§ 8.33 a.m.
§ Mr. Hugh Dykes (Harrow, East)
I am glad of the opportunity to raise, briefly I hope, the important question of the activities of the Department of Health and Social Security in the provision, financing and planning of electromechanical and hydraulic equipment for registered disabled people.
Naturally, I should be delighted to have the Minister's attention on this subject. If he is to continue to be interrupted by the hon. and learned Member for Leicester, West (Mr. Janner), I shall not be able to get his attention at all.
Without in any way wishing to be churlish at this early hour in the morning, I should like to express some dismay that the Under-Secretary of State with special responsibility for the disabled is not on 2391 the Front Bench to answer any points I make. I appreciate that the exigencies of productivity nowadays apply to the public service. Therefore, the idea that one very competent Minister, who has made a lengthy speech on one subject, should immediately switch his mind to another rather complicated subject should not be too surprising. However, I must, without overdoing it, express my regret that the Minister's distinguished colleague, who has so much experience and knowledge of disabled people, is not here. I hope that the hon. Gentleman will give me a proper explanation for his absence.
This is an important matter. The continuing problem of constraints on public spending, to which the Minister referred in the previous debate, will affect many areas of spending on health, social and welfare services. Therefore, there is a natural anxiety, shared by many people, that it will affect equipment for disabled people. One hopes that it will not. Some of this equipment is not exactly one-off, but limited in application and scope because so few people need it. None the less, the global expenditure figure for such items of equipment can be modest compared with the vast total expenditure by the Department and by local authorities on other services and equipment.
I should not be offended if the Minister did not speak at the same length as in the previous debate. but I would like a progress report on his Department's work last year and plans this year in the provision, financing and planning of equipment for registered disabled people. Perhaps he could also give us a progress report on how the Chronically Sick and Disabled Persons Act is functioning and how the links between his Department and local authorities are developing. He could take this opportunity to assuage the anxieties that progress has not been sufficiently rapid to meet the needs of the disabled. These needs are often individual, even esoteric, and applicable to only one person or a small group, but they can also apply to larger groups.
In the last debate on the homeless, the Under-Secretary used the phrase "gross misconduct and illegal activity". I thought that he was describing his Government's record over the past 12 months, but I am sure he would deny that. I would not use the phrase about the 2392 problem I wish to raise, but it is causing considerable anxiety. I would guess that 45,000 registered disabled people could be affected by a decision on a particular piece of equipment—the raising seat wheelchair. This is a tiny item compared with all the activities and provision of equipment of the Department, the area health authorities and the hospitals, but I consider it to be very important. On all the available research and evidence of the past 10 years, it is clear beyond all but unreasonable doubt that a wheelchair that does not have a seat fixed at a certain height can make a tremendous difference to many registered disabled people, including those with sclerosis and even high degrees of paralysis.
Apart from being interested in the problems of disabled people, I am also a governor of the Royal National Orthopaedic Hospital. All this began in the context of the Royal National Orthopaedic Hospital's work on the subject, which began eight years ago. This is not the exclusive preserve or achievement of that hospital, and similar work has been done elsewhere and by specialised engineering companies which engage in medical work and have a high degree of experience and knowledge.
In spite of repeated pressure to get on with this work and to get the Department to overcome its irrational timidities about the merits of the project and begin marketing it efficiently—perhaps in limited quantities in view of the money difficulties—there has been successive bureaucratic delay without reasonable explanation. This situation is not the responsibility only of this Government, because there were equally infuriating delays under the previous administration.
In 1971 I saw an early model which had been developed at the hospital works by a dedicated team. One of that team is a shy self-effacing person whose name will not mention but who has done many years of selfless work for disabled people. That team is in despair at the lack of encouragement by the Department for this vital work.
There could be a tremendous argument among engineers about the best means of raising the seat. The normal system is battery operated, but the size of the battery could present difficulties. There is also the relatively primitive hydraulic type by which the disabled, provided 2393 they have strong enough arms, can pump the platform up. There is also a combination of both systems, but the electrical system is of prime interest. The cost of each unit is just a few pounds. Evidence not only from the Royal National Orthopaedic Hospital source but from other sources indicates that the unit could be fitted to existing wheelchairs, although that modification is more expensive than fitting a unit in a tailor-made chair.
I am alarmed that this piece of equipment has made such slow progress. Information in my files shows that it was provisionally approved last April, and the hospital thought it had the go-ahead and that there would be a marketing contract and full encouragement by the Department. The Minister knows far better than I what that means for a piece of equipment. However, in the last few days I have been approached by the engineering companies and the hospital asking for an explanation of the delay. There has been no explanation from the Government. We want a proper explanation and an assurance that the project will go ahead as fast as possible.
I should be grateful for reasonable answers on these points and a wider progress report, but my gratitude will not be as great as that of the many thousands of disabled people who eventually, with full marketing and supply, could benefit from this project. The Minister will appreciate the diffierence to a disabled person who is not totally immobilised but who may be established in a wheelchair and can move himself along in the normal way if, by raising the platform of the wheelchair, he can more easily launch himself into a walk with crutches. It enhances and increases such a person's independence of movement in a dramatic fashion. It renders him less reliant on nurses and other assistance in institutions, hospitals, nursing homes or even in a domestic environment. Therefore, the saving psychologically as well as in other resources would be considerable.
I hope that the Minister will respond to what I have said. I have qualified it by saying that I do not expect him to give the detailed explanation that his colleague the Minister for the disabled could provide, but I should like to hear a reasonable explanation, as would many others.
§ 8.46 a.m.
§ Mr. Meacher
By leave of the House. I am grateful to you, Mr. Deputy Speaker, for prompting me.
In replying to the succinct and reasonable points raised by the hon. Member for Harrow, East (Mr. Dykes) may I, first of all, indicate that the reason I am replying to this debate rather than my hon. Friend the Under-Secretary is that my hon. Friend has had a long-standing engagement to participate in an important conference in relation to the disabled and although he had hoped that it might be possible to speak, had this debate taken place earlier, it has not proved possible. I apologise to the hon. Gentleman, but I hope that he understands.
I fully share the hon. Gentleman's concern that every available technique should be harnessed to achieve the improvement of the quality of life of disabled people. All such techniques, including those in which electro-mechanical and hydraulic principles are applied, are recognised by the Department as essential contributors to that end.
However, before turning to equipment of these particular kinds and the elevating chairs to which the hon. Gentleman made special reference, I shall give a brief progress report on the provision of aids of this kind.
Such aids are usually classified according to their purpose rather than the particular kinds of engineering involved. There are: prostheses or externally worn aids which replace a missing part of the body, orthoses or aids designed to strengthen or correct a defective part of the body, mobility aids, nursing aids and aids to daily living. Equipment of all these kinds could include equipment involving electro-mechanical or hydraulic systems.
The degree and nature of the Department's involvement in planning and supply varies. At one extreme, in relation to prostheses, the Department is very closely and directly involved in work on 2395 artificial limbs, at all stages from research into untried new ideas to contracting for manufacture and supply. On the other hand, many aids to daily living are supplied by local authority social service departments, who buy them from commercial sources. The Department may have no direct role in relation to a particular item, though we do promote the circulation of information about all such equipment.
One problem is that an elaborate device may be produced which is not closely enough related to real and practical needs. We have found that in general it is more satisfactory to identify the needs and problems and then seek out the best ways for meeting and solving them. In some cases this approach may well point to desirable changes in the environment rather than to elaborate equipment. To give an obvious example the effort put into, say, kerb-climbing wheelchairs, needs to be related to the progress being made in making wider provision of dropped kerbs at road crossings. Therefore, it is a question not only of greater sophistication of equipment, but possibly of changes in the environment.
I want to say somethinig about the implications of this general approach, and what sorts of things the Department does in carrying it forward.
First is research into needs. Following the very valuable basic survey of handicapped people undertaken by the Office of Population Censuses and Surveys on behalf of the Department five years ago, that same office has recently undertaken, and will soon be reporting on, a survey of wheelchair users which included a number of questions designed to disclose unmet needs. The Department is also supporting a major study by Professor Warren at Canterbury into the needs of disabled people.
Secondly, research and development with new devices is undertaken at units wholly or partly financed by my Department, such as the Biomechanical Research and Development Unit at Roehampton which has a special concern with artificial limbs, or by way of special projects also sponsored and paid for by the Department which are carried out by individuals or institutions on an ad hoc basis.
2396 Thirdly, the Department may undertake or sponsor the evaluation of existing and newly developed equipment. Those who are seeking to prescribe equipment need to have detailed information about such things as performance, mechanical efficiency and safety, ease of operation by the user, maintenance, and suitability for installation in domestic premises.
Finally, and perhaps most important, they want to know that the equipment does what the manufacturer claims for it. A great deal of information about available devices has already been collected and the facilities of my Department are available to social workers seeking advice on particular problems in relation to the disabled. In this way we hope that the disabled who have special requirements will be supplied with the type of equipment, often of a very specialised and individual kind, which is suited to their needs.
Some progress is also being made in devising British Standards for items such as wheelchairs and walking aids; and such work may be extended into the field of lifts and stairlifts. This I admit, is fairly unspectacular work, but it is of great importance in securing that well-designed and well-made articles are widely available from a number of makers.
Fourthly, the Department arranges for contracts for the production of equipment for which there is likely to be a widespread demand. These contracts are either for a specific number of items for direct purchase by the Department for the National Health Service or on a "call off" basis, by which I mean that health and local authorities, other public authorities and approved voluntary organisations may order items against them.
In going on to refer to particular items of equipment, and moving nearer to the focus which the hon. Gentleman chose, I shall in some instances be able to refer to specific costs. The hon. Gentleman asked me to do that. But I must stress that it is not possible to name a total figure for the spending on research and development, or on supply, for electromechanical and hydraulic equipment. As I have said, we do not classify our expenditure in these terms.
2397 I have mentioned the point that electromechanical and hydraulic devices are not dealt with as a special field, with a special role for the Department. Powered wheelchairs are an important field. My Department supplies electrically-powered wheelchairs for indoor use by people who are so severely disabled that they cannot walk or propel themselves by hand and who can, by use of a powered wheelchair, achieve some degree of independence—of ability to look after themselves through the daily routine of eating, bodily functions and so on—in the home. Altogether over 5,000 such chairs are on issue: we supply about 1,800 new ones a year at an annual cost of rather more than £400,000 a year.
We also supply attendant-controlled electrically-powered outdoor wheelchairs to severely disabled people who cannot propel themselves outdoors and who have an attendant who is able to go out with them and control the chair but is not strong enough to push it. Of these, there are nearly 4,000 on issue, and we supply some 2,500 annually at a cost of over £200,000.
I come to the subject to which the hon. Gentleman gave great attention, namely, elevating wheelchairs. Several designs of wheelchairs fitted with electrically and hydraulically operated elevating seats including one designed by the Royal Orthopaedic Hospital at Stan-more have been tried but these have not generally been received enthusiastically. This is a problem. It may well be that, on balance, the more satisfactory solution for most people is to adapt the environment so that a disabled person can use an ordinary wheelchair. This is a reference to the difficulties of an ideal design, which suggests that there may be better ways of solving the problem. In the case of a disabled housewife, for example, the lowering of cupboards, worktop heights, light switches and so on may be more satisfactory than propelling herself around the kitchen elevating and lowering the seat of the wheelchair in order that she may carry out her normal everyday domestic responsibilities.
After that discouraging start, I should say that the Department has not turned its face altogether against extending its range of wheelchairs, which have not been close enough to the ideal. They include 2398 one fitted with an elevating seat as well as a hydraulic lifting device which, when fitted to a normal wheelchair, will lift it when occupied to a height of 12 inches. Possibilities of improvement are still being explored but with the present pressure on resources, I cannot promise that we could introduce this extra benefit for wheelchair users even if we could get the ideal design. There is the constraint on resources to be considered as well as the difficulty of design, which we have not yet overcome.
Before leaving the subject of powered wheelchairs I must say something about occupant-controlled powered wheelchairs for outdoor use.
§ Mr. Dykes
Before the Minister does that, may I repeat the basic principle behind the elevating wheelchair? I appreciate what he says about someone raising and lowering herself to attend to cupboards in a kitchen, but that is not the main point. The main point is to enable disabled people to get into and out of the wheelchair more easily by putting themselves into a quasi-vertical position more easily.
§ Mr. Meacher
I accept that. That is why we believe that there is still a great deal of point in trying to get the most suitable design, but I am advised—I am not a technician—that we have not yet achieved a design which would be considered ideal for this purpose. But I agree that that remains a purpose which will not be solved by changes in the environment, by changing the physical configuration of the disabled person.
On the question of occupant-powered chairs for outside use, my Department does not supply such chairs, but I am very well aware that there are commercially produced electrically-powered chairs of this kind and that they can bring very great benefits by providing independent outdoor mobility for people who cannot achieve it in any other way. A good many of the potential users of such chairs are people who cannot drive on the roads and so have never benefited from the vehicle scheme, but as the mobility allowance is phased in, starting next January, I look forward to some recipients of the allowance who may feel they need one of these useful machines being enabled to afford to buy one.
2399 It has been suggested to me from time to time that we should issue these machines free. I can hold out no early hope of this becoming financially feasible, and in any case we have not yet felt so persuaded of the technical merits of any particular model to look on it for provision as a standard issue. But as hon. Members are aware, we have made provision—in subsection 5(b) of the new Clause 37A of the Social Security Act, 1975—for abatement of mobility allowance if such a wheelchair is issued in the future, and if an individual elects to have one instead of drawing the full allowance. This provision may bring within the range of financial feasibility a development which otherwise could not he afforded and we are keeping it in mind.
There is also the family of electrically-operated "possum" devices, which enable people who are so disabled that they have little or no movement in their limbs to control a range of domestic systems and appliances such as telephones and television sets, heaters and so on. The hon. Gentleman is aware of the techniques of minimal movement required to operate them. These environmental controls for the severely disabled are available under the National Health Service in cases agreed by regional health authorities. Typewriter controls are available to those severely disabled people who, in addition, are unable to communicate verbally.
It was estimated that the cost of central supply for 1975–76 would be £150,000, but development of new equipment might well increase this estimate. Time does not allow me fully to enumerate all the items of equipment. However, I should like to comment on one point which was raised by the hon. Gentleman. I refer to the question of registered disabled people. My Department's responsibility and concern is not limited to those who are registered. Although we monitor progress on local authority registration and encourage registration, we are well aware that by no means all disabled persons are registered.
Whatever the pattern on which research and production is conducted, I am sure that it will be beneficial if we can do much more by way of evaluation of new developments. Imaginative evaluation 2400 will spark off ideas for further development. But such work makes heavy demands on resources, especially on the professional and technical people who must work together—some of them being expert in the medical and social problems of handicapped people, while others are skilled in the technologies involved. Even within the constraints on Government expenditure, which unavoidably prevent us from doing as much as we would like, we intend to deploy our resources to ensure that, amongst other aims, we make the most of the scope for applying electromechanical and hydraulic techniques in the service of the disabled.
Even though I may not have answered all the points raised by the hon. Gentleman, I hope that I have given a progress report on our efforts and how we are focusing our limited resources on this problem.