§ Mrs. Edwina Currie (Derbyshire, South)
I am glad to have the opportunity of raising the case of Shelley and Russell Tulloch.
The case raises interesting topical questions concerning mobility allowances and who is eligible to qualify. Shelley and Russell are two constituents of mine who live in Melbourne, which recently won the best-kept village competition in Derbyshire. Shelley was born in December 1960, and therefore will soon be 24, and Russell was born in October 1962, and is now 22. When Shelley was three, it was clear that something was seriously wrong. She was diagnosed as suffering from a rare chromosomal abnormality. By that time, Russell had been born, and it was too late. That family now has two vigorous mentally handicapped adults in the household.
The main feature of the disability is mental handicap. It is slowly progressive, getting worse in the most tragic way. It is accompanied by mild motor problems, such as clumsiness. Russell also has petit mal and is treated with phenobarbitones and other drugs. However, it appears that his condition is not controlled, but is slowly getting worse. Indeed, the drugs seem to make his behaviour more unpredictable and make him less co-operative. Shelley does not have those problems, but she is much more aggressive than her brother and also occasionally suffers from deafness. The main difficulty with them both is behavioural problems, because they are unpredictable, and can be very noisy, aggressive and persistent. They tend to pester strangers and their activities may be unreliable.
I should like to quote from the original application by Mrs. Tulloch for the mobility allowance back in September 1982. It explains clearly what the family's problems are. Mrs. Tulloch said:I am applying for the Mobility Allowance on their behalf to help towards the cost of my own transport, which is a necessity to enable us to have any life outside the house, as I cannot cope with them alone on public transport for the following reasons:—As part of the exercise for today's debate, I asked Mrs. Tulloch to make a note of the essential mileage that she did on behalf of those young people that was associated not with their attendance at the day centre, but with activities such as riding for the disabled, sports clubs, 925 swimming and attendance at a gateway club run by the local branch of Mencap. To her own astonishment, she realised that she was doing over 9,000 miles a year in her own car on behalf of the two young people. The result is a commendable quality of life. It is entirely right that I should pay tribute to Mr. and Mrs. Tulloch for the care, dignity, intelligence and good humour with which they have cared for those very disabled young people for more than 20 years, and with which they intend to go on caring for them.
- 1. They are very outgoing by nature but can be aggressive towards me when restrained.
- 2. They can make a nuisance of themselves with other passengers by going to sit with strangers and chatting incessantly about nothing or asking personal questions. Some people don't mind, but others do, or are unable to cope with the situation.
- 3. They argue and fight with each other a lot which can be embarrassing, especially if they start swearing.
- 4. Public transport runs to time schedules, mentally handicapped people can be very stubborn when they want to and 5/10 minutes on your side makes a great deal of difference when you have appointments to keep. Public transport will not wait for you!
- 5. We live in a rural area and I travel 8 miles into the nearest town at least twice a week to take them to a Youth Club, as there are no facilities for them in our immediate area. If I went by bus we would have to walk about a ¼ mile from the nearest bus stop to the Club. On other evenings I take them to other places or just for a run somewhere to get them out. They don't like walking any distance, and their powers of concentration are poor, consequently they will not sit at anything for long, so I find through experience the best solution is to take them out. I also have regular hospital, dental and doctor's appointments to keep for both of them."
We should also pay tribute to all the staff at the special school that the young people used to attend in my constituency and now at the Newhall adult training centre run by Derbyshire social services, and all the professional staff associated with Russell and Shelley, for the extraordinary way that they help the family to cope. I have no doubt from what I have seen elsewhere that without such attention and care both those young people would have been in institutions a long time ago.
The difficulties are recognised through the payment of attendance allowance for both young people and, of course, they both qualify for non-contributory invalidity pension. However, Mrs. Tulloch does not qualify for invalid care allowance, as she is a married woman. Whatever the difficulties of coping with one mentally handicapped person in the household, I am sure that the House will recognise that they are compounded by there being two.
The history of the application for mobility allowance starts more than two years ago. On 22 September 1982 the claim for mobility allowance for both young people was received and a medical examination was arranged. The examination was carried out on 29 December 1982 and refusal was recommended. On 18 February 1983, Mrs. Tulloch lodged an appeal. A further medical examination by the medical board took place on 8 June 1983 and it recommended acceptance and payment of mobility allowance for Shelley and Russell. There was jubilation in the Tulloch household when they were informed of the positive decision on 18 July. It is worth observing as an aside that it had taken nearly nine months from applying for to being granted. Although the allowance is backdated, the delay is typical and is much to be regretted.
The Secretary of State then decided to appeal to a medical appeal tribunal and the hearing was held on 22 September 1983. The Secretary of State's appeal was allowed and mobility allowance was refused. The family was notified on 2 November 1983. An appeal against a medical appeal tribunal's decision can be made only on a matter of law.
My involvement commenced soon after. Till June 1983, Mr. and Mrs. Tulloch had been the constituents of my hon. Friend the Member for Erewash (Mr. Rost), who I know had been active on their behalf and had given them excellent advice. That it was excellent advice is shown by the fact that they had achieved mobility allowance. I first met them on 18 November 1983 and I wrote to the Secretary of State on 6 December. I know that the letter was received as it was acknowledged. Unfortunately, everything seemed to grind to a halt at that point. I wrote again on 29 February and again on 17 July 1984. I am not being awkward and I hope that I have not been nagging. I know that Ministers are deeply and genuinely concerned about the mentally handicapped. They have shown that in regard to many cases. However, I must ask whether it 926 would be possible to have a reply to the correspondence that I have sent during the best part of what now amounts to one year.
Why did the DHSS appeal against the award when it had been granted after two medical examinations? Why did the Department not leave well alone? I think that part of the answer lies in the Secretary of State's observations to the second appeal, which goes to the heart of mobility allowance regulations and limitations. I should like to quote from it. Mobility allowance is payable under the Social Security Act 1975 to someone who is suffering from physical disablement to the extent that he is either unable to walk or virtually unable to do so. As to the virtual inability to walk, the Secretary of State observed:It is for the tribunal to decide how far ability is affected by impairment of balance, inco-ordination of movement, behavioural limitations, the reed for guidance, supervision or support … In their statement of reasons for three decisions dated 4 January 1983 a Tribunal of Social Security Commissioners gave guidance on the relevance of assistance needed and behavioural factors in determining whether a person is unable or virtually unable to walk. The Commissioners decided that a person who is able to walk only with assistance (ie guidance, supervision or support) should not for that reason alone necessarily be found to be unable or virtually unable to walk. The Commissioners considered however that the need for such assistance was a facet of the manner in which a person could make progress on foot and should be taken into account by the adjudicating authorities … Similarly the Commissioners considered that behavioural limitations on a person's walking ability would also generally affect the manner, and possibly the speed, of his walking. They considered that if a person could be caused to move himself to a designated place only with the benefit of guidance and supervision and possibly after much cajoling the point may be reached at which the person may be found to be virtually unable to walk.That view was clearly taken in the first appeal but not in the second.
This is the crux of the matter. There is no argument about these young people being able to put one foot in front of the other. If they were in the House, they could walk from one end to the other. They have some trouble with steps and may have difficulty if they are not familiar with the area. It also depends substantially on their mood whether they will budge at all. That is not the problem. The more important fact is that they cannot go far without supervision. They cannot use public transport alone—they would be in some danger if they did and they would certainly be a nuisance to other passengers. They require constant care, guidance and control and without help they are just as housebound as if they were physically handicapped.
I am aware that many cases are under review. One is currently under discussion in another place. The entire issue of disability is under review. That effort by right hon. and hon. Members is to be welcomed. The question is whether mentally handicapped people are disabled. I say that they are, as they cannot travel independently. I believe that we should change the mobility allowance rules and allow them to claim.
Mobility allowance has been one of the most successful of all recent benefits. More than 300,000 people currently claim the comparatively modest sum of just over £18 a week and about 10 per cent. have commuted the money to enable them to buy a vehicle. Since 1979, there has been a more than 100 per cent. increase in the benefit in cash terms. There is no doubt that the Government have made every effort to be generous to disabled people. However, the regulations are restrictive and out of date. They were old-fashioned when they were proposed, in that they did 927 not take account of mentally handicapped people who are now living in the community in greater numbers. If we are to make headway in caring for such people in the community and if we are to give reasonable support to such families and parents, we should grant applications such as this.
Tragically, sooner or later, this family will have to give up caring for these disabled people at home. Shelley and Russell's conditions are getting worse and their parents are getting no younger. However, it will happen later by many years rather than sooner if appropriate help is given. It is the DHSS's view, which is well stated in many policy documents, that it is cheaper and better to care for people at home. That has been at the heart of DHSS policy for many years. I therefore urge my hon. Friend to consider these matters sympathetically.
§ The Minister for Social Security (Mr. Tony Newton)
I am grateful to my hon. Friend the Member for Derbyshire, South (Mrs. Currie) for raising this sad case today. I am glad that she has had an opportunity to do so. She will realise that, in view of the way in which she has, with her customary initiative, seized the opportunity at fairly short notice, I have not been able to refresh my mind on the details of the case to the extent that I would normally wish before replying. She deserves the admiration of her constituents for the way in which she has pursued the case and for raising it today. Constituents who have such an assiduous Member of Parliament pursuing their interests are indeed lucky.
The debate enables me warmly to join in my hon. Friend's tribute to Mr. and Mrs. Tulloch for their devoted work in bringing up Shelley and Russell. Their work must command the admiration of us all. Having experienced the problems that mental handicap can bring, though not in my immediate family, I appreciate what devotion must have been required from Mr. and Mrs. Tulloch. I have listened with great sympathy to what my hon. Friend has said. I shall study her speech with care and look into the delay in responding to her letters. I shall ensure that we are in touch with her as soon as possible.
I endorse what my hon. Friend said about the importance of mobility allowance and about the emphasis that the Government have put on it and confirm the figures that she gave. Mobility allowance is now received by about 340,000 claimants, at a cost of about £360 million a year. The Government's commitment to the benefit is reflected in the fact that it will have been virtually doubled by the uprating in a week's time, when it will reach £20 a week. It is an important benefit in the network of benefits available to disabled people.
At a tangent to the main thrust of my hon. Friend's argument, I noted her reference to the delays that take place in processing mobility allowance claims. It is an inescapable fact that if a claim goes to appeal, whatever its route, it is likely to experience longer delays than an ordinary, straightforward claim. Given that the numbers of claims for the benefit have been rising rapidly—the Government welcome that—and that their assessment depends on the use of scarce medical manpower, the difficulties are clear.
My hon. Friend knows that it was as a result of our general concern about the delays occurring to mobility 928 allowance claims that my predecessor as Minister for the Disabled, my hon. Friend the Member for Hornsey and Wood Green (Sir H. Rossi), commissioned a report by a retired civil servant, Peter Oglesby. The report made a number of recommendations, including ways to speed up the administration of mobility allowance claims. The Government have acted on a significant number of those recommendations, although some remain under consideration.
As a result, the past two years have shown a significant speeding up of the processing of mobility allowance claims. I pay tribute to the work of our officials at North Fylde central office in Norcross, who have put great effort into improving the way in which claims are handled. We are doing everything we can to reduce those delays and to keep them to a minimum, and we have already had considerable success.
I now turn to specific issues connected with the case of Mr. and Mrs. Tulloch and of Shelley and Russell. In view of the age of Shelley and Russell, any claim for mobility allowance is technically a claim by them. For anyone over 16, the claim and payment of the benefit is to the individual concerned rather than to his parents. Perhaps that shows how difficult it would be to follow my hon. Friend's suggestion and consider some mobility allowance claims together and some circumstances as a whole. The benefit is paid to individuals and claimed by individuals. If one attempted to consider some claims together, it would be difficult to decide which individuals should be lumped together for the purposes of a claim. I hope that my hon. Friend will accept the considerable difficulties which her suggestion would create.
My hon. Friend implied that in the adjudication on such a benefit it should be possible to consider circumstances such as the availability of public transport and other factors affecting the environment of claimants. I have heard that argument before. At first one reacts sympathetically to it, but when one considers it seriously it is difficult to see how one could make differentiations equitably in the payment of this or other social security benefits according to geographical location. To give an obvious and crude example, it would be absurd if a person who happened to live in north London was refused mobility allowance because he was on a bus route and consequently moved to a remote village in Essex to qualify because he was no longer on a bus route. I hope that my hon. Friend accepts the difficulties inherent in such differentiation.
The major thrust of my hon. Friend's remarks related to the position of mentally handicapped people under the mobility allowance scheme. As she said, there has recently been difficulty in interpreting the regulations for mentally handicapped people and for other categories of potential or aspiring claimants. They include blind people, whose needs were the subject which last brought me to my feet in the House this week, and of deaf-blind people.
There are obvious difficulties and disadvantages in specifying particular types of disability as automatically qualifying for benefits designed to reduce the consequences of disability. I hope that my hon. Friend will agree that many mentally handicapped people would not qualify for mobility allowance. I have visited the large mentally handicapped hospital in my constituency on a number of occasions. Many people there have no difficulty in walking and making their way about, although they are mentally handicapped. However, I accept that certain conditions and degrees of mental handicap can cause real 929 difficulties in that direction. I merely seek to establish that one cannot sensibly say that mental handicap alone, without regard to its degree, extent or consequences, should be taken as an automatic passport to the payment of mobility allowance.
Recently, the process of determining the interpretation of the mobility allowance rules has given rise to considerable discussion among adjudication authorities—this will soon reach even higher levels—about how the regulations should be applied to the mentally handicapped, the blind, the deaf-blind and other categories. As my hon. Friend said, a tribunal of social security commissioners dealt with claims from three mentally handicapped children in an effort to clarify the interpretation of the legislation for people who needed assistance to move around. The decision was reported as R(M)1/83. In their decision, the commissioners held that the need for guidance, supervision and support was a facet of the manner in which a person could make progress on foot and therefore should be considered by independent adjudicating authorities in deciding claims, but that it was not in itself conclusive.
Earlier this year, the Court of Appeal gave judgment in the case R(M)1/84, which involved a blind person who had directional problems. In that case, the question of guidance, supervision and support was a relevant factor. The claimant was unsuccessful, but the extent to which the judgment affects the conclusions reached in R(M)1/83 is arguable. Case law is therefore in an unsatisfactory state, but we hope that that will be resolved, as the case reported in R(M)1/84 is now on appeal before the House of Lords in its judicial capacity. The hearing is due on 7 March 1985 according to my latest information. I am sorry that that is still some time ahead. When we have the results, we shall consider the need for further guidance and, if necessary, we shall amend the regulations in the light of it. I can make no promises about what we might think it appropriate to do in the light of the outcome, but we are conscious of the difficulties in interpreting the regulations in cases such as those of Shelley and Russell Tulloch. Although I cannot hold out an immediate hope of a dramatic change, I hope that I have said enough to show that we are worried about the problem and that we wish the position to be more clear.
I cannot say much more to my hon. Friend today. We are genuinely and deeply sympathetic to the problems that she described, and I am glad to know that the Tullochs are receiving substantial support from the social security system in the form of attendance allowances in both cases and non-contributory invalidity pensions, which will shortly become severe disablement allowances, in both cases. That reflects Ministers' anxiety — certainly my anxiety as a social security Minister with responsibility for the disabled — to ensure that support is available to families in such circumstances. I can say nothing more about the specific mobility allowances in this case, but I shall be in touch with my hon. Friend as soon as possible.