HC Deb 04 August 1976 vol 916 cc1882-910

11.46 p.m.

Mr. Gerard Fitt (Belfast, West)

I wish to draw attention to the tragic way in which social services in Northern Ireland, particularly those for the handicapped, are falling sadly behind what is provided in all the other regions of the United Kingdom.

We have always regarded Northern Ireland as a deprived area. When I talk of the plight of the disabled I am not exaggerating, because there is real distress among many thousands of disabled people in the Province. Tonight I wish to focus the Government's attention on their plight. If as a result the Government take remedial steps, that will be just one more honour that they will have picked up.

Let me put the problem in its true perspective. This is not just a question of failing to provide a telephone, an adaptation to a house or some other amenity which is normally provided. This problem is linked with many of the other problems in Northern Ireland. Over the last 10 years there have been many social advances in this part of the United Kingdom, but allied to all the problems created in the Province by the campaign of violence are other more deeply inlaid problems of people who cannot defend themselves.

There are tremendous difficulties in trying to deal with the political and constitutional problems, but while concentrating on those we should never forget that the ordinary people who are not involved in the great political issues are also the responsibility of the Government. One of the reasons for the lack of social advance in Northern Ireland has been the absence of legislation. Legislation is needed to impose sanctions and to compel steps to be taken which otherwise would not be taken.

It is possible now to look back and see that the Labour Government in 1966–67 presided over a period of great social reform. During that time many Labour Members and some Conservatives succeeded in getting Private Members' Bills on to the statute book. These measures eased the disabilities from which many people were suffering at that time.

Just before the defeat of that Labour Government, my hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) had taken on to the statute book one of the most compassionate pieces of legislation passed this century—the Chronically Sick and Disabled Persons Act. That Act has brought tremendous assistance to many people throughout Great Britain, but tragically it does not apply to Northern Ireland.

I hope that I shall have the support of hon. Friends and hon. Members from Northern Ireland in my plea that the Act's provisions should be extended to Northern Ireland. The procedures of the Whips Office will prevent my hon. Friend the Member for St. Pancras, North (Mr. Stallard), who has had an all-consuming interest in the problems of the handicapped for many years, from expressing his support, though I know he is in full hearted agreement with my objective.

People refer to the Chronically Sick and Disabled Persons Act as the Alf Morris Act, and it will always be identified with its sponsor. We had our own political and constitutional problems in Northern Ireland on the day that the Bill was given a Second Reading here, and I did not take the opportunity to ask then that it should be extended to Northern Ireland.

My hon. Friend the Member for Wythenshawe said on Second Reading: The Bill deals with many problems, all of them intensely human, but has a single intention. This intention is to increase the welfare, improve the status and enhance the dignity of the chronically sick and of disabled persons. Those are my sentiments exactly. I hope that they will be shared by the Government and that they will be persuaded to extend the provisions of the Act to cover the people of Northern Ireland, who are now under the direct control of this House.

My hon. Friend concluded his speech by saying if we could bequeath one precious gift to posterity, I would choose a society in which there is genuine compassion for the very sick and the disabled; where understanding is unostentatious and sincere; where needs come before means; where, if years cannot be added to the lives of the chronically sick, at least life can be added to their years; where the mobility of disabled people is restricted only by the bounds of technical progress and discovery; where the handicapped have the fundamental right to participate in industry and society according to ability; where socially preventable distress is unknown; and where no man has cause to be ill at ease because of disability."—[Official Report, 5th December. 1969; Vol. 792, c. 1851–63.] I am sure that those sentiments have the approval of the whole House—Government and Opposition, major parties and minor parties. I hope that at the conclusion of the debate we shall be told that there would be no great political difficulties or upheavals in the Government in extending the provisions of the Act to include Northern Ireland.

It is not enough for Members of Parliament to have visions. It is necessary for us to make visions become reality. My hon. Friend the Member for Wythenshawe has done so. He has demonstrated his courage and tenacity in Opposition and in Government. That attitude has benefited many people throughout the island of Great Britain. I am sure he will have earned the undying gratitude of the beneficiaries of the Act, who are not in a position to defend themselves.

Section 1 is the key to the whole Act. It lays the obligation on local authorities in the United Kingdom to ascertain and compile statistical evidence of the disabled within their communities. They have an obligation to ascertain the exact number within their area who are deaf or partially deaf, blind or partially blind, immobile because they do not have the use of their limbs, mentally handicapped or suffering, for example, from spina bifida. They have an obligation to direct their attention to those who in any way find themselves afflicted by a disease or by an injury which has been brought about by accident.

In the latter case it is possible to refer specifically to Northern Ireland, where it is made all too clear that there are many people, including the young, the old, children, babies and old-age pensioners, who have lost their limbs and their mobility and are suffering grievous bodily harm because of the explosions that have taken place.

Section 1 of the Act makes it obligatory for local authorities in the United Kingdom to compile that information. If that is not done, how is it possible to know the numbers involved or the extent of the problem or to take remedial action to ease it?

I contend that my colleagues in the Northern Ireland Office would not have any of the difficulties involved in compelling reluctant local authorities to implement this legislation if the Act were extended to Northern Ireland. That is because the social services are operated by the area health boards, which are under the direct control of the Minister who is in charge of health and social services in Northern Ireland. He would not have to force compliance or compel authorities to engage in this operation against their will. He would be able to give an instruction to the area health boards to get the information. Having obtained it, we should know the extent of the problem in Northern Ireland.

It is not right that in 1976, when I asked the Minister responsible for health and social services in Northern Ireland for the total number of households that have received adaptations because of the disability of the inhabitants, I should get an answer stating that the statistics are not available. I have put down a number of Questions on this subject. I would not say that the answers I received were evasions, and I do not blame the present Government for those answers. However, those answers have highlighted the problem which exists and they are the reason why I am engaging in this debate tonight.

When I recently asked the Minister whether he could tell me the total number of households which had received assistance, and what the figure was per thousand of the population, the answer I received was: This information is not available in the form requested. It is hoped, however, that statistics will be available for future years."— [Official Report, 27th July 1976; Vol. 916, c.198.] That consolidates the case I am putting forward. No attempt has been made by the authorities in Northern Ireland, whoever they may be, to collate this information so that we can once and for all know the total number of disabled and deprived people in Northern Ireland.

Since engaging in the exercise of questioning the Minister, and involving myself deeply in this problem, I have received numerous letters and personal telephone calls from the various voluntary organisations in Northern Ireland which are trying to cope with a problem which the Ministry is not even aware of. I contend that those well-intentioned people, giving of their time and energy, and trying to cope with the problem, are not receiving the assistance they require.

Until I received a letter from the Spina Bifida Association of Northern Ireland, I did not know that Northern Ireland had the highest rate of spina bifida in the world. More than 160 children are born there every year with spina bifida. Anyone who has any knowledge of that dreadful disease will recognise the hardship it presents to the parents of the children who are born with such a disability. After reading that letter, which I intend to give to the Minister, I am convinced that not enough has been done to help even that one section of the disabled in Northern Ireland. Even that one section has been deprived.

When we discuss Northern Ireland in this House, the statistics that are given usually relate to the number of people shot or killed or the number of explosions which have taken place. I regard the figures for the disabled as equally important because they represent people who are not involved in the troubles. More information about the disabled needs to be gathered before the Minister can take positive action.

Recently the Government commissioned an Amelia Harris report about the disabled, and statistics were gathered throughout Britain. But that survey did not apply to Northern Ireland. In addition, all the legislation aimed at bringing about social reform does not apply to Northern Ireland.

I was a Member of the Northern Ireland Parliament for many years. That Parliament fell down badly in respect of what it should have been doing throughout its existence to try to alleviate the distress which existed within the Six Counties.

There will have to be a crash programme now. Every agency available to Ministers should be used to ascertain the extent of the problem. The incidence of handicap in Northern Ireland can only be gleaned from another set of figures. In 1971, identical legislation was introduced in Great Britain and in Northern Ireland giving the constant attendance allowance to people who needed frequent attention and supervision by day and night. The evidence of the payment of that allowance is that the incidence of handicap in Northern Ireland is twice what it is in other parts of the United Kingdom.

On 1st January 1976 the number per thousand of the adult population receiving the allowance at the higher rate was 5.88 in Northern Ireland and 4.55 in Wales but less than 3 in Scotland and every other region of the United Kingdom. The lower rate was paid to 3.68 adults per thousand in Northern Ireland, 3.01 in Wales, 2.24 in the North-West, 2.10 in the North and less than 2 in Scotland and every other English region.

Before one can qualify for this allowance, one must be really incapacitated —almost completely unable to move. The fact that over 12,000 people in Northern Ireland receive it shows that that is only part of the problem. What about all the other people who do not qualify for the allowance but who are still severely disabled? If those numbers are added, a situation is revealed which no Government should tolerate for a minute longer than is necessary.

I have been in touch with many people before bringing this matter before the House tonight. They have convinced me that the incidence of handicap—whether it be people who are blind, those who are dumb or those who cannot use their limbs—is twice as high in Northern Ireland as it is in any other part of the United Kingdom. I accept the validity of the figures which have been given to me. If the Minister wishes to challenge them, I shall listen with interest to what he has to say.

There are three categories on social service registers in Northern Ireland—the visually impaired, the hearing impaired and the general classes. In England, between 1970 and 1974, the numbers in the first two categories—the blind and partially sighted and the deaf and hard of hearing—increased slightly, whereas in Northern Ireland they fell by 15 per cent. What was the reason for that fall? I do not accept that figure. I believe that the fall shows only that people do not want to know and that no agencies are available to find out the true figures.

The total number of handicapped people in England and Wales rose from 234,100 in 1970 to 497,200 in 1974—an increase of 112 per cent. During the same period in Northern Ireland the increase was only 16 per cent.—from 8,052 to 9,331. Again, there must be some dramatic reason for the fact that these figures are falling or are remaining static or increasing very slowly in Northern Ireland while there has been a dramatic increase in the numbers in other parts of the United Kingdom.

Again, the percentage of the population on the general classes register in 1970 in England and Northern Ireland was roughly 0.5, but by 1974 it was 1.07 in England, but only 0.61 in Northern Ireland. There is no reason to believe that in Northern Ireland the situation has changed or improved so much over the past few years.

Latest estimates in England suggest that at least 650,000 people were on the general classes register at 31st March 1976, making 850,000 together with those with sight and hearing impaired. That represented about 1.4 per cent. and would seem to be in line with the statistical evidence of the Amelia Harris Report, which did not cover Northern Ireland. We should get something like that report in Northern Ireland.

I am raising this matter tonight because of my fear and because of replies I received in response to Questions I put down recently. In one reply, the Minister in charge of social services said: In a planning paper issued in 1974, the Northern Ireland Department of Health and Social Services advised health and social services boards that they should supplement the information available from their handicapped registers and their existing knowledge by drawing on any other source to which they have access and by carrying out local sample surveys to build up an assessment of the total number of physically handicapped persons, the nature of their handicap and the need for services."—[Official Report, 6th July 1976: Vol. 914, c.515.] That all sounds very well. It was an instruction given in 1974 to local authority area boards to try to elicit such information as they could.

In another reply the Minister said: The health and social services boards have not yet in general had the staffing and other resources to undertake formal surveys of the needs and numbers of disabled people in their areas, but are in contact with and providing services for a large number of disabled people."—[Official Report, 8th July, 1976; Vol. 914, c.702.] To say the least, those replies seem inconsistent. In one the Minister said that area boards had been instructed to find out all they could, but in the other he said that area boards did not have the staff to carry out the surveys.

We heard only last week that there is to be a cut in public expenditure of £35 million. The Secretary of State for Northern Ireland is here tonight and he has to arrive at a decision, I think, as to where those cuts are to take place. I should hazard a guess that cuts will apply to health and personal social services in Northern Ireland.

I am drawing the attention of the House to the neglect of the past, by past Governments in Northern Ireland, then by local authorities and now by the area boards. How, in the name of Heaven, shall we engage in trying to halt the rise in these statistics if we are not given them and if there is not the money to employ staff?

We are dealing with the disabled, the partially blind or deaf and the immobile. Disablement arises for many reasons—for instance, mental handicap. The mentally handicapped cannot attend at a social security office and argue their case. If these cuts are imposed on the health and social services, further confusion will be created and we will never be aware of the true extent of the problems in the Province.

I am grateful to those of my hon. Friends who have stayed tonight to support my point of view. Under the Act to which I have referred, local authorities and the Northern Ireland area boards could supply telephones to the disabled, whose only lifeline is in many cases the telephone. Until the latter end of 1973 not one telephone was supplied. In 197374, 70 telephones were supplied—what extravagance ! —in contrast to the 4,550 telephones supplied for the disabled in Manchester in 1976.

I acknowledge the economic difficulties with which the Government must contend, although I object to the way in which the cuts are being imposed by the Chancellor of the Exchequer. There are certain areas in which, in view of the enormity of the social problem, a Government with any compassion or humanity cannot make cuts.

I hope that what I have said has convinced my hon. Friend the Minister that the restriction of the Chronically Sick and Disabled Persons Act—the Alf Morris Act—has led to an aggravation of the deprivation experienced by many in the Province. Section 1 of the Act is the key, because until we ascertain the figures we cannot hope to come to grips with the problem. Some London employment agencies use the slogan "If we do not know you, we cannot help you." That slogan could well be used by the Department of Health and Social Services in Northern Ireland.

I hope that my hon. Friend, when replying, will indicate that the Alf Morris Act, perhaps with improvements, will be implemented in the Province. I have complimented this Act, although it does not do all that was intended of it. No social services legislation could solve all the problems. Whatever its deficiences, we need that Act in Northern Ireland—or something like it—before we can begin to grapple with the problems with which we have lived for so long.

I hope that the Minister will accept my criticisms. They were not directed against him or the present Government, but I want him to tell us that when we return after the recess we shall be able to consider a one-clause Bill to extend the Alf Morris Act to Northern Ireland.

12.20 a.m.

Mr. John Dunlop (Mid-Ulster)

On many occasions when I have followed the hon. Member for Belfast, West (Mr. Fitt) there has been contention between us, but tonight I heartily agree with him and support what he has said about the Act. I believe that I speak for my colleagues when I say that we support him and agree with every word he has said. We are willing to sit all hours of the night to pass an Order extending the principles of the Act to Northern Ireland. We have sat through the night on other issues and we are willing to do so again.

The main theme of the speech by the hon. Member for Belfast, West, was the plight of the handicapped. Some time ago I received a letter from the National League of the Blind and Disabled, and I wish to make a plea on its behalf. I ask that the blind should qualify to receive the mobility allowance for the disabled. Government Back Benchers recently tabled a motion which stated that: this House is of the opinion that blindness is a locomotor disability and should be recognised as such for the purposes of all State benefits and allowances. But the blind do not receive mobility allowance unless they have an ancillary condition which is taken into account in the overall judgment of their mobility.

We all have a deep sympathy for those who are deprived of the use of their lower limbs and who are confined to wheelchairs, but the loss of sight is perhaps the greatest disability that anyone can suffer. To live in a world of perpetual blindness, never to see the faces or forms of friends, never to appreciate the colour of the land, sea or sky, must be the worst deprivation of all. Blindness is a paramount disability and should be regarded as such. I sincerely and earnestly plead that the blind be considered for mobility allowance.

I now turn to the decline of the National Health Service in West Ulster. The service is crumbling in that area. The problems are practical and not ideological. I recently talked to two or three doctors, who said that they did not give two damns about the controversy over the phasing out of pay beds. Their problem was the lack of staff. The main reason for the failure of the health services in my constituency and many other parts of Northern Ireland is the lack of medical and para-medical staff.

In the Committee stage of the Health Services Bill the question of queue-jumping was laboured continually. It is a big jump from Enniskillen to Belfast—about 100 miles. That jump is made to get on the queue for medical or surgical attention, never mind jumping the queue.

I have received some statistics from the town of Omagh, where the Tyrone County Hospital is situated. I am told that there is reason to believe that three senior consultants, one from Omagh and two from Enniskillen, are planning to leave. A senior surgeon in Omagh, at present on sick leave, retires at the end of November. His retirement will leave a big gap in the hospital. There is no possibility of filling the vacancies. Nobody wants to come in to make good the wastage caused by retirements for health reasons and age.

We have reason to believe that the third Omagh consultant is planning to leave. He is the only surgeon in the area. His departure would mean the closure of surgery, accident and emergency cover in Omagh and the closure of the casualty department. That is a serious matter in a country where, in addition to accidents in the home, in industry and on the roads, terrorist activities can occur out of the blue, causing a big problem for any hospital or medical staff.

I recently heard that in the constituency of my right hon. Friend the Member for Down, South (Mr. Powell) the large Daisy Hill Hospital in Newry had closed its casualty section because of lack of staff. I suppose that that is the town with the largest population in my right hon. Friend's constituency. With the upsurge of violence in recent days, this poses a great problem. The health service is unable to meet the demands thrust upon it.

There has been no surgical relief in the town of Omagh since 1st June. There we have one specialist in anaesthetics, who is providing a 24-hours-a-day, seven-days-a-week service for three hospitals. If that is not a desperate situation, I do not know what is.

The senior medical officer for the Western Region, based in Londonderry, informed me on Friday morning that he envisaged only long-range cover for a consultant service in Omagh for the foreseeable future. The outlook is black. Something must be done to encourage consultants and specialists to come into such areas. We cannot expect junior doctors to give their services unless we have senior consultants who are already at the top of the tree.

I turn to the general practice service. In the Mid-Tyrone area there is one doctor who has the largest national health panel in the whole area. At the moment he is a sick man. His partner, or assistant, is a compulsive drinker. On any given evening between 6 and 7 o'clock this man is not fit to diagnose a cut on his own finger, let alone give medical attention to a district that covers 25,000 to 30,000 people. I am told on good authority that in this area there are three doctors who, if they are not alcoholics, are compulsive drinkers. Not much can be expected from them on any evening. Thus we see that the general practitioner service in the area is in a serious condition.

I understand that the Prime Minister is to meet the British Medical Association soon. He would be well advised to understand that doctors need to be reassured. They need to be encouraged to stay in the United Kingdom, because there is a vast exodus of qualified doctors, specialists and consultants from the United Kingdom. This poses a serious problem for the health service. Morale and staffing must be kept up. Doctors must be encouraged to stay in the United Kingdom.

I was in consultation with some doctors last Friday morning about the problems of the Western Region. They told me that they went on a month's holiday, some to the United States, some to Canada and some to the Continent. I was told that at the end of that month they came home with approximately £1,000 net after meeting their expenses. They said that most of them applied the money to buying a new car for the next year. Surely it is no wonder, if men can earn these sums, that they give in their notice, pack their bags and make for those lands where everything is so much better and where their services are able to command better rewards. The key to the problem, not only in Western Ulster but in the whole of Northern Ireland—indeed, in the whole of the United Kingdom—lies in the question of rewards. These must be adequate and competitive to keep our medical and para-medical staff in this country. Money spent in encouraging consultants, specialists and doctors to stay in this country would be well spent.

Not so long ago I received a glossy report from the Northern Health and Social Services Board. It contained a report of a project which I do not think will materialise in the next decade, yet the report said that the board had already employed a consultative, planning and organising staff. A senior medical officer, a deputy senior medical officer, a senior nursing officer and an assistant nursing officer had also been employed. These people are drawing salaries in connection with a project that has not even been begun. Not a brick has been laid, and most probably will not be in the present economic climate for perhaps 10 years.

Would not the money being spent be better employed in encouraging qualified men and women to go to remote areas of Northern Ireland and bolster up the health service? I ask the Minister and the Government to use all their influence to encourage medical staff to go to these needy areas of West Ulster and prop up the present crumbling health service there.

12.35 a.m.

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

I must declare an interest. I am the oldest Member of this House and I am to some extent disabled in that I have a plastic hip. My excuse for intervening in the debate, and for stopping until this very late hour in order to do so, is that I took a prominent part in the deliberations which led to the Chronically Sick and Disabled Persons Act 1970. I am particularly interested in the cause of the disabled, wherever they are.

As my hon. Friend the Member for Belfast, West (Mr. Fitt) said, the Act does not apply to Northern Ireland, unfortunately. He has described the failure of the Northern Ireland authorities to inform themselves of the needs and the numbers of handicapped persons in the Province. Clearly, if one does not know who they are and where the need arises, one cannot give assistance. Section 1 of the Chronically Sick and Disabled Persons Act 1970, as my hon. Friend very rightly said, puts a mandatory duty on local authorities to keep a register of the disabled.

I remind the House of the difference in the set-up between Northern Ireland and the rest of the United Kingdom. The division which separates the health and the personal social services here has been removed by incorporating the health and social services into four area boards. I think my hon. Friend referred to them. The area boards are responsible to the Minister of State.

Here, when Government Ministers are asked about the great variation—and there is often a great variation—in the provision of services for the handicapped, they can to some extent fob the matter off by referring to the fact that the responsibility is that of the local authorities. In Northern Ireland, however, it is the Minister of State who is responsible and who, of course, is responsible directly to Parliament.

Those area boards, I understand, were set up as agents of the Ministry in 1973. Although there can be great administrative advantages in combining the health and social services, there can be dangers. It is possible for one to absorb too much of the financial cake. Perhaps my hon. Friend the Minister has figures to show how the proportion of expenditure by area boards between health and social services has changed since their inception.

I draw the attention of the Minister to some figures in the Public Expenditure White Paper Cmnd. 6393. Tables 2.11 and 2.15 give the figures for expenditure on the health and social services in Great Britain and Northern Ireland respectively, and there are special analyses of such expenditure in Wales and Scotland in Tables 3.1 to 3.4.

I should like to compare the figures given for the current year—that is, 1976–77—with the estimates for 1979–80, the last year to be included in the tables. In Great Britain as a whole—that is, excluding Northern Ireland—the total expenditure will rise from an estimated £5,317.3 million in 1976–77 to £5,548 million in 1979–80, an increase of 4.34 per cent. That is an increase in real terms, not money terms, and it is far more modest than most Members would wish. We must, however, accept the circumstances in which we find ourselves.

If separate analyses for Scotland and Wales are worked out, one can discover that the increase in Scotland, Wales and England will be very much of the same order but that in Northern Ireland the increase from 1976–77 to 1979–80 is from £166.9 million to £172 million. That is an increase of only 3.06 per cent.—considerably less than the 4.34 per cent. in the rest of Great Britain.

The Public Expenditure White Paper is a complicated document. It may be that the figures I have quoted are not absolutely comparable, but, on the face of it there is a discrepancy which is unjustified. I hope that the Minister will give a convincing explanation or rectify this anomaly.

The other document on which we have to rely for the Government's intentions in Northern Ireland is called "Strategy for the Development of Health and Personal Social Services in Northern Ireland", which was published last year. It is full of good intentions but in fact it is a disappointing and vague document, particularly when compared with the paper "Priorities for Health and Personal Social Services in England" which was published earlier this year.

In the chapters concerned with disabled people, the latter document bears the imprint of my hon. Friend the Under-Secretary of State for Health and Social Security who has responsibility for the Disabled, but I fear that handicapped people in Northern Ireland will miss his direct influence more and more in the coming years.

The Department's document provides a breakdown of expenditure on personal social services in Northern Ireland which is not provided in the Public Expenditure White Paper. The price bases are not the same, so I shall not give the actual figures. However, it appears that in 1974–75 the proportion of expenditure on personal social services within the total health and social services budget in Great Britain was 14.5 per cent. In Northern Ireland it was 8 per cent. Again, I should like the Minister to explain the discrepancy. It may be that the figures are not comparable, but I am sure that they point to the truth.

I do not deny that in past years there has been a greater increase of expenditure on personal social services in Northern Ireland than in other sectors. In general, however, the document bears out the implications of the subsequent Public Expenditure White Paper that personal social services in Northern Ireland are increasing at a moderate rate but from a very low base.

The pressure generated in England principally by the Chronically Sick and Disabled Persons Act and, indeed, by the efforts of my hon. Friend the Under-Secretary has not been equalled in Northern Ireland. Therefore, I am afraid that the relative position must decline still further.

It is important that the House should remember that Section 2 of the Chronically Sick and Disabled Persons Act 1970—unfortunately it does not apply to Northern Ireland—put a mandatory duty on local authorities in England, Scotland and Wales to make arrangements for the provision of certain services for handicapped people where they are satisfied that those services are required. It is important to remember what services were set out as being part of that mandatory duty: practical assistance in the home; the provision of wireless, television, library or similar recreational facilities; lectures, games and outings; facilities for, or assistance in, travelling to benefit from these or similar services; adaptations to the home—that is important—or additional facilities designed to secure greater safety, comfort or convenience; holidays; meals at home; a telephone—that is most important—and any necessary equipment to enable the disabled person to use the telephone.

Perhaps the most controversial items on that list are telephones and adaptations, telephones because some of our bureaucrats cannot understand their true value—we know that that is the case in England—and adaptations, to which they cannot agree, because they involve substantial expenditure. We recognise that telephones are a lifeline to people who are housebound, but the need has been far from implemented even in England although the provisions of the Act lay that mandatory duty upon the local authorities.

As my hon. Friend the Member for Belfast, West said, we have to recognise the present economic situation, and in the light of public expenditure cuts which, I am afraid, must come I suppose that the needs of the disabled will be less and less fulfilled. It must be emphasised again and again, however, that those to whom the normal means of social contact are denied because of their disability deserve a telephone as of right, and that is the intention and meaning of the Act.

I should like here to ram home the point that no local authority in England or Wales had a rate of provision of telephones of—although it is not enough—less than the average in Northern Ireland of 0.04 per thousand of the population. That statistic was revealed in an answer given to the hon. Member for Exeter (Mr. Hannam) on 22nd July. In fact, the variation of provision by local authorities in England and Wales was from 0.056 per thousand population in Bradford to 3.742 per thousand population in the London borough of Islington. It is a great pity that Northern Ireland should come so far behind. I have again and again stressed that we do not do enough in England with our local authorities to carry out what the Act requires, but we can see how much less is done in Northern Ireland.

The position regarding assistance for adaptations is a little better, and there has been a distinct improvement since reorganisation, but I should like to quote the figures given in reply to my hon. Friend the Member for Belfast, West. They show that between 1970 and 1974 the number of structural adaptations carried out by the former welfare authorities, and in 1974 by the area hoards, rose from 129, a rate of 0.08 per thousand population, to 0.27 per thousand population, while the figure in England for 1974–75 showed that 41,200 households were assisted with adaptations—a rate of 0.89 per thousand population.

In the light of the figures I have quoted, I want to say something more about the document to which I referred, "Priorities for Health and Personal Social Services in England". I want to ask my hon. Friend the Minister specifically whether he will ensure that the expansion specified there for England is not only matched in Northern Ireland but is surpassed in view of the low base.

Hon. Members in England have viewed with some measure of approval the second paragraph in the chapter on services for the physically handicapped which says: A high rate of expansion (9 per cent. a year) is suggested for home aids and adaptations and certain other services provided under Section 2 of the Chronically Sick and Disabled Persons Act 1970 which make an important contribution to the quality of life of the physically handicapped. The contribution would be no less important in Northern Ireland than in England. My hon. Friend the Member for Belfast, West has made an eloquent plea, supported by statistics, and a very sound argument for the introduction of legislation to extend the benefits of the Chronically Sick and Disabled Persons Act. I support that plea and ask the Minister, in view of the appalling position and the dreadful need, to help in ensuring that assistance is given in a quarter where it is surely well deserved.

12.52 a.m.

Mr. Max Madden (Sowerby)

Helping the disabled to try to lead normal lives is a heavy responsibility throughout the United Kingdom. The problems and the challenges are no less severe—indeed, they are perhaps all the more severe—in Northern Ireland.

As a member of the all-party Disablement Group in this House and a member of the Northern Ireland Group of the Parliamentary Labour Party, I hope that I may be permitted to make a brief intervention in this debate. We would all pay tribute to the hon. Member for Belfast, West (Mr. Fitt) for initiating this debate and for his speech, which was a characteristic contribution of an hon. Member who has cared about the problems of Northern Ireland ever since he came to the House. I thank the hon. Member for Mid-Ulster (Mr. Dunlop) for his contribution. He raised the question of the provision of a mobility allowance for the blind, which many of us think is long overdue and is urgently needed. We must also pay tribute to my hon. Friend the Minister for being here to answer the debate and to the Secretary of State, who has also attended the debate, thus showing his personal concern.

All hon. Members who have spoken have drawn attention to the fact that important sections of the Chronically Sick and Disabled Persons Act do not apply to Northern Ireland. Many of us recognise that this omission was tragic and deplorable, and we hope that it will be remedied as soon as possible.

It has been estimated that there are 835,000 handicapped and impaired people in need of rehousing in England alone. Accommodation occupied by these people is no older or newer than that occupied by the general population of the United Kingdom. Three-fifths of these handicapped people live in accommodation with stairs, although it is not known how many have to climb stairs in order to get to their accommodation. We can expect that the relative position in Northern Ireland is far worse, and certainly statistics demonstrate that this would be the position.

The White Paper on Public Expenditure refers to this matter in paragraph 5 of the chapter dealing with Northern Ireland. It says: A recent survey has shown that the condition of the housing stock in Northern Ireland is worse than in any other region. Greater emphasis will, therefore, be placed on the rehabilitation, repair, and improvement of existing houses in order to increase quality and number of houses available for occupation. In addition the survey provision will be large enough to allow rather more new houses to be completed in the public sector over the next five years than the 36,406 which were completed in the past five years. I want to know from my hon. Friend the Minister whether that statement's optimism must be tempered, particularly in the light of the recent statement by the Chancellor of the Exchequer on public expenditure. We must ask ourselves tonight what type of homes are needed for the disabled in Northern Ireland and in other regions of the United Kingdom.

In a recent report on the mobility of physically disabled people, Lady Sharp said: A home in which a severely disabled person can, as far as possible, be independent is something that every one of them ought to have. I believe that nothing like enough has been done to see that disabled people have such homes; though there is no information available about the amount of housing that exists in which the disabled could manage for themselves and…could manoeuvre in a wheelchair. There has been reference to the Chronically Sick and Disabled Persons Act. Section 3 is in two parts, and they are most important because they emphasise not only the duty to provide special housing but the duty to provide the Secretary of State with information on what is proposed and achieved.

What is lacking in Northern Ireland, therefore, is not only this same duty but adequate information. In reply to the hon. Member for Belfast, West, my hon. Friend the Minister of State said recently that since the inception of the Housing Executive in 1971 about 1,500 dwellings had been specially provided for disabled persons. These included mobility, wheelchair and sheltered houses, together with adaptations of existing dwellings, and represented provision at the rate of approximately one dwelling per 1,000 of the population. The Northern Ireland Departments of the Environment and of Health and Social Services and the Housing Executive were considering what additional steps needed to be taken to deal with the special housing needs of the disabled.

On the surface that sounded impressive, but lumping together many different types of provision can be misleading. In a reply on 5th February to my hon. Friend the Member for Eccles (Mr. Carter-Jones) the Minister admitted that in the previous 12 months the Housing Executive had completed only four wheelchair housing units, 22 sheltered housing units and no mobility housing. The position on starts was even worse with only seven wheelchair housing units started and no mobility or sheltered housing starts.

The most fundamental aspect of wheelchair housing is that it provides extra space for the circulation of the wheelchair beyond the normal Parker Morris standards. As a result, costs rise above the normal cost yardstick allowances. The structure of the house is designed throughout for the wheelchair user, and fixtures are selected to meet his or her needs where he or she is thought to be likely to use them. The Central Council for the Disabled has various specific criticisms of the criteria. I shall not go into that. It is more important for me now to describe the people who are likely to need wheelchair housing designed from scratch with them in mind.

It caters, therefore, primarily for those confined to a wheelchair who must have access to all principal rooms and be able to operate freely in them. It is also desirable for those currently ambulant or semi-ambulant but with deteriorating conditions. It is obviously sensible for someone with multiple sclerosis or muscular dystrophy not to have to move from ordinary housing to mobility housing and later to wheelchair housing as the disease progresses.

The number of people needing wheelchair housing has been estimated at 1.6 per thousand of the population of the United Kingdom. The authorities in the United Kingdom have a long way to go before the need is met, and I hope that the housing cuts recently announced will not impair the drive to increase the numbers of this type of housing.

Mobility housing is difficult to define. The report of the Central Council for the Disabled states: Mobility housing is intended to incorporate certain basic features for physically handicapped people, so that it can accommodate either able-bodied tenants or disabled tenants. The basic criteria are that door sets and corridors should be 900 mm. wide, that there should be a level or ramped access, and that bathroom, WC and at least one bedroom should be at the same level as the entrance. Fundamental principles of the concept are that there should be no extra space and no extra cost beyond normal Parker Morris standards. Mobility housing is designed for people who do not require wheelchair housing. That is a rather negative definition, but in general it is designed to cover disabled people who, even if they use a wheelchair, are not confined to it and who can, for example, leave the wheelchair when they wish to use the bathroom.

All possible housing should be subject to mobility standards. Perhaps its greatest advantage is to allow the full integration of severely disabled people into the community. It is not often realised that, even if a person confined to a wheelchair has a perfectly designed house, he cannot be considered a member of the community if every time he wishes to see his friends they have to visit him because he is unable to get into their homes.

Sheltered housing is a concept used in connection with the elderly. There are good grounds for thinking that many elderly people, by choice, wish to live together, but there are no grounds for thinking that young disabled people wish to live together merely because they are disabled. Exactly the opposite is usually the case.

When thinking in terms of sheltered schemes, we are thinking of housing for the elderly or, by an extension of the phrase to include warden-assisted dwellings, for very severely disabled people who need so much support in the community that it is impracticable, with the best will in the world, to house them other than in some form of cluster.

Housing for such people requires the closest co-operation between housing, health and social service authorities. In the United Kingdom, and especially in Northern Ireland, the opportunities for such people to leave hospital and residential accommodation and lead their own lives in their own homes is almost non-existent.

We are concerned in this debate about the disabled in Northern Ireland, but disability knows no barriers. It is the same whether the disabled person is in Northern Ireland, Yorkshire or London. What makes the difference is the financial circumstances of each person. The better-off can temper their disability. We must be particularly concerned about people of modest means living in underprivileged and deprived areas.

This debate is about the two nations. The nation that we are talking about in particular is Northern Ireland, but the nation that I represent in the deprived part of the North of England experiences the same deprivations as some parts of Northern Ireland. The list of the hon. Member for Mid-Ulster of inadequacies in the number of doctors, dentists, hospitals and the rest could be repeated for my constituency. We share that bond of underprivilege.

The only way to remedy the situation is to ensure that all disabled people are given the same opportunity to overcome their disability. We must make sure that resources are allocated fairly and without discrimination and are not determined by where a person lives.

That brings us back to the central argument of public expenditure. It is all very well for hon. Members to talk about the need to reduce public expenditure, but they sometimes overlook the fact that it is not a paper exercise. It concerns people and the ability to provide resources to help underprivileged people.

I wish that the people who press for less public expenditure would attend debates such as this. We have had debates tonight about the sea and the air. Now, at last, we are talking about people, and the Benches normally occupied by the official Opposition are barren for the first time. It is also to be remembered that the advocates of maximum cuts in public expenditure come from the Opposition Benches. It should not go without notice and comment that those Benches are barren now that we are talking about people and the consequences of reducing public expenditure.

Mr. Anthony Berry (Southgate)

rose—

Mr. Madden

I must apologise, I did not see the hon. Gentleman sitting in the far corner. If he, like me, had been in the Chamber at 3 o'clock this morning discussing broadcasting, I am sure he would have been reassured to know that where he happens to be seated has been rescued from the establishment of the broadcasting booth. It is now to be established in the opposite corner. That will enable the hon. Gentleman to sit in that dark recess on other occasions.

I believe that an imaginative housing programme is the most important single item in the integration of disabled people. I hope that my hon. Friend the Minister will reassure the House that the Northern Ireland Office and the Housing Executive share that view. I hope he will be able to give us some hope that the Chronically Sick and Disabled Persons Act, which has done a great deal to alleviate the difficulties of disabled people, will be extended to Northern Ireland. I hope that he will be able to give us some glimmer of hope that the blind will be in receipt of the mobility allowance before long.

Most of all, I hope my hon. Friend will make it clear that he will be defending the interests of the underprivileged in Northern Ireland and that as a member of the Government he will be defending the interests of the underprivileged in other parts of the United Kingdom in the exercises that are concerned with reducing public expenditure. I warn my hon. Friend, as many of my hon. Friends have warned members of the Cabinet, that that is not a paper exercise. In fact, it concerns people. We should remember this in our consideration of these important matters. I hope that my hon. Friend will give us some information about positive action which is being taken in Northern Ireland on the part of and in the interests of disabled people.

1.8 a.m.

The Under-Secretary of State for Northern Ireland (Mr. James A. Dunn)

I, too, thank my hon. Friend the Member for Belfast, West (Mr. Fitt) for bringing this matter to the Floor of the House. I have been involved personally with the physically and mentally handicapped for many years. I am aware of the deep feelings that are held on these matters.

The Chronically Sick and Disabled Persons Act 1970 has been the subject of most of the discussion. It is believed that in Northern Ireland we urgently and badly need that Act. That is not so. Services under the 1970 Act are provided under the basic legislation, and we have the Health and Personal Social Services Order 1972. It is widely drawn and covers every situation that has been brought to the notice of the House during the debate.

In Article 4(1) the Order places a duty on the Department of Health and Social Services to provide or secure the provision of personal social services designed to promote the social welfare of the people of Northern Ireland. In Article 15 it requires the Department to make available advice, guidance and assistance to such extent as it considers necessary. The Department discharges its duty through its agents, the four area boards, and is thus in a position to influence directly the provision of services for the handicapped under these powers.

The Department has reviewed the provisions of the Chronically Sick and Disabled Persons Act to ensure that no disabled person in Northern Ireland is, so far as can be ascertained, deprived of any service or benefit that he or she might have had under that Act. The Health and Social Services Order provides sufficient powers to enable the area boards to offer the basic health and social services. We shall continue to keep the position under constant review. If additional legal powers on the lines suggested by hon. Members are found to be required, my right hon. Friend the Secretary of State has already assured the House that he will be quite willing to take appropriate action.

Where the Department or agencies other than the area boards are concerned, the Department maintains a close liaison in order to ensure that the interests of the disabled are adequately represented. The Northern Ireland Housing Executive, for example, provides special housing for wheelchair or mobility cases, and in co-operation with the area boards it provides adaptations and aids where these are necessary. The Department of the Environment operates a limited "orange card" scheme for parking, and this will be extended when conditions allow. The provision of means of access to publicly-owned buildings is already a matter of policy, and this will be further extended to all new places of public access by means of amendments to the Building Regulations. New Crown buildings already follow the code for the provision of special toilet facilities, and district councils and other agencies have been requested to pay particular heed to the need to make provision.

A booklet "Help for the Handicapped" has recently been revised and reissued and distributed to handicapped persons and organisations interested in their welfare. This sets out very clearly the benefits and services available and is intended to encourage the handicapped to make use of them. I shall send copies to right hon. and hon. Members and if they require further copies I should be grateful if they would let me know their requirements and I shall see that they are dispatched.

With my colleagues in the Northern Ireland Office, I am very conscious of the need to maintain and develop services for the handicapped. In reality the constraint is not lack of law and will but lack of money and manpower. Our basic philosophy is to provide as much support and manpower. We want to encourage them to make a useful contribution and to keep active in community affairs. We hope to encourage them to aim at a full life and to assist them to play their part.

Within the limitations imposed, we intend to seek every opportunity to extend care and services to which we attach high priority. As the economy improves, more resources will be devoted to improve the range and standard of care, and we have the duty, the power and the will to do so.

My hon. Friend the Member for Belfast, West drew particular attention to the lack of recent statistical information or adequate information. Frankly, I accept that this is so. But I can tell him in all honesty that I would defy anyone in this House to tell me of any local authority which has adequately identified the disabled and the range of their disablements. It is one thing to make that mandatory upon local authorities by putting it in legislation, but to leave them to provide the resources to identify and quantify the needs of the disabled and handicapped has been a mammoth task.

I myself have been involved with voluntary agencies helping to identify disablement in my own neighbourhood. We did a canvass on the doorsteps—not a political canvass but a list of questions about people in need, mentally or physically disabled and about consequent problems in the home. That was done intensively in one small area and it took nine months.

If we could harness the agencies which have shown interest and enthusiasm in this matter to do the groundwork and provide the statistics and identify areas of need, perhaps that would give us an indication of what we must do to serve the needs of the community.

Mr. Madden

I take completely my hon. Friend's point about collecting information. Any of us who know the difficulties of local authorities must recognise the truth of what he says. Is there any possibility within the job creation scheme and similar exercises not only of mobilising the means of acquiring the information but also of providing employment, even if only temporary? That would meet two important objectives in Northern Ireland.

Mr. Dunn

My hon. Friend has pre-empted me. I was about to suggest that that was an area that we could consider and discuss with the Manpower Services Agency.

Returning to the point of my hon. Friend the Member for Belfast, West, last year's figures are not yet available in all cases, and reorganisation has meant some of the boards computing figures on an entirely new basis. I, too, regard this as important. While I and my colleagues are concerned to improve the collection and publication of these important statistics, I must say honestly that some of the problems will not be easily overcome, bearing in mind what I have said about collecting and collating the statistics required.

Mr. James Molyneaux (Antrim, South)

Does not the Minister agree that we probably came nearest to the ideal in ascertainment and registration when we had in Northern Ireland the special care authorities which dealt with that area of the mentally handicapped which I know is of great concern to his Department? Is there not a lesson to be drawn from the fact that that service has deteriorated since we streamlined its operation and integrated it into the work of various other bodies?

Mr. Dunn

I have no evidence to support what the hon. Member says. I cannot speak with great authority because I have not given the matter the study it deserves, but the hon. Member will know of the interest I have already shown. We have now started to work towards finding some of the solutions which are required. I hope that in the near future my right hon. Friend and my other colleagues in the Northern Ireland Office will be able to give more information on this matter.

The hon. Member for Mid-Ulster (Mr. Dunlop) referred to the mobility allowance for the blind. Northern Ireland has parity in all the allowances with the rest of the United Kingdom. I would only add that whatever changes are made will automatically be applied to Northern Ireland.

On the question that the hon. Member raised concerning medical services in West Belfast, may I tell him that that part of Northern Ireland shares with several other parts of the United Kingdom the difficulty of providing acute hospital services in thinly populated areas away from large centres of population. The problem is not peculiar to Northern Ireland or unique to West Belfast.

The Tyrone County Hospital problem is short-term and has been caused by the unexpected illness of two out of three consultant anaesthetists—the other is on annual leave and has been asked to return urgently to cover the present emergency. There is, however, a registrar available to give cover as required. We hope that that cover will be sufficient to meet demands at present. Following the retirement of the consultant radiologist, the post has been advertised three or four times but no applications have been received. Arrangements for a radiology service on a temporary basis have been made with the Eastern Health and Social Services Board.

In these smaller hospitals which provide a surgical and medical service, consultant staffing under the health service has been increased to two in all specialities in order to cater for sickness and leave.

It is increasingly difficult to fill consultant posts in many of the smaller hospitals, and because of the stricter criteria for recognising posts for postgraduate medical training it is difficult to attract junior doctors to these hospitals. The board and the Department have set up a working party to look at the longer-term problem of maintaining acute hospital services in remote areas, but we shall not easily overcome the problem of attracting staff to these smaller hospitals.

I should like here to pay tribute to those dedicated consultants and doctors who, along with the nursing and supporting staff, make such a significant contribution to the health and well-being of the population in remote areas through this service in small local hospitals. Hon. Members will wish to join me in that tribute. General practitioner services in West Ulster, judged by the average size of a doctor's list, compare favourably with any other part of Northern Ireland, and the number of patients per doctor is substantially lower than the average for Great Britain.

I sympathise with the concern expressed by the hon. Member, and I know of the desire of people to have available the best possible hospital facilities and to have them close at hand. These two desires cannot always be easily reconciled. I have had this in my own constituency—as have most hon. Members in rural and urban areas. The problem is not directly one of money; it is how long we can continue to attract even the most dedicated doctors to work in these small hospitals.

There is a tendency to specialise, and it appears to me as a layman that from time to time there is overt pressure to divert young and capable doctors, who might otherwise serve in the smaller hospitals with distinction and dedication, to bring them into the larger hospital units. Whatever reason the medical profession has for it, it is a known fact.

Mr. J. Enoch Powell (Down, South)

I am grateful to the hon. Gentleman for giving way. In that connection, how far has consideration been given to the linkage of the smaller hospitals with the larger ones and with hospitals where teaching is carried out? The hon. Gentleman will probably be aware that in London and other parts of England that has been done with beneficial effect. I wonder whether the possibilities of something of that kind are being considered in Northern Ireland.

Mr. Dunn

This is being considered. No doubt what the right hon. Gentleman illustrated is well in the minds of those who are studying the matter and who will be making firm recommendations. This policy is not working efficiently in all parts of the United Kingdom. It can be adapted only in limited and constrained circumstances. There must be an understanding in the profession in the area concerned in order to bring it into effective operation.

A number of questions were put to me relating to statistics. We are gravely short in certain respects. It would be wrong of me to give answers which might be inaccurate. I have told the House that my right hon. Friend the Secretary of State and all my colleagues in the Northern Ireland Office are determined to overcome this problem. We hope in the coming year to receive the help of those Members who have expressed interest in Northern Ireland affairs tonight. We hope that they will extend their enthusiasm to those who are mentally handicapped. The 1972 Order gives us all the powers we need.

I again congratulate my hon. Friend the Member for Belfast, West on bringing this matter to our attention tonight and I express the hope that what has been said will be noted by those who read our debates.