§ 4.4 p.m.
§ Mr. Michael Morris (Northampton, South)
It is only in recent times that this House and people outside have begun to understand that the problems of the deaf are not the same as the problems of other handicapped persons in our community.
Hon. Members will know that the Warnock Committee is looking into the education of handicapped children. I am pleased to inform the House that the association for the deaf in Northamptonshire has put in its contribution by way of evidence.
I wish to look at one aspect which affects deaf children and their families—namely, the attendance allowance in general and the specific cases of the Misses Holden, Robinson and Hayes. I am glad to say that the Holden and Robinson families are present to listen to our deliberations although, regretfully, Yvonne and Amanda will not hear a word of what we say.
The attendance allowance arrangements are set out on a brief piece of paper—Form DS389—which splits attendance allowances first by day and by night and then by subdividing them into problems to do with physical and bodily functions. Secondly, there is an aspect of continual supervision in connection with many of the safety aspects of life.
I am happy to say that we are not concerned in the least with any of the problems to do with bodily functions. It is true that the majority of deaf children are pretty hale and hearty in wind and limb. For the vast majority their only problem in life is that they cannot hear what is said to them. Therefore, it is the second part of both the day and night requirement with which I am concerned—the section that begins with "continual supervision".
There are one or two areas of the report that a claimant family has to make that I should like to highlight. If we look at the medical aspects of the report we find that the whole emphasis is, in the main, geared to other forms of handicap. It is to do with bodily functions, and 1883 little space is given to the problem of continual supervision and especially continual supervision in respect of the disability of the deaf. If we examine closely the area on the form which deals with the claimant's statement to the examining doctor we find that there is inadequate space for a family to communicate to the doctor undertaking the examination the stress and anxiety that they, as parents, are facing.
I am married to a general practitioner and therefore I believe that I understand the problems that the ordinary practitioner faces when undertaking medicals. However, on the evidence I have seen, there is a disturbing spread of time as regards the length of the examination. Some medicals are completed in three or four minutes, compared with others that take the best part of half an hour. I question the rejection of an attendance allowance for a medical that takes up to only four minutes.
Before I move into the specifics of the three cases I should like to refer to the background. As far as I can gather there have been approvals of about 22 attendance allowance cases in the Northampton area, many of which have concerned families with a child suffering from partial deafness. As the Minister will know, there are good social organisations where deaf families tend to meet, talk and help each other. When families put in for an allowance they know from their own experience the relative deafness of other families. When they discover that three families whose children are recognised by the deaf fraternity to be very handicapped, they express surprise at the rejection.
The three families to which I wish to refer entered their applications in the normal way. Their applications were rejected. They appealed, and their appeals were rejected. Then I came on the scene and asked for a review.
The main feature of these cases, which are all similar, is that all three children are very deaf and have been so since birth. All three go to special schools—two to a residential school in Birmingham and one to a local school. So in two cases we are talking about the need for a partial allowance at weekends and during holidays. All three are considerably more deaf, as measured by audiographs, 1884 than others to whom attendance allowances have been granted.
Among the papers that I shall hand to the Minister after this debate are some referring to children who have been granted attendance allowances. I believe that their cases should be kept confidential; they are included for comparison and for no other reason.
Why are these three children worthy of the Minister's time—I thank him for coming today—and of my first Adjournment debate? The answer lies in that what their families have to suffer. There is no doubt that these three children are fully handicapped—not in relation to physical actions: they can eat, drink, laugh, run and jump as well as any other children—but because, first, they can hear nothing. In our environment, with people rushing around all the time, these children are totally unaware of the dangers of our extensive traffic. Therefore, as soon as they step outside the safety of their homes, they are at risk.
Second, they are part of a family, I am pleased to say, but whenever any of the children wants to go out to take part in society, as we would all want them to do, they have to be accompanied. There is no chance of any of them going alone. If someone has to accompany them, there are all the attendant problems of who is to look after the children left at home.
At night, when they call out, it is no good giving a reassuring answer, as I would do to my four-year-old to reassure him that we are still there—that is, if the House has risen at a reasonable hour. Nor is this just a difficulty for a few months, or for the period when a child is young, up to, say, the age of about four. Night after night, week after week, year after year—these children are now just turned 10—the parents have to get out of bed, go into the child's bedroom, sit with her and reassure her and then return to bed, only to have to repeat the process a few hours later.
Special provision is needed also because of the children's disability. Their lack of ability to communicate—they can do so only by sign language—injures their personalities. The problems of the children are probably even more acute than those of their parents. They will naturally also have behaviour problems, due primarily to their non-comprehension of 1885 what life is about. On occasions, this will give rise to tantrums, which are really tantrums arising from frustration. There will occasionally be an element of aggression—not because of malice but simply because the children get frustrated at their inability to communicate. Of course, this frustration will lead to some element of aggression and occasionally to danger to other parties.
In our sophisticated life today, the non-comprehension of these children of the dangers around them means that they are at greater risk, for example, from shocks from electrical equipment. Again, these are dangers that they do not fully comprehend.
Difficulties are intensified for children like these three, who have been deaf from birth. I am afraid that their speech is still subnormal and, in the case of one of them, virtually non-existent.
Because of the nature of their particular cases they have greater dependence on their families than children who suffer from partial hearing. In reality, their contact with the normal environment is lost. Thus, what we would call a normal mother-child relationship, is turned into what I call a live attendance relationship, because every minute of every day, except when they are fast asleep, someone should be with these children.
Apart from the vulnerability that they suffer from, this lack of auditory warning means that the children need constant attention, and because the mothers are there that job falls primarily on them, although it is to the credit of the fathers in these cases that they have taken on a major rôle. However, either parent has to act as permanent interpreter of needs.
The mother has to deal with the psychological problems of the hearing handicap)—the distress, anger and frustration which inevitably leads to constant changes of mood. As one of the parents said to me in my surgery, "We are the voice, the ears and the interpreter of our children". That is an everyday occurrence—seven days a week except when the children are away at school.
There is an added strain which is not particularly pertinent to the attendance allowance. It is the strain on the children who go away every week. They go up the motorway to Birmingham and are brought back at the weekend.
1886 In the papers that I shall hand to the Minister he will find the history of the cases. However, since I made my preliminary inquiry of the authorities I have suggested to the parents that we should ask for some further evidence, not just from the normal medical examination but from those who have had contact with the children over a long period of time. Therefore, I shall submit copies of letters from the Royal National Throat, Nose and Ear Hospital, the Nuffield Hearing and Speech Centre. Those papers concern Miss Robinson and Miss Holden. The same could be obtained for Miss Hayes.
In addition, we contacted the senior peripatetic teacher for the deaf in Northamptonshire, a Mr. Hamp, for a report. The parents asked whether we could use the evidence received as supporting evidence. Mr. Hamp's letter concludes:You may, if you wish, use this letter as supportive evidence.Therefore, it is appropriate to quote from it. I want to quote some paragraphs about Amanda. The letter says:I have known Amanda since she was about 3 years old when I first started visiting your home to help in teaching her and to give parent guidance. Audiogram after audiogram has confirmed that Amanda has a profund loss of hearing in both ears, with the loss over the main frequencies for speech mostly greater than 100 decibels. She is now wearing two very powerful Philips body-aids, but her loss is so great that she has to rely almost completely on lip-reading and might well give a false impression of her ability to hear. You will, of course, realise that only a combination of Amanda's intelligence and much hard work by yourselves and her teachers have made it possible for her to develop speech, although very restricted in range and of a deaf quality.Amanda obviously requires a great deal of adult supervision and this is why she has to be educated in a very small class. Obviously, this supervision has to be greater outside the classroom situation as you know only too well. In my opinion she is severely handicapped and is certainly not functioning in the same manner as a hearing child of the same age.Since my work is in the area of deaf children I feel rather perturbed as I personally know of children with a much lesser degree of hearing who have qualified and are getting the attendance allowance.That is professional evidence, going back over a long period of time.
I would mention just briefly a similar letter on Miss Holden, which says:I have been associated with Yvonne's education since deafness was diagnosed in 1887 infancy. In view of this profound loss of hearing, even her two powerful Wilco aids would not amplify speech sufficiently to enable her to learn to speak with intelligibility.The letter concludes,I cannot really understand the decision of the Department of Health and Social Security in Yvonne's case and would support any further application.There is evidence in depth in those letters.
In conclusion, what I am asking the Minister to do is to look at the three cases and the wider implications of them. I believe that the form as it exists at present is not designed to help with diagnosis of deaf children. I am not confident that all the doctors undertaking the medical checks are being briefed properly in relation to the attendance allowance requirements for deaf children. I believe that there is some need for guidance for the claimants in the first place, so that they can put their case quite clearly, and not on appeal.
My own view, which I believe is shared by others, is that the time has come for the assessment board to be given some guidance on how to differentiate between partial deafness and full deafness. There is probably a need for some national level of deafness to be settled. There is an abundance of academic work to enable these standards to be set. Once a national level has been set, that will lead to the obvious corollary of a register of the deaf.
It is my belief that these three children have been unjustly discriminated against, not through any malice on anyone's part but simply through non-comprehension by the authorities of the nature of the children's handicap. I hope that their cases will receive a full and sympathetic hearing.
§ 4.22 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Meacher)
First, I should like to thank the hon. Member for Northampton, South (Mr. Morris) for raising what is a most important matter in a very sincere and thoughtful manner. I commend him for choosing this subject for his first Adjournment debate.
The first point I should like to make is that attendance allowance is not and was never intended to be compensation for disablement. Perhaps I may start 1888 with the final remarks of the hon. Gentleman when he drew a distinction between partial and fuller deafness. Even if one were able to reach a precise definition, that would not necessarily determine entitlement to attendance allowance, though I agree that such a definition may be useful for other medical or sociomedical purposes.
It is important to emphasise that attendance allowance is not compensation for disablement, because there is clearly a great deal of misunderstanding about this. I do not for one moment dispute that these three children are severely disabled in the way that the hon. Gentleman very movingly described, but this is not in itself sufficient ground to qualify for attendance allowance. To satisfy the medical requirements for an attendance allowance, these little girls must not only be severely disabled but, as a result of that, must require a lot of attention from another person in connection with their body functions or continual supervision from another person to avoid substantial danger to themselves or to others. I am well aware, of course, that the hon. Gentleman in a good deal of what he said was putting forward evidence to substantiate these criteria.
The lower rate of £7.10 a week is payable if one of the day conditions is satisfied or one of the night conditions, and the higher rate of £10.60 per week is payable if a day and night condition are both satisfied.
I should also mention one additional condition for children under the age of 16. That is that the attention or supervision must be substantially in excess of that normally required by a child of the same age and sex. Therefore, for example, the fact that a child may be a poor sleeper, perhaps because of the disability, is not necessarily a sufficient ground for meeting the attendance allowance criteria. It may be, but it is not necessarily; and that is a matter for decision by the delegated medical practitioner.
As the hon. Gentleman knows, it is for the Attendance Allowance Board, which, I stress, is an independent statutory board, to decide whether the medical conditions are satisfied. In passing, I wish to say how grateful I am to the chairman, Lord Amulree, and his colleagues for all they have done to get the attendance allowance scheme going since its 1889 inception. Clearly, however, the Attendance Allowance Board cannot deal with all cases itself, so the Act empowers it to delegate its functions in individual cases to medical practitioners.
The hon. Gentleman made some reference to the manner in which medical practitioners may on occasion carry out their duties as delegates under the Act. I should say here that the length of visit needed by a doctor to obtain the information for completion of the medical report varies, as one would expect, from case to case, and the aim of the doctors on these visits is to establish the attendance requirements—I emphasise that—and for this purpose a full examination is not always needed. I am sure the hon. Gentleman will appreciate that.
The hon. Gentleman added, however, that parents may not always be able fully to communicate on the forms provided the degree of stress and difficulty which they have experienced. I assure him that there is no reason whatever why parents or others with care of a child in such cases should not take the opportunity to send additional letters or papers to accompany the forms which are provided expressly for this purpose. We should in no way seek to circumscribe the full transmission of information which might be relevant.
In these three cases of deaf children, the Board's delegates decided that the medical conditions were not satisfied. This is not to say that the children do not require any attention or supervision from anybody. It means merely that the Board's delegates considered on the evidence before them that the amount of attention or supervision which they need does not measure up to the medical requirements set out in the Act, that is, in Section 35 of the Social Security Act 1975.
I have spoken of the three cases collectively, but I should make clear that they were dealt with individually at different times, and three different doctors gave the review decision. This point about cases being looked at individually is important, because it is inappropriate to treat all people suffering from a particular disability as though their needs were identical. Each case must be, and, I assure 1890 the hon. Gentleman, is, considered on its own merits.
Let us take, for example, the case of hearing impairment. A person suffering from a slight hearing deficiency would have relatively little need for attention or supervision compared with a person who had profound deafness. But a person who goes deaf in later life is in a quite different position from a child born deaf. Moreover, needs differ as between people of the same age and with the same degree of deafness. Some will adjust to the handicap, while others, as the hon. Gentleman rightly said, will develop serious personality problems.
Multi-handicap, such as being deaf and dumb or deaf and blind, would, of course, tend to increase dependence on others. I should add here, since the hon. Gentleman drew attention to those who may have less deafness than these three children, that even a person with less deafness could have greater need for supervision than a person with a greater degree of deafness just because in the former case the deaf condition was, say, in conjunction with other personality problems.
Because of this difference in needs between people with the same type of disablement, the situation is difficult and no meaningful comparison can be drawn with other claimants unless the detailed evidence on which the cases were decided can also be compared. In the case of children, for instance, one parent may make light of what needs to be done for a child while another parent may overstate the needs. I am not saying that with any individual case in mind. Another problem that arises in comparing cases is that the medical provisions laid down in the Act relate to the amount of attention or supervision that is required, which can, of course, be either more or less than that which is actually given.
I know that the Board is very conscious of the criticisms which are sometimes expressed about its decisions. It makes every effort to achieve consistency. It appreciates the problems in trying to achieve consistency, bearing in mind that claims for the allowance are currently running at the level of about 100,000 a year with decisions being given on its behalf by delegated medical practitioners working at the 10 English regional centres as well as Edinburgh, Glasgow 1891 and Cardiff. The Board examines a sample of its delegates' decisions and gives guidance to its delegates on individual cases. Delegates also refer difficult or borderline cases to the Board for its decision. In addition, delegates attend meetings of the Board. In these ways there are very full and free exchanges between the Board and its delegates, all of which are designed to achieve a high level of consistency in decision-making as far as is possible. I must, however, stress that the question of consistency is a matter for the Board as an independent body entrusted by Parliament, under statute, with the job of deciding whether or not the medical conditions for the allowance are satisfied.
The hon. Member also mentioned the amount of attention or supervision which parents have to give deaf children who are living at home compared with parents of deaf children who are away at boarding school and are at home only for holidays and perhaps weekends. As for satisfaction of the medical conditions, it does not matter who is providing the 1892 attention or supervision which the child requires, but the allowance is not payable for any periods during which the child's accommodation is being provided under certain statutory provisions which are listed in the Attendance Allowance Regulations. Generally speaking, this means that when a local authority has arranged for a child to go to a boarding school the attendance allowance is payable to the parents only for the weekends or holidays spent at home. I think that that will be considered reasonable. The difference in the amount of attendance provided by these families is, therefore, reflected in the amount of attendance allowance which is paid.
§ The Question having been proposed after Four o'clock and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at twenty-six minutes to Five o'clock.