- (a) a disabled person is living at home and receiving a substantial amount of care on a regular basis from another person (who is not a person employed to provide such care by any body in the exercise of its functions under any enactment), and
- (b) it falls to a local authority to decide whether the disabled person's needs call for the provision by them of any services for him under any of the welfare enactments,
§ Brought up, and read the First time.
§ Mr. Deputy Speaker
With this it will be convenient to take amendment (a), at end add'and shall determine the need of that other person for support and assistance in providing the care required to enable the disabled person to remain living at home.'and Government amendment No. 5.
§ The Minister for Social Security (Mr. Tony Newton)
I am conscious that in presenting new clause 10 I am in the odd position as Minister with responsibility for the disabled of taking part, for the first time, in the proceedings.
The House will understand if I use the words used earlier by my hon. Friend the Member for Derbyshire, South (Mrs. Currie) that I too have been removed from public life by the proceedings of the Social Security Bill upstairs. I am not quite sure whether I would regard that as being removed from public life, but it certainly is as obscure as it is strenuous. There will be those in the House who feel that a Minister for Social Security who has been through the last two months of argument, especially on severe weather, would welcome a period of obscurity. In some ways that is true.
I express my regret to the House that I have been unable to take part in the earlier proceedings. I had a conflicting engagement this morning, also of great importance to disabled people. I attended a conference on the McColl report on the artificial limb and appliance service. I notice that the hon. Member for Eccles (Mr. Carter-Jones) appears not to have heard about that. It was organised in Kensington by Therapy Weekly. I spent an hour and a quarter at the conference this morning.
I would like to take an opportunity to pay my own tribute to the hon. Member for Monklands, West (Mr. Clarke) and other hon. Members, including the hon. Member for Caernarfon (Mr. Wigley) who have played an important part in presenting the proposals. The hon. Gentlemen have played a constructive part in working with the Government to reach the present position.
Albeit in his absence, I pay tribute to my right hon. Friend the Minister for Health who, because of my absence and other commitments, has taken a special interest in the Bill. He has played a skillful and constructive part, along with the Opposition Members. I only hope that my own interest which I can assure but not prove, but which has been expressed behind the scenes, has been helpful and constructive.
The House will be aware that the Government strongly support the principle which inspired the original clause presented by the hon. Member for Monklands, West which 524 is clause 5 in the Bill as it stands. The same principle underlines the Government's new clause 10 which is intended to replace clause 5.
We recognise the vital role of informal carers in providing support for disabled people who live in the community. We have tried to reflect that in a variety of ways recently, including the important work being done in and through the Department's social work service, now the social services inspectorate. For example, we have mounted a variety of studies and seminars, in which I have taken part occasionally, to draw much greater attention to the needs of informal carers and to encourage those engaged in the provision of services to take more account of those needs in their services.
Despite that, we did not feel, as my right hon. Friend will have explained earlier, that clause 5 was acceptable in view of the open-ended statutory obligation it imposed on local authorities and of the potentially large implications for them and for resources going well beyond those already represented by other parts of the Bill. We therefore propose to replace clause 5 with new clause 10, which would require social services departments, when assessing the needs of a disabled person in receipt of a substantial amount of regular care from any person other than an employee of the statutory services, to have regard to the carer's ability to continue to provide that care.
Although that provision is in several respects more limited than the hon. Member for Monklands, West would have wished, it goes further in one respect. Following the consultatio exercise, we concluded that it would be impracticable to restrict the definition of carer to people in the same household as the disabled person, so new clause 10 extends the definition of carer to include any person who provides a substantial amount of regular informal care. I hope that that modification is thought sensible.
I should like to say something about amendment (a) and the starred amendment (b), which has been tabled by the hon. Member for Caernarfon but has not been selected. Apart from a minor technical objection, which I shall not go into, we are anxious that amendment (a) would virtually restore the open-ended commitment which we felt unable to accept in the original clause. I know that the hon. Member for Monklands, West doubts whether the interpretation of his amendment is correct but I am sure that he recognises that, in the letter circulated to all of us today by the Association of County Councils, it says that new clause 10 is probably all that is possible. It also says that it is anxious about the additional resource consequences which would be reflected if the amendment were incorporated.
It is with some regret that I cannot advise the House to accept amendment (a). If the hon. Gentleman and the House are ready to accept my advice, I shall re-examine new clause 10 to see whether there is any way in which we can modify our proposal to help meet the hon. Gentleman's concern. That is not a commitment beyond a genuine commitment to examine the matter. I shall also consider amendment (b), which would extend the new clause fairly generally to clarify the anxiety that underlies both amendments.
We must accept that a balance has to be found between taking what I regard as a valuable step forward in new clause 10 to recognise the needs of carers more by doing so in an Act of Parliament and writing into the Bill a provision with potential resource implications which 525 might mean considerable deferment of the time when it is possible to bring the provision into effect under the commencement order procedure.
We must ensure proper recognition of the need to consider the position of carers. My concern is such that I would rather have a clause that we can hope to bring into effect reasonably quickly than one which while it might represent a world to which we hope to be able to move in due course, might delay introducing effective legislation that recognises the problems that face carers.
If the House is willing to accept the new clause in the spirit in which it has been tabled, it would be one of the Bill's provisions that we could hope to bring into effect at an early stage.
§ Mr. Tom Clarke
Again, I shall attempt to be brief, although the issue which is raised by the new clause is an extremely important one and invites a much longer debate than time allows.
My amendment sought to emphasise that our aim should be to enable disabled persons to remain living at home. That was the purpose of the amendment that was moved in Committee with universal approval by my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley).
The second purpose of the amendment is to confirm that an assessment of a disabled person's needs could be demanded by the carer. Circular 12/70 of the DHSS implies that a local authority must assess all disabled persons whether or not they want to be assessed. That is 100 per cent. automatic assessment. That does not happen and delays between requests for assessment and assessment are often long. I believe that the existing law needs clarification, and it is not my purpose to extend it. There has been some misunderstanding about the amendment.
The Minister has said—I am sure after great thought—that there is a technical objection to the amendment, and I must consider that seriously, which I do. I take on board that he has said that he will re-examine these matters, including the amendment of the hon. Member for Caernarfon (Mr. Wigley), which has not been selected. When the Minister has an opportunity to carry out that re-examination, I ask him to take into account the discussions that we had in Committee and the representations that we have received from many professional bodies and voluntary organisations as well as individuals in response to the document on resources which was produced by the Government. I hope that we can take up that issue again on Third Reading.
I am certain that the group which is making the greatest contribution towards coping with the problems faced by the disabled and saving the Treasury the most money is that which is formed by carers. That said, the Minister is right when he says that it would be wrong if Parliament, in undertaking a serious review of the disabled, took a decision which had not been properly considered. I would not want to take that risk. The problem is too important to allow that to happen and carers deserve much more consideration than a hasty decision. Without withdrawing one iota from the commitment of the sponsors of the Bill towards carers, I do not propose to press my amendment.
§ Mr. Rowe
There would be tremendous medium and long-term savings in looking after carers a great deal better than at present. A horrifying proportion of carers are more than 60 years of age and many of them are suffering from a wide variety of potential or existing disabilities because of the pressure under which they live. More than anything else they need some form of respite care and, even as far as the Government have gone, that is a very important step.
I should like to make a point similar to the one I made earlier. I believe that there is enormous scope far beyond anything that the Government have so far admitted, for using those currently unemployed, especially young people, through the community programme and other ways to provide the respite for carers that we are talking about and support for handicapped people in their own homes. It has been estimated that more than 2 million handicapped people are looked after at home and the opportunities for using the community programme are colossal. The experience of community service volunteers with the independent living scheme is an indicator in one direction and its experience of placing more than 2,000 young people every year at a cost of £300 per head a year in this way is a clear sign of what can be done. I hope that my hon. Friend the Minister, who knows so much about this subject will urge the Paymaster General, who says that in his experience the scope does not exist, to look at the possibility of setting up in his own Department, in conjuction with the community programme, the kind of national scheme which would give carers the support they need. If he does not provide that support, he will land the Health Service with a colossal bill because it will break down.
§ Mr. Wigley
I shall be brief for obvious reasons, because I have been exhorting other people to be brief.
The position of carers is extremely important, as the Minister has said today and on other occasions. Although it is not possible to go as far in the Bill as we had originally hoped, I trust that we can consider whether new clause 10 can be more finely tuned to achieve the objectives referred to by the Minister. I thank the Minister for his willingness to respond.
Amendment (b) is starred, so we cannot take it on board today. However, perhaps between now and the Bill's consideration in another place it will be possible to see the difference between amendment (a) and amendment (b). Amendment (a) refers to determiningthe needs of that other personand amendment (b) refers to
whether by making available additional services, the provision of that care may be maintained."'There is a difference in that it does not bring in an additional assessment procedure, but tries to help the Government to achieve their objective of giving support to enable a disabled person to remain in the community. As a responsibility for assessment of disabled person already exists, all we are doing is extending the Government's clause to provide that the local authorities, in assessing that need, shall also have regard towhether by making additional services available, the provision of that care may be maintained.That is a compromise between amendment (a) and where the Government start. It may give an opportunity to achieve our aim—in other words, to provide services to help disabled people to remain in the community without bringing about an additional bureaucracy of any sort or 527 additional assessment procedures which may consume resources. At the same time, we should be able to direct services to where there has been maximum impact and by doing that avoid the additional public cost of people having to go into institutional care which is unacceptable for social reasons. There may be room for consideration along those lines in another place, and if the Minister will ensure that we will be grateful.
§ Mr. Thurnham
The clause draws attention to the great job done by carers and the massive cost involved in the provisions to give them adequate help. I have been happy to support new clauses 11 and 12, but the cost aspect has caused concern. I note that the hon. Member for Monklands, West (Mr. Clarke) has said that he will not press his proposal.
My hon. Friend the Member for Exeter (Mr. Hannam) would have liked to speak on this clause if he was here. He has asked me to apologise for his absence. I understand that the Prime Minister is visiting his constituency to look at new facilities for the disabled, and that is why he felt unable to be here today. He has asked me to add his congratulations to those already given to the hon. Member for Monklands, West on his work in introducing the Bill and on the Government's warm and positive response to the spirit of it and their backing of the need for resources.
I should like to mention again to my hon. Friend the Minister the points made by the Association of County Councils in a letter that I received today. The ACC cautioned that if a Act is put on the statute book but not implemented, that can lead to considerable difficulties. The ACC refers to the fact that
the proviso of deferring implementation until those resources are available has proved problematic in the past. The Children Act 1975, for example, was implemented piecemeal over more than 10 years which contributed in no small measure to the current confusions and complexities of child care law. The Government should accept the need to discuss with those responsible for giving effect to the Bill a proper programme of implementation fully resourced at each stage.I am sure that the hon. Member for Monklands, West in putting forward the compromises that he has, will expect to see the Bill implemented to a proper timetable as soon as it is on the statute book.
§ Mr. Carter-Jones
Some hon. Members have buzz words and buzz expressions. My right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) always argues that where one sees a disabled person, one sees a disabled family. Amendment (a) goes to the heart of the matter. The carer is absolutely essential, and often is part of the family.
I have a buzz word in the House. When I talk about disability I always talk about "slice by slice". I am a great salami expert. We have had two slices of salami today. I hope, from what the Minister said, that there is a slight chance that he has got the knife over another small slice and will move a little further towards helping us. Even the Americans, in the latest report on independence, produced by the Council for the Handicapped, made that very point.
I make this one plea to the Minister. He and I have talked often about the use of advanced technology to allow disabled people and their families to have some form of independent living. We are making considerable progress, but when we talk about the mentally handicapped and the mentally ill, it is not so easy to provide what is needed in the way of environmental controllers to give that 528 independence. Therefore, the carer becomes more important than ever and is of deep consequence and significance for the family.
I hope that the Minister will think carefully about his half promise. If he made it a firm promise, I should be happy.
§ Mr. Kennedy
The caring issue particularly interests and concerns me. Of all the things in the Bill, what attracted me in particular was the opportunity at long last to have this recognised in legislation. At first we did not know what form the recognition would take. However, it is important that there is some recognition of the role and contribution of informal carers, and of local authorities having to take those people into account in their planning, services and so on.
As there appears to be further compromise going on between the promoter of the Bill, the hon. Member for Monklands, West (Mr. Clarke), and the Minister, which is welcome, I hope that once the measure becomes law the Government will, in the spirit of the Bill and their own clause, take further opportunities to try to encourage local authorities to enter into voluntary agreements with carers on the provision that can be made available to them. I accept that there are revenue stipulations. There is an enormous amount to be done.
I echo what the hon. Member for Eccles (Mr. Carter-Jones) has said, that we have many highly charged political debates in the Chamber about the future of the welfare state. We all agree that if it were not for the informal, and often unnoticed and insufficiently supported, caring sector in our community, the welfare state would be in a state of crisis and collapse. Therefore, anything that gives legislative recognition to the position of carers, as the new clause does, is welcome.
§ 1 pm
§ Mr. Ashley
I felt slightly worried until, a few moments ago, my hon. Friend the Member for Eccles (Mr. Carter-Jones) made his standard salami speech, and I know now that we are back on course and having a normal debate on disability.
The Minister must have felt uncomfortable when speaking about new clause 10, because he is aware of the problem of carers. Some time ago, in chilly Westminster Hall, he received a deputation, which I led, of appallingly disabled people and their carers. He listened sympathetically, and the case was put vividly by those carers whose lives have been devastated.
Some Members who have spoken today have got the costs all wrong, as have the Government, because costs will be saved by helping carers. If a carer cannot cope, both the disabled person and the carer will go into hospital and the cost will become astronomic. This is a saving measure, and a humanitarian one. It is a cliché to say that we cannot afford to do anything, but it is true. We cannot afford not to help carers. Carers are an exploited section of our community. They save the Government, not just the DHSS, billions of pounds. I hope that carers will be helped because they deserve to be and because they will help the Government. I am glad that the Minister will reconsider the issue.
§ Mr. Alfred Morris
The Minister said that he would look at new clause 10 to see whether it could be strengthened. It can be strengthened. Our view is that new 529 clause 10 merely reflects existing local authority practice. I understand that that is also the view of the Association of County Councils. We hope that the Minister's review of what he is proposing will proceed urgently and that there will be more official understanding than we have seen so far of the vital importance—I use the word "vital" in its literal sense—of recognising the centrality of the role played by carers of disabled people.
We are extremely reluctant to see any dilution of the Bill's provisions on this important matter. As my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) said, if the carer breaks down, then two people can find themselves in institutions. It is both self-defeating and inhumane not to help the carer where that can vouchsafe the independence of the disabled person. Our fundamental concern is not to delay the proceedings on the Bill and thus, although reluctantly, we accept what the Minister has said.
The hon. Member For Exeter (Mr. Hannam) played an important part in the discussions on this matter in Committee. We appreciate why he cannot be with us today, and I join in the compliments that have been paid to his tireless efforts in support of the Bill.
§ Mr. Newton
I warmly endorse what has been said about my hon. Friend the Member for Exeter (Mr. Hannam) who has played an important and constructive part in our debates. I intervene again to make sure that I cannot later be accused of having misled the House. I am conscious, as the House knows, of the needs and problems of carers, and I am anxious to advance in a number of ways the extent to which we recognise and meet those needs throughout the variety of our provisions and not just those covered by the Bill.
In fairness to all, I must make it clear that in what I said about looking again at amendment (a), tabled by the hon. Member for Monklands, West (Mr. Clarke), and amendment (b) tabled by the hon. Member for Caernarfon (Mr. Wigley), I do not wish to suggest that I see an opportunity greatly to widen the scope of the Government's new clause in a form that would have substantial resource implications. As I understood the hon. Member for Monklands, West, he did not feel that his amendment had those implications. If it could be shown that his interpretation of the amendment was right and that ours was wrong, or that we could make some other change that would help to meet anxieties, I would be willing to look at that. But I cannot give a commitment to conduct an extensive review of new clause 10 in a way that would give the impression that we would greatly extend and expand its scope in terms of its resource implications. I would not like to mislead anyone about that.
§ Mr. Tom Clarke
The Minister referred to the possible interpretations of my amendment and undertook to reconsider it. Will that be in time for the Government's views to be considered by the other place?
§ Mr. Newton
If I could see any way of achieving a satisfactory compromise between the different interpretations of the hon. Gentleman's amendment, I would hope that it might be done in time for the debate in the other place. However, I do not wish to leave any room for doubt. I do not believe it is possible for the Government to recommend amendments in the other place that will 530 clearly greatly increase still further the Bill's resource implications. In so far as we are talking about amendments that make the purpose of new clause 10 clearer, I certainly undertake to look at them. But I cannot undertake to incorporate or recommend amendments that would increase still further the Bill's resource implications.
§ Question put and agreed to.
§ Clause read a Second time, and added to the Bill.