§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Bates.]
§ 10.19 p.m.
§ Mr. George Younger (Ayr)I am grateful for the opportunity of raising the question of travelling expenses for hospital treatment for the disabled. I am raising this matter in particular because I have discovered what I think all hon. Members would agree is an anomaly in the present regulations which is not only acting very unfairly on a constituent of mine who has drawn it to my attention but must affect quite a number of people throughout the country.
Before I explain this matter, I should like to pay tribute to the work that is being done for disabled people by the Department and in particular the work that is being done by the Under-Secretary of State with responsibility for the disabled. I know that the hon. Gentleman would have wished to be here this evening, but as he is abroad on official business that is not possible.
I am delighted to see the Minister of State, Scottish Office, present on the Front Bench, but perhaps he will not mind if I express surprise that he is there rather than a representative of the Department of Health and Social Security. Unless I am mistaken, this is not a peculiarly Scottish problem. This is a Scottish illustration of what I believe to be a national problem. I hope that the Minister will confirm that this is so after I have explained the position. I hope he will assure me that he is here as a representative of the Government as a whole and not merely of the Scottish Office. I hope that this matter will not be treated as a Scottish problem, because it concerns the United Kingdom as a whole.
Those who are disabled are eligible for all the assistance that is available to National Health Service patients generally for medical treatment and for expenses involved in that treatment. These include transport by ambulance when this is recommended as being medically necessary. I understand that an allowance to cover the cost of travel if an 1404 ambulance is not available is made to a patient who suffers financial hardship. Such hardship is assessed, following an application, by the Supplementary Benefits Commission, which carries out its task with care and humanity within the regulations.
The problem arises when a patient requires treatment over a long period and wishes to continue to work. As soon as a patient is employed and starts earning, he will almost certainly lose his travelling expenses because of the rules within which the Commission must work.
I can best illustrate the situation to the House by describing briefly the case of my constituent Mr. Lawrence Devlin, of Prestwick. He is aged 20 and suffers from a very severe kidney deficiency. He had a kidney transplant operation some time ago but it was unsuccessful. Following the failure of the operation, he has required regular kidney dialysis treatment on a kidney machine. There are no facilities near Ayr, and he has to travel from Prestwick to Glasgow—a distance of 30 miles—for this treatment on three days every week in his life. For the first six weeks after his operation he was taken to Glasgow by ambulance, as is proper. Once he had sufficiently recovered, however, he felt that he would like to go back to his job as an apprentice joiner in Prestwick. This he did.
Everyone will agree that my constituent's courage and determination in insisting on going back to work when many others would have sat back at home saying, quite reasonably, that they could not work was extremely admirable. The Minister has expressed this view to me in correspondence.
Mr. Devlin began to combine travelling to Glasgow on three days each week and working in the remaining time left in the week. When he started back at work, his earnings usually amounted to a maximum of £34 a week gross and his weekly travelling expenses for going to Glasgow for kidney treatment amounted to £8.50 a week. Both those figures have changed slightly through the impact of inflation, but the relationship between them is about the same.
With other deductions such as national insurance and PAYE, Mr. Devlin is left with small take-home pay for the effort that he puts in. He therefore applied 1405 Through the local office of the Department of Health and Social Security for help with his travel expenses. His application was rejected because, as he was working, he did not qualify for anything from the Supplementary Benefits Commission. On querying this, he was told that if he were not working he undoubtedly would have qualified to have the travelling expenses paid.
This, therefore, is the ridiculous situation which I wish to be put right. This young man is severely disabled and has to have his intensive treatment on a more or less permanent basis. He could perfectly easily sit back at home, do no work, live on social security and get all his travelling expenses paid for going up to Glasgow, for his treatment. However, because he refuses to sit back in that way but insists on going to work and making a contribution to the community instead of living off it, his travelling expenses are taken off him. My case simply is that that situation is not acceptable and some way must be found of getting round it.
Mr. Devlin's mother came to see me about this matter when the situation arose about the travelling expenses. I took the matter up initially with the Minister who has responsibility for the disabled, but the matter was passed to the Under-Secretary of State for Scotland as the administration of the travel expenses side of the Health Service comes under the Scottish Office.
I wish to place on record my gratitude for the trouble the Minister has taken in looking into this case during the course of the fairly lengthy correspondence we have had about it. In the course of that correspondence the Minister, in spite of all his efforts, has only been able to repeat that the regulations cannot be altered to allow for this sort of case without paying for all travel for all treatment for all patients.
I also approached the area health board to establish whether a special kidney machine which had been installed at Heathfield Hospital in Ayr for use by holidaymakers could be offered to Mr. Devlin, whose need was every bit as great. The area health board was very helpful but after a careful investigation regretfully concluded that the machine could not be made available for Mr. Devlin as it was fully committed for holidaymakers during the summer months.
1406 I also inquired whether, as is done in some cases, it was possible for arrangements to be made for Mr. Devlin's home to be fitted with a machine for kidney treatment. Unfortunately investigations showed that his home was not suitable for such a machine to be fitted there, and that is not a possible solution.
So what can be done about this wholly unacceptable situation for my constituent and, no doubt, many others throughout the country in a similar situation? A distinction must be found which identifies this problem and enables some help to be given to these people. It should not be all that difficult to find a distinction.
I have a suggestion to make that I hope the Minister will consider. My constituent is not, after all, simply any old Health Service patient with a temporary illness which needs treatment. He is a disabled person who may have to continue this treatment for a very long time. I suggest that the solution may lie in empowering the Minister with responsibility for the disabled, or some other Minister, to pay travelling expenses in such cases when they are necessary to enable a disabled person to continue working.
There is nothing new about special legislation, special arrangements and special Government effort to encourage and enable disabled people to work. After all, there are fairly stiff provisions requiring firms and Government Departments to take on a quota of disabled people. Recently there has been criticism of Government Departments, among others, for not doing sufficient in this regard. So the principle is long established that it is acceptable to make special arrangements to enable disabled people to get employment. That is our aim in this case.
I suggest, therefore, that we should regard the provision of travelling expenses for treatment which is required on a more or less permanent basis for disabled people to enable them to work as a sufficiently limited commitment for the Government to undertake and sufficiently open to control and definition to provide a possible solution to this problem.
I hope that the Minister will consider that as a constructive suggestion. I have already offered to him that, if he will put 1407 it to his advisers and suggest that there is a possibility here, I shall be prepared to attempt to get a Private Member's Bill through to enable it to be done if Government support in drafting and in time can be offered to help me to do so. I should be doing it not only for my constituent, although that is important, but also for what I believe must be a considerable number of disabled people throughout the country, people who in some cases may be struggling to carry on their employment in the face of disability or in many other cases may not now be able to take up work because of the inhibitions and costs which they would incur if they did so.
I believe that this might be a welcome step—certainly welcome, I am sure, to the Government and to the Minister—to encourage more disabled people to take employment, to their benefit, to the benefit of the community and to the benefit of the disabled in general.
Therefore, in raising the matter on behalf of my constituent, I hope that the Minister, apart from giving his side of the case, which he must know well by now, will regard my suggestion as affording a constructive way to widen the help for all disabled people. This is a side of the life of the disabled which, I am sure, we all wish to encourage—that is, the ability to take useful employment in spite of severe disability. I believe that progress on the lines I suggest would be greatly welcomed by many hon. Members on both sides who, I know, are working extremely hard to help the disabled in every way they can.
§ 10.32 p.m.
§ The Under-Secretary of State for Scotland (Mr. Harry Ewing)I am grateful to the hon. Member for Ayr (Mr. Younger) for his kind words and for the efforts of those on both sides of the House who work on behalf of the disabled and do all they can to try to lighten the heavy burden which the disabled have to carry.
The hon. Gentleman made a general point on the question of the ability of the disabled to travel to hospital and whether they should be recompensed for their travelling expenses, and, of course, he has raised the particular case of his constituent, Mr. Lawrence Devlin, with 1408 whom I have the greatest sympathy. He also asked why I should be here to answer the debate.
On the latter point, it is quite correct that in normal circumstances my hon. Friend the Under-Secretary of State for Health and Social Security with responsibility for the disabled would have been here to answer the debate, and would have wished to be here. However, as the hon. Gentleman knows, my hon. Friend cannot be here, and when it was known that the case to be raised was that of Mr. Lawrence Devlin it was decided that I should reply in view of the correspondence about the case which had passed between the hon. Gentleman and myself.
It is worth saying in addition that the payment of travelling expenses to patients attending hospital, whether those patients are disabled or not, rests on Section 3(4) of the National Health Service (Scotland) Act 1947, and also on the 1974 regulations for Scotland governing expenses in attending hospital. Therefore, the Scottish Office has a full part to play in this matter. Perhaps I may add on the general subject of travelling expenses in Scotland that the Scottish Office is at the moment paying out through the National Health Service about £300,000 a year to patients of all descriptions who have to travel to and from hospital and who, admittedly, meet the criteria which successive Governments have applied to this aspect of the National Health Service.
I hope that as my reply unfolds the hon. Gentleman will see that I am most anxious to try to be particularly helpful to Mr. Devlin.
The Government accept the principle that people should not be prevented from obtaining treatment under the National Health Service simply by the fact that they are unable to afford the cost of travel to where the treatment is given. It is on this basis that regulations were made which provide that the travelling expenses of hospital patients and of those who require to travel with them may be reimbursed by the hospital where it would cause hardship to the patient if he had to pay them himself. Patients on supplementary benefit or family income supplement automatically receive reimbursement at the hospital. Other patients on low incomes can apply, using a form which is supplied by the hospital and which they send to their local social security office. 1409 Assessment is carried out by the staff of the Supplementary Benefits Commission and the hospital is advised of the amount, if any, which may be repaid.
As I have said in a letter to the hon. Gentleman, the primary requirements of a scheme of this kind are that it should be operated equitably and should help those most in need. My own view is that the present scheme satisfies these criteria, although, unfortunately, it fails to satisfy some applicants who, from their own point of view, feel that they should qualify. It is difficult to visualise a scheme not based on financial hardship which could be restricted to helping cases such as that of Mr. Devlin without bringing in everyone who has to incur any material expense in travelling to hospital.
The suggestion is that the test should be one of motive. I accept that Mr. Devlin is an example to many people in obtaining a job and choosing to work when in many ways I am sure there are days when he would rather stay at home because of his illness. He is an example to all of us. But it would be difficult to apply a test of motive rather than means. The cost of extending the suggested kind of scheme to all who travel to hospital would be prohibitive and I doubt whether the general principle—meeting without restriction the cost to anyone in reaching the point where a public service is available—would commend itself. Certainly it would have repercussions in many fields.
I should repeat, however, that I have the greatest sympathy for Mr. Devlin in the situation in which he finds himself, and I am most anxious to offer any assistance I can, although I must in all honesty say that there is no prospect of amending the current travelling expenses scheme in such a way as to solve Mr. Devlin's problem. I think that a more acceptable solution would be to try, as I have tried, to arrange for Mr Devlin to receive treatment much nearer his home. I believe that in such cases the real answer is not that we should be paying people travelling expenses to travel 30 miles but that we should make every effort to ensure that they receive the much-needed dialysis treatment nearer their home. This I am prepared to do.
I know that the hon. Gentleman has already aproached the Ayrshire and 1410 Arran Health Board with a proposal of this kind. I have seen a copy of the letter it sent to him, in which it indicated that there were difficulties in helping in this way, but I propose to ask the board to look at this case again, if need be in conjunction with the Greater Glasgow Health Board, to see whether some arrangement can be made which would save Mr. Devlin from having to travel to Glasgow for treatment. Having met patients of this character, I am convinced that it is not really travelling expenses that they want but treatment without having to travel a great distance for it. I am sure that this is particularly true of Mr. Devlin. I am prepared to speak to the Ayrshire and Arran Health Board and the Greater Glasgow Health Board and make every effort to see whether we can make some arrangement to help Mr. Devlin and prevent him from having to travel to Glasgow.
Although I have indicated that there are limits to what can be done about travelling expenses, I should stress that the Government are sympathetic to the travelling needs of the disabled and have been active in promoting their interests, either directly or through agencies. Hon. Members will be aware of the former invalid transport arrangements, now replaced, for new patients, by the introduction of the mobility allowance in January 1976. The mobility allowance of £7 per week is to be increased to £10 per week in July 1978.
In addition to the scheme for the travelling expenses of hospital patients generally, there are special arrangements for war pensioners who are travelling for treatment for their accepted war pensioned disablement. In certain circumstances, the Family Fund can help a family with a severely handicapped child with travelling expenses for visits to the child in hospital or, occasionally, with expenses arising out of the child's attendance to the hospital for treatment. Decisions about whether help can be given in this way lie with the Joseph Rowntree Memorial Trust, which administers the fund on the Government's behalf. Local authorities have been given the power to arrange free or concessionary travel by bus for disabled people of any age, as well as for elderly people, although it is, of course, for each local authority to decide what concessions to provide.
1411 Inevitably, there will always be cases, such as that of Mr. Devlin, which do not quite qualify for assistance with travel to hospital, but I think that within the various provisions which I have mentioned hon. Members may be reassured that assistance is available where it is clear that the patient cannot afford the cost of travel.
In view of the general reference made by the hon. Member for Ayr to other people throughout the United Kingdom, I felt that it was worth putting on record the other forms of assistance that are available to those who have to travel to hospital. I promise the hon. Member that I will again ask the Greater Glasgow Health Board and the Ayrshire and Arran 1412 Health Board to have another look at this. I know that Mr. Devlin was offered some dialysis treatment, and I accept that it is not always possible to install one of these machines in a home. It depends on the nature of the construction of the house, among other things.
If the hon. Member will agree to leave the matter with me, I will approach both health boards. I assure him and, through him, Mr. Devlin that I will do all I can to obtain an arrangement whereby Mr. Devlin can be treated nearer home, thus avoiding the need to make long journeys three times a week to Glasgow and back.
§ Question put and agreed to.
§ Adjourned accordingly at seventeen minutes to Eleven o'clock.