HC Deb 20 March 1972 vol 833 cc1209-38

10.30 p.m.

Mr. Greville Janner (Leicester, North-West)

I am grateful to have the opportunity to raise the question of the pathetically inadequate Supplementary Estimate for attendance allowances. This problem potentially affects probably hundreds of thousands of people in this country.

The problem was brought most vividly to my attention a few months ago by the parents of an eight-year-old boy called Jimmy Martin, who was born with no legs and only one arm. His parents came to see me. They told me that they had been refused an attendance allowance. I found that quite unbelievable, and advised them to appeal. They appealed, and the appeal failed. Why?

The reason, to some extent, is the greatest tribute that could ever be paid to the parents and the school. This little boy, with three false limbs, goes to the local Woodstock Primary School, and is treated just like other children. He manages in school along with the rest of the children. He is a determined, courageous little man.

His parents bring him up with such affection and normality that they have fooled even the doctors who examined him in connection with the allowance. The doctor who examined Jimmy on behalf of the Attendance Allowance Board found that he sleeps at night. Apparently that is taken as preventing the parents from obtaining an attendance allowance. My question is: when are we going to spare a little more money so that we no longer have to say that a child with three limbs missing is not sufficiently disabled for an allowance to be paid?

I have here a statement signed by a doctor—whose signature, happily, is in decipherable—giving the reasons why Jimmy's application was turned down: I accept that James will require during the day attention and supervision substantially in excess of that normally required by a boy aged eight. With regard to the night I accept that he sometimes requires attention". He has one limb on at night; the others come off. If he can get out of bed, he cannot get back. He cannot attend the toilet on his own; he cannot get on or off. He has to have people with him at every minute, day and night. Since the moment of his birth this little child has not been left alone.

The doctor continues On this issue, however, I am not satisfied that he normally requires prolonged or repeated attention in connection with his bodily functions during the night. I accept that he is not left alone in case he should come to harm"— that is the point— and that there is a propensity to falls during the day". I am told that he sometimes falls half a dozen times during the day and on many occasions he rips his trousers. He also has an artificial arm which wears through the elbow of his jacket. He manages magnificently, but he is seriously disabled. … I find no propensity to substantial danger during the night"— that is when he has three limbs off— and I am not satisfied that he requires continual supervision from another person in order to avoid substantial danger to himself or others substantially in excess of that normally required by a boy aged eight. I disagree with the doctor, who continues with a phrase which upsets many people, including myself: I express my sympathy for this severely disabled boy"— this is a question not of sympathy but of justice and humanity to the child and his parents— but the matter to be determined by me is whether James satisfies one or other of the requirements specified in the appropriate Act and Regulations. I am not satisfied that he 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, and requires attention and supervision substantially in excess of that normally required by a child of the same age and sex, or that he is so severely disabled physically or mentally that he requires continual supervision from another person in order to avoid substantial danger to himself or others and requires attention and supervision substantially in excess of that normally required by a child of the same age and sex. This is for a child who has not been left alone for a moment since his birth, and who has only one limb out of four. To suggest that this brave young boy does not require constant supervision in the ordinary sense of the word is, to my mind, a travesty of the English language. It may be that he does not need to have somebody by his bedside all night, but that is not the criterion upon which the attendance allowance is, or should be granted. Somebody has to be in attendance so that if he needs anything it can be got for him. A child of that sort cannot be left alone at any time.

I soon discovered that this child's case is far from unique. The number of cases that have, unfortunately, come forward as a result of the story of Jimmy Martin becoming known is large, indeed, and the range is tremendous. Many of them are extremely sad cases. My experience is that they have come through to almost every hon. Member, on both sides of the House. In this case I do not feel that we on this side of the House have anything to be particularly permanently proud of, except that the Act that was brought in was brought in by the previous Government, but none too soon. I do not feel that this is a matter upon which we can have complete self-satisfaction. I believe that this is a matter that ought to be reconsidered at once.

The range of illness covered is extraordinary. There are many mentally handicapped people who are much worse than Jimmy Martin, and whose parents cannot bring their cases before the public. The worst of these is a child who is a spastic, quadruplegic, doubly incontinent, unable to walk without support, epileptic, who can never be left alone unless strapped into a chair, and an I.Q. so low that it is untestable. Yet his parents have been refused a constant attendance allowance.

Floods of letters have come to me and to the Martins during the last few weeks, and they are very sad indeed. Why should the law be interpreted in this way? Is it just a question of cost? Apparently about 38,000 people have been turned down. If that is a cost of £5 a week in round figures—£4.80 tax-free—it means about £10 million a year. Are we so poor that we cannot afford that for the worst off of our people? Surely it is a disgrace to our country that we are prepared to quibble over the wording of regulations or an Act of Parliament so as to shut out of our mercy those who most need it?

A letter in today's Evening Newssays that it would cost about ½p per person per year to see that these people get help. Even if the Minister is right in thinking that 400,000 people may be involved, that is not a matter upon which we should be mean or stingy. It is a question of common justice. These cases are dealt with in Holland and Germany in a proper manner. We should not be left behind.

I received a letter today from a doctor who spoke about a person who has to remain in hospital, unhappy, and costing the country at least ten times the amount of the allowance, because his wife was refused constant attendance allowance which would have enabled her to have her husband at home. This question is not confined to children. It concerns very old and dying people, who would be infinitely better off in their own homes if only some small support could be given to the families whose job and wish it is to look after them but who cannot afford to do so.

The amount of £4.80 is not large to many people, but to those who are living on the verge of poverty and to old-age pensioners it is a fortune—enough to enable them to care for those who could live at home. It costs £20 a week to keep a person in the average hospital. A sum of £4.80 is one-quarter of that. On my reckoning, if about 12,500 people now in hospitals could be enabled to live at home as a result of a wider and more humane interpretation of the regulations there would even be a profit, if one looked at it from the point of view of cost, which repeat I do not. What is being asked for is a very small increase—£270.000—compared to a vast and intolerable problem. Many people in this country, of all political beliefs, feel that the situation must be changed at once.

I wish to pay tribute to the many people who have written about this, and to those who have written to the Martins. I have here a pile of the kindest and most wonderful letters that I have ever read—some from people who have sent little gifts not only to Jimmy but to Wendy, his normal, 11-year-old sister, so that she will not feel out of it. I pay tribute to Douglas Bader, a very great man, who kindly lent his support to this campaign. I pay tribute to those who have organised or agreed to be patrons of a petition in Leicester, to be presented to this House in due course, including the Lord Mayor and Mayoress, leaders of all faiths, headmasters of local schools, the President of the Beaumont Working Men's Club and the Editor of the Leicester Mercury.

I also pay tribute to the people who had wished to finance this campaign. I hope that that will not be necessary, because if the campaign has to go forward the Leicester Corporation has offered the use of an empty shop and the Leicester Mercury has agreed, at no charge, to print 10,000 petition forms. The petition will be distributed by schools, churches, working men's clubs and licensed victuallers. This is a show of unanimity in the face of intolerable injustice. I hope that it is welcome to both sides of the House.

Mr. Tom Boardman (Leicester, South-West)

I pay tribute to the hon. and learned Member for the publicity which he has achieved in the case of Jimmy Martin. I agree that too often those who have the care and love do not get the cash. But would not the hon. Gentleman also pay tribute to the Government who brought in this grant, which extends to 75,000 people who are even more severely handicapped—a grant which his party when in office did not give?

Mr. Janner

I am sorry that the hon. Gentleman has seen fit to look at the matter in that way. I shall be pleased to pay tribute to the Government if the uncoroborated rumour that I hear is true—that this regulation is to be interpreted so as to help those who are excluded at the moment. We should not forget the Act brought in by my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris). But this Government brought in welcome regulations, and I look forward to welcoming an extension of those regulations, if that is forthcoming.

In a letter, the Secretary of State, to whom I pay tribute as being a kindly man, has said that in due course the Government intend to extend the present arrangements. But, unfortunately, he declined—this letter was written on 7th March—even to see the Martins and their children, because, he said: This really would be to raise false hopes of an immediate award of an allowance, and I do not think it would be right for me to do that. I am happy to pay tribute to the right hon. Gentleman for changing his mind; changing one's mind is a sign of strength. When he heard that the Martins were coming to the House he kindly agreed to see them and to refer the matter again to the Attendance Board, but he emphasised again that this was not to offer hope of any immediate change.

I hope that the Minister will tell us whether reports of a change are true. The petition in the City of Leicester is at present being held up until next Monday, in the hope that the statement which has appeared in the Press is true.

I hope that the Minister will tell us what the Government are to do, in the name of humanity, honour and justice, not only for Jimmy Martin but also for the thousands of handicapped people and their families for whom, in the past few weeks, the name of little Jimmy Martin has become a symbol of hope.

10.45 p.m.

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

The House owes a debt of gratitude to my hon. and learned Friend the Member for Leicester, North-West (Mr. Greville Janner) for raising the question of the attendance allowance and for dramatising, by means of the very sad case of Jimmy Martin, the problems arising in connection with the attendance allowance.

I want to sound a word of warning to the House. I know that my hon. and learned Friend will not misconstrue what I have to say. The genuinely sad case of this young boy has vitally highlighted some of the problems of the attendance allowance, but the House should not overlook the many other cases, which are not attractive like a young boy who is, in a sense, a hero and who has been photographed with another hero—a very moving spectacle: I commend the courage of both of them.

The House must not forget the many unglamorous people who require the attendance allowance. Some of those who need the allowance are very old; some are very sick; some are very crippled; some are very gloomy; some, indeed, are unpleasant; many of them are miserable. These are the cases that many hon. Members on both sides have been concerned with for a number of years. My hon. and learned Friend has done a great service by highlighting the general problem with the one case. It would be a terrible mistake if we were to overlook the wider concept and the more general problem of these people.

The question has been raised of who should take credit for the attendance allowance. I believe that that is a sterile argument. It is not a question whether the Labour Government proposed it and this Government disposed it. People on both sides of the House have habitually worked for the disabled in all kinds of ways, in all kinds of weathers, and at all times. If there is to be any credit—although one does not want to select any body of people—it belongs to the Disablement Income Group, which conceived the idea of the attendance allowance and persuaded the Labour Government to accept it. It was accepted by the Labour Government in principle. People like Miss Mary Greaves and Mr. Duncan Guthrie who were behind it. That led to its acceptance by the Labour Government and its ultimate operation by this Government.

My fear is that the examples that all hon. Members could quote will be overlooked. I will quote three examples, quite apart from the many in my constituency with which I have been personally involved and about which I have made representations. These three examples are as striking as any I have ever heard, yet they are of an entirely different type from the one rightly raised by my hon. and learned Friend. One of them is that of a 22-year-old incontinent girl, weighing 16 stones, who has screeching fits and who lives at home. A girl of that kind, screeching like mad and having fits, surely deserves the attendance allowance. She does not get it.

Then there is the case of a totally blind man whose wife gave up her job to stay at home to look after him. He has not been given the constant attendance allowance. Likewise, there is the case of a 35-year-old woman who is a paraplegic, suffering from deafness, with bladder trouble. She cannot walk, go upstairs, or use the bath. Surely she deserves the allowance. Incidentally she has been deserted by her husband.

Why is the allowance refused in these cases? If people are sedated at night they are not regarded as being in need of attention. If people have a mechanical bed, that very fact is held to be a reason for not giving them the allowance. If people are incontinent for one or two nights, rather than every night, they do not qualify.

But the main reason is the application form which the Government have designed. Its terms are too black and white, in that everything depends far too much on the interpretation of the doctors. Some doctors do not visit patients before making their assessments. The Government may decided to make such visits mandatory, in which case they might consider paying doctors a fee for this work, in view of the extra responsibility—but that is a subject on which I cannot expand in this debate.

The rejection form tells people that there is no appeal against rejection, yet many reviews have been granted, and the terminology of an "appeal" as distinct from a "review" is confusing, especially to sick people. I hope that the Minister will rephrase the wording and make it clear that if an application is refused a right of appeal may be exercised.

It would be helpful if the Minister would recommend that the social services officer of the local authority should visit every person who applies for the constant attendance allowance. That would help to ensure that such people are made aware of all the services provided by the authority.

I pay tribute to my hon. and learned Friend for highlighting the fundamental problem of the attendance allowance. The new provision is a step forward, although it is not as major a change as the Act pioneered by my hon. Friend the Member for Manchester, Withenshawe (Mr. Alfred Morris). It represents a promising beginning. I would be out of order in asking for the scheme to be extended, but I assure the Minister that the whole House would be warmly appreciative if he would take account of the representations that have been made in this debate.

10.54 p.m.

Mr. Tom King (Bridgwater)

I apologise to the hon. and learned Member for Leicester, North-West (Mr. Greville Janner) because I was absent at the beginning of the debate and because I may have to leave a little early. I am myself somewhat disabled, having left hospital at mid-day today. I hope that I shall be able to remain on my feet long enough to make two brief points.

What was said by the hon. Member for Stoke-on-Trent, South (Mr. Ashley) was absolutely right. That this is a promising beginning should be the underlying message of the debate. That is what hon. Members on both sides of the House recognise about the constant attendance allowance.

If there were anything that other hon. Members and I could do for Jimmy Marlin that would help him and improve his health we would want to do it, but we are facing the problem of introducing gradually, progressively and, I hope, continually an improving form of help in this tragic matter. I doubt whether there is any hon. Member who has not had tragic instances brought to his attention, now that the rules have been drawn, of those simply appalling cases that fall just outside the present regulations. That is why I welcome my right hon. Friend's assurance that attention will be given to this matter and that as soon as possible we shall look for some widening of the criteria. But let us not forget that when those criteria are widened, yet again we shall find many tragic cases that will still sadly fall outside the provisions of the regulations and whatever lines we, in our wisdom, as a Parliament, draw.

My hon. Friend the Under-Secretary is considering a case that I have referred to him. So often these cases and the appeals fall over the problem of "night" and that it cannot always be claimed that regular night attendance is required. But all hon. Members must know of many cases where the degree of attendance and the degree of appalling concern by day is such that the question of attendance by night hardly seems relevant. Many people are appallingly physically handicapped but are mentally perfectly sound and are a pleasure to live with, being courageous, bright and intel- ligent, but they require constant physical attendance, by day and by night.

There is an enormously strong case for saying that the other sad category of people whose condition is such that to live with them is a tragedy every minute of the waking day but who, by treatment, mainly by sedation, require no treatment by night and are therefore rendered ineligible for the allowance are, in certain cases more entitled to some assistance. It is in no sense of criticism that I say to the hon. and learned Member for Leicester, North-West that in spite of the welcome that has been given, I have some doubt whether this is the right forum for discussing this matter. Whatever the hon. and learned Member may say, hopes have been raised and many people will be seeing the anomalies For every Jimmy Martin, and the tragedy that Jimmy Martinis, there are many thousands more. Few would conceive that there are 78,000 cases worse than Jimmy Martin. The case from my constituency that my hon. Friend the Undersecretary is considering is more deserving than Jimmy Martin, with great respect for the concern of the hon. Member for his constituent. As the hon. Member for Stoke-on-Trent, South very wisely said, my case is much less attractive in some way; it concerns a rather elderly gentleman. The problems that he raises for his family are serious.

Against the background of the many serious problems that the Measure inevitably raises, our approach must be most prudent and conscious of the interests not so much of those who fall within the criteria that we establish as those who fall just outside and who are to be so disappointed.

Speaking as a lame duck myself—I hesitated to use the words—I hope that hon. Members on both sides of the House will appreciate the strength of the beginning that my hon. Friends have made. This is a measure that we all welcome, and we must all think most wisely about its further expansion.

11.1 p.m.

Mr. Edwin Wainwright (Dearne Valley)

We were all sorry to hear that the hon. Member for Bridgwater (Mr. Tom King) has been in hospital, but we are all glad to see him here this evening speaking on behalf of the people mentioned by my hon. and learned Friend the Member for Leicester, North-West (Mr. Greville Janner). This is a question on which we should not be thinking in party terms. The Measure could have been brought in years ago. The Labour Government were responsible, through my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) for introducing it. It was brought in by one Government and implemented by another, and one side cannot seek to claim party advantage for it.

There are many cases throughout the country that one could argue to the Minister as being in special need. The interjection by the hon. Member for Leicester, South-West (Mr. Tom Boardman) was uncalled for. It is not a question of handling out praise but of what will be done about the matter. Are we certain that the guidelines are correct? To qualify for an allowance a person must be so severely disabled, physically or mentally, that he has, for six months or more, needed frequent attention throughout the day and repeated attention during the night.

I have raised two cases with the Secretary of State. One concerns a man aged 87. I must be careful what I say, because the family concerned are so independent that they do not want the neighbours to know of their problems. They carry a very heavy burden. It is always more difficult to get a wife to look after her father-in-law than to look after her own father. In this case the 87 years-old man is the husband's father. He has to be lifted in and out of bed and looked after throughout the day. He can stagger about slightly. He ought to be in a geriatric ward, cared for by the nation. That is the sort of case where we should be keen to make a small contribution, because by caring for the old man at home the couple are saving the State a considerable sum of money. All too often we place the responsibility on the sons and daughters of elderly people—children who are independently-minded, thoughtful and sympathetic. Therefore, we should look at the thousands of similar cases throughout the country.

My second case concerns a young lad with cerebral palsy, who has had difficulty in walking throughout his life. He is a very independent boy, who tried to earn his own living by typing, using his fore- head, because he has no use of his left arm. With his right arm he can just hold someone's hand, but he has no grip. He walks with tremendous difficulty, and must be watched, but he is so independent that he gets about. He has been looked after by his parents since he was born. He will never be capable of earning a wage. With our present high rates of unemployment, someone 10 times less physically handicapped would have difficulty in finding a job.

His parents love him very dearly, and will look after him regardless of what the State does, but they feel that in other cases not so bad as their son's the allowance is being paid. They think that they themselves may have been a bit more open in filling in the form. I should just like to read one part of the form:

"Change position whilst in bed Yes
Get out of bed … Yes, with someone at hand because of the tendency to fall
Walk Yes"

I have seen this boy walk. He does so more by sheer determination than by physical ability. It continues:

"Use stairs Yes"—

he crawls upstairs—

"Dress and undress No
Wash No
Bathe No
Shave No
Eat No
Drink Yes, through a straw
Go to the toilet No"

In his 21st year, he has to be looked after.

I hope that the Government will examine such problems. If society cannot afford to help those looking after others in such circumstances, we are not carrying out our responsibility. There is a clear demarcation. One either claims £4.80 or has nothing at all. We should see whether a little other help can be given and make certain that our society looks after such people far better.

Society is being helped in cases like the first that I mentioned, because it is far better for an elderly parent to be kept at home, where he is looked after by those who love him and whom he loves, than to go to a geriatric ward.

Therefore, I appeal to the Minister, who I know is very kind-hearted, to make certain that the Cabinet opens the purse strings a little more, so that we can make some contribution to help those many thousands of poor people to keep their loved ones at home without suffering too much financially.

11.8 p.m.

Mr. Cecil Parkinson (Enfield, West)

I thank the hon. and learned Member for Leicester, North-West (Mr. Greville Janner) for raising the subject. At my advice bureaux over the past two months I have had a string of parents of mentally-handicapped children who are very perturbed that within the group of mentally-handicapped children in the town of Potters Bar, which is part of my constituency, certain children are being allowed the attendance allowance and a number of others, some of whom all the parents are agreed are possibly more deserving, are being refused the allowance.

I have looked into this problem in depth, to a certain degree. One of the aspects to which I would like to draw my hon. Friend's attention is that to some extent the disability of the child is not the governing factor; it is the lack of ability in his parents to articulate their problem. This means that parents who are not used to writing letters or explaining their problem are at a disadvantage compared with parents of a less disabled children who are good at putting their case.

Last Saturday, the secretary of a local group of the mentally disabled visited me and gave me a list—which I have passed on to my hon. Friend—of children whom she regarded as deserving of help but who were not getting it. Because she did not want to deprive any child already getting help, she did not list them, but she assured me that there were considerable numbers of them.

The constant attendance allowance must be universally welcomed. The Labour Government thought of it, and this Government carried it out. As a practical person, I tend to side with the people who have taken action, but I also admire those who thought of it. But I am worried. One can see the problem of people who cannot express themselves, compared with those who can. A system of allowances must not necessarily go to the group of people with the most ability to express themselves but who may not always be the most in need; it must be equally available to all in need of it. I entirely agree that an allowance should be tailored to the needs of the individual case. I do not know how one gets over that difficulty. I know that it exists, and from my experience in my constituency I know that there is a danger of injustices being done. I do not think that the ability to explain the need ought in the end to determine the benefit.

I am told that good politicians produce answers and not questions, but in my brief experience in this House I have found that I am constantly being landed with problems, and am constantly writing to my right hon. and hon. Friends in the Government and handing the problems over to them. That is not very satisfying to me, and I am sure that it is infuriating to them. But there is a problem here. I do not know what the answer is, but I do not believe that we are on the right lines. The Government deserve great credit for introducing the constant attendance allowance, and the 78,000 people in receipt of it have undying gratitude to them for it. I urge my hon. Friend to think of a way of overcoming the problem which, in my own rather faltering way, I have tried to outline.

11.14 p.m.

Mr. R. C. Mitchell (Southampton, Itchen)

Probably every hon. Member over the last year or so has had many cases brought to his attention, many of them similar to those which hon. Members detailed tonight. The Minister has sent me letters on various occasions about such cases. I want to interpose my genuine appreciation of the courtesy with which he and his Department have always dealt with the cases that I have sent to them. I do not propose to detail those cases now, for I do not think that I would serve a useful purpose by doing so. I have found, however, that in about 75 per cent. of the cases that have been brought to my notice the original rulings have been reversed on appeal.

Although that indicates something to me I am not sure what it is. It may be, as my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) said, that there is something wrong with the initial procedure. The form that has to be completed is somewhat complicated. A more educated person would be better able to complete it in a manner which would satisfy those concerned than would a less well educated person. It could be that the doctor's report goes through without the person concerned having been examined by that doctor.

There is also great confusion about the letter that refuses the allowance in the first instance. It is long and rather complicated, and it does not state clearly that there is a right of appeal. The letter is in a jargon that is difficult to understand. I have found that a number of my constituents did not ask for their cases to be reviewed because they did not know that they could do so. I therefore wrote to my local paper asking all whose cases had been turned down to send details to me, and those details I sent to the Minister. If they had not read the letter in the local paper I am certain that many of them would not have asked for a review. Now 75 per cent. of those cases have been granted on appeal. That can happen when an independent doctor makes a thorough examination of the person concerned.

The main stumbling block in difficult cases which have been refused is the phrase about constant attendance at night. Even the most disabled person usually sleeps at least part of the night, and it is very rare that one needs constant attendance at night. I appeal to the Minister, even at this late hour, to get on the telephone to No. 11 Downing Street and to say to the Chancellor of the Exchequer, "In your Budget tomorrow please do something about this problem." That message might not fall on deaf ears.

Mr. Eric Ogden (Liverpool, West Derby)

Paragraph 33(b).

Mr. Mitchell

I hope that it will be possible to extend this allowance to a greater range of people. The wide range of disability cases has been brought to the attention of many, including me, through this allowance. I did not appreciate that the range was so great, and I doubt whether the Minister did until so many cases were brought to his notice. Please, if possible, let us have an extension to a wider range at the earliest possible moment.

11.20 p.m.

Mr. David James (Dorset, North)

I want to subscribe to what the hon. Mem- ber for Southampton, Itchen (Mr. R. C. Mitchell) said, and to the spirit in which he said it. This is undoubtedly a beneficent scheme, fulfilling a long-felt want. As the hon. Member pointed out, it has not worked out as happily as we would have liked. I rise because I have the Adjournment debate and have been kicking around the building, and also because I had a particularly tragic case brought to my attention only this morning. In my constituency I do not have surgeries, because it is made up of small villages. I live in the middle and my people come to see me on a Monday morning. I had an old gentleman come to see me. I will not mention him by name because I have not had a chance to tell the Minister about this case. He is aged 76. He had to retire prematurely because he had T.B. He also has angina.

His wife, who is a heavy woman, four years his senior, had a crippling stroke six years ago which left her paralysed down her left side. Two years ago she had a spasm which equally affected her right side, and I am afraid that she had another stroke last Thursday. What concerns me about this case is that my constituent applied about four months ago and he has not yet even got the initial decision. I understand that there has been a log-jam in the Department owing to the large number of cases with such an imaginative scheme. But for people of 76 and 80 four months is a great part of their lives. In the event, from what the man tells me, because the doctor has been to investigate the case, I feel it may be turned down.

When we are talking of constant attendance by night I can only say that this man, with a bad heart, had to manhandle his wife out of bed four times last night alone. Yet he apologised to me because he was ten minutes late this morning! I do not want to tear at heartstrings, but this is an infinitely tragic business. Like everyone else I fully accept the Government's good intentions. I fully understand that what they have designed is for the best—that this is a dummy run of an entirely new type of scheme. I accept the point made by others that in some cases this keeps people out of geriatric wards, but I urge the Minister to have a far-reaching look at the criteria underlying current assumptions to see whether this well-intentioned scheme cannot be improved.

11.24 p.m.

Mr. J. D. Concannon (Mansfield)

I am not particularly concerned about who brought in this scheme, or about who gets the credit. What I am perturbed about is that no one is at present getting any credit. As it is working there is a lot of bitterness and anger among those who thought they would be entitled to it. Most Members have these tragic cases in their constituencies. We can all recite them. I welcome this scheme, but I want to see it extended and applied more fairly. I have gone to various homes in my constituency to see retired and injured miners, and I have helped them fill in these forms. This is a difficulty. I have sat there and actually filled in the forms for them because they have found it difficult to follow what it was about. They thought that if they filled in the form themselves they would not do it properly and that would count against them.

I sometimes filled in a form with my tongue in my cheek, thinking that the person concerned was not in such a bad way as the person whose form I had filled in last week, whose application was not accepted. My surgery is filled with people who are complaining that other people have qualified whereas they have not, although they are in a worse position.

We all give an unqualified welcome to the scheme, but we want to see it working better and more fairly. I do not want this scheme to go the way of other schemes. Problems arise not for the people receiving social security benefits but for those who are just beyond the point of entitlement. When the Labour Government made provision for cheap television licences for people living in old folks' homes. Members of Parliament had a lot of trouble explaining to people why they could not have cheap licences. I do not want this scheme to founder in that way.

I thank my hon. Friend for bringing up this subject, and I ask the Minister to make sure that this worthwhile scheme works more fairly.

Mr. Eric Ogden (Liverpool, West Derby)

Anyone looking at the Order Paper might have thought that a debate on the Consolidated Fund (No. 2) Bill would be a dull and dry affair, yet, as we have seen, it has encompassed the needs of the coal industry and the needs of our constituents individually and collectively. It has probably not escaped the Minister's notice that this debate has produced more agreement between the two sides of the House than almost any other subject that we have discussed during the last two years. This is not pressure, or redress of grievance before taxation; this is showing a common concern from both sides of the House.

The debate highlights the dilemma of delegated legislation. Parliament introduces legislation, but individual cases cannot be decided by the Secretary of State, the Minister of State or the Parliamentary Under-Secretary; they have to go down the line to area boards and the good men and women who serve on them. The good decisions we accept without challenge. We may sometimes think that a constituent has been lucky, and we do not press it too far.

I understand that the Minister is to review the regulations and guide lines. I hope that I shall not embarrass him by saying that his Ministry has a particularly strong team and that he is known to be not only a competent but a compassionate and humane Minister.

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

I thank the hon. Gentleman.

Mr. Ogden

I will not ask too much from him in return for that expression of thanks. It is possible to draft new regulations and new guide lines, but a hint is as good as a nod to many people down the line.

It would be of some help if the Department were to make it known—not by any directive, but perhaps through the usual channels—that the Minister would look with favour, or even not look with disfavour, on area boards being as generous as possible within the rules and regulations. Let it be known that the Department is concerned about some of the anomalies and is willing to discuss how they can be overcome. In the meantime, the people with responsibility could be asked to help. That is the intention of the Act of Parliament, rather than that there should be a strict examination of any particular wording. If the hon. Gentleman seeks to show his Department's concern he will satisfy my demands at least for tonight.

11.31 p.m.

Sir Brandon Rhys Williams (Kensington, South)

I shall speak for only a minute, to add my name to those of hon. Members who have asked my hon. Friend to look at the workings of these provisions. There is a saying that one has to draw the line somewhere, and there is a deeper saying that the letter kills and the spirit gives life. The spirit in which the Government acted in bringing in the attendance allowances was right, and was endorsed in all parts of the House. All hon. Members know the difficulties that are being encountered. One cannot be too specific under the rules of order in trying to suggest a remedy, but we must all know what that remedy is.

Since we have with us a representative from the Treasury—the Financial Secretary—I hope that he will not mind my saying that his right hon. Friend at the Elephant and Castle has the reputation that at this time he has the Treasury eating out of his hand. I hope that he will soon prove once again that his intentions towards the disabled are as optimistic as anyone could wish, and that the Government will respond in the most generous fashion at an early date.

11.33 p.m.

Mr. Alfred Morris (Manchester, Wythenshawe)

This has been an extremely worthwhile debate, and my hon. and learned Friend the Member for Leicester, North-West (Mr. Greville Janner) has made a renewed and moving plea on behalf of his admirable young constituent. I had the pleasure last week of dining here with this heavily disabled little boy. He is a delightful child, with loving and devoted parents.

On the last occasion on which the attendance allowance was debated—on 21st February last—my right hon. and hon. Friends and I argued for an increase in the amount of the allowance and an easing in the rules of entitlement. Unfortunately, we were voted down. That was very sad, but the rules of order do not permit us to pursue all our arguments tonight. We must all recognise the limitations of this debate. It would, of course, require new legislation to change the regulations. The only thing we can discuss in this debate is the administration of the existing law.

What has been demonstrated in this debate is that there are many anomalies in the administration of the attendance allowance. I understand that the Secretary of State has asked for the case of the boy from my hon. Friend's constituency to be looked into again. That must mean that the Secretary of State is uncertain whether it was right in that case to refuse the attendance allowance. I know that the Attendance Allowance Board will look as sympathetically as possible at any possibility of granting the allowance to this little boy.

There has been no animus in this debate. It appeared as if there might be when the hon. Member for Leicester, South-West (Mr. Tom Boardman) seemed to claim the copyright of the attendance allowance for his party. I take it that was a misunderstanding on his part. He was corrected by his hon. Friend the Member for Enfield, West (Mr. Parkinson). As we have been reminded, the allowance was conceived and first proposed by the last Labour Government.

It is refreshing that hon. Members on both sides want to reach maximal agreement in discussions about disablement. I believe that the Under-Secretary would like very much to see an easing of the rigid rules of entitlement, and I hope that we shall hear from him that progress is likely to be made in easing the regulations at a very early date.

My hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) spoke with all his customary wisdom. His speeches on this subject are always deeply felicitous. He reminded us that there are many cases of unattractive people requiring much more sympathy than they have received so far.

I want to refer briefly to the case of one very severely disabled woman who has been refused the attendance allowance. I quote from a statement made to me by her husband. He wrote: My dear wife who is now 51 years of age has been completely housebound for 22 years. She suffers from anxiety neurosis and agro-phobia and has also had rheumatic fever three times. 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. I myself have not been out of our front door since March 1967. The attendance allowance was refused in that case.

We were told in our recent debate by the hon. Member for Cornwall, North (Mr. Pardoe) of another deeply disturbing refusal to pay the allowance to a very grievously disabled man.

I am glad that an hon. Member opposite referred to the problems experienced by the parents of mentally handicapped children in this connection. I have recently been in touch with the Secretary of State on behalf of the South Manchester Mentally Handicapped Children's Parents' Association. I have told the Minister that children with exactly the same condition and in exactly the same circumstances are being treated differently in neighbouring localities. Some are receiving the allowance. Others are not.

My hon. Friend the Member for Mansfield (Mr. Concannon) was eminently justified in saying that it is the anomalies that have arisen which are of very special concern to right hon. and hon. Members on both sides.

The mother of one mentally handicapped person who has been refused the allowance writes: My daughter, Victoria Susan, will be 26 on the 22nd March, 1972. She looks like a 10 year old but is not capable of doing some things that a 2 year old child could do with ease. She has to be assisted with bathing, washing, dressing, eating … She can only say a few words and cannot say her own name properly … Few would deny that this is a disabled person who is in need of constant attention. People with exactly the same condition have been granted the allowance in other localities. I hope that the Undersecretary will recognise that we are very disturbed by the anomalies that have been set in relief by the debate, as by previous debates on this deeply important subject.

My hon. Friend the Member for Southampton, Itchen (Mr. R. C. Mitchell) suggested that the Under-Secretary should telephone the Chancellor of the Exchequer saying that there would be a convenient opportunity in the Budget tomorrow afternoon to satisfy the wishes of both sides of the House. We now have the Financial Secretary of the Treasury with us. He will want to facilitate the passing of the message. I am sure that he is now convinced of the strength of feeling on both sides of the House on this issue.

There is a rumour abroad, indeed there has been definite Press reporting—to the effect, that the Government intend to grant the attendance allowance to the constituent of my hon. and learned Friend the Member for Leicester, North-West (Mr. Greville Janner). Last Saturday's Daily Expressstated: Now the Social Services Ministry is expected to announce new rules for cash help for the disabled. A new rate for those like Jimmy who need daytime attendance—expected to be more than half the full allowance—will probably be announced next week. I hope that the Under-Secretary will now confirm or deny such reports. We for our part hope that the report is accurate. If it is not, I hope that the Minister will say so tonight in order not to excite false hopes among the severely disabled.

I ask the Under-Secretary to respond sympathetically and constructively to all the points that have been raised. I am satisfied that the hon. Gentleman will want this debate to be marked with a statement of some importance from his Department. I know that he will do everything he can to see that this debate ends on a constructive and purposeful note by making the fullest possible statement in reply.

11.45 p.m.

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

If only the hon. Member for Southampton, Itchen (Mr. R. C. Mitchell) had made that suggestion 40 minutes ago—before the eleventh hour—Imight have been able to do something for him but he has unfortunately missed the opportunity, even with my hon. Friend the Financial Secretary so close to us.

At the outset, in order to put the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris) out of his misery I must eschew the temptation to say anything about burdens which may or may not fall upon the public purse in future, because that would be entirely out of order in this debate. We can debate only the burdens which now fall upon the Treasury, so I hope that the hon. Gentleman will excuse me from making any reference, or rising to the tempting bait that he set before me to refer to what might happen in the future.

I ought also, to apologise to the House for standing here tonight in place of my hon. Friend the Member for Somerset, North (Mr. Dean), who is away indisposed—I hope temporarily.

As regards the case of James Martin, which has inspired the hon. and learned Member for Leicester, North-West (Mr. Greville Janner) to raise in the House today general problems, related to the attendance allowance for limbless and other disabled people, when my right hon. Friend met the hon. and learned Gentleman with James Martin and his family at the House last Tuesday, he undertook to ask the Attendance Allowance Board to reconsider Jimmy's case. The hon. Member for Wythenshawe referred to that. My right hon. Friend has written to the Chairman of the Board putting to the Board a formal application for a review. Any question whether Jimmy satisfies the conditions for the allowance must be regarded as sub judice, and in those circumstances it would be improper for me to pursue his case.

I should, however, like to do two things—first, to pay tribute, as I am sure we all would, to Jimmy's spirit and the devoted care given to him by his parents and, secondly, to reiterate what my right hon. Friend said when talking to the hon. and learned Gentleman and to the Martins, namely, that he was anxious not to raise false hopes. On the one hand the Attendance Allowance Board is an entirely independent body, and on the other, in exercising its judicial function in relation to individual cases it is bound by the statutory conditions that have been approved by Parliament.

Against the background of an almost unanimous expression of view, it is worth staying that this is not a proper area for party political warfare, since the allowance was conceived under the previous Administration and born under this one. It is, nevertheless, fair to invite hon. Gentlemenopposite—particularly the hon. and learned Member for Leicester, North-West, who made a vigorous and almost attacking speech—to bear in mind, if they consider it fair and proper for hon. Members to raise anomalies which they find in the operation of the Act, that it is an Act which Parliament approved, and that every hon. Member takes some responsibility for the Act as it stands, whatever the defects that we may be finding in it in practice. It is an Act of necessary dual parentage, in party political terms, and the hon. and learned Gentleman has as much responsibility for its failure to help Jimmy Martin as I have. None of us would differ on that.

Mr. Greville Janner

We must change it.

Mr. Alison

The hon. and learned Gentleman says that we must change it, but that lies in the future. There has been no lack of suggestions as to how it may be changed, and I believe that that spirit is widely shared in the House. Indeed, my right hon. Friend has made it clear that this was a first step, and we need no pushing to conceive of the possibility of subsequent steps.

There is one other point about Jimmy Martin's case on which the hon. and learned Gentleman asked for information from my right hon. Friend at the interview, and to which he referred in his letter of 16th March. In connection with the determination that has been given on review in Jimmy's case it is possible to bring an appeal to a National Insurance Commissioner, obviously with the leave of such a Commissioner, as must normally be achieved, on a question of law.

I would advise the honourable and learned Member that the time taken to deal with such an appeal is very much a matter for the National Insurance Commissioner, who is also quite independent of my right hon. Friend's Department. The hon. and learned Member will note that an appeal can be brought only with the leave of the Commissioner. Since a further review by the board has been set in motion the hon. and learned Member may think that at this point of time the possibility of an appeal on a question of law may be left, notwithstanding that the normal three months' time limit from the date of the review determination, on 3rd January, for applying for leave will expire at the beginning of next month. There will, of course, be a further right of appeal—subject to leave being granted—in connection with the further review which the Board will now be undertaking—and which, no doubt, will take some time to complete. I understand that, so far, no appeals have been heard by the Commissioner.

In one respect I am particularly glad that the hon. and learned Member has given me, by raising this matter this evening, the opportunity to say something about the attendance allowance. Over the period of nine months or so since we started the take-on of claims in June, 1971, more than 140,000 claims to attendance allowance have been received and over 15,000 applications for review. Clearly the Board could not handle all those claims and reviews itself, and it exercised power given to it by the Act to delegate its functions in respect of individual cases to medical practitioners. This it has done, to medical practitioners operating in the 10 English regional centres and at Edinburgh, Glasgow and Cardiff. The more arduous task of dealing with applications for review has in general been delegated to medical staff of my Department working at the Department's Central Office at Norcross, Blackpool.

The hon. Member for Stoke-on-Trent, South (Mr. Ashley) mentioned people knowing about the possibility of a review. When the medical requirements have not been satisfied, a letter notifying the "failure" is sent to the claimant. The same letter contains full details of the possibility not only of a tribunal but of a review.

The hon. Member for Southampton, Itchen complained that the letter was a little obscure. We have taken that point. A revised version which he may not have seen is now in the pipeline, and may be in operation.

Mr. Greville Janner

Have not some 68 per cent. of all appeals succeeded? If so, does that not suggest that the original criteria applied by the Board are very stiffly applied, and that some steps could be taken by way of direction from the Department?

Mr. Alison

That was another point made by the hon. Member for Southampton Itchen. Yes, a high percentage—I believe that it is 70 per cent.—succeed on review. But that is a little misleading, because when refusals occur in the first instance and review applications come in some of them are very straightforward, some call for further evidence, and some have to be referred to the Board because they are cases of special difficulty.

The easy ones are decided promptly. This gives rise to the rather high success on review percentage which I have already quoted. If we take into account the other two categories and lump those in—they are much less likely to be successful—the average tends to be brought down. Therefore, the high review figure is misleading. It has to do not only with the circumstances which I have just described but with the build up of case law in this sphere.

Mr. Ashley

Is the hon. Gentleman aware that every hon. Member has in his postbag evidence that many severely disabled people fail to understand the provisions on the form? Many people simply do not know that they can appeal or apply for what the Minister calls a review. The word "review" is misleading. Could not the form be changed, so that it simply says, "Your application has been rejected", when it is rejected, "but you are entitled to appeal against this decision"? The terminology is important to ordinary people.

Mr. Alison

I will try to answer the hon. Gentleman's misgivings by sending him a copy of the latest letter of refusal, which is in draft, to see whether he thinks it is sufficiently clear in setting before applicants the possibility of having a second bite at the cherry. We are confident that it sets out clearly the further opportunities available.

My hon. Friend the Member for Enfield, West (Mr. Parkinson), in a moving and helpful speech, referred to the lack of articulation of some of his constituents who are unable to express the full circumstances affecting themselves or members of their families. I can assure him that in cases of refusal there automatically follows a call on the family concerned by a medical practitioner—not the family doctor—whose job it is, upon a review being applied for, to look at the circumstances of the individual applicant. I believe that lack of articulation in these circumstances can still be compensated for by the personal experience of the visiting medical practitioner.

I should like to take this opportunity of expressing again our and the Board's confidence in the medical practitioners who have been involved. There have been many of them. They have performed a magnificent task over recent months, and without them there could have been no attendance allowance.

It is deplorable that in the wave of—perhaps understandably—emotional publicity surrounding Jimmy Martin's case there should have been uninformed criticism of the Board and of the doctor who dealt with Jimmy's case, without regard to what the attendance allowance is really all about, and what the Board's limitations are. It is governed by what Parliament has decided and what every hon Member saw fit to pass without Division at the time of the original Act. The Board and its delegates carry out the law which we have made both humanely and imaginatively. The Act makes it quite clear that the attendance allowance is awarded on the basis of the degree of attention or supervision needed and not on the basis of the cause of disability which gives rise to that need for attendance.

In saying that, I do not want in any sense to derogate from the claims made upon the community and its services by those severely disabled people, including children, who have parts of two, three or even four limbs deficient. It is an attendance allowance, and was conceived as such; it is not a broader disability allowance.

I wish to put the matter in a wider perspective. I am advised—and I can say this with confidence—that over the last months those who have been closely involved in dealing with applications for the allowance have undergone a heartrending experience. This is true not only of the Department's lay staff but of those who are medical men with wide experience of illness and disability, members of the Board and their delegates.

On them in particular has lain the responsibility of making decisions which can lighten the burdens of a sorely-tried family or disappoint them. I was shocked to hear of the case to which my hon. Friend the Member for Dorset, North (Mr. David James) referred. It sounds as if something went wrong with the documentation, I can assure him that I shall look closely into the case when his letter is at hand.

I will give the House some examples of the sort of cases with which those responsible must deal, and if I relate them solely to children it is because this debate arose from the case of a child. If I limit them to particular groups it is because my time is limited, and disablement is almost unlimited in the way in which it can arise and provide a need.

The first group of children about whom I wish to talk are those who suffer from the effects of a tragic condition, of which examples will be known to hon. Members, namely, spina bifida. The children about whom I am thinking particularly are the ones in whom the effects are so bad that they are completely paralysed from the waist down. Not all of them are as bad as that, but there are thousands who, even after the spinal defect is repaired, are left with no muscular power and no feeling at all from the waist down.

With such loss of muscular power they cannot walk and so, for mobility, rely on a wheel chair. But that is not all. They are also incontinent of both bowel and bladder, and I can leave it to the imagination of hon. Members to comprehend what this means in the way of attention. Moreover, I am advised that this incontinence in these children can lead to additional complications. Many of them have had surgical treatment to cope with their urinary incontinence and the effect is, in simple terms, to drain their water through a hole in the lower part of their body into a plastic bag.

Some of these children have the added trouble of a condition known as hydro-cephalus. In the old days it was called water on the brain. It can now be relieved by a tube running from the head down into the upper part of the body, complete with valve. Despite their problems, many of these children and bright and cheerful. Some have the added burden of mental handicap. Probably about 2,000 of these children have qualified for the allowance, but others, though severely disabled by this condition, have not qualified where they require little or no attention during the night.

However, we can feel some sense of relief in the knowledge that the terrible sorts of condition that I have been describing have brought children into benefit in this regard, to the great relief and spirit of hope of long-suffering and courageous parents.

I turn the attention of the House to the problems, with which the hon. Member for Manchester, Wythenshawe dealt—he rightly described these children as some of the most needy among the handicapped—of having mentally handicapped children in the home. Mental handicap, like other causes of disablement, covers a wide range. But there are in the community devoted parents looking after mentally handicapped children—some of them no longer children in the accepted sense of the word—who are very severely disabled indeed.

Many of them go to special schools, but for others that is not possible. Some are ineducable, difficult to train in even the most elementary matters, hyper-active, aggressive and destructive. Some are physically handicapped as well, and need cleaning up in the night. Some are active in the night and need to be stopped from getting into a dangerous situation both by night and by day.

Some of these children are a wearing burden to their parents, who none the less accept that burden willingly and cheerfully, both by day and by night, and I am glad to inform the House that about 8,500 mentally handicapped including children, have qualified for the attendance allowance. Here again is a good step forward in relieving human misery as a result of what Parliament has accepted as a first stage.

I could go on much longer telling the House about the problems of some of the disabled people in this country, including children, who are all among the most disabled members of the community. I hope that what I have said will illustrate, without seeking to detract from the devoted care given to Jimmy Martin by his parents, that there are many others of whose problems we are deeply aware, and that the attendance allowance is helping large numbers to a considerable extent. That is the answer that I give to a rhetorical question which a newspaper leading article asked last week. "Who does qualify for the allowance?", was the question. The answer is that by now 75,000 of the most severely disabled members of the community qualify, some 18,000 of them being children. The figure of 75,000 represents 50 per cent. more awards already than the total of 50,000 which we origin ally estimated on the basis of figures from the O.P.C.S. Survey.

Mr. Alfred Morris

How many applications have been rejected?

Mr. Alison

The figure of applications that I gave earlier was about 140,000, and it is about a 62 per cent. success rate overall. A total of 50,000 awards was the original estimate, and we have exceeded that, with our total of 75,000, by about 50 per cent. Over 10,000 claims remain to be dealt with. More are continuing to come in, at an average rate of about 2,000 a week, and have done so even in the last four weeks. Those who qualify include the very severely disabled limbless, equally with other very severely disabled people. Moreover, whereas we originally estimated that there would be roughly one successful award to every two claims, the average success rate up to 14th March was 62 per cent.

For children, hon. Members—particularly the hon. and learned Member for Leicester, North West—will be interested to know that the success rate is as high as 75 per cent., and is well above the average for adults. I have just been advised that the total number rejected, including those not reviewed, is 48,000.

I conclude by saying that we have never pretended that the attendance allowance as it now it would meet the needs of all disabled people. Again and again my right hon. Friend and my hon. Friend the Under-Secretary have said that we regard it as only a start, and that that start would help only the most severely disabled members of our community who need the most care, by night as well as by day. This is the clear and distinct principle, of the need for the double attention, on which the present law stands. However, we have always said that we hope to extend that principle, bringing in much larger numbers. But that would require legislation, and discussion of that is out of order in the present context.

I am glad, however, that we have had the debate today. It has given me an opportunity to put some of these issues before the House in their wider perspective. It has enabled the House to reflect once again on the tragic cases which show that legislation which the whole House wished to accept was justifiably called the first step. Every case that has been spoken about tonight will be carefully weighed and pondered by my right hon. Friend and by my hon. Friend the Under-Secretary. It will reinforce our determination to consider the first step as only the first step, and to look forward as soon as we can to expanding the range of the attendance allowance.