SOCIAL SECURITY (KIDNEY PATIENTS) (Hansard, 15 February 1978)

§ Sir George Young (Ealing, Acton)

I beg to move, That leave he given to bring in a Bill to extend to kidney patients on dialysis units the attendance allowance provided under Social Security Acts. The object of this Bill is to restore the attendance allowance to a number of kidney patients who have recently had it taken away from them, to ensure that it is not taken away from others who are having their cases reviewed, and to extend it to other kidney patients who would not otherwise qualify because of the tighter rules now operated by the Attendance Allowance Board.

There are at the moment 2,226 people in the United Kingdom who are on dialysis machines because their kidneys have failed. For them dialysis two or three times a week is essential for survival. By dialysing on a machine the impurities in their blood are removed.

This Bill is concerned with those who dialyse at home—a development which is to be encouraged, since it takes pressures off our hospitals and enables patients to lead as normal a life as possible in the community. Home dialysis is a tedious and lengthy operation not without risk. The Attendance Allowance Board estimates that for each dialysis session it takes three hours to prepare and strip down the machine and some five to 12 hours to dialyse. The vast majority of kidney patients have to dialyse between two and three times a week.

Dialysis should not be undertaken by the patient on his own. When dialysis takes place in hospital, an attendant has to be present. There is even more reason for someone to be present when dialysis takes place at home. There can be blood leaks, the patient can become hypertensive, injections have to be administered, or something can go wrong with the machine.

We are, therefore, speaking of a small number of patients who suffer from a distressing disease. The only hope of recovery lies with a transplant but, regrettably, over 50 per cent. of kidney transplants fail, and there are not nearly enough donors to satisfy demand.

447 I turn now to the attendance allowance, which is the national insurance benefit that has aroused the current controversy. The statutory medical requirements for receiving the allowance are laid down in Section 35 of the Social Security Act 1975. This stipulates that in order to qualify for an attendance allowance at the higher rate, a person must be so severely disabled, physically or mentally, that for six months or more he has required by day frequent attention or continual supervision to avoid substantial danger to himself or others, and, at night, prolonged or repeated attention or, again, continual supervision to avoid substantial danger. To qualify for the lower rate of allowance—which is the one that concerns most kidney patients—a person must satisfy one of the day conditions or one of the night conditions.

The scheme is administered by the Attendance Allowance Board, and it appears that, up until last summer, most kidney patients qualified for the lower rate of attendance allowance.

Last summer, the Attendance Allowance Board reconsidered its rules. It appears that it was prompted to do so by the introduction of faster dialysers, which were capable of reducing the length of each session. It concluded that as from 21st June, there should be a lower limit of not fewer than three sessions at night of any duration, and not fewer than three sessions by day, each of six hours, in the case of those who dialyse at home, in order for a patient to qualify for the allowance.

These rules have been applied to new applications since then, and to existing recipients as and when their cases come up for review or reassessment. The new rules disqualify approximately three-quarters of kidney patients from the attendance allowance. People who dialyse twice a week, for however long, no longer qualify, and those who dialyse for three times a week during the day for fewer than six hours are also ineligible.

From information kindly given to me by the hon. Member for Derby, North (Mr. Whitehead), I understand that the vast majority of the patients in Derby dialyse twice a week for a period of 10 hours on each occasion. They are now disqualified from receiving the allowance.

448 There are five reasons for requiring the Board to relax its stringent requirements. First, there is an inbuilt incentive now not to use the modern, quicker dialysers in order not to lose financially. This cannot be right, particularly if one is trying to use machines more efficiently, and increase the number of patients per machine.

Secondly, an attendant is still needed, whether dialysis takes five hours or six, and a nurse can cost up to £22 a week. Thirdly, the earning capacity of the kidney patient is still restricted because of his disability. He is less able to earn overtime, to work shifts, or travel away from home.

Fourthly, unfair distinctions are now being made between one type of dialysis patient and another, a distinction made not on the degree of disability but on the type of machine available for treatment.

Finally, without the attendance allowance and the resources so provided to pay for an attendant, more kidney patients will be compelled to dialyse in hospital, where there is already a shortage of kidney machines.

If I may put the problem to you, Mr. Speaker, in terms of your own position, it is as if the Fees Office told you that, because the trains to Cardiff were now much quicker, they were going to take away the Speaker's flat and expect you to go home each night.

To overcome this problem—and I cannot over-emphasise the high feelings amongst kidney patients that the Board has generated—I advocate a wider use of discretion, and a less rigid adherence to quite arbitrary and unsuitable rules. I believe that discretion should be exercised in such a way as to include the vast majority of kidney patients.

I hope that the Government will acknowledge that the present situation is both unsatisfactory and unfair, and that they will support my Bill. I think that they exhibited some sympathy for what I am trying to do at Question Time on 10th January. On that occasion, the Minister of State for Social Security, whom I am pleased to see here, said, in response to a question from the hon. Member for Derby, North: I fully take the point that my hon. Friend makes. It raises the question whether the attendance allowance is a suitable benefit for 449 such patients, in the light of the Board's decision. In that respect, the Government would be prepared to examine the position, but without commitment at this stage. Later, after renewed pressure from all quarters of the House, he said, But we want to examine this matter more fully. It has now been brought, quite properly, to the House, and they Government will want to look at it."—[Official Report, 10th January 1978; Vol. 941, c. 1432–3.] If I am given leave to introduce the Bill, I hope that the Government will support it and give this modest amount of assistance to a small group of people, and I hope that the Minister responsible for the disabled, who I am also pleased to see here, and who is well aware of the problems caused, will lend his weight to this campaign when it comes to discussions with his ministerial colleagues, not least with Treasury Ministers, about the future of the Bill.