly mentioned Section 21, the badge scheme. He said that not only had his people got it off the ground but that it had been fully implemented—that is, in a city of 230,000—in just over seven weeks. They did it by massive publicity in the local newspaper and by word of mouth through the voluntary organisations.

The director of social services was quite perturbed that we were not taking note of the improved transport provisions that he had managed to obtain for Southampton. Apparently, a year ago there were three buses for transporting the disabled; now there are six. The home help service in Southampton has expanded by 12 per cent. in the last year. He was also put out over the registration of the disabled. Only four areas in the country are making a 100 per cent. survey, he told me. They are Chester, Coventry, Isle of Wight and Southampton. On 1st March the voluntary organisations in Southampton will begin the survey. Many organisations are helping—the Round Table, the Council of Churches, one of our largest grammar schools, King Edward's, and the college of technology. Altogether there will be over 200 volunteers to carry out this vital work.

The director also mentioned the rapid rate at which Southampton was managing to get finance from the Depart ment of Health and Social Security. We talk about Ministers being reluctant to release money but he mentioned the following provisions: a hostel for the mentally handicapped, £78,000; a day centre for the mentally ill, £80,000; a training centre in the eastern part of the city, £77,000; a hostel for residential care of the mentally handicapped, £75,000; a day centre for 18 mentally handicapped children, £25,000. He added that this was only part of the programme and mentioned two day nurseries being built, one in the centre of the city and another on the western outskirts. I asked whether day nurseries had much to do with the mentally handicapped. He said "Yes, we give absolute priority to the children of disabled parents."

Local authorities are not just sitting back and taking no notice. The home help service could well be improved but it will be recalled that on 5th November we had a debate on housing when I said that the Habinteg Housing Association had informed me that there was little suitable accommodation in the United Kingdom for the severely disabled. This is perhaps where we could help some of the disabled to look after themselves. We must have purpose-built accommodation. I asked my hon. Friend the Under-Secretary of State for the Environment whether he could direct that 2 per cent. of local authoritiy housing stock should be purpose-built for the disabled. By that I do not mean that we have to find the disabled person and then build the accommodation. We can build accommodation with wide corridors and doors, with facilities for hoists and ramps, and they can still be let to perfectly normal families until the need arises for a disabled person.

In his reply my hon. Friend said: I question whether it would be right for the central Government to impose such a mandatory requirement on local authorities. I hope that it will not prove to be necessary. I certainly think that it would be wrong to impose such a mandatory requirement in advance of the study to which I have referred."—[OFFICIAL REPORT, 5th November, 1971; Vol. 825, c. 611.] I have no hesitation in saying that when the 100 per cent. survey is completed the numbers that will be revealed as requireing purpose-built housing will be astronomical. I firmly believe that when local authorities get down to the problem it will be seen to be only the tip of the iceberg. I ask my hon. Friend to impress upon his colleagues the sheer necessity for implementing as much as possible of Section 3.

9.0 p.m.

Mr. Alfred Morris (Manchester, Wythenshawe)

There have been many notable speeches in this debate. The House is often at its best when the problems of the long-term sick and disabled are under discussion.

Somerset Maugham said To write simply is as difficult as to be good. The Prime Minister's Amendment is drafted with more subtlety than simplicity, but it cannot hide the Government's failure to be as good as we should have liked them to be. The Government have congratulated themselves in the Amendment on the rising provision for…aids for the disabled". As the Secretary of State knows, that statement is villainously complacent and totally unjustified. Indeed, there is much in the Amendment which is purely schmooze. [HON. MEMBERS: "What?"] I hope that that is not a new parliamentary word. It means, as the right hon. Gentleman may be aware, moonshine.

The Secretary of State always gives the impression that he has a great deal to say and too little time in which to say it. He always appears extremely impatient to get on with his speech. Yet he never provides any time for discussion of the problems of the long-term sick and disabled. Nor do his right hon. Friends. He should have had the good grace today to thank the Opposition for finding time for this important debate. The right hon. Gentleman expresses surprise. But why? On the last occasion that we had a full debate on the problems of the chronically sick and disabled, it was due to the luck of my hon. Friend the Member for Eccles (Mr. Carter-Jones) in the Private Members' ballot.

It is shameful that the Government have not even provided time to debate the extremely important report of Amelia Harris. It is not for the Secretary of State to give the impression that he is deeply concerned, more deeply than we are, with the problems of the chronically sick and disabled. If that were so, he would have persuaded the Leader of the House to find Government time to discuss these pressing problems.

My right hon. Friend the Member for Blackburn (Mrs. Castle) referred to a very disturbing case. I now have the correspondence in that case. It was said to her in a letter dated 14th January from the Secretary of State: In Mr. Rimmer's case, the replacement of his sickness benefit of £5 by invalidity benefit of £7 means that after allowing for the increase in the supplementary benefit scale rate, his income was £1.75 above his assessed requirements, and this was why he no longer qualified for a prescription exemption certificate on income grounds. The House will agree that my right hon. Friend was eminently right in implying that the Government's left hand does not appear to know what their right hand is doing. They give something to the chronically sick with one hand and take it away with the other.

The hon. Member for Oxford (Mr. Woodhouse) rightly emphasised that three-wheeled vehicles are, for many very severely disabled people, unsafe and unstable and should be replaced by four-wheeled vehicles. The House should know that the four-wheeled vehicle need be no more expensive per vehicle than the three-wheeler. Motor manufacturers with whom Graham Hill brought me into contact affirm that they could produce a four-wheeled vehicle, with adaptations for severely disabled people, just as cheaply as a three-wheeler. The Government's reply to that is that nevertheless the cost would increase. They say there would be a rise in the number of entitled applicants. What they are really doing is rather like distributing distasteful sweets, not because they are cheaper, but because fewer people will want them.

Mr. Marten

I think the hon. Member is fair enough to agree that the Government's view is exactly the same as the view his own Government took.

Mr. Morris

The hon. Gentleman has been campaigning for a long time on this question. He and I have had some success in proving our point on cost. I think we have proved it more since this Government came to power than we were able to do previously, for one of the charges against the right hon. Gentleman is that while his predecessor may have lacked information he is guilty of obscurantism. We have shown that it is possible to provide disabled people with suitable transport. He refuses to do so. That is why he has been condemned on this matter by representative people in the disablement field outside this House. The Disabled Drivers' Association made a statement to me this evening saying it welcomed the provision of cars for haemophiliacs and disabled mothers and the cash alternative in lieu of a vehicle. It went on to say that it regrets the abolition of petrol allowance for tricycle users and that this should not only have been retained but substantially increased.

I was in touch over the weekend with Mr. Peter Large, of the Joint Committee on Mobility for the Disabled. He was hoping that the Secretary of State's statement would offer some major improvement for the disabled passenger. It is a very odd thing that under our present arrangements the more one is disabled the less one receives. The Secretary of State told us this evening that the claims of disabled passengers will be considered in the study about the future of the vehicle service. I would say to him that the matter is an extremely urgent one. He must not mistake the feeling on this side of the House that something must be done in the very near future to help the disabled passenger.

My hon. Friend the Member for Willesden, West (Mr. Pavitt) spoke movingly on behalf of the blind. He spoke as well about the need for more interdepartmental co-ordination. The Secretary of State should not be too touchy or tetchy. I think he was both touchy and tetchy in his replies to my hon. Friend the Member for Halifax (Dr. Summerskill) at the opening of the debate. He is not at his best when he seems restive. We are not attacking the right hon. Gentleman. [HON. MEMBERS: "Oh?"] We are attacking the whole Government of which he is a member. Even friendly observers tell us that there has never been a more decidedly one-man Government than we have now. The "one man" is not the right hon. Gentleman.

The hon. Member for Luton (Mr. Simeons) referred to the serious unemployment problems of severely disabled people. I am sure it will be recognised by the Secretary of State that the present unemployment figure for employable disabled people is totally unacceptable to this side of the House. There has been a shocking increase in that figure during the last year. In the past five years, there has been an increase of 30,000.

It has been argued recently in a report from the Spastics Society that the present arrangements for the employment of severely disabled people are completely unsatisfactory. No doubt the Secretary of State has seen the report, which says that employers are evading the issue by filling their quota with those who are only "technically disabled", people who have a finger missing, or a slight limp, or who suffer from a high-sounding complaint which involves no disablement. According to the report, one placement officer has said: It has sometimes taken me as long as three years to find just one opening for a handicapped person. There is no doubt that stricter enforcement of the quota system would create more jobs for the disabled. If the figure of 3 per cent. is inadequate, let us review the figure. Surely the right hon. Gentleman cannot be satisfied with the present incidence of unemployment among employable disabled people. He argues that it is not his responsibility. That is our argument. There are too many Ministers with responsibilities; there should be more co-ordination of departmental responsibilities.

The hon. Member for Luton in referring to the problems of unemployment, made an impressive case against the complacency of Whitehall. This is not regarded as an unimportant matter by people who speak for disabled people outside the House. May I now refer to one speech that was not made in this debate? My hon. Friend the Member for Newcastle-under-Lyme (Mr. Golding) has the honour to represent the Post Office Engineering Union. The Welsh members of that union have taken the wholly unprecedented action of contracting with the Post Office to install telephones entirely in their own time and without pay. My hon. Friend has put it to me that, unfortunately, the Department of Health and Social Security is saying that members of the union who do this voluntary work may not be covered for industrial injuries benefit. Since this work can be extremely hazardous, he regards that as scandalous. Hon. Members on both sides of the House have condemned local authorities for dragging their feet in implementing the Chronically Sick and Disabled Persons Act. What my hon. Friend is saying is that the Secretary of State has been dragging his feet on this deeply important matter.

The Post Office Engineering Union has a proud place in the Labour movement. It has given the Chronically Sick and Disabled Persons Act a great filip by its members agreeing to offer their services without pay. The trade union movement is often subjected to considerable criticism by hon. Gentlemen opposite, but we have not heard one word of praise from the other side of the House for this remarkable initiative taken by the Post Office Engineering Union. Will the Secretary of State please look very carefully indeed at this point?

In the Chronically Sick and Disabled Persons Act we were attempting not merely to change social provision for the long-term sick and disabled. We were seeking as well an attitudinal change. We wanted disabled people to be regarded with enhanced dignity and to improve their status in society.

We appreciate what the Secretary of State has done to give effect to Section 17 of the Act, which deals with one of the most sensitive problems in the whole field of social service; namely, the problem of the young chronic sick, many thousands of whom have languished in geriatric wards. The right hon. Gentleman announced the spending of £3 million for building special hospital units for the young chronic sick for the purpose of Section 17. He has now increased the figure to £5 million. I hope he will increase it to any figure that is necessary to make an end of this problem.

We are grateful to the right hon. Gentleman for his circular about abandoned children in hospital. We are grateful to the authorities of the House for what has been done to improve access to the Palace of Westminster. Far more could be done to improve access to public and social buildings. I hope that Ministers will not be as complacent as some have suggested they have been in giving full effect to our intention that all public and social buildings shall be accessible to the severely disabled.

It has been argued that we are wrongfully attempting to divide the House on this issue. On the contrary, I suggest that we have tabled a blameless Motion, and, if there were no Amendment, there would be no Division. The Amendment is factually inaccurate, which I hope hon. Gentlemen opposite will come to see. Our proposition was drafted with a high degree of moderation and reasonableness.

The Government should not take lightly what has been said on the question of the attendance allowance. My hon. Friends feel that the rules of entitlement are far too restrictive. No doubt some hon. Gentlemen opposite agree with us. I have received details of many hundreds of cases, but I will cite only one at this stage. A correspondent writes: My dear wife who is now 51 years of age has been completely housebound for 22 years. She suffers from anxiety neurosis and agoraphobia and has also had rheumatic fever three times. He writes that for 16 years his wife's father had been living with them and that this had enabled him to continue his, the husband's, employment. For the last 18 months of my father-in-law's life I paid a neighbour to come in and be with them both. He goes on to say that his wife's health deteriorated and adds: In March, 1967, my father-in-law died. I have not been outside our front door since then. Nearly two years ago, her condition again worsened and she became confined completely to bed. She has tension in the throat and finds it very difficult to swallow—at one time, she could not even swallow liquid. She was in this state for months and lost a tremendous amount of weight. I am looking after her entire needs both day and night and have done so these past five years. He was a skilled man, and could not continue with his job because of his wife's illness. He has been refused attendance allowance. There are many such cases where the attendance allowance has been refused on grounds which I find utterly inexplicable.

I referred earlier to aids, and my hon. Friend the Member for Eccles had a good deal to say about Section 22 of the Act. The first annual report under Section 22 is wholly unacceptable. It may be argued that in saying this we are being partisan. Mr. Duncan Guthrie, Director of the Central Council for the Disabled, describes the report as …a slim and not very encouraging document". He goes on: The nature of Government reports is to be drily factual, but this one shows too many threadbare patches to be welcomed very enthusiastically by the disabled. Virtually no figures are given except for the total expenditure on the research and development of equipment for the disabled by the Department of Health and Social Security (something over £165,750) and by the Scottish Home and Health Department (£24,700). The current defence White Paper postulates the spending of an additional £66 million on research and development for military purposes in the coming year. With a tithe of that expenditure, the lives of countless disabled people in this country could be transformed. If it is right to spend £66 million in a year on additional research and development under the military account, the right hon. Gentleman ought not to come before us with such pride about his success with the Treasury.

Mr. Guthrie goes on to refer to work which goes on daily in hospitals which he says, …is aimed at giving relief…to patients with varying degrees of disability. With commendable frankness the report says that 'occasionally hospital authorities may provide limited funds for more formalised programmes of research and development on devices likely to become more widely adopted within the hospital service'. The occasionalness of these limited funds for equipment, restricted apparently to use within the hospital service, is certainly discouraging for the physically handicapped and provides a pointed comment on Lord Rothchild's argument for a customer-contractor relationship in medical research. Of all the sections of medical research, the development of equipment would clearly be the most appropriate for his businesslike proposals. 'The customer says what he wants: the contractor does it (if he can); and the customer pays '. The customer in this case, the Department of Health and Social Security, has made too poor a showing to encourage the transfer of funds from the Medical Research Council's limited allocation to the Department of Health and Social Security, as urged in the Rothschild Report. Thus we are not by any means exaggerating when we say that the Government's performance in implementing the Chronically Sick and Disabled Persons Act has been totally inadequate.

I could quote from other documents received from organisations representing the disabled to show that there is considerable disquiet with the first annual report issued under Section 22. I hope that we shall never again have such an unsatisfactory report presented to us under that section.

Sections 9 to 15 of the Act have not been properly implemented so far. These sections concern representation for the disabled on councils and committees advising Ministers and public authorities. I hope that the Under-Secretary will tell us that it is the Government's intention to implement these sections fully at the earliest possible date.

Sections 25 to 27 have not been fully implemented. They concern special educational provision for deaf-blind children, autistic and other children suffering from early forms of childhood psychosis and dyslexic children. Not nearly enough urgency has been shown.

The hon. Member for Southampton, Test (Mr. James Hill) spoke about housing for the disabled. He appeared to agree with us that there has not been sufficient action so far under Section 3. As I understand it, there are only 1,000 purpose-built homes for disabled people. Who on the Government side of the House can say that that is satisfactory after all the pressure that has been exerted from both sides of the House in recent years?

I heard today from Lady Hamilton of the Disabled Living Foundation, who puts it to me that all elderly people's accommodation should be purpose-built to cater for the problems of severely disabled people. There is a great deal of overlapping between the problems of the disabled and the elderly simply because so many elderly people are disabled.

The Secretary of State should be in urgent consultation with organisations representing the disabled on the very important problem of housing provision for the long-term sick and disabled living at home.

We are deeply concerned that Section 1 has not been properly implemented to date. The right hon. Gentleman knows that that Section is about finding out who the disabled are and where they live. The provisions of the Section introduce an entirely new principle into the Welfare State. Instead of resting on the principle of self-application, we placed on public authority the duty to seek out those who could benefit from this legislation.

We appreciate the difficulties of local authorities because of the Seebohm reorganisation, but some local authorities anticipated the Secretary of State's activation of section 1. Liverpool in a period of only 10 months in 1971 identified 6,300 previously unidentified cases of severe disablement. Manchester is identifying cases at an annual rate of 5,000. We know that the Secretary of State has modified his advice to local authorities. This is a matter of the utmost urgency. There are 4,000 people working voluntarily to identify the missing disabled in the London Borough of Croydon alone. In the London Borough of Ealing 1,100 sixth-formers identified 1,300 previously unidentified disabled people in a week. If individuals can voluntarily give that kind of service, why cannot Ministers do more than they have done so far in emphasising the urgency of these matters?

The local authorities which are not implementing the Act fully and humanely are not saving public money. On the contrary they are wasting it. There are far too many severely disabled people who have to go into hospitals, or are otherwise institutionalised, because of our failure to provide home care facilities for the long-term sick and disabled.

My right hon. Friend the Member for Birmingham, Stechford (Mr. Roy Jenkins) wrote to the right hon. Gentleman on 4th May and said this: …your statements to the House on financing the Act seem to me to be misleading. It is, of course, the wish of all of us that this important new Act should wholly succeed in its purpose. But I am sure you will now agree that it does not help for the utterly inaccurate impression to be given that it is an Act which somehow reached the Statute Book without the enabling provisions of a Money Resolution. Parliament wills the end by unanimously approving the Money Resolution. It is for the Government to will the means.

If the Secretary of State wants to do himself a favour he will increase the resources available to local authorities. An annual increase of 12 per cent. is not enough. It is in the interests of central Government to ensure that more people live in the community and fewer people live in institutions. It is far more costly to public funds for people to live in institutions than to live in the community. I hope it will be appreciated that the attendance allowance meets only part of the extra costs of some severely disabled people who live at home.

I hope we shall hear something from the Under-Secretary of State about a strategy for a disablement income. I should like to see such an income that would take account of the loss of earning power by the severely disabled. This has proved possible in other countries. Why is it not possible here? I should have thought that hon. Members opposite would have thanked us for emphasising the pressing urgency of problems such as these.

It has been said that the handicapped person should be considered in relation to his family and to society as a whole, but this is not an entirely one-sided relationship. A balance sheet should be drawn up to weigh the strengths of the disabled person against his limitations and to calculate what he can give to the community as well as what he will have to draw from it because of his affliction. Only then can a practical plan of action be framed. We see no evidence of a real strategy to improve the welfare and status of disabled people. We regard the invalidity allowance as ludicrously inadequate.

Our Motion, in our view, is reasonably worded. It should commend itself to hon. Members opposite. I say to them that we are determined to go on pressing the case for improvements for the disabled, and we make no apology whatever for pressing the Motion in the Division Lobby tonight.

9.32 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)

This debate has taken place against the background of growing public awareness of the real scale and toll of disablement in our community. The terms of the Motion are critical and controversial and I shall come to its precise charges in due course. At the same time I cannot help reflecting—and here I echo the remarks of my hon. Friends the Members for Birmingham, Edgbaston (Mrs. Knight) and for Oxford (Mr. Woodhouse)—that we make much more progress in these matters in a bipartisan spirit, and I believe that the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris), with his honourable record in these matters, is at his best when he is piloting all-party Bills through the House rather than when he is taking a critical stand on the performance of one side of the House.

The truth is that there is no monopoly for party compassion or party concern in this matter. The point is generally taken that there is a universal concern. It is not by critical Motions on the Order Paper that we shall see major far-reaching changes in the scale of help which is given to the disabled. The reality is—and I share the point of view expressed by the hon. Member for Eccles (Mr. Carter-Jones) when he talked about a major communications problem—that progress is made only when the public are fully apprised of the true condition of those who suffer from disablement. It is this painstaking, often agonising, slow process of public education which alone makes possible even critical Motions by an Opposition, let alone sea-changes in the scale of provision of public resources for the disabled.

Tribute is due primarily not to Oppositions for tabling rather fatuous Motions but to the long and honourable record of hon. Members on both sides who have espoused the cause of the disabled—the hon. Member for Stoke-on-Trent, South (Mr. Ashley), his hon. Friend the Member for Wythenshawe, my hon. Friends the Members for Newbury (Mr. Astor), for Banbury (Mr. Marten) and for Oxford, the hon. Member for Eccles, my hon. Friend the Member for Wells (Mr. Boscawen); one could go on almost indefinitely. These are the people who really make the changes, and they do it by a process of education, which itself is started and opened up by a great mass of voluntary organisations throughout the country. I should add that Governments themselves—Governments of both parties, I readily concede—make a significant contribution.

We should not overlook the fundamental landmark represented by the report by Amelia Harris, commissioned I think by Mr. Kenneth Robinson in his day and which probably takes its origins from the Bedford College survey on methods of categorising the disabled, the study of locomotor problems and so on. My right hon. Friend and I in our Department will be seeking to put that report largely into effect.

The sombre truth which one must recognise, and which has come increasingly into the public eye since Amelia Harris's report, is that the greater the degree of handicap the more likely is an individual to be housebound, if not chair-hound or bedfast; and, in consequence, because he is confined to the home, there is a very real chance that he will be out of public sight. I need not complete the sad corollary of the fate of those in our society who have the misfortune to be out of sight.

We have seen the real disadvantage suffered by the mentally handicapped and the mentally ill as a result of their isolation, a disadvantage which, by special measures, the House is now steadily seeking to put right. We are determined that the increasing knowledge which we now have of the real condition of those who are all too often out of sight as a result of physical handicap will give rise to a remedy by the major steps in terms of both finance and manpower which the Government have in view.

Mr. Carter-Jones

The hon. Gentleman is repeating the point which I constantly make. Financial resources are important, but the person of whom he is speaking now has literally, physically, to be found, and this can be done only by means of positive search. This is why I want the hon. Gentleman to deal with the main question of recognition by local authorities.

Mr. Alison

I am sure that the hon. Gentleman makes a bipartisan point. No one wishes to inhibit; everyone wants to encourage local authorities to set about discovery. Indeed I believe that we have here the ingredients of a crusade in the making, with vast numbers of citizens of good will being increasingly mobilised to assist in the highly specialised work of proper assessment of disability and the business of keeping the numbers in view up to date by regular check.

I have a large number of issues to deal with, some of them broad mainstream topics, some of them individual and rather specialised, and I hope that the House will bear with me if, in doing my best to touch upon them all, I chop about a little from point to point.

First, I take the vexed question of registration. I hope that the House will have noted carefully my right hon. Friend's announcement of the consultations which he is putting in hand to devise a set of statistics which will be the most suitable both for monitoring performance and for maximising the information and intelligence available about those who are registered. But it may be helpful if I explain in a little more detail just how dangerous it is to rely simply on bald figures of the kind with which we are at present concerned.

The Amelia Harris survey published last May showed that over the country as a whole—the information related to the year 1968–69—while about 12 per cent. of handicapped people were registered with local authorities, about 40 per cent., or nearly four times as many, were receiving one or more local authority health or social service. It follows from this that the numbers registered could be very greatly increased without any alteration in the numbers receiving help. What is true over the country as a whole will also be true, subject of course to inevitable local variations, within each local authority, hence the danger of attaching any great significance to figures of the numbers registered.

In general I accept that the increases in numbers registered are likely to reflect increases in the numbers actually receiving services, but comparisons drawn between different local authorities based solely on this yardstick are more harmful than helpful. Financially the real problem at the moment is not only that some expenditure—for example, expenditure by local authority health services—cannot be separated out between recipients who are handicapped and those who are not. So there is inevitably some expenditure of which we cannot take full account.

There is the additional problem that the expenditure on handicapped people as such which could be separated out and itemised—that which arises under Section 29 of the National Assistance Act, 1948—relates almost invariably to the larger block of people who are receiving services and who are not necessarily registered. Therefore, if the numbers regis tered increase while local authority expenditure remains constant, there will be a diminishing per capita allocation, whereas in fact there has been no change in the total. The situation could even arise where expenditure on the handicapped was increasing but the numbers being registered were increased faster. There would then be the appearance of diminishing expenditure per capita. This would be not only misleading but completely demoralising if the facts were presented in terms of local authorities which were failing in their duties. Many of them are certainly not so failing.

Mr. Ashley

Will the Under-Secretary deal with this vital point? Irrespective of the figures for registration, statistics are now available which prove conclusively that some local authorities are spending as little as one-sixth of what other local authorities are spending on the disabled. Would the Under-Secretary therefore agree that this is a grave dereliction of duty by them? Will he ask his right hon. Friend to intervene and do something about this?

Mr. Alison

The hon. Member for Stoke-on-Trent, South, for all his marvellous enthusiasm for this cause, must recognise that even on a per thousand basis there are, as the Amelia Harris report makes quite clear, very substantial differences in the incidence of handicap in the different parts of the country. For example it is alleged to be, according to Amelia Harris, 24.7 per 1,000 in the South-East and 40.1 per 1,000 in the South-West. This is why it is difficult to select one particular local authority for comment. I have some fellow feeling for my hon. Friend the Member for Canterbury (Mr. Crouch). It is not right for a local authority, active in the South-East, where the incidence is so much lower than in other parts of the country, to be held up as a butt for criticism. The local authorities in Canterbury have done a very great deal. For example, the city council has set up a steering group—to be advised by Professor Warren, Director of Health Services Research at the University of Kent, Canterbury—designed to pave the way for the fullest possible implementation of the provisions of the Act.

Mr. Alfred Morris

In view of the purported confusion about the figures and spending, is it the Minister's view that there should now be specific late support grants for spending on the chronically sick and disabled?

Mr. Alison

It is hardly in keeping with the whole trend of making local authorities more responsible, with greater statutory and financial responsibilities, a trend in which both parties have a stake, to start substituting specific grants because it is said that we cannot trust them. They are subject to elected representatives, and to the influences of debates in this House. I believe that we can rely on the local authorities and their elected representatives, sensitive to local opinion and readily supported financially by the central Government, to do what the Act expects of them.

I should now like to say something about the attendance allowance. My right hon. Friend and I have noted the rather judicious balance of commendation with lively dissatisfaction, which is perhaps the inevitable result of any new outlay in the interests of the public which Governments make. Parliamentary appetite in this field, as in other fields, rapidly seems to increase with the eating. I share the balanced view of my hon. Friend the Member for Newbury that this Government have acted both earlier and more generously than their predecessors envisaged acting. We are only at the beginning. We have made an innovation, a real start in a sense that no other Government have done.

The hon. Member for Stoke-on-Trent, South, talked about the loss of supplementary benefit where the invalidity allowance is awarded. He must realise that a complete cut-off of supplementary benefit does not necessarily occur when the invalidity allowance is awarded. It depends, as always in the calculation of supplementary benefit, on the margin between the resources and requirements, which is, in common with the practice for other national insurance benefits, taken into account. It is simply a matter of the extent to which there is a gap between resources and requirements. If such a gap remains, there is no reason why supplementary benefit should be cut off in every case.

The hon. Member for Cornwall, North (Mr. Pardoe) rather disappointed us by threatening that he would vote with Labour Members, who are under a three line Whip, against the Government on the Motion. He asked in particular whether the attendance allowance was being administered in the spirit intended by Parliament. The evidence lies in the 74,000 awards so far made, half as many again as were originally estimated. The awards are being made in accordance with the law as it now is. The Attendance Allowance Board, an independent body of the highest standing, which was set up precisely for this purpose, is constantly alert to the task of trying to ensure unanimity and consistency of standard in the decision process. That is why there is a high rate—now up to over 70 per cent., I believe—of successful applications for review. That is the means of evening out any unevenness in decisions at the initial application stage.

This is an innovation, a positive new net increase in benefits available. We are only at the beginning, the first stage. We expect it to rise to a very much higher and more spectacular orbit, taking its right place in the order of priorities.

A good deal has been said about housing. It has been said at different times that one of the effects of the Act should be to give a new impetus to the provision of specially designed housing for the disabled. Local authorities were making these provisions before the Act came into force, but the number of housing authorities which have submitted proposals to the Department of the Environment since Section 3 of the Act became operative in August, 1970, rose from 27 in February, 1970, to 140, with proposals for 493 dwellings for the disabled, in the period between August, 1970, and December, 1971—an indication that local authorities, as we would expect, take seriously the intention of Parliament in passing the Act.

My Department and the Department of the Environment have been co-operating in a follow-up study of the Amelia Harris study devoted entirely to housing. The objective is to establish the extent to which the housing needs of the disabled can best be met by adapting a disabled person's existing dwelling, or providing him or her with a new house to the Parker Morris standards for local authority housing, or by providing a new dwelling which is specifically purpose-built. This follow-up study is likely to take a little while, and as an interim measure my right hon. Friend the Secretary of State for the Environment has announced his intention within the next two or three months to give advice to local authorities on what they can be doing to assist disabled persons whilst it is in train. When the study is completed, the Government will be taking a fresh look at the whole policy on housing for the disabled in the light of the advice they receive.

My hon. Friend the Member for Oxford (Mr. Woodhouse) asked about the effect of the Housing Finance Bill upon housing for the disabled. The proposed model scheme for rent allowances in the private sector or rent rebate for council houses provides for £2 of war or industrial injuries payments or their equivalent and £4.80—the full value—of the attendance allowance to be disregarded. The formula for calculating housing subsidies to local authorities under the new scheme would make allowance for the provision of these disregards. This is very much an incentive to local authorities to provide special housing.

Mr. McElhone

rose—

Mr. Alison

I hope the hon. Gentleman will forgive me if I do not give way. I have only seven minutes left in which to cover many points on different issues which have been raised in the debate.

Mr. McElhone

On a point of order, Mr. Speaker. [HON. MEMBERS: "Disgraceful!"] This is not disgraceful. You will be aware, Mr. Speaker, that this is the second major debate on disablement within the last few months in which Scotland's situation has been treated in a shabby manner.

Mr. Speaker

Order. The hon. Gentleman's comment appears to go to the content of the Minister's speech and cannot possibly be a matter of order.

Mr. Alison

Not only has Scotland its full share of the application of the Act, with England and Wales, but my right hon. Friend the Secretary of State for Scotland is and was one of the most active promoters and stimulators of the Act.

I come now to the announcement which my right hon. Friend the Secretary of State for Social Services made about the change in the invalid vehicles service. The changes have been generally welcomed. I want to touch on one or two points mentioned by my hon. Friend the Member for Oxford, and I do so because the three-wheelers will continue to be on issue and it is extremely important that the thousands of people who will continue to use them should do so with the utmost confidence. My hon. Friend gave some shocking examples of tragic accidents which have occurred to those driving three-wheelers, but examples could also be given of shocking and tragic accidents to those driving four-wheeled vehicles. Both the insurance premiums charged for three-wheelers and the accident results demonstrate that the three-wheelers can be regarded in a thoroughly favourable light from the point of view of safety.

The suggestion that the single wheel might be placed at the rear of the three-wheeler is interesting, but it misses the point that the three-wheeler has a tiller bar or a light steering wheel, which may be fitted according to need, to give lightness of steering, which is an essential ingredient which would be lost if the third wheel were placed at the back. My hon. Friend the Member for Oxford suggested that war pensioners always had motor cars, but some have three-wheelers precisely because those are the sort of vehicles that they can drive for themselves.

The hon. Member for West Lothian (Mr. Dalyell) launched into a fascinating but brief speech on the subject of kidney transplants.

Mrs. Castle

Before the hon. Gentleman leaves the subject of vehicles for the disabled, could he tell the House what additional expenditure the Government are proposing on these vehicles?

Mr. Alison

My right hon. Friend has already told the House that there would be no net additional expenditure but a reallocation of expenditure now being made; but he went on to announce a far-reaching long-term review and I cannot anticipate what may be its effect upon expenditure.

My Department has conducted a detailed examination into the subject of increasing the supply of kidneys. My right hon. Friend has concluded that it would be wrong to amend the Human Tissue Act, and unnecessary to do so, in order to increase the supply of kidneys. The law as it stands contains no impediment to voluntary bequests and already there are 200 transplants each year without apparent legal challenge. We are investigating the possibility of devising an effective and acceptable means of donor recruitment.

The hon. Member for West Lothian repeated this evening a point he made when we discussed the matter privately—the extent to which the limiting factor may be the attitude of the doctors who look after the patients who are the donors, as it were. I promised to write to him about this and I will do so. Our present information remains unqualified—that there are two parties in this equation, not only those interested in getting the organs but those who look after and are responsible for the donors.

My right hon. Friend and I have carefully noted a number of other matters and we shall have to write the Members concerned about them, because time does not permit me to go into detail tonight.

Mrs. Castle

Have another day.

Mr. Alison

The right hon. Lady might care to suggest a nice bipartisan Motion for debate.

The Motion is a self-indicting Motion. The Opposition talk about continuing lack of provision. I am glad that they have had the grace to use the word "continuing", because it is capable of retrospective interpretation. If there be any lack of provision, the roots of that lack go back further than the 20 months during which the present Government have been in power.

Without in any way wanting to denigrate or diminish the value of what the hon. Member for Wythenshawe and his hon. Friends, on both sides of the House, managed to do in the Chronically Sick and Disabled Persons Act, I observe that those roots lie way back in many earlier Statutes. The history of Socialism in this respect is a history of 13 wasted Socialist years since the time when the Attlee Government introduced the National Assistance Act, 1948, which contained many ingredients for help for the chronically sick and disabled which the Labour Party never implemented.

Question put, That the Amendment be made:—

The House divided: Ayes, 309, Noes 271.

Division No. 61.]	AYES	[10.0 p.m.
Adley, Robert	Buchanan-Smith, Alick (Angus, N&M)	du Cann, Rt. Hn. Edward
Alison, Michael (Barkston Ash)	Buck, Antony	Dykes, Hugh
Allason, James (Hemel Hempstead)	Bullus. Sir Eric	Eden, Sir John
Amery, Rt. Hn. Julian	Burden, F. A.	Edwards, Nicholas (Pembroke)
Archer, Jeffrey (Louth)	Butler, Adam (Bosworth)	Elliot, Capt. Walter (Carshalton)
Astor, John	Campbell, Rt. Hn. G.(Moray & Nairn)	Elliott, R. W. (N'c'tle-upon-Tyne, N.)
Atkins, Humphrey	Carlisle, Mark	Emery, Peter
Awdry, Daniel	Carr, Rt. Hn. Robert	Farr, John
Baker, Kenneth (St. Marylebone)	Channon, Paul	Fell, Anthony
Balniel, Lord	Chapman, Sydney	Fenner, Mrs. Peggy
Barber, Rt. Hn. Anthony	Chataway, Rt. Hn. Christopher	Fidler, Michael
Batsford, Brian	Chichester-Clark, R.	Finsberg, Geoffrey (Hampstead)
Beamish, Col. Sir Tufton	Churchill, W. S.	Fisher, Nigel (Surbiton)
Bell, Ronald	Clarke, Kenneth (Rushcliffe)	Fletcher-Cooke, Charles
Bennett, Sir Frederic (Torquay)	Clegg, Walter	Fookes, Miss Janet
Bennett, Dr. Reginald (Gosport)	Cockeram, Eric	Fortescue, Tim
Benyon, W.	Cooke, Robert	Foster, Sir John
Berry, Hn. Anthony	Coombs, Derek	Fowler, Norman
Biffen, John	Cooper, A. E.	Fox, Marcus
Biggs-Davison, John	Cordle, John	Fry, Peter
Blaker, Peter	Corfield, Rt. Hn. Frederick
Boardman, Tom (Leicester, S.W.)	Cormack, Patrick	Gardner, Edward
Body, Richard	Costain, A. P.	Gibson-Watt, David
Boscawen, Robert	Critchley, Julian	Gilmour, Ian (Norfolk, C.)
Bossom, Sir Clive	Crouch, David	Gilmour, Sir John (Fife, E.)
Bowden, Andrew	Crowder, F. P.	Glyn, Dr. Alan
Boyd-Carpenter, Rt. Hn. John	Curran, Charles	Goodhart, Phillip
Braine, Bernard	Davies, Rt. Hn. John (Knutsford)	Goodhew, Victor
Bray, Ronald	d'Avigdor-Goldsmid, Maj.-Gen. James	Gorst, John
Brewis, John	Dean, Paul	Gower, Raymond
Brinton, Sir Tatton	Digby, Simon Wingfield	Grant, Anthony (Harrow, C.)
Brocklebank-Fowler, Christopher	Dixon, Piers	Gray, Hamish
Brown, Sir Edward (Bath)	Dodds-Parker, Douglas	Green, Alan
Bruce-Gardyne, J.	Douglas-Home, Rt. Hon. Sir Alec	Grieve, Percy
Bryan, Paul	Drayson, G. B.	Griffiths, Eldon (Bury St. Edmunds)
Grylls, Michael	Maddan, Martin	Rost, Peter
Gummer, Selwyn	Madel, David	Royle, Anthony
Hall, Miss Joan (Keighley)	Maginnis, John E.	Russell, Sir Ronald
Hall, John (Wycombe)	Marples, Rt. Hn. Ernest	St. John-Stevas, Norman
Hall-Davis, A. G. F.	Marten, Neil	Sandys, Rt. Hn. D.
Hamilton, Michael (Salisbury)	Mather, Carol	Scott, Nicholas
Hannam, John (Exeter)	Maude, Angus	Scott-Hopkins, James
Harrison, Brian (Maldon)	Maudling, Rt. Hn. Reginald	Sharples, Richard
Haselhurst, Alan	Mawby, Ray	Shaw, Michael (Sc'b'gh & Whitby)
Hastings, Stephen	Maxwell Hyslop, R. J.	Shelton, William (Clapham)
Havers, Michael	Meyer, Sir Anthony	Simeons, Charles
Hawkins, Paul	Mills, Peter (Torrington)	Sinclair, Sir George
Hay, John	Mills, Stratton (Belfast, N.)	Skeet, T. H. H.
Hayhoe, Barney	Miscampbell, Norman	Smith, Dudley (W'wick & L'mington)
Heseltine, Michael	Mitchell, Lt.-Col. C. (Aberdeenshire, W)	Soref, Harold
Hicks, Robert	Mitchell, David (Basingstoke)	Speed, Keith
Higgins, Terence L	Moate, Roger	Spence, John
Hiley, Joseph	Molyneaux, James	Sproat, Iain
Hill, John E. B. (Norfolk, S.)	Money, Ernle	Stainton, Keith
Hill, James (Southampton Test)	Monks, Mrs. Connie	Stanbrook, Ivor
Holland, Philip	Monro, Hector	Stewart-Smith, Geoffrey (Belper)
Holt, Miss Mary	Montgomery, Fergus	Stodart, Anthony (Edinburgh, W.)
Hordern, Peter	More, Jasper	Stoddart-Scott, Col. Sir M.
Hornby, Richard	Morgan, Geraint (Denbigh)	Stokes, John
Hornsby-Smith, Rt. Hn. Dame Patricia	Morgan-Giles, Rear-Adm.	Stuttaford, Dr. Tom
Howe, Hn. Sir Geoffrey (Reigate)	Morrison, Charles	Sutcliffe, John
Howell, David (Guildford)	Mudd, David	Tapsell, Peter
Howell, Ralph (Norfolk, N.)	Murton, Oscar	Taylor, Sir Charles (Eastbourne)
Hunt, John	Nabarro, Sir Gerald	Taylor, Edward M.(G'gow, Cathcart)
Hutchison, Michael Clark	Neave, Airey	Taylor, Frank (Moss Side)
Iremonger, T. L.	Nicholls, Sir Harmar	Taylor, Robert (Croydon, N.W.)
Irvine, Bryant Godman (Rye)	Noble, Rt. Hn. Michael	Tebbit, Norman
James, David	Normanton, Tom	Temple, John M.
Jenkin, Patrick (Woodford)	Nott, John	Thatcher, Rt. Hn. Mrs. Margaret
Jessel, Toby	Onslow, Cranley	Thomas, John Stradling (Monmouth)
Johnson Smith, G. (E. Grinstead)	Oppenheim, Mrs. Sally	Thomas, Rt. Hn. Peter (Hendon, S.)
Jones, Arthur (Northants, S.)	Orr, Capt. L. P. S.	Thompson, Sir Richard (Croydon, S.)
Joplinq, Michael	Osborn, John	Tilney, John
Joseph, Rt. Hn. Sir Keith	Owen, Idris (Stockport, N.)	Trafford, Dr. Anthony
Kaberry, Sir Donald	Page, Graham (Crosby)	Trew, Peter
Kellett-Bowman, Mrs. Elaine	Page, John (Harrow, W.)	Tugendhat, Christopher
Kershaw, Anthony	Parkinson, Cecil	Turton, Rt. Hn. Sir Robin
Kilfedder, James	Peel, John	van Straubenzee, W. R.
Kimball, Marcus	Percival, Ian	Vaughan, Dr. Gerard
King, Evelyn (Dorset, S.)	Peyton, Rt. Hn. John	Vickers, Dame Joan
King, Tom (Bridgwater)	Pike, Miss Mervyn	Waddington, David
Kinsey, J. R.	Pink, R. Bonner	Walder, David (Clitheroe)
Kirk, Peter	Pounder, Ration	Walker, Rt. Hn. Peter (Worcester)
Kitson, Timothy	Powell, Rt. Hn. J. Enoch	Walker-Smith, Rt. Hn. Sir Derek
Knight, Mrs. Jill	Price, David (Eastleigh)	Wall, Patrick
Knox, David	Prior, Rt. Hn. J. M. L.	Walters, Dennis
Lambton, Lord	Proudfoot, Wilfred	Ward, Dame Irene
Lane, David	Pym, Rt. Hn. Francis	Warren, Kenneth
Langford-Holt, Sir John	Quennell, Miss J. M.	Wells, John (Maidstone)
Legge-Bourke, Sir Harry	Raison, Timothy	White, Roger (Gravesend)
Le Marchant, Spencer	Ramsden, Rt. Hn. James	Whitelaw, Rt. Hn. William
Lewis, Kenneth (Rutland)	Redmond, Robert	Wiggin, Jerry
Lloyd, Rt. Hn. Geoffrey (Sut' nC' dfield)		Wilkinson, John
Longden, Gilbert	Reed, Laurance (Bolton, E.)	Winterton, Nicholas
Loveridge, John	Rees, Peter (Dover)	Wolrige Gordon, Patrick
Luce, R. N.	Rees-Davies, W. R.	Wood. Rt. Hn. Richard
McAdden. Sir Stephen	Renton, Rt. Hn. Sir David	Woodhouse, Hn. Christopher
MacArthur, Ian	Rhys Williams, Sir Brandon	Woodnutt, Mark
McCrindle, R. A.	Ridley, Hn. Nicholas	Worsley, Marcus
McLaren, Martin	Ridsdale, Julian	Wylie, Rt. Hn. N. R.
Maclean, Sir Fitzroy	Rippon, Rt. Hn. Geoffrey	Younger, Hn. George
McMaster, Stanley	Roberts, Michael (Cardiff, N.)	TELLERS FOR THE AYES:
Macmillan, Maurice (Farnham)	Roberts, Wyn (Conway)	Mr. Reginald Eyre and
McNair-Wilson, Michael	Rodgers, Sir John (Sevenoaks)	Mr. Bernard Weatherill.
McNair-Wilson. Patrick (NewForest)	Rossi, Hugh (Hornsey)
NOES
Abse, Leo	Barnett, Guy (Greenwich)	Boyden, James (Bishop Auckland)
Albu, Austen	Barnett, Joel (Heywood and Royton)	Bradley, Tom
Allaun, Frank (Salford, E.)	Baxter, William	Broughton, Sir Alfred
Allen, Scholefield	Benn, Rt. Hn. Anthony Wedgwood	Brown, Bob (N'c'tle-upon-Tyne, W.)
Archer, Peter (Rowley Regis)	Bennett, James (Glasgow Bridgeton)	Brown, Hugh D. (G'gow, Provan)
Armstrong, Ernest	Bishop, E. S.	Brown, Ronald (Shoreditch & F'bury)
Ashley, Jack	Blenkinsop, Arthur	Buchan, Norman
Ashton, Joe	Boardman, H. (Leigh)	Buchanan, Richard (G'gow, Sp'burn)
Atkinson, Norman	Booth, Albert	Butler, Mrs. Joyce (Wood Green)
Bagier, Gordon A. T.	Bottomley, Rt. Hn. Arthur	Callaghan, Rt. Hn. James
Campbell, I. (Dunbartonshire, W.)	Huckfield, Leslie	Pannell, Rt. Hn. Charles
Cant, R. B.	Hughes, Rt. Hn. Cledwyn (Anglesey)	Pardoe, John
Carmichael, Neil	Hughes, Mark (Durham)	Parker, John (Dagenham)
Carter, Ray (Birmingh'm, Northfield)	Hughes, Robert (Aberdeen, N.)	Parry, Robert(Liverpool, Exchange)
Carter-Jones, Lewis (Eccles)	Hunter, Adam	Pavitt, Laurie
Castle, Rt. Hn. Barbara	Irvine, Rt. Hn. Sir Arthur (Edge Hill)	Peart, Rt. Hn. Fred
Clark, David (Colne Valley)	Janner, Greville	Pendry, Tom
Cocks, Michael (Bristol, S.)	Jay, Rt. Hn. Douglas	Pentland, Norman
Cohen, Stanley	Jeger, Mrs. Lena	Perry, Ernest G.
Coleman, Donald	Jenkins, Hugh (Putney)	Prentice, Rt. Hn. Reg.
Concannon, J. D.	Jenkins, Rt. Hn. Roy (Stechford)	Prescott, John
Conlan, Bernard	John, Brynmor	Price, William (Rugby)
Corbet, Mrs. Freda	Johnson, Carol (Lewisham, S.)	Probert, Arthur
Cox, Thomas(Wandsworth, C.)	Johnson, James (K'ston-on-Hull, W.)	Rankin, John
Crawshaw, Richard	Johnson, Walter (Derby, S.)	Reed, D.(Sedgefield)
Cronin, John	Jones, Barry (Flint, E.)	Rees, Merlyn (Leeds, S.)
Crosland, Rt. Hn. Anthony	Jones, Dan (Burnley)	Rhodes, Geoffrey
Cunningham, G.(Islington, S.W.)	Jones, Rt. Hn. Sir Elwyn (W. Ham, S.)	Richard, Ivor
Cunningham, Dr. J. A. (Whitehaven)	Jones, Gwynoro (Carmarthen)	Roberts, Albert (Normanton)
Dalyell, Tam	Judd, Frank	Roberts, Rt. Hn. Goronwy (Caernarvon)
Darling, Rt. Hn. George	Kaufman, Gerald	Robertson, John (Paisley)
Davidson, Arthur	Kelley, Richard	Roderick, Caerwyn E.(Br'c'n & R'dnor)
Davies, Denzil (Llanelly)	Kerr, Russell	Rodgers, William(Stockton-on-Tees)
Davies, Ifor(Gower)	Kinnock, Neil	Roper, John
Davies, S. O.(Merthyr Tydvil)	Lambie, David	Rose, Paul B.
Davis, Clinton (Hackney, C.)	Lamond, James	Ross, Rt. Hn. William (Kilmarnock)
Davis, Terry (Bromsgrove)	Lawson, George	Sandelson, Neville
Deakins, Eric	Leadbitter, Ted	Sheldon, Robert (Ashton-under-Lyne)
de Freitas, Rt. Hn. Sir Geoffrey	Lee, Rt. Hn. Frederick	Shore, Rt. Hn. Peter (Stepney)
Delargy, H. J.	Leonard, Dick	Short, Rt. Hn. Edward (N'c'tle-u-Tyne)
Dell, Rt. Hn. Edmund	Lestor, Miss Joan	Short, Mrs. Renée (W'hampton, N.E.)
Dempsey, James	Lever, Rt. Hn. Harold	Silkin, Rt. Hn. John (Deptford)
Doig, Peter	Lewis, Ron(Carlisle)	Silkin, Hn. S. C.(Dulwich)
Dormand, J.D.	Lipton, Marcus	Sillars, James
Douglas, Dick (Stirlingshire, E.)	Lomas, Kenneth	Silverman, Julius
Douglas-Mann, Bruce	Loughlin, Charles	Skinner, Dennis
Driberg, Tom	Lyon, Alexander W. (York)	Small, William
Duffy, A. E.P.	Lyons, Edward (Bradford, E.)	Smith, John (Lanarkshire, N.)
Eadie, Alex	McBride, Neil	Spearing, Nigel
Edelman, Maurice	McCann, John	Spriggs, Leslie
Edwards, Robert (Bilston)	McCartney, Hugh	Stallard, A. W.
Edwards, William (Merioneth)	McElhone, Frank	Stewart, Rt. Hn. Michael (Fulham)
Ellis, Tom	McGuire, Michael	Stoddart, David(Swindon)
English, Michael	Mackenzie, Gregor	Stonehouse, Rt. Hn. John
Evans, Fred	Mackie, John	Strang, Gavin
Ewing, Henry	Mackintosh, John P.	Strauss, Rt. Hn. G. R.
Faulds, Andrew	Maclennan, Robert	Summerskill, Hn. Dr. Shirley
Fisher, Mrs. Doris (B'ham, Ladywood)	McMillan, Tom (Glasgow, C.)	Swain, Thomas
Fitch, Alan (Wigan)	McNamara, J. Kevin	Taverne, Dick
Fletcher, Raymond (Ilkeston)	Mahon, Simon (Bootle)	Thomas, Rt. Hn. George (Cardiff, W.)
Fletcher, Ted (Darlington)	Mallalieu, J. P. W. (Huddersfield, E.)	Thomas, Jeffrey (Abertillery)
Foley, Maurice	Marks, Kenneth	Thomson, Rt. Hn. G.(Dundee, E.)
Foot, Michael	Marquand, David	Thorpe, Rt. Hn. Jeremy
Ford, Ben	Marsden, F.	Tinn, James
Forrester, John	Marshall, Dr. Edmund	Tomney, Frank
Fraser, John (Norwood)	Mason, Rt. Hn. Roy	Torney, Tom
Freeson, Reginald	Mayhew, Christopher	Tuck, Raphael
Galpern, Sir Myer	Meacher, Michael	Urwin, T. W.
Garrett, W. E.	Mellish, Rt. Hn. Robert	Varley, Eric G.
Ginsburg, David (Dewsbury)	Mendelson, John	Wainwright, Edwin
Golding, John	Mikardo, Ian	Walden, Brian (B'm'ham, All Saints)
Gordon Walker, Rt. Hn. P. C.	Millan, Bruce	Walker, Harold (Doncaster)
Gourlay, Harry	Miller, Dr. M. S.	Wallace, George
Grant, George (Morpeth)	Milne, Edward	Watkins, David
Grant, John D. (Islington, E.)	Mitchell, R. C.(S'hampton, Itchen)	Weitzman, David
Griffiths, Eddie (Brightside)	Molloy, William	Wellbeloved, James
Griffiths, Will (Exchange)	Morgan, Elystan (Cardiganshire)	White, James (Glasgow, Pollok)
Grimond, Rt. Hn. J.	Morris, Alfred (Wythenshawe)	Whitehead, Phillip
Hamilton, James (Bothwell)	Morris, Charles R. (Openshaw)	Whitlock, William
Hamilton, William (Fife, W.)	Morris, Rt. Hn. John (Aberavon)	Willey, Rt. Hn. Frederick
Hamling, William	Moyle, Roland	Williams, Alan (Swansea, W.)
Hannan, William (G'gow, Maryhill)	Mulley, Rt. Hn. Frederick	Williams, Mrs. Shirley (Hitchin)
Hardy, Peter	Murray, Ronald King	Williams, W. T.(Warrington)
Harrison, Walter (Wakefield)	Ogden, Eric	Wilson, Alexander (Hamilton)
Hart, Rt. Hn. Judith	O'Halloran, Michael	Wilson, Rt. Hn. Harold (Huyton)
Hattersley, Roy	Oram, Bert	Wilson, William (Coventry, S.)
Healey, Rt. Hn. Edward	Orbach, Maurice	Woof, Robert
Heffer, Eric S.	Orme, Stanley	TELLERS FOR THE NOES:
Hooson, Emlyn	Oswald, Thomas	Mr. James A. Dunn and
Horam, John	Owen, Dr. David(Plymouth, Sutton)	Mr. Joseph Harper.
Houghton, Rt. Hn. Douglas	Paget, R. T.
Howell, Denis(Small Heath)	Palmer, Arthur

Question accordingly agreed to.

Main Question, as amended, put and agreed to.

Resolved, That this House welcomes the present Government's introduction of the Attendance Allowance for the very severely disabled, the invalidity benefits for the chornic sick an their families and the rising provision for buildings and for the facilities and aids for the disabled; and commends the Government's realism in encouraging local authorities to implement the provisions of the Chornically Sick and Disabled Persons Act as fast as increasing staff and increasing resources allow.