§ Order for Second Reading read.9·37 am
§ Mr. Tom Clarke (Monklands, West)
I beg to move, That the Bill be now read a Second time.
I am extremely grateful and profoundly privileged to have the opportunity to present the Bill on behalf of my sponsors. I acknowledge the tremendous assistance that I have been given by right hon. and hon. Members on both sides of the House. I especially thank my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) and his all-party disablement group for endorsing the Bill and showing that they feel that it represents a priority when set against the problems that face us.
I accept that the coverage for this important event should, perhaps, be as distinct as that of other events—for example, the meeting that is taking place in the Royal Albert hall today. The implications of the Bill will perhaps have an influence on many more people than those whose causes are being debated at the Royal Albert hall. I regret that the interests of the disabled—of ordinary people—have not as yet captured the imagination of the media in a way that I consider to be important and which might be helpful to the progress of the Bill.
This is the first full debate on disability in the House for some time. If the Bill is enacted in due course, I hope that it will prove to be as major an advance as the Disabled Persons Act 1981, a measure which was piloted through the House by the hon. Member for Caernarfon (Mr. Wigley), and the Chronically Sick and Disabled Persons Act 1970, which was introduced by my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris).
The Bill is firmly based on what has now become known internationally as the "Alf Morris Act". I pay tribute, as I think hon. Members would wish me to do, to my right hon. Friend the Member for Wythenshawe for his unstinting work for the disabled—[HON. MEMBERS: "Hear, hear."]—as a Back Bencher, as a Minister, and, for the time being, as an Opposition spokesperson.
I want to quote from the significant speech that my right hon. Friend made on 5 December 1969 in his Second Reading debate. He said something then which matches the test of time:if we could bequeath one precious gift to posterity, I would choose a society in which there is genuine compassion for the very sick and the disabled; where understanding is unostentatious and sincere … where, if years cannot be added to the lives of the chronically sick, at least life can be added to their years".—[Official Report, 5 December 1969; Vol. 792, c. 1863.]If I can emulate that today in only a minor way, I am delighted to echo those sentiments.
I hope that the Bill will add to the "Alf Morris Act" and to the principles of the International Year of Disabled People—principles which show that we should be searching and seeking for full participation and equality for disabled people and giving those words genuine and true meaning.
Seen in its proper context, the Bill will give increasing recognition to the rights of disabled people to have a full say in decisions which concern them. It recognises that 1347 decisions are usually taken for, not with, disabled people; that disabled people have rights as well as needs; that disabled people are uniquely qualified to contribute to determining their needs; and that disabled people represent an untapped resource for society, offering great potential not just for their own individual achievement but for the enrichment of the whole of society.
I have received many letters from organisations, individuals and families from all over the United Kingdom. I know that other hon. Members have had that experience as well. At this stage I would simply like to quote a letter which I received from a parent of a mentally handicapped person in Lanarkshire who said:My son now aged 22 years suffers from cerebral palsy and is both mentally and physically handicapped. As parents we have always treated him as an equal to his three younger sisters. Therefore, he is very much part of our household, giving us the love and affection that only a son like he can give. They have a stabilising effect in a household that only persons with these disabilities can have.I quote that to show the affection and genuine commitment in every sense to disabled people and in the knowledge that it is reciprocated in a way that all of us accept and welcome.
The people covered by the Bill are clearly defined and I want to repeat the definition because there have been some misunderstandings elsewhere. The definition is clearly stated as:Any person to whom section 29 of the National Assistance Act 1948 applies"—namely, people who are blind, deaf or dumb, substantially disabled by illness, injury or congenital deformity, or who are suffering from mental handicap or mental illness.
The Bill is intended to cover England, Wales and Scotland. In my recent travels in many parts of the United Kingdom, from Manchester to Edinburgh to Glasgow, some doubt has arisen on that point. When I visited the constituency of my hon. Friend the Member for Glasgow, Maryhill (Mr. Craigen) that point was raised and I hope that I assured those who were present that Scotland has in no sense been forgotten. Incidentially, I saw the excellent Maryhill central halls and the splendid work of voluntary organisations and individuals.
§ Mr. Jim Craigen (Glasgow, Maryhill)
I am grateful for that. I know that my hon. Friend's visit was much appreciated, but did he find, as I have in the recent past, that while there is more scope for and call on the time of voluntary bodies they are now even more strapped for cash than ever because of the cuts in Government backing?
§ Mr. Clarke
I am sure that my hon. Friend makes a valid point. I am equally sure that not only will that be pursued in the course of the debate but in the many other debates when we come to argue about the priorities that we attach to these important matters.
§ Mr. Patrick Cormack (Staffordshire, South)
Does the hon. Gentleman agree that the problems just referred to could equally well be solved if the Government would heed the campaign led by my hon. Friend the Member for Exeter (Mr. Hannam) on VAT and charities?
§ Mr. Clarke
I am sure that the House will take on board the hon. Gentleman's comments. I am delighted to take interventions, but, if there are too many, some other legislation that might have been considered may not be reached.
1348 My hon. Friend the Member for Maryhill referred to the voluntary organisations and that point is important. But I wish to develop my remarks to embrace the dedication—I use that word after great thought—of local authorities and health authorities in the way in which they deal with these important matters. I hope that they will accept that the Bill is an attempt to improve the situation of millions of disabled people and that that can indeed, be done, especially with the co-operation and commitment of such bodies, which have themselves a great deal to gain from improved administration, co-ordination, co-operation and efficiency. Therefore, I look forward to even more support than perhaps has been expressed so far by the various local authorities and people involved in health administration.
There will be improvements indirectly for the disabled, for example, over the right to be consulted on the planning of services. But perhaps more importantly there will be direct requirements that will be of assistance to the disabled among three special priority groups—young persons leaving special education, people leaving mental handicap or psychiatric hospitals and people whose carers can no longer cope.
I recognise that the timetable for considering the Bill is inevitably short, but I have endeavoured already to implement the basic thrust of the Bill's approach by seeking to consult as widely as possible, not just by way of correspondence—there has, as I have said, been a lot of that, and welcome it is too—but in meeting organisations representing disabled people and organisations of disabled people and listening carefully to what they have to say.
I want to acknowledge the assistance that I have had from the three Ministers on the Front Bench today—the Minister for Health, the right hon. Member for Brentford and Isleworth (Mr. Hayhoe), the Under-Secretary of State for Scotland, the hon. Member for Argyll and Bute (Mr. MacKay), and the Minister for Social Security, the hon. Member for Braintree (Mr. Newton). The right hon. Member for Brentford and Isleworth and the hon. Member for Argyll and Bute will expect me, and rightly, to thank them for their contributions. Older hands in these matters have advised me that at the various ministerial meetings that took place, formal and informal, I should remember that in meeting two Ministers I should be ready to face Mr. Nice and Mr. Nasty. My problem, without wishing to make any comment on the attributes of both Ministers, is to decide which of those labels applies to which Minister. I think that the compromise is to distribute them fairly between both and to tell them that I shall suspend judgment until I see their performance in Committee.
§ Mr. Clarke
We shall come to that later.
Whatever our differences, we have all-party support and support throughout Britain for this measure. That must be an important consideration for us all, whatever our personal views. There comes a point when we cannot simply ignore public opinion or the views of those who deal daily with these problems. There needs to be continued consultation.
I understand from the Secretary of State that amendments will be submitted in due course, and I hope that they will strengthen the Bill. I accept that the Bill is 1349 a framework for progress. If the Government table amendments, I think that the British people will clearly say, "Do not weaken this legislation, for which we have been waiting for many long years. Give strength and conviction to it." I think that the Secretary of State would be well advised to do what they say.
The Bill's main principles are clearly determined by its short title. The Bill is about the services to and for disabled people which they receive individually or collectively. It is about consultation—the right of individuals to be consulted about services to them and the right of organisations of disabled people to be consulted about general services. The Bill is about representation—principally the right of disabled people to appoint a representative to speak for them. Above all, it is about crisis prevention. There will be a duty on local authorities to intervene before, rather than after, a crisis arises for the three key groups—children needing special education, people leaving mental handicap or psychiatric hospitals and people whose parents can no longer cope.
It might be for the convenience of the House if I refer briefly to each clause to explain my position and that of the Bill's sponsors. Clause 1 deals with the right to be represented. It builds on the successful advocacy schemes which are already in operation. It converts a concession into a right. This measure is of special concern to the mentally handicapped and the mentally ill. I draw the attention of Ministers to the 1980 DHSS review of mental handicap services, which specifically said:The most important factor in safeguarding the position of vulnerable patients and ensuring that their rights are upheld is personal contact between the patient and someone whose job it is to explain the position from the patient's point of view".Clause 2, on assessments, will extend existing good practice. Information will be made available in booklet form. The right of disabled persons to present their views will be acknowledged. A written record of decisions will be made available to the disabled person or his representative.
Clauses 3 to 7 concern the move from crisis management to crisis prevention among the three groups I have identified. Clause 3 especially deals with young persons needing full-time education. Of all the clauses in the Bill, clause 3 is the one on which I have received outstanding support. I hope that, whatever the amendments that appear in due course, the Government will bear in mind that many organisations throughout the United Kingdom support this measure and believe that it is long overdue.
Often people leave school and fall into a trap not of their making. This frequently imposes a great strain on aging parents trying to cope full-time with a difficult domestic situation. With clause 3 we want to ensure that the social services departments and, in Scotland, the social work departments, are asked to act as the one door to all services. I know a young widow in my constituency with three children. Her son, who is approaching 19, is profoundly mentally handicapped. He is having difficulty in coping with plans for the future. Much more help should be available in such circumstances. I hope that the clause will strengthen the position of that young woman who has coped magnificently, and similar families.
§ Mr. Peter Thurnham (Bolton, North-East)
Does the hon. Gentleman agree that people who are considering adopting handicapped children are especially concerned about cases such as the one he mentioned and what is to 1350 happen to such a child when he reaches 19? Will there be sufficient care, and will there be sufficient help for the carers?
§ Mr. Clarke
I am delighted that the hon. Member for Bolton, North-East (Mr. Thurnham), with his knowledge and experience of these matters, has made that point.
The main thrust of clause 4 concerns discharge from hospital. Individuals and public bodies have made many representations to me on this. On 4 December, an interesting debate on the mentally ill occurred in the other place. Time and again, speakers of all political complexions and of none pointed out that many mentally handicapped people—I accept that the debate was about the mentally ill—are finding themselves in prison because the courts have decided that there is nowhere else to send them. That is all the more reason why we should look closely at these matters.
I have not plucked the 28-day provision out of thin air. The Mental Health Act Commission in its biennial report stated:Discharge of a patient should be regarded as a process, rather than an event—a process of stages leading up to the event of physical discharge. Sudden discharge should be a thing of the past.The Bill's sponsors and I have borne that recommendation in mind in making this provision.
There is appalling evidence of the lack of co-ordination on these matters, leading to a great deal of hardship and mental anguish for the people who are least able to cope. They are discharged from mental hospitals and no assessment of their needs is made. If no such assessment is made, it becomes more difficult to make adequate provision for them.
I know that we shall, in due course, have a debate on resources, but this is an opportunity to avoid wasteful expenditure, caused when patients go in and out of hospital like yo-yos, and to assess and deal properly with long-term needs.
The Royal College of Psychiatrists in a letter to me has said that itis very concerned that run-down of mental hospitals is already occurring up and down the country without adequate alternative provision being made by Local Authorities. In many areas there are no plans to accommodate vulnerable and dependent patients following their discharge into the community after many years in hospital.I am sure that the House would wish to bear those points in mind.
§ Mr. Canavan
I support my hon. Friend's comments. Does he agree that the health authorities should not be allowed simply to pass the buck to the social work departments, bearing in mind the severe financial constraints that all local authorities are suffering because of Government policy? Does my hon. Friend agree that the National Health Service should have a continuing dominant role in the provision of community care for patients discharged from mental hospitals? Does my hon. Friend agree that the NHS and local authorities need much more generous funding from the Government if community care is to be a success? This is needed instead of community care on the cheap, which would mean that patients suffering mental handicap or mental illness would be wandering the streets, as happens in some countries such as the United States?
§ Mr. Clarke
I entirely agree with my hon. Friend. I hope that in due course the House can address itself to that serious problem.
Clause 5 deals with carers. This country owes an immense debt to carers, who do first-class work. They could never be paid for their dedication all round the clock, seven days a week, 52 weeks a year. The least we can do for carers is to offer them the right, when they feel that they can no longer cope, to a fresh assessment of their own position. I hope by that assessment to encourage local authorities to make reasonable provision for respite leave in recognition of the tremendous work that carers and often parents are doing.
I have had numerous representations on that point. One theme that shines through letter after letter in respect of carers is the question from elderly carers or from those worried about elderly carers, as to what will happen to the handicapped child after the parent can no longer cope or, perhaps, has gone. I hope that the clause, if it is endorsed by the House, will give reassurance to some extent about that important point.
§ Dr. Norman A. Godman (Greenock and Port Glasgow)
That clause is one of the most important in my hon. Friend's Bill. Does he agree that one element of support that can be given to carers, which provides immense relief, is that of a break from caring—the provision of a holiday relief for such people each year?
§ Mr. Clarke
My hon. Friend has made an extremely good point. The assessment that we wish to see would mean that much more attention is paid to the important matter that he mentions.
Clauses 6 and 7 are an extension of the Education Act 1981, but no new statutory duties are involved. The procedures are based on existing best practice and on good administration which, I hope, saves time and money and emphasises the need for the full involvement of the disabled persons in decision making.
Clause 9 deals with advice to disabled people. It is a minor extension of the desire and the request for local authorities to provide information. I am sure that the House will be reassured by the knowledge that provision has been in force in Northern Ireland since 1978.
Clause 10 deals with public bodies. We ask that people appointed to committees should represent the views of disabled people. Times are changing. In the overwhelming majority of cases, disabled people can articulate their own views. When appointments are made to public bodies, I hope that that point will be borne in mind and that when the Bill becomes an Act it will give statutory backing to that principle.
Clause 11 deals with the role of this House. When my hon. Friend the Member for Falkirk, West (Mr. Canavan) intervened, he reminded me that this clause, if approved in due course, will ensure that this Parliament will have information about people in mentally handicapped and psychiatric hospitals, and, what is even more important, it would know what happens to them after they are discharged. Although I am not asking for something like "War and Peace" to be presented to the House every second week, I believe that it is right that the House should know the global position. It would therefore be better informed when we have debates on this subject and about the resources which have been mentioned.
That would avoid the nonsense—worse than that: the unacceptable practice—of people being discharged from 1352 mental hospitals into community care which, hon. Members on both sides of the House know, in many cases does not exist.
Clause 12 deals with planning. I pay tribute to the Ministers involved for the measures that they have already introduced in respect of building regulations and access to buildings. The clause extends those principles to development plans. There is a need for disabled people to be involved at an early stage if provisions are to be right and money, again, is not to be wasted.
I have received representations from Scotland where a strong view is held that the principles contained in the clause might be adapted to meet Scottish needs. That matter will be raised as the Bill is debated.
Clause 13 is regarded by many people as controversial. I hope that in due course that will not prove to be the case. It relates to co-operation in planning services in Scotland. We are behind England and Wales, where health authorities are required to set up joint consultative committees and to include representatives on them from the voluntary sector.
The clause does not establish new bodies, but requires co-operation on joint planning, consultation with voluntary organisations and the need to publish joint plans. I know that the Under-Secretary of State for Scotland who has responsibility for health is aware of the many views that exist on that issue. It is right to remind him that of all the clauses this is the one which received most tepid response—if I can put it that way—in Scotland. As I understand he does, I look forward to the discussions that we will have in Committee. I hope that we can give profound consideration to that clause and perhaps find ourselves able to reflect what is, I believe, the overwhelming view of the people of Scotland—that the planning of these matters should not be left to a few people on health boards but that the consumers should have a meaningful say in how these matters are being dealt with.
§ Mr. Tom Cox (Tooting)
My hon. Friend is talking about Scotland. I wish him well in his endeavours, but I hope that he will learn from the many mistakes that, unfortunately, we have made in England, especially in local government, where often social services departments do not liaise with housing departments. There is utter confusion. I hope that he will bear that point in mind and try to avoid the pitfalls that we experience week by week with many of our authorities.
§ Mr. Clarke
I am grateful to my hon. Friend for making that point. I welcome what he said. I am sure that the Minister responsible for Scottish health matters was listening even more carefully and will find that such a comment will encourage him to take a view different from the one that he has so far.
Clause 14 deals with financial provisions in respect of the Bill. I recognise that there are not just limitations, but profound limitations, on a Member seeking to introduce a measure of this kind. I thank the Minister for Health, because I understand that he intends to introduce a money resolution.
I have been involved with local government, so may I make the request and express the hope that the Minister will also put money into the rate support grant settlement for any initial extra cost? Then, when the Bill is enacted, we can debate the resources which might be required.
If we have genuine consultation and co-ordination, accept that there are people who know much more about 1353 these matters than we do, and if we take that expression of opinion into account and have a genuine democratic input into the decision-making process, I believe that money will be saved. I must admit, however, that that is not the Bill's major intention.
Clause 15 deals with phasing. It gives to local authorities, public bodies and others the right to express their views as to when each section of the Bill should be applied, in consultation with the appropriate Minister.
As the Bill makes its way through the House, a great deal of public interest will be expressed. I believe the support which is already known to exist among hon. Members will grow and will influence our deliberations. I am delighted that organisations such as the Convention of Scottish Local Authorities, the Association of Metropolitan Authorities, the Association of Scottish Local Health Councils, Care in the Community—the Scottish working group—the Association of Directors of Social Work in Scotland and numerous voluntary organisations and individuals throughout the country have expressed their support for the principles of the Bill. I am delighted that we are reflecting the opinions of people who have done so much for the disabled and with the disabled and, above all, the disabled themselves. Disabled people within our society represent enormous potential for themselves, for the community, for their environment and for the nation. That is something that the Bill seeks to acknowledge.
Over 10 years ago, the United Nations General Assembly adopted a declaration on the rights of disabled people and called for national and international action to ensure that it would be used as a common base and frame of reference for the protection of those rights. The declaration said:Disabled persons have the inherent right to respect for their human dignity. Disabled persons, whatever the origin, nature and seriousness of their handicaps and disabilities have the same fundamental rights as their fellow citizens of the same age which implies, first and foremost the right to enjoy a decent life as normal and full as possible.I believe that the Bill represents a small step in that direction. Given imagination and positive support, I believe that it represents a major beacon which, in time, the rest of the world may wish to copy.
§ Mr. John Hannam (Exeter)
I apologise for the fact that I have a bad cold, so I will keep my comments brief. I am an extremely enthusiastic supporter of the Bill and am proud to be one of its sponsors. I should like to congratulate the hon. Member for Monklands, West (Mr. Clarke) for his choice of legislation and the way in which he has presented it to the House. He was fortunate to draw such a high place in the ballot but the disabled in Britain are more fortunate in having such a good champion of their interests.
I was not so lucky in the ballot. I drew number 19, but I am endeavouring to secure a second Reading for my Corneal Tissue Bill which will help with the increased provision of eye transplants. I am celebrating today because I have just received a letter from my hon. Friend the Under-Secretary of State for Health and Social Security stating that the Government are able to give full support to that Bill. Therefore, I hope and trust that it will start its passage later today.
This Bill is a very good one. As the hon. Member for Monklands, West has stated, it has received little publicity 1354 in the press as it is not an eye-catching Bill. It is not as eye-catching as some of the other matters that are taking place in London today. However, it is important for disabled people and has been strongly supported at local level. Its effect will be to pull together much legislation and Government policy concerned with the provision of services for disabled people.
The Bill will make all the difference to the quality of decision making and the provision of services affecting disabled people. It is built out of years of experience of the provisions of such services. It picks out aspects of good practice and puts them into legislation. It does not put any additional duties on local authorities to incur extra expenditure. In some ways, as the hon. Member for Monklands, West stressed, it will streamline much of the bureaucracy involved in assessing the needs of a disabled person. I warmly welcome the Bill and I hope that it receives its second reading today.
The Bill is about better assessment procedures and the involvement of the disabled person and his or her representative in that assessment. I should like to highlight a few areas which I believe are particularly important.
Clause 3 is of particular interest to me. It deals with young handicapped people leaving school. The Education Act 1981—on the Bill for which I served—has done much to improve education for disabled children although there is still much to be done. However, for many reasons the Bill did not cover young people moving out of the school system at the age of 16 or 19. That has meant, as we have found through many of our constituency cases, that many children, having received appropriate education and care, are suddenly faced with an array of bodies all of which are reluctant to take responsibility for their needs. That has led to a waste of good resources and practices established during that person's school years.
The Bill builds on many of the practices established under the Education Act 1981, under which the local education authority has a duty to assess a child with special educational needs and to produce a statement of special educational needs. That should take into account the views of the parents and should outline the education authority's view of the needs of the child and how it intends to meet those needs. The Bill provides that the education authority responsible for a child or young person should inform the social services department, at least a year before the person is going to cease to receive full-time education. Not later than three months before that person's education is due to cease, the local education authority will inform the social services department of what further education or training is appropriate for the young person or child. The social services department will then make an assessment of that person's needs within the three months.
I believe that that will bring many advantages without incurring any additional cost. The local education authority already has assessments of the person involved and the social services should, under the Chronically Sick and Disabled Persons Act 1970, be making an assessment of the person. It will mean that the local authority is aware of a person's needs before he or she requires their services. It will ensure improved communication between the local education authority and the social services department which is most desirable in the provision of good community care. It will help to ensure that resources are targeted where they are needed, when they are needed. Local authorities frequently have to spend more at a later stage because of a failure to identify needs in time. It will 1355 encourage forward planning of services and, most important of all, the assessment will involve the young person and his or her representative.
That process must seem like good common sense to most people, but it is not carried out in many authorities. Some do carry out such procedures, but the Bill will ensure that such good practice is universal across the country.
Clause 10 highlights the central principle of the Bill, which is that the needs of disabled people are most efficiently and effectively met if the disabled people themselves are involved in the planning and decision making. It builds on sections 9 to 15 of the Chronically Sick and Disabled Persons Act 1970. That Act provided that a number of specific committees should include at least one person with experience of the needs of disabled people. To a large extent that has been achieved. We have all seen great progress in our constituencies in the involvement of disabled people on various committees. However, it has often led to a token disabled representative being nominated to a committee who is not truely accountable to disabled people. Clause 10 will ensure that such appointments are made only after consultation with the organisation of disabled people. I believe that that is important.
Clause 12 builds on existing practice on access for disabled people. We have made considerable progress in that area in the past few years. In 1985, regulations came into force that will ensure that all new offices and shops and one-storey buildings provide access facilities for disabled people. That is to be extended to cover all new buildings. We hope that it will also be extended to include alterations and extensions. It has now been established that access for disabled people is a genuine planning issue. That took many years to achieve. It was a long battle, but an important result was achieved.
The Bill amends the Town and Country Planning Act 1971. It will ensure that the local planning authority takes into account the needs of disabled people when it reviews or examines matters affecting the development of the area, that it also includes in its local structure plans measures to improve access to the environment for people with disabilities, and that disabled people are provided with adequate information and opportunities to make representations on those matters.
Once again, the Bill is doing no more than building into legislation what is already carried out in some local authorities as a matter of course, and has proved to be good practice. For example, one such matter on which local authorities should be consulting disabled people is pedestrianisation, which is taking place in many of our towns and cities. The Access Committee for England has been particularly concerned about some pedestrianisation schemes failing to take into account the needs of disabled people. What tends to happen is that, when an area is turned over to pedestrians, disabled people lose the facility to park outside the shops in which they wish to shop. It is factors such as that which planners must look at before finalising new schemes.
It is on such matters and on the whole issue of community care that improvements can be made without the local authority incurring any additional costs. Time and again, we hear of decisions being taken that have not accounted for the needs of disabled people, and of bureaucracy ploughing on and not stopping to think about 1356 the implications of a particular decision on disabled people. The local authority then has to pick up the pieces; in the meantime, considerable frustration has been caused to disabled people.
Like other hon. Members here today, and as the hon. Member for Monklands, West said, I have received letters of support from a wide range of local and national organisations, for example from the Devon Association for the Blind, which says that everything in the Bill adds up to good housekeeping. I received a letter from the Spastics Society drawing attention to the fears and worries facing elderly parents about the future of their disabled sons and daughters after their death.
I should like to quote from a letter that I received yesterday from the chairman of the Exeter and District branch of the Royal Society for Mentally Handicapped Children and Adults. It is a wonderful MENCAP branch of which I have the honour to be president. The chairman, Mr. Randall, expresses concern in his letter about the number of mentally handicapped people coming out into the community without proper assessment and preparation of facilities. He writes that in Exeter and District, where we have a good relationship between the health authority and the local community,Occupation in leisure hours, evenings and weekends is at a premium. There are three clubs operating each on one night a week—they are overloaded already and are invaluable to the community and to the authorities who depend so heavily upon their existence, yet they receive no financial help from those authorities.Therefore, we must make sure that there is proper co-ordination between our various statutory authorities—between the health and social services departments, and the education and leisure committees. Clause 4 will help immeasurably in achieving that end.
Disabled people and their carers will at last be brought within a working framework, which began in 1970 with the Chronically Sick and Disabled Persons Act. Since then we in the all-party disablement group have helped to secure much progress. We are proud to help to secure the Second Reading of this excellent Bill.
§ Mr. Alfred Morris (Manchester, Wythenshawe)
It is now virtually an annual custom for the House to debate one or more private Members' Bills on the problems and needs of Britains's 5.5 million disabled people and their families. Yet it is not by any means an old custom. In fact, before the Chronically Sick and Disabled Persons Act 1970, there were entire Parliaments in which the claims of disabled people were never debated at all.
It seems outrageous, even incredible now, but in the Parliaments of 1959–64 there was not one debate on disability in the House of Commons. Going further back, there was not a single mention between 1945 and 1959, in the manifestos of either of the main political parties, of anything that might be done specifically to help people with disabilities.
In congratulating my hon. Friend the Member for Monklands, West (Mr. Clarke) on his choice of Bill, I also most warmly thank him for so strongly maintaining the important new custom of this House. At the same time, I recall with gratitude today the generosity, among many others over recent years, of the right hon. Member for Western Isles (Mr. Stewart) and of my hon. Friend the Member for Liverpool, West Derby (Mr. Wareing), who 1357 unhesitatingly used their good fortune in the ballot for private Members' Bills to advance the claims of disabled people.
The new custom of which I speak owes much to the work of the all-party disablement group in the House and, in particular, to the untiring endeavours of my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) and the hon. Member for Exeter (Mr. Hannam), as its officers. It was the all-party disablement group, in its early stages, which made my task much easier than it would otherwise have been in securing the enactment of my Chronically Sick and Disabled Persons Bill in 1970. The group's officers helped to build a unity of purpose in the House which, against very daunting odds, vouchsafed the Bill's enactment. In the entirely new climate which the measure created, spending on services and benefits for chronically sick and disabled people rose in the Act's first decade and, under successive Governments, from £330 million in 1971–72 to £3,030 million in 1981–82. That, too, in no small part, was the all-party disablement group's achievement.
§ Mr. Alexander Eadie (Midlothian)
My right hon. Friend has given a chronology of the events. I hope that he remembers the legislation that I introduced, the Education (Mentally Handicapped Children) (Scotland) Act 1974. It was readily taken up by the present Lord Gray of Contin and it made a tremendous difference to the mentally handicapped, as it meant that children in Scotland were no longer deemed ineducable.
§ Mr. Morris
I well recall my hon. Friend's important initiative in 1974. There are many other Bills that pressure of time makes it difficult for me to mention today. I am grateful also, of course, to the hon. Member for Caernarfon (Mr. Wigley), among others, for the very important Disabled Persons Act 1981. May I just say, too, that it will be wrong for me to give way to right hon. and hon. Members this morning, as much as I would like to. This is because I know that the Minister is under pressure of time. I naturally want him to have full opportunity to reply to the debate.
In referring to the influence of the all-party disablement group in all that has been achieved for chronically sick and disabled people, I must also briefly mention the untimely recent death of the right hon. Sir Neil Marten. He was a distinguished member of the group over many years and was of enormous help throughout the proceedings on the Chronically Sick and Disabled Persons Act. He was fearless, incredibly industrious and a strongly principled man of the highest integrity. I mourn his passing, as I feel sure will the House as a whole.
My hon. Friend's Bill aims to ensure fuller and more humane implementation of the Chronically Sick and Disabled Persons Act in the conditions of today. It is a private Member's Bill eminently worthy of the name. Many such Bills are, in fact, Government Bills masquerading as private Members' Bills. They are sponsored by hon. Members who win high places in the ballot for a reward of the whole range of help available to Ministers in promoting legislation. Not only their Bills, but often their speeches, are wholly drafted for them. They are briefed by civil servants on every aspect and detail of the legislation and its effect, and, among other favours, are guaranteed not just the benevolence but the practical assistance of the Government Whip's Office. That was not 1358 the primrose path chosen by my hon. Friend. He has opted for the hard and hazardous road of presenting a private Member's Bill properly so-called and richly deserves the reward today of achieving a unanimous Second Reading for his Bill.
My hon. Friend opened the debate with a speech that was at once well-informed, persuasive and characteristically sincere. He was strong on issues of principle and flexible about the means of giving them effect. The content and manner of his speech will have won him support on both sides of the House and, from this Opposition Front Bench, I pledge our full support for the aims of this Bill.
There will be many technical and drafting points to consider in Committee and all of us know that the Bill will not solve all of the problems to which it is addressed. Yet it provides a new framework for progress and we, on this side of the House, will play our full part in detailed discussions on the Bill upstairs. The only real issue today is whether the Bill should go to Committee and we have no doubt whatever that it should so proceed.
Over the years since 1970, millions of people with disabilities have been helped by the provisions of the 1970 Act, but the emphasis in many localities has too often been on what the providers thought best, with little if any attempt to consult disabled people or their representatives. The single most important aim of my hon. Friend's Bill is to give disabled people a much bigger say in the making of decisions that crucially affect their own lives. It asserts the right of disabled people to an active involvement in the assessment of their needs and is strongly endorsed by their organisations.
There can be few hon. or right hon. Members who have not been moved by the extent of the support for this Bill among the voluntary organisations that work to make life better for disabled people. The Bill's recognition of the importance of assessing the needs of carers is very widely welcomed in the voluntary sector, as is the call for an annual review of community care plans for children and adults in long-stay mental handicap and psychiatric hospitals. It is a Bill about trying to bring representation into rehabilitation which can do much, given the support it merits, both to improve the quality of life of people with disabilities and to ease the strain on families.
The Bill is wholly consistent with some of the major aims of the world charter for disabled people, the international drafting committee of which I had the honour to chair as the first ever Minister with responsibility for the disabled, and which the Prime Minister "warmly welcomed" on behalf of the British Government at 10 Downing street on 11 November 1981. That alone entitles the Bill to the Minister's approval and I hope that, when he speaks today, he will do so in full support of its provisions—indeed that he will pledge himself to help in strengthening the Bill, wherever possible, when we come to discuss it in more detail in Committee.
When this Government came to power, they promised to single out disabled people for special help. Yet all of us know, on both sides of the House, from our mailbags, as from our meetings with disabled people, that they complain today of being singled out for special hardship. They insist, with total justification, that they have been pushed to the back of the longest and most heartbreaking queues in Britain, those for jobs and homes, and of being the victims of some of this Government's unkindest cuts of all. I was given last week, by Peter Large of the 1359 Disablement Income Group, who is held in the highest respect in all parties, a list of 12 very damaging actions by the Government against disabled people since they came to power. It is an indictment as formidable as it is authoritative.
The disabled and their families suffer disproportionately from cuts in social spending. Special housing provision for the disabled has slumped disastrously since 1979, while housing adaptations have also been much more difficult to secure. For many, the tragic cost has been to lose their independence and their reaction is often one of anger when people in authority talk piously of community care. If anyone doubts the seriously adverse effects for disabled people of the sustained assault on local government spending over recent years, let them look at the published statistics of help made available under the Chronically Sick and Disabled Persons Act since the Government came to power.
This debate gives the Minister an opportunity to make some amends. I hope that he will put to shame the Ministers who responded for the Government to the important Bills of the right hon. Member for Western Isles and of my hon. Friend the Member for Liverpool, West Derby, both of which were defeated by procedural manoeuvring of the shabbiest kind. I hope the right hon. Gentleman will also take the opportunity that this debate provides to deal as conclusively as he can with questions of current concern which, if unanswered today, are bound to recur in Committee.
First of all, there is the question of charging for home helps. It is the Government's policy, confirmed by one DHSS Minister after another, that local authorities should not charge people who are provided with home helps, under the Chronically Sick and Disabled Persons Act, if they are in receipt of supplementary benefit. Yet many such people are still charged for their home helps. Take the case of the London borough of Barnet, whose policies affect the Prime Minister's own constituents in Finchley. That local authority still imposes home help charges on disabled people in receipt of supplementary benefit—including disabled constituents of the right hon. Lady—and I approached her about it on 1 December last to see whether she could help to have the policy urgently reviewed. I told her of the very deep concern, among organisations of disabled people, that the Government's policy is being flouted in the Prime Minister's own constituency and at the expense of the most needful of her electors. Seven weeks later I have still not had her reply.
The rationale of excluding people on supplementary benefit from home help charges is, of course, that very often the only alternative to helping them to live at home is to admit them to hospitals or other institutions at far greater cost to the taxpayer and/or ratepayer than the cost of providing a home help. That is why it is against their interests and is self-defeating to charge disabled people for their home helps if they are on supplementary benefit. I hope that the Minister will now strongly reprove Barnet and the other authorities which still force disabled people into making the choice of paying for their home helps or economising on food and warmth. It is a grossly reprehensible policy that amounts to kicking people when they are down. I implore the Minister to speak out against it loud and clear today, since it makes no sense whatever to threaten the independence of people who, if they are 1360 forced into institutional care, involve central and/or local government in far more public expenditure than the cost of help in the home.
Home helps are unquestionably one of the most cost-efficient of all sources of assistance to disabled people. Yet in most localities there are now fewer home helps than the DHSS's own recommended minimum of 12 per 1,000 of the population. The Liberal-controlled Isle of Wight provides less than one quarter of the Government's minimum. With one exception, all of the councils at the top of the league are Labour-controlled or built up their home help service during a recent period of Labour control. All of the councils at the bottom of the league, with the exception of the Isle of Wight, are Conservative-controlled.
Newcastle upon Tyne has 16.25 home helps per 1,000 of the population, compared with Barnet's 3.96; and Lewisham has 15.25, compared with Surrey's 3.47. Ironically, the reward for the caring councils is to be branded by the Government as overspenders and they are financially penalised for refusing to cut the provision they make. How can that possibly be justified by Ministers who profess a commitment to community care?
The Minister will know, from his colleague the Minister with responsibility for the disabled, of the concern expressed to the Government by organisations of disabled people about the effect on the most caring local authorities of the Government's proposals for changing the social security system. In particular, there is concern about their ability to cope, even with their legal responsibilities to disabled people, if the present system of single payments for exceptional needs is abolished.
Many voluntary organisations see the Government's proposal to replace these payments by a cash-limited social fund as a step towards passing the "final safety net responsibility" for claimants in urgent need from the DHSS to local authorities. At a time when brutal cuts in the Government's rate support grant already involve agonising choices for councils, that is a deeply worrying prospect. In fact, as described in the White Paper, the social fund is akin to sealing the valve on a pressure cooker while keeping the heat going. Sooner or later, as compelling needs are no longer met, there will be an explosion. The social fund is, as Action for Benefits has said:a disaster waiting to happen that will have grave social consequencesIn the week before the Christmas recess, on 17 December, the Minister with responsibility for the disabled met the all-party disablement group to discuss the Government's proposals in the White Paper. He was told in detail of the anxieties of the organisations of and for disabled people. The Spastics Society had commented on the proposals in a paper headedProgramme for Disaster for Disabled People",while the Disability Alliance described them as:pernicious proposals which will hit the poorest and most vulnerable groups in society.Is there any likelihood that the arguments put to the Minister with responsibility for the disabled on 17 December will soften the Government's proposals as they affect disabled people?
I raised with the Minister with responsibility for the disabled the case of Jennifer, a severely disabled person who is also housebound and incontinent. The Government's proposals will, in the Spastic Society's 1361 view, create for her "a major crisis". Jennifer also has renal failure and is treated by dialysis. She now receives £23.30 in additional allowances as follows: heating addition—she is housebound—£5.45; diet addition for her renal failure, £10.65; laundry addition because of her incontinence, £1.80; bath addition because of her incontinence, £3.90; and special wear and tear on clothing, £1.50.
According to the White Paper's illustrative figures the disabled person's premium is to be pitched at £12.25, or only half of what Jennifer and other severely disabled people like her now receive. If she is put under pressure in that way, there may be no alternative to institutional care, and the whole purpose of my hon. Friend's Bill will be shamefully subverted. It is a matter of some urgency, therefore, for the Minister to say whether the criticisms we raised with the Minister with responsibility for the disabled before the recess have had any effect on the Government's thinking.
Ministers are never slow to pay tribute to carers. As the number of very elderly people in the population goes on rising, the extent to which we depend as a community on the unpaid labour of their friends and relatives also increases. As the cared for grow older, so do the carers, which is why clause 5 of my hon. Friend's Bill is so essential. If the carer breaks down, either physically or emotionally, the state has two disabled people to look after instead of one.
Over recent years we have seen how failure to provide adequate community care involves higher costs for the community in the long run. I refer to the sharp upsurge in supplementary benefit payments to support people in private residential homes. The early intervention that the Bill proposes will, in the view of many experts, actually save resources. The Government must in this debate clarify their social security policy for carers. I appreciate the Minister's problem, and that his hon. Friend the Parliamentary Under-Secretary of State for Scotland may respond later in the debate where he himself cannot do so.
Are the Government willing to face further humiliation in the European Court over extending invalid care allowance to married and co-habiting women? Again, how can they possibly justify cutting the supplementary benefit entitlement of carers in their White Paper proposals? Today carers may receive the long-term rate of supplementary benefit after a year, but in the White Paper they are treated in the same way as an unemployed person. I ask the Minister to comment on that when he replies, and must remind him that it is just not good enough for the Government to ask us to await the results of their prevalence study of people with disabilities, which will not be available for several years.
By definition of the word "family", if one member is disabled the whole family will probably be involved in the problems of disability. That is why it is the merest mistake to think that the problems of disability affect only the 5.5 million disabled people in Britain today. As I argued when commending my own legislation to the House, the mother of a disabled child is affected, like the child of a disabled mother. With millions more they, too, are involved in the problems of disability, and the involvement of family is nowhere stronger than it is in the case of disability caused by mental illness. When mental illness strikes, as in the case of schizophrenia, the family as a whole can be devastated by its consequences, and it is the beginning of 1362 wisdom in any discussion about disability to realise that very often one can only help the disabled person in the context of family.
I most warmly congratulate The Times and, in particular, Marjorie Wallace on her superb series of articles on schizophrenia, for which she richly deserves a major journalistic award. In a powerful leading article on 19 December, The Times put some very important questions to the Government, which deserve the Minister's attention today. I ask him to respond, in his speech, both to that leader and the eloquent message of the articles by Marjorie Wallace. I hope also that he will acknowledge the relevance of the Bill to many of the issues that were raised.
In its leader of 19 December, The Times said:The policy of making care in the community available is the right one. It is the execution which is proving weak.it sought a closing of the gap, as my hon. Friend's Bill does, between precept and practice and, under the very apt headingEase a Tragedy, Stop a Scandalit challenged the Government to recognise both the urgency and compelling importance of ensuring that people with schizophrenia, like other victims of mental illness, receive the right help, in the right place at the right time. It was worthy of the attention of everyone in positions of responsibility for the mentally ill.
Through lack of clear ministerial guidance, many needful families have been unaware that the Chronically Sick and Disabled Person Act applies, where appropriate, as much to the mentally ill and the mentally handicapped as to people with physical and sensory disabilities. As the Minister will know, under section 28 of the Act the Secretary of State, where it appears to him to be necessary or expedient to do so for the proper operation of any provision of the Act:may by regulations made by statutory instrument, … make provision as to the interpretation for the purposes of that provision of any of the following expressions appearing therein, that is to say, 'chronically sick', 'chronic illness', 'disabled' and 'disability'.Activating section 28, to make it absolutely clear that the mentally disabled are covered by the legislation is one positive step open to the Government that could have an immediate and beneficial effect for many families now trying to cope with the problems of mental illness who are unaware of their statutory rights under the 1970 Act.
Like other right hon. and hon. Members on both sides of the House I am concerned about the special educational needs of children who suffer from dyslexia. Late last year, there was a High Court ruling which ought to improve the educational opportunities of many thousands of such children. It was held that the Hampshire education authority's refusal to recognise that a 13-year-old boy with dyslexia had special educational needs—and to make special provision for him—was based on an error of law. That case prompts me to say that it is perhaps timely for section 27 of the 1970 Act, which deals with special educational treatment for dyslexic children, to be reviewed when my hon. Friend's Bill reaches Committee. The Minister may wish to discuss this with his colleagues at the Department of Education and Science as consideration of the Bill proceeds. Meanwhile it will be helpful to the House, as to the parents of all dyslexic children, to know what study the Government have now made of the implications of the ruling in the Hampshire case and what action they propose to take.
1363 The parents of dyslexic children are not alone in wanting to see the Government's rhetoric matched by realistic action to relieve their anxieties. My friend Peter Mittler, the professor of special education at the university of Manchester, with responsibility for the training of teachers of children and young people with special educational needs, told me only this week of the daunting difficulties he and his colleagues are facing. They are involved in a programme of teacher re-education in consequence of the Education Act 1981, and their centre at Manchester university is a world leader in the field of special educational needs. They provide a wide range of courses, both part-time and full-time, in which large numbers of teachers and psychologists are being trained for positions of responsibility in meeting special educational needs in ordinary schools. Yet, although they are at the sharp end of implementing the Government's policy in this field, their work is constantly undermined by a crippling shortage of resources.
Professor Mittler writes:To give you just one example, we had to abandon one of only four courses in this country in the education of children with social and emotional difficulties. Only London University now has a course on working with what used to be called maladjusted pupils—surely a high priority, since ordinary schools are not succeeding in retaining and teaching these pupils, with the result that increasing numbers of them are being sent to special schools, contrary to national policies and professional advice. We have tried to retain some aspects of our teaching in this field by buying in part-time help, but there are no funds to continue this work next year.In a strongly compelling passage in his letter, Professor Mittler goes on to say:The education of the children of this country, and the training of those who teach them, is a higher priority than spending more than £1 million a day in maintaining a presence in the Falklands, not to mention the billions of pounds we spend without question on nuclear armaments.He believes, as I do, that politics is fundamentally about priorities and the allocation of resources, and that this country cannot afford to neglect the education of its handicapped children. He makes the point, as I have done in many recent debates on disability, that the problem of meeting the legitimate claims of disabled people, not least of disabled children, is basically one not of resources but of political will and priorities. The right hon. Gentleman may like to comment on Professor Mittler's deeply disturbing statement to me.
I hope that the right hon. Gentleman will also comment on the case for reconsideration of the provisions of section 22 of the 1970 Act, which requires a report to Parliament each year on progress made in research and development work carried out, by or on behalf of any Minister of the Crown, in relation to equipment that might increase the range of activities and independence or well-being of disabled persons and, in particularly, such equipment as might improve their indoor and outdoor mobility. The annual reports which have been presented under section 22, many of them of high quality, are of the first importance to disabled people and their organisations. They are all too often unplublicised and unread, which is why many informed people feel that there should now be a requirement for them to be debatable by Parliament. The necessary amendment to section 22 is one that we could perhaps consider in Committee. If we can do so, it will be seen as a positive step by disabled people and by many right hon. and hon. Members on both sides of the House.
1364 The very sharp differences in what different local authorities now provide under section 2 of the 1970 Act alone justify the main provisions of my hon. Friend's Bill. The Royal Association for Disability and Rehabilitation is to be congratulated on its work in producing a code of practice for use by local authorities in implementing the Act. The code gives valuable guidance on both assessment of need and the provision of services but, in supporting my hon. Friend's Bill, the royal association now appeals with all of the other main organisations for a strengthening of the Act itself.
In this regard, I was pleased to note a point made by the hon. Member for Hornsey and Wood Green (Sir H. Rossi), speaking as a former Minister with responsibility for the disabled in the present Government. He made plain his dissatisfaction with the way in which section 2 of the 1970 Act is now too often applied when, in July 1983, he said:Local authorities are both 'judge and jury' regarding assessment of need and there is no right of appeal; perhaps a disabled person should have recourse to the Courts instead of having to work through the Secretary of State for Social Services.My hon. Friend's Bill does not go that far, but, if the present Minister feels that his predecessor's view should be looked at in Committee, I am sure that my hon. Friend will want to respond sympathetically and that he will be pleased to look at any proposition that is put to him, from either side of the House that can strengthen and improve the provisions of his Bill. As of now, the former Minister's statement strongly underlines the moderation of my hon. Friend's approach. He wants to work closely with everyone who can assist him and the House for the sole purpose of helping some of the most needful people in this country.
The Act which this Bill seeks to amend, and whose 15th anniversary was marked by our debate last June, reached the statute book entirely without party animus. Everyone who spoke, whether here on the Floor of the House or upstairs in Committee, seemed to know the value of things as well as their cost. It was a rare parliamentary moment when unity of purpose, in an important cause, triumphed over every other consideration, and when innumerable people and organisations outside parliament worked with us to achieve lasting progress for disabled people.
In their thousands, those people and organisations helped to transform the whole climate of parliamentary and public opinion from one of, at best, benign charity to one of acceptance that disabled people are entitled to live independent and dignified lives as full members of the community. Their 'Word Charter' asserts that disabled people have the same rights as all humanity to grow and to learn, to work and to create, to love and to be loved. That is the philosophy of my hon. Friend's Bill, which is why he deserves all possible support and success in his endeavours.
§ The Minister for Health (Mr. Barney Hayhoe)
I congratulate the hon. Member for Monklands, West (Mr. Clarke) on his good fortune in coming first in the ballot—that is the essential element—and on his choice of subject. There are notable precedents for using private Members' Bills to legislate on services for the disabled. Indeed, the Bill before the House builds very much on the foundations laid more than 15 years ago by the Chronically 1365 Sick and Disabled Persons Act 1970. I am glad to follow two sponsors of that Act—my hon. Friend the Member for Exeter (Mr. Hannam), whose work in the all-party group is well known, recognised and respected on both sides of the House, and the right hon. member for Manchester, Wythenshawe (Mr. Morris), who has a distinguished record of concern and action on behalf of the disabled.
The right hon. Gentleman paid a rightful tribute to Neil Marten—someone whom I first met at a conference on developments for young people in 1946—which will have been warmly welcomed on both sides of the House. However, I am not sure whether I can say the same about some of the right hon. Gentleman's other comments in his wide-ranging speech. He took advantage of the traditions and procedures of the House, which do not confine a Second Reading debate to matters precisely relevant to the Bill and which permit hon. Members to range as wide as they wish, but within the limitations that you impose, Mr. Deputy Speaker, across other areas. Many of the right hon. Gentleman's points will be more relevant to the Social Security Bill, to which we gave a First Reading earlier today, and I have little doubt that the right hon. Gentleman will return to them during the Second Reading debate on that Bill, if he is fortunate enough to catch the eye of the occupant of the Chair.
A notable absentee from our debate is my hon. Friend the Minister with responsibility for the disabled. He has explained to the hon. Member for Monklands, West why he is not standing at the Dispatch Box speaking on behalf of the Government. But he was able to hear the opening speech in the debate, and I shall have the advantage of his advice when further consideration is given to the Bill. My hon. Friend is bound up with the Social Security Bill, and, as the right hon. Member for Wythenshawe will readily acknowledge, it is difficult to be involved in the Committee stage of a complicated Bill on Tuesdays and Thursdays and then to give adequate attention to the Committee stage of a private Member's Bill, which will normally be considered on Wednesdays.
Although regretting the absence of my hon. Friend the Minister with responsibility for the disabled, I am delighted that my hon. Friend the Parliamentary Under-Secretary of State for Scotland with responsibility for health is here. If provoked, he may intervene on particular Scottish matters, although I know that he wishes to give hon. Members as wide an opportunity as possible to participate in the debate.
I make it clear at the outset that the general philosophy that has inspired the provision of the Bill is, by and large, wholly in line with Government thinking on services for disabled people. A more open style of communication between disabled people and those who provide services for them, better communications between authorities and better co-ordination of services, proper regard for the needs of informal carers are all principles that, in one way or another, the DHSS and the health departments and Scotland and Wales have tried to promulgate and encourage among those working in this sector for many years, and under successive Governments.
I quote just two examples of recent DHSS activity to illustrate the point. On the co-ordination of services, I published only a few weeks ago—at the very end of November—a report entitled "Progress in Partnership" on ways of improving collaboration between health and local authorities in planning and delivering health care and 1366 social services. I have agreed with the local authority and health authority associations about the need to follow up the report as soon as possible with guidance to authorities on joint planning.
With my hon. Friend the Parliamentary Under-Secretary, I participated in a meeting with the local authority associations and others earlier this week.
On informal carers, I remind the House of the recent project of the Department's social work service—now the social services inspectorate—to draw attention to the needs of informal carers and to encourage policy makers, managers and front line workers to consider how support for a dependent person's informal carer could be made an integral part of the range of services needed for effective community care. A number of elements in the centrally-funded programme which is called "Helping the Community to Care" are also specifically concerned with support for informal carers. I join in the tributes to the work that they do and the crucial and vital contribution that they make towards caring and coping with the disabled within the community.
The general principles that the Bill seeks to enshrine are ones that, for the most part, the Government wish wholeheartedly to endorse. This is a Bill whose heart, if I may put it in this way, is very much in the right pine. However, when one turns from general principles to specific provisions, I am afraid that my enthusiasm for the Bill becomes rather less glowing. This is despite the fact that the hon. Member for Monklands, West was kind enough to show me and ray hon. Friend the Scottish Minister with responsibility for health the early draft of the Bill, before it was published. Subsequently, he incorporated a number of changes that were suggested to him into the published version. I think that he will agree that many of the suggested changes made a significant improvement to the Bill. I am grateful to him for the action that he has taken. However, from the Government's point of view, the changes do not go far enough, and some substantial further changes will be needed before the Bill can become a workable measure that the Government can support.
One objection to a Bill such as this, which lays specific and detailed duties on local authorities and others in respect of particular client groups, is that it must inevitably put pressure on local authorities to concentrate some of their effort and resources on one kind of client rather than another. I do not want to make too much of this argument. Physically and mentally disabled people are of course priority groups in terms of Government policies, and much existing legislation—including of course the Chronically Sick and Disabled Persons Act to which I referred earlier—could be described as "client-group specific".
On the other hand, I remind the House that, given the need of all local authorities to control their overall expenditure—and I make absolutely no apologies for the fact that there is such a need—any extra pound that a local authority has to spend on services for disabled people as a result of this Bill could well mean a pound less for other groups which hon. Members might feel should be given at least as high priority—elderly people, the frail, or children at risk. If the resources are constrained, there is no increase and the effect of the Bill is to direct more of those resources to the particular groups with which the Bill is concerned, that inevitably means, as a matter of mathematics rather than a matter of policy, that there are fewer resources available for other groups.
§ Mr. Jack Ashley (Stoke-on-Trent, South)
I appreciate the point that the Minister is making, and that it poses a difficulty for him. However, does he agree that one of the crucial aspects of this Bill which should recommend it to the Government is that it is cost effective and will not cost the Government a great deal of money? Will he endorse that general principle of the Bill?
§ Mr. Hayhoe
I shall continue to make the point that I was making, because I shall deal, at least to a limited extent, with the resources problem that is linked with the Bill.
§ Mr. Dafydd Wigley (Caernarfon)
Does the Minister accept that the Government, in giving certain priority to the needs of the mentally handicapped and mentally ill, must inevitably imply that there should be a resource allocation deserving some priority? If there is no additional priority in resource allocation, surely the Government's words towards these groups are meaningless.
§ Mr. Hayhoe
As the right hon. Member for Wythenshawe said, in the past decade substantial extra resources have been allocated by consecutive Governments. My point is the narrow but important one that if legislation such as this leads merely to a change in the direction to which resources are deployed, it can have the effect of reducing resources for other groups not covered by legislation such as this but which have an equal, or at least some similar, claim upon available resources. Surely my point commends itself to the House. We have to be careful to recall that there are other groups within society—I mentioned the frail, the elderly and children as examples—at risk that also have claims upon public resources.
§ Mr. Thurnham
Does not the pressing need for resources for the disabled, to which the Bill points, emphasise the need for local authorities to use all their resources with the greatest efficiency? This is only a small part of their total revenue, and there need be no need for a diminution of other resources if local authorities use their resources efficiently.
§ Mr. Hayhoe
I agree with my hon. Friend. He knows that this has been the thrust of Government policy on the National Health Service, and much more widely. We are seeking the efficient use of resources. We want to deploy them in the best possible way by delivering care and services where they are most needed. I am glad that at least on this part of my speech I carry the whole House with me.
There is no doubt that to give local authorities new duties of the sort prescribed in this Bill—in particular, duties as to precisely when and how the assessment of a disabled person's needs should be carried out—will have quite substantial resource implications, although I am not in a position to attempt to quantify them at the moment. However, I and, I am sure, all right hon. and hon. Members have seen the briefing that has been provided by the Association of Metropolitan Authorities. One paragraph of its letter states:The Bill, as it stands would increase expenditure on service provision very significantly indeed. Additionally the administrative structures and staff to support the formal assessment and appeals system which the Bill seeks to introduce would be a costly business. We do not object to the Bill in principle but we believe that the expenditure implications are formidable.1368 May I now say something about the Association of County Councils, because it is wise to get the views of both of these major local authority associations clearly on the record. The ACC says:There is a further point which causes concern, that of over-bureaucratisation … Indeed, at a time of scarce resources, it could be argued that the money which might otherwise have been spent on administrative processes to the benefit of no one.I take into account what my hon. Friend the Member for Bolton, North-East (Mr. Thurnham) said a moment ago—that very few right hon. and hon. Members would argue that resources ought to be diverted away from care and services for the disabled to administrative purposes.
§ Mr. Tom Cox
Is the Minister for Health aware that what he is saying will be received with utter disbelief by the very people who are looking to my hon. Friend's Bill for help? There are two old psychiatric hospitals in my constituency. If we are to get people out of them, financial resources are needed in this area, otherwise they will remain there and all this talk will be meaningless.
§ Mr. Hayhoe
If the hon. Gentleman is arguing in favour of the Bill because it will lead to a significant extra flow of resources into the areas with which the Bill is—concerned, he is making the same point as I am making—that as it stands the Bill can lead to an extra flow of resources. But it will not go necessarily to the client groups to which the hon. Gentleman has drawn attention but to the bureaucratic processes. I should have thought that nobody would want that to happen.
§ Mr. Hayhoe
I should prefer not to do so at this stage, because the sharp criticisms that I have made of the Bill's provisions are not my words but those of the Association of Metropolitan Authorities and of the Association of County Councils.
§ Mr. Wareing
I am grateful to the right hon. Gentleman for giving way. A number of right hon. and hon. Members have received the AMA's briefing, and the Minister for Health is perfectly correct in saying that it points to the serious financial implications of the Bill. However, if he looks at the last paragraph of the AMA's letter I am sure that the Minister has to admit that it is not true that the AMA is saying that what is needed is simply a movement of resources from one priority area to another within the existing budget. In its last paragraph the AMA says:It is for the government to decide whether or not to give effective support for this Bill and we hope that you will be able to urge the necessity for such support.As the Minister for Health has responsibility for disabled people, it is for him and for his right hon. Friend the Secretary of State for Social Services to use their muscle in Cabinet to get such resources for local authorities. I am sorry to intervene at this point, but I understand that the Minister has to leave the House, which will probably be before I am able to catch your eye, Mr. Deputy Speaker.
§ Mr. Hayhoe
I do not think that I misrepresented the AMA's position in any way. I quoted the points that it was making. The record will show, I think, that in no way did I misrepresent what the AMA said. The hon. Gentleman must have misunderstood me. When he looks at the record I think he will find that that is so. The Bill's sponsors may well reply—indeed, this is implicit in one or two of the comments that have been made—that the Bill requires 1369 all authorities only to do what the best of them are doing already. But local authorities must have the right to order their own priorities within the broad framework prescribed from the centre. If this Bill were enacted, it would be bound to inhibit them to some extent from doing so.
The basic difficulty here, I suggest, is not the general principle of legislation relating specifically to disabled people. As I say—and I pay tribute to those concerned—there are distinguished precedents for that. However, the detailed nature of many of the specific provisions in the Bill are, in the Government's view, a recipe for inflexibility, bureaucracy, legalism and waste. We are sustained in that view, to some extent at least, by the briefing we have had from the local authority associations.
§ Mr. Tom Clarke
I am sorry to intervene, but I understand that the Minister for Health will be leaving the Chamber at a later stage.
§ Mr. Hayhoe
Perhaps I can clarify this matter. Many hon. Members seem to be wholly misinformed—I think inadvertently — by the right hon. Member for Wythenshawe. I said merely that I hoped, as is not abnormal in these circumstances, to be able to slip out of the Chamber for a brief time during the course of the five hours that might be devoted to this debate and I thought that it would be useful to make the Government's position clear before doing so. I intend to leave the Chamber, but of course I shall return to listen to and take note of what is said later in the debate.
§ Mr. Clarke
Will the Minister for Health accept from a former president of the Convention of Scottish Local Authorities, which supports the Bill, that there has hardly been a measure introduced by any Government of whatever political complexion upon which local authorities have not said precisely the kind of thing that they are saying in those briefings and that there has hardly been a time when Governments of all political complexions have not dismissed the representations and said that the local authorities ought to try to make better use of their resources?
§ Mr. Hayhoe
There is something in what the hon. Gentleman says. However, one needs only to look at the detailed prescription that is contained in many of the Bill's clauses—a matter to which we shall return if the Bill is given a Second Reading—to see that in many areas it imposes a new bureaucratic burden upon the local authorities and, indeed, upon others. This detailed and over-prescriptive approach appears throughout the Bill. The worst offenders are clause 6—procedures for assessment—and clause 7 which seeks to transplant a procedure from the Education Act 1981 and transform it into a provision for adult disabled people, a proposal about which the Government have already expressed scepticism in their response to the recommendations relating to community care of the Select Committee on Social Services.
There are other examples. In the Government's view, legislation should provide a framework within which services can be developed locally, not the sort of detailed prescription which is set out in the Bill. Potentially, the Bill could provide a basis for building some modest extentions to the existing strategic framework within which services for the disabled are provided. But if, as I expect, the House gives the Bill a Second Reading, a lot 1370 of work will be needed to remove some of the bureaucratic excesses and let the basic framework of principle emerge. But those are matters for the Committee and Report stages.
The Government applaud many of the ideas behind the Bill, but to its individual provisions our attitude is one of sceptical neutrality. I cannot positively commend the Bill to the House in its present form, but neither do I oppose its Second Reading. If the House takes the view that the Bill merits further detailed discussion, I hope that the hon. Member for Monklands, West and his sponsors will be prepared to respond constructively to amendments, some perhaps radical and substantial, which the Government will bring forward. If they do, it is likely that at the end of the day they will be responsible for a Bill that provides a useful if modest development of the present legislative basis on which services are provided for disabled people. That is a worthy achievement for any Member of this House.
§ Mr. Jack Ashley (Stoke-on-Trent, South)
I warmly congratulate my hon. Friend the Member for Monklands, West (Mr. Clarke), not only on his choice of subject for the Bill, but on the admirable way in which he presented it this morning. The fact that he was so reasonable should commend the Bill to the House. Indeed, the Minister has told us that my hon. Friend has been very reasonable in his discussions with the Department and in seeking to accommodate it so that the Bill could proceed unimpeded.
A number of people have helped in the preparation of the Bill. The all-party disablement group was only too delighted to give all the support that it could. I pay tribute to Peter Mitchell and John Healey who have made a major contribution to its preparation. We appreciate their work both for the all-party disablement group and in the preparation of the Bill.
Given the help that we have had and given the good will on all sides of the House, I was deeply disturbed by the Minister's speech. He began well by saying that the philosophy of the Bill was in line with Government thinking. That is fine—anyone can agree with a general philosophy. I suppose that Adolf Hitler could have said that Churchill's philosophy was in line with his—peace in our time. But that general philosophy led to war between our two countries when it came to the detail of interpreting the philosophies of Nazi Germany and Great Britain.
The application of the general philosophy as adumbrated by my hon. Friend the Member for Monklands, West and the general philosophy as explained by the Minister may appear to be the same. However, what the Minister said about the application of that philosophy shows that we are diametrically opposed in the implementation of the Bill.
The significance of that is that the Government may basically oppose the Bill. I hope that they will not do so on Second Reading today. Some influential members of the Conservative party are on record as supporting the Bill. I pay a warm tribute to the hon. Member for Exeter (Mr. Hannam), whom I feel I should call my hon. Friend. He supports the Bill and I hope that he will vote in favour of it, together with his colleagues who have also expressed their support. We need the support of those Conservative Members in Committee, assuming that the Bill reaches 1371 Committee. If the Bill is emasculated in Committee, we shall be left with nothing. I beg Conservative Members to support the Bill both in principle and in detail.
I understand that the Government cannot simply accept the Bill as it stands and that they will seek to amend it in Committee. However, I hope that the changes will not be so great as to make the Bill a nonentity. We need a great deal of understanding and co-operation, and the Minister's remarks upset me deeply. I hope that he will not push his points too far.
The Minister spoke of the costs of a bureaucratic burden. I think that he misunderstands what is required which is simply planning by local authorities to ensure that the disabled people provided for in the Bill have the benefit of planned transition from one stage to the next. The young disabled at school, the mentally handicapped in hospitals and the carers all need that sort of help. The whole aim of the Bill is to help them at the trigger points. We must plan those transitions. They may mean to some people bureaucracy, but to dismiss the idea as bureaucratic is the wrong approach.
We know from our discussions in the all-party disablement group that local authorities are jealous of their autonomy. We respect that autonomy, but we cannot leave this matter to local authorities alone because their provision is far too patchy. The Minister must intervene and put pressure on local authorities. He must insist that they provide resources that make it easier for the disabled to cope with their difficult periods. Therefore, there is no point in the Minister talking about the autonomy of local authorities.
The Minister quoted the AMA and the ACC, but was he doing so with approval? If he was, those words were really his words, even though he was quoting their words, his words were put into the mouths of the AMA and the ACC.
I am anxious not to make a long speech because I frown on long speeches. I shall briefly refer to my other points. The Bill confers new rights on disabled people, which is why I commend it to the House. They will have the right to information about themselves and the right to be involved in their cases. That is of paramount importance. The Bill gives a voice to those who hitherto were silent. It ensures open government for the disabled, which is something that we badly need. This Bill tackles the indifference and apathy of authorities and institutions and takes the disabled further along the road to equality. It enables them to have more control over their own destinies and helps them to make or to be involved in decisions about them. The Bill is a blow to the patronising attitude of so many people and it buttresses the self-respect of the disabled.
The Bill tackles long-standing scandals arising from society's neglect of the disabled, and my hon. Friend the Member for Monklands, West mentioned three groups in his admirable speech. He referred to handicapped school leavers, the mentally handicapped who leave hospital to live in the community, and carers. These groups have all suffered from an administrative failure to identify their needs, and there is no point in the Minister saying that helping them will cause bureaucracy. I hope that the Minister will change his view and his mind on that issue.
Handicapped children are protected while they are at school but they are neglected on leaving school. Their real 1372 needs should be recognised. The sad reality is that they go out in the world to face prejudice and sometimes derision. The stage at which they really need help is when they leave school.
The mentally handicapped who are leaving hospital represent the latest scandal. It is scandalous that mentally handicapped people should leave hospital, be confronted with normal responsibilities and find themselves bewildered. They go out into the big, wide and hard world without any help. They are people who can slither into miserable oblivion unless we can give them the sort of help that they need.
I pay tribute to what the Government have done for carers. I acknowledge that they have tried to help them but, unfortunately, they have not done enough. I hope that carers will be helped further.
The Government have helped to get children out of mentally handicapped hospitals but not enough has been done for them. A significant number have left the hospitals but those who are discharged find that there is no proper assessment of their needs. The Bill will ensure that they are properly assessed, which is a vital requirement.
Disability is always an individual affair and specialist and comprehensive assessment is vital. It is an individual matter and even the same diseases can have variable effects. In conferring new rights on the disabled, the Bill establishes good practice and ensures a framework for good service provision.
I have seen enough of the present Minister for Health to believe that he is a reasonable man. I believe that he is amenable to argument. I am aware of the constraints that he has to face and I know that his Department is faced with cash problems, for example, but I emphasise that the Bill is a low-cost measure. It does not demand massive expenditure. It goes a long way to provide new rights for three groups of vulnerable people and I hope that it will be given a Second Reading. I hope also that we shall all try to be reasonable in Committee. I trust that the Government will not try to emasculate it.
§ Mr. Wareing
On a point of order, Mr. Deputy Speaker. I think that you will agree that my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) is a respected standard bearer for the disabled and that his speeches need to be considered. Is it not a convention of the House that, when a right hon. or hon. Member has spoken, he remains in his place to hear at least the speech of the Member who is called to take up his remarks. I think that it is discourteous for the Minister to absent himself from the speech of my right hon. Friend.
§ Mr. Deputy Speaker (Mr. Harold Walker)
The Minister referred to his necessary absence from part of the debate.
§ Mr. Peter Thurnham (Bolton, North-East)
I congratulate the hon. Member for Monklands, West (Mr. Clarke) on his good fortune. I well remember the excitement of the ballot. I was present at the draw. Statements were made on how many Members would pledge themselves to introduce another Bill to follow the measure about which we heard so much during the previous Session, which fell into the trap of being highly controversial.
First, I congratulate the hon. Gentleman on his good fortune. Secondly, I congratulate him on his wisdom in 1373 choosing such an important subject to take up in his Bill. As my right hon. Friend the Minister for Health has said, it is a warm-hearted Bill which has the support of both sides of the House. It seems that it will not run into the dangers of other private Members' Bills. At least, I hope that it will not. I heard my right hon. Friend the Minister for Health say that he was sceptical about some of the detailed clauses, but, I was pleased to hear the Government say, through my right hon. Friend, that they support warm-heartedly the ideas that are behind the Bill. I hope that that commitment will come through in Committee. It is obvious that a great deal of detailed work will have to be done at that stage.
It is so important for a Back Bencher to choose a subject that will ensure the safe passage of his Bill through the House. We learned in the previous Session that a Private Member's Bill can face opposition that is 99 per cent. based on procedural matters and 1 per cent. on content. We saw some extraordinary manoeuvres during the passage of the Bill that Mr. Enoch Powell attempted to introduce. I am pleased that the hon. Member for Monklands, West did not fall into that difficulty, especially as he had been involved in Mr. Powell's Bill as a member of the Committee that considered it. He must have been subjected to pressure to bring such a Bill before Parliament again.
At this stage I should declare an interest. I am not familiar with all the details of the legislation to which the hon. Member has referred, which stretches back over many years, but I have a practical interest in these matters through having brought into my family a handicapped child, who had been in care for many years. For six years he was shuffled from one place to another, and attempts to place him had broken down. He was in good temporary care before he came to my family but he had had six years in care. He had been advertised for 18 months as needing parents while my family and I, who lived only 30 miles away, had had our name down for over two years, having stated that we were interested in fostering or adopting a handicapped child.
I drew attention in an Adjournment debate on 25 November to the need for the Government to give greater help in co-ordinating services to ensure that when would-be parents are available and a child is in need of care, the two parties can be brought together. It is no good leaving these matters to local authorities. We often find that those who are involved are confronted with a sort of pass-the-parcel exercise, with the chances of coming to grips with the problem being submerged in bureaucratic difficulties.
I wish the hon. Member all success with his Bill. I trust that it will have a safe passage through Committee and Report. I am sure that he is relieved to know that no Bill is ahead of his and that no manoeuvres can take place that threaten the passage of his measure or hinder it. I hope that the Government will show commitment and that they will ensure that individual clauses do not give rise to difficulties on the grounds of excessive expense or bureaucratic pressures.
I draw attention to the need for handicapped children to receive special care, especially those who are still in institutions. The campaign which was mounted by Exodus rightly drew attention to the fact that over 500 children are still in hospitals in England and Wales. Throughout the United Kingdom there are probably about 1,000 children in National Health Service institutions, to which we can 1374 add an uncertain number who are, in effect, in long-term care in local authority institutions. I estimate that there are in total about 3,000 children in that predicament.
I welcome the work which is done by the British Agencies for Adoption and Fostering which has placed 2,000 children with special needs and has currently launched an appeal for £200,000 to help with its work in placing the next 2,000 children. The children who are now coming forward for placement are those with the most difficult needs, for whom care is most needed. If people are considering adopting or fostering a child with severe handicap they need to know what care will be available while the child is young and at the difficult stage when the child is 18 or 19 years old and falls into a gap. The Bill rightly draws attention to that latter point and it is that feature of it which I welcome most warmly. The hon. Member referred to 18-year-olds as falling into one of three key areas.
I am particularly concerned about all three of the key areas mentioned by the hon. Gentleman—the 18-year-olds, the hospital leavers and the carers who cannot cope. Adoptive or foster parents of handicapped children are most concerned about just those three areas. They are worried about what will happen to a child when lie or she reaches the age of 18 and what help can be given if the child leaves hospital and the parents fall ill.
I recently received a long letter from a lady in an adjacent constituency who had seen a newspaper article. It is one of the most heart-rending cases that I have heard recently. The hon. Member for Exeter (Mr. Hannam) said that this was not an eye-catching subject and that perhaps there were more eye-catching items in the news this week. But I congratulate my local paper on its treatment of the subject and I am sure that other local papers give full attention to this subject. My local paper the Bolton Evening News drew attention on its front page on 26 November to two forgotten children—case one, David, and case two, Ian—who have been in care, in one case for over five years, while the local authority has tried to find adoptive or foster homes. I am sure that there are people who would like to take them into care and they will be interested in the Bill and whether they will be able to do that and do it with confidence.
We have already touched on the need for respite care and that was dealt with in a recent article by Madeleine Simms in The Lancet on 2 November 1985. She wrote of the dreadful predicament of parents of severely handicapped young adults and she quoted the response of people whom she had been to see. It is appalling to read the remarks of some of those parents who said that they felt that they were imprisoned because of the difficulties that they were facing and the lack of help that was available to them. That shows the serious needs to which the Bill pays attention.
Some parents said that their difficulties were so great that, had they been able to consider an abortion at the time of the pregnancy, they would have opted for it and they could now see no end to their problems. The Bill should rightly help draw attention to such problems.
The Bill has been described as being cost-effective. Let me draw attention to the sort of costs that have been quoted. The latest figure that I have for the annual cost of looking after a mentally handicapped child in institutional care in the Greater London area is £19,000 a year and that excludes capital charges. If people were prepared to adopt or foster children in care, the costs would be less. so long 1375 as respite care and other services are made available. I draw the attention of the House to the fact that voluntary care is available. It is not just a question of money but of co-ordinating all the efforts of those people who are available. I am sure that many more people could be found to help children.
The British Agency for Adoption and Fostering has done a great deal to draw attention to that problem. In a recent book entitled "Against the Odds: Adopting Handicapped Children" Catherine Macaskill says that there has been a revolution. It is a revolution that not all local authorities are properly aware of. The greater the needs of a child the more people who wish to adopt or foster rise to the challenge. Years ago, such children were locked away because it was felt that nobody wanted them. Now it is more like mountaineering—the higher the mountain, the greater the challenge. The more profound the degree of handicap, the greater the child's needs and the greater the challenge to the parents. Not all local authorities are aware of that. They are inclined to think that people who offer to adopt or foster a handicapped child must be odd. In many cases a family which has taken one child is interested in taking another, but the local authority regards them as being doubly odd.
§ Mr. Andrew Rowe (Mid-Kent)
I confirm what my hon. Friend says. Many years ago, I went to the Lennox castle hospital, the largest institution for the mentally handicapped in Scotland, and was told by the medical superintendent there that he was confident that a number of staff working in that institution would not be there if there were not patients in that hospital with a handicap which most local authorities would regard as making them unadoptable.
§ Mr. Thurnham
That illustrates exactly the point that I am making. I recommend that hon. Members should read Catherine Macaskill's book. She says that the revolution started in America and is now here. The British Agencies for Adoption and Fostering have done an excellent job in producing a book called, "Be my Parent" which is available at nearly all local authority offices.
The right hon. Member for Ashton-under-Lyne (Mr. Sheldon) is not here today, but I do not think that he would mind me referring to a parent who wrote to me as a result of the newspaper article on 26 November to describe her dreadful predicament. The letter runs to 16 pages. She has a child, Sarah, who she is barely able to look after any longer. The mother has had to go into hospital for a serious brain operation and she finds that because of the effects of that operation, and the child's growth and greater weight, she can now hardly manage. When she turns to the Thameside local authority she finds that help is not as readily available as she hoped. Her letter is most moving and I only hope that she is now able to get the help that she so desperately needs.
That is the exact predicament which the Bill will deal with. I hope that it will provide that lady and many others like her with a solution to their great problems. That lady has looked after her child for 11½ years. All this time she has assumed that, if she were not able to care fully for the child, alternative care would be available, but she now finds that there is not. The child has the mental age of a one-month-old baby and is incapable of any further development. The child is unable to move properly 1376 although she has been going to a school for day care. The mother now finds that she cannot manage at home, despite the commitment of all the years of care for her daughter. Obviously, she is most worried about what will happen if she cannot continue to care for her.
I conclude by congratulating the hon. Member for Monklands, West on the choice of such an important subject—his ideas are so good. I have not been able to go through the Bill in the detail in which it will be gone through in Committee, but I hope that the Government will be able to come to an understanding with the hon. Gentleman about the detailed provisions so that the Government can give full support not only to the ideas but to every word of the Bill.
§ Mr. Tom Cox (Tooting)
I join the many other Members who have paid warm tribute to my hon. Friend the Member for Monklands, West (Mr. Clarke) for introducing the Bill. As we know from the people we meet in our constituencies, this matter is crucial to them.
It is significant that, in a week in which there have been so many happenings in the House, this debate shows how the House really works. It shows that hon. Members whatever their party, get together and try to work together on the crucial issues that affect so many people. This is where the House comes into its own. This is what the people we represent expect from it.
I refer to clause 4. The speech by the Minister for Health fills me with concern. To make meaningful progress in getting people out of hospitals and back into the community will cost money. I am sure that many hon. Members agree. The people who come out of mental hospitals will need specialised back-up services for a considerable period. The Minister said, "Of course, the Government are concerned. Of course, we would like to do something." That is the old record by the Government that we hear repeatedly. They would like to do things for everyone but, if it will cost anything, they say, "Sorry, nothing from us today." That seemed to be the Minister's comment.
I am sure that in the run-up to the Budget the Prime Minister and many other Ministers will make statements about how essential tax cuts will be. We all know that, if tax cuts are to mean anything, they will be given only to those who are already on high incomes, as has happened repeatedly under the Government.
We should help the people mentioned in the letter to the hon. Member for Bolton, North-East (Mr. Thurnham) and the letter to my hon. Friend the Member for Monklands, West which outlined the difficult problems. Some of the Minister's comments were an insult—such as, "If if will cost money, the Government cannot give it much warm support." In the coming weeks we shall hear only, "Tax cuts are the priority." They are not. It is up to the Government to have the courage to say, "Of course, we would like to give tax cuts but we believe that sections in the community have a greater priority. We must help them." We know that we shall never get all the money that we want for the issues that interest us as individual Members, but I believe that the Minister should think again about his comments. They will be received with utter disbelief by the many people who have listened to or read the debate. This Bill will be meaningless if the right hon. Gentleman pursues that line in Committee.
§ Mr. Roy Galley (Halifax)
The hon. Gentleman is right that the Bill and the whole principle of community care will cost more money. That must be the case if the provisions are to succeed. I am a little concerned that the hon. Gentleman's comments are a little out of balance with the actual position. Does he not accept that the increase in health resources of 20 per cent., above any allowance for inflation, in the past five or six years and the projected increase in this week's public expenditure White Paper are a substantial additional injection of funds into health? There has been also a substantial additional injection of funds into social services. The mentally ill and the mentally handicapped have priority in that injection of funds. That may not be enough—we can argue about that—but it must be taken into account. The hon. Gentleman must balance his comments about resources.
§ Mr. Cox
I think that progress has been made. Many hon. Members will know from their experiences in their constituencies that that progress had to be made and still must be made. What are our priorities? They are the issues we are discussing—not the tax cuts about which we shall hear in the next few weeks.
Clause 4 recommends that 28 days' notice of discharge should be given to a local authority. That is commendable. Many people in my area, especially the elderly—I cannot believe that it is just my area—complain that they are virtually turned out of hospital, often with little or no back-up services in the community, and told, "Get your neighbour to keep an eye on you and to do the shopping." Notice must be given and assessment services provided if we are to ensure that the people who come out of hospital, where they have perhaps stayed for many years, are to be helped.
I return to the intervention by the hon. Member for Halifax (Mr. Galley). There are two psychiatric hospitals in my constituency—Tooting Bec and Springfield. The Government blackmailed us about Springfield hospital. It is an old-type mental hospital establishment. To the credit of the staff, doctors and local administration, they wanted to make improvements. The problem was that the South London hospital for women in my part of south London was closed. We were told, "If you want progress in Springfield hospital, the South London hospital must be closed." This kind of thing has happened repeatedly under the Government. To make progress in one aspect of health care, other services in the area must be closed so that the money can be reallocated. That is what is so wrong with the Government's policy. Unless we get away from that attitude we shall not make the progress we want. There has been an uphill battle in many areas to obtain the type of services—whether NHS or local authority—that are needed.
An allocation of money will mean that those services can begin to develop. We do not consider frequently enough the surplus land and buildings that belong to local hospitals. I do not particularly disagree with such sales—if the land and buildings are surplus, sell them—but I object to how that money is used. In my area, where hospitals have been closed, land has been sold off. We had an enormous struggle to obtain what we believed to be a fair share of the proceeds. The money did not go to us, as we believed it should. We could have done a great deal with it. We must look into this aspect of policy.
Young disabled people have a different attitude to their lives. They are not prepared to accept the conditions under 1378 which middle-aged or elderly disabled or handicapped people have had to live for many years. Obviously, the disabled and mentally ill have a right to say what type of role they wish to play in society. Many of the Bill's provisions will go a long way towards ensuring that their voices are heard because, far too often, they are not.
I have commented twice on hon. Members' remarks about participation. The views of the families who look after disabled and mentally ill people must be taken more account of to ensure that they are not always struggling to overcome the problems with which they live, not just for a few weeks and months, but often for many years.
There must be greater participation between hospitals and local authorities. The role of local authorities must be improved enormously. Within a local authority one department often follows one policy while another department follows a different policy. It might be thought that those departments must liaise, but one wonders how much liaison there is when one see letters about decisions that have been made. We cannot allow a debate such as this to go by without paying the warmest tribute to the staff working in hospitals catering for disabled and mentally ill people.
There are two psychiatric hospitals in my area. I go and I see the staff. I am full of admiration. I ask myself whether I could do that job. I do not know. We must obtain a genuine commitment from the Government towards the staff in National Health Service hospitals. We do not always see it. The staff should not always have to fight to obtain better working conditions and salaries. They do a job that demands the highest calibre of people. They should not be seen, as so often they are unfortunately, to be struggling to improve their conditions.
A few weeks ago MIND organised a conference called "Patients before People". That should be the aim not just of this Government but of all Governments, local authorities and those of us who have some power to make decisions. I hope that that will be the motto that we shall try to follow. We have a long way to go. As long as we can see progress and see that patients are again being treated as people in our community, we shall have gone a long way towards making life much better for many people who deserve a much better deal than, unfortunately, they have had in the past.
§ 12.3 pm
§ Sir Nicholas Bonsor (Upminster)
I add my voice to those who have already congratulated the hon. Member for Monklands, West (Mr. Clarke). I am pleased to be able to take part in a debate on a subject upon which both sides of the House are warmly united. I agree with most of the Bill's detail.
Before commenting on the details, I should like to lay two red herrings that have been introduced by two Opposition Members. It is a pity that the hon. Member for Tooting (Mr. Cox), in what was so many ways an excellent speech, could not resist the temptation to make some party political digs on an occasion when I might have hoped we could try for more unanimity. What he said—I suppose that I should be grateful for this—showed the fundamental weakness of the Socialists' case which has been demonstrated every time that they have held office. It can be summarised briefly. Socialists are incapable of grasping the fact that unless we can found a strong economy and have a tax system which will encourage initiative, enterprise and growth, we shall not have the 1379 public funds available to spend upon public services such as the one that we are discussing and which we are dedicated to improving.
The hon. Gentleman attacked the Government for proposing tax cuts. He will find that the people will not agree with him, particularly if, as I hope, my right hon. Friend the Chancellor of the Exchequer introduces those cuts by way of altering the tax threshold so that more people can be taken out of the tax system, and not take it off the top, but that is something we shall have to see.
§ Sir Nicholas Bonsor
I do not pretend that is has, but I did not raise the point. The hon. Member for Tooting raised it, and it had to be dealt with.
§ Mr. Thurnham
Everyone has said that voluntary care is the most important part of care in this country. The less tax burden those people have the better. They can then care for themselves. It is no good regarding the state as a nanny to take over whenever there are any problems. People should have the money in their pockets to care for themselves.
§ Sir Nicholas Bonsor
My hon. Friend makes a valid point. One could go further, because the Bill is about encouragement and assistance given to the carers. The better off the carers, the less financial support they will need to carry out the magnificent work they do.
The Bill is about the quality of life of those people who have the misfortune to suffer handicaps. Without wishing to dismiss or diminish the importance of physical handicaps or to denigrate the importance of supporting such people, I should like to address my comments to the subject of mentally handicapped people. I believe that that is where the greatest need lies and where society is slowest to respond.
It is sad but true that most people prefer to ignore mentally handicapped people. They are embarrassed by them. They often do not extend the same sympathy to those who suffer from mental handicap as they do to those who are physically handicapped. That is especially true of communities around homes for the mentally handicapped and of people who might be able to offer the mentally handicapped work within their capabilities. The Government can, and I hope will, do more to encourage people to understand the problems better and to participate more fully in assisting to care for afflicted people.
The quality of life is affected by the Bill primarily through its encouragement of greater support for those who come out of the institutions in which many have to spend a large portion of their lives.
The Government are as dedicated—notwithstanding the implication in the otherwise good speech of the right hon. Member for Manchester, Wythenshawe (Mr. Morris)—to encouraging the return of handicapped people into the community as are Opposition Members. Much of the Government's enterprise and attention are, as the right hon. Gentleman well knows, aimed at that purpose.
The survey established last summer to identify the needs of the handicapped and to see what further must be done is already under way. When it has reported, I trust that the Government will introduce further legislation in accordance with its recommendations.
1380 It would be unfair to allow the right hon. Gentleman's untrue attack upon the Government's policy to be unchallenged. He said that the Government were doing less for handicapped people than the Labour Government had done. That is not true. He said that he had a list of 12 things which someone had given him critising the Government and saying how they had hurt handicapped people. One can point to shortcomings in every Government policy. I have no doubt that one of the criticisms justified but equally I have no doubt that many are not. What is undoubtedly true is that the Government have put aside far more resources to deal with the problem than any other Government.
§ Mr. Thurnham
The right hon. Gentleman is shaking his head, but he should know that that is a fact.
§ Mr. Morris
The hon. Gentleman referred to the survey on disabled people on which the Office of Population Censuses and Surveys is working. The results of that survey are not expected for some years. The Government are taking decisions as if the results were already known. I agree about the importance of the survey. Incidentally, the 12 points put to me were those of Peter Large of the Disablement Income group. He is known and respected as a disabled person by both sides of the House.
§ Sir Nicholas Bonsor
I accept the right hon. Gentleman's comments about Mr. Large. In the matter of the report he cannot have his cake and eat it. He is saying that the Government are taking no action but he is also saying that the Government are taking action as if the report were already completed. In the circumstances, I am sure that the right hon. Gentleman would not wish the Government to sit back and do nothing while waiting for the report. Nothing that the Government are doing is not subject to review when the report is published. His point is not a good one. He knows, as well as I do, that £5 million has been spent in 1985–86 and much of that has been set aside specifically for benefit for the long-term sick and disabled. That figure is substantially more than double what was being allocated in 1978 when the Labour party was last in office. I believe that the Government's record is nothing to be ashamed of in terms of the way in which the disabled are being supported.
I should like to congratulate the hon. Member for Monklands, West on avoiding the pitfalls of party political cross-Chamber argument. He gave a magnificent opening to the Bill, which has played a large part in cementing the intentions of both sides of the House to see that the Bill is successful. The hon. Member mentioned the effect of the inefficiency in some areas of the present administrative system and the way in which, without putting further allocations of funds into that system, much could be done which is at the moment left undone. I endorse that whole-heartedly.
I believe that one of the most important shortcomings in the area of mentally handicapped people is the accommodation in which they have to spend their lives if they are institutionalised beyond help. In my previous constituency of Nantwich, some hon. Members may recall that during the previous Session I had to fight, by way of an Adjournment debate, against an area health authority decision abruptly to close a small local hostel for the mentally handicapped holding 15 people and transfer them 1381 to a huge conglomerate in the middle of Manchester. The area health authority showed an unbelievable callousness. It ignored the medical advice that at least two of the people living in the hostel would probably die if they were moved. It ignored the wishes of the people in that hostel to remain in a village environment where they could get out and meet the people and do some light work. It ignored all the fundamental necessities of public health care.
It was only with the help of my hon. Friend the Member for Hampstead and Highgate (Sir G. Finsberg), who was then Minister of State for Health and Social Security, that I managed to forestall the area health authority's wishes and win a reprieve. During that reprieve, we have changed the hostel from a public service hostel to a private trust. Without putting any additional allocated funds into the hostel above those which were already being spent in the public sector, the private trust has managed to give everybody who lives there a room of their own, a colour television and proper furnishings. Before that, they were living in dormitory accommodation with very little privacy and no amenities.
I do not believe that the public service is incapable of administering such homes with equal efficiency, but I believe that in almost all cases at present it is failing to do so. I hope that, when my right hon. Friend the Secretary of State looks at the Bill and the provisions that must be made for the mentally handicapped, he will do everything he can to review, audit and check the efficiency of our present health administration service to make sure that the public, especially those who are being cared for, are getting full and proper value from the funds allocated to the problem.
I will not detain the House long on specific clauses because most of them have been adequately covered. Clause 1 is particularly welcome for the mentally handicapped. The right of representation instead of the facility for representation is a significant change that the Bill will introduce, I hope unchallenged in Committee and at the Report stage. For the mentally handicapped, even more than the physically handicapped, such representation is essential to ensure that the rights and the needs of the people who cannot look after themselves are properly safeguarded.
The assessment of those needs must be improved, again more for the mentally handicapped than for the physically handicapped. Clause 4 sets out the way in which that should be done. Clause 5, which is equally welcome, gives an additional assessment of the capacity of the carers to cope and provides for support to be given to them if that capacity falls short of what is needed. The people who put in the wonderful work of looking after the disabled, both mentally and physically, need a greater back-up and support. They often undertake those duties and carry them out to the best of their ability but find that it involves more than they expected. When that happens, the carer and the cared for are bound to suffer.
There are three reservations that I should like to bring to the attention of the hon. Member for Monklands, West. I should like him to consider them before the Committee stage, and perhaps I could have his answers then. I join with the Minister for Health in having reservations about the bureaucratisation. That is a horrible word but I cannot think of a better one.
§ Sir Nicholas Bonsor
That is right. It is always difficult when defining statutory duties to get the balance right between giving sufficient power to the local authorities to help and giving too much power to them, so that instead of helping they interfere. The paperwork and the red tape that follows that often undoes the good work that would be done and which the legislators intend to do. In Committee and on Report, we must ensure that the Bill gets that balance right.
I am puzzled as to why, under clause 3(3), the consent of the child is required and the consent of the parent is required only if the child is incapable of forming a judgment. I am not sure of the legal position, because I have not had the opportunity to check it, but I should have thought that a 13 or 14-year-old child to whom that may refer might be capable of forming a judgment, but that if that judgment is at odds with that of the parents one should back the parents rather than the child. The parents' judgment is more likely to be in his interest.
§ Sir Nicholas Bonsor
Not always, but generally. A 13 or 14-year-old has not had the experience of an older person. One is not always in the best position to make the decision for oneself. I should like to see a safeguard so that an adult judgment can be exercised in the matter.
The hon. Member for Monklands, West asked for a list of the numbers and ages of handicapped people. I am not convinced that such a list would assist the House in the form in which the Bill appears to demand it. For example, it does not give any breakdown of the severity of the handicap. It does not say whether the handicap is mental or physical or to what degree of handicap it applies. A breakdown of numbers and ages, particularly in the adult section, between 18 and 95, will not be of great assistance. The hon. Gentleman might like to consider whether better and more useful information might be achieved by some other means.
With those reservations, only one of which could be described as serious, I have the greatest pleasure in welcoming the hon. Gentleman's proposals, and I shall certainly support them.
§ Mr. Dafydd Wigley (Caernarfon)
I congratulate the hon. Member for Monklands, West (Mr. Clarke) on his good luck and thank him warmly for choosing this subject for the Bill, which is very relevant. We all know that those who come first in the ballot are under considerable pressure as to the legislation that they introduce. The Bill reflects the priority that the hon. Gentleman has given to this subject, which is shared in all parts of the House, as is evident from the debate. I hope that it is a priority that the Government will continue to support, not only in theory but in practice as far as possible, with the resources that are available.
The House knows of my interest in the area and of the family interest that we have. For that reason, apart from all the others, I wholeheartedly support the objectives of the Bill. I hope that it is given a unanimous Second Reading and that it goes forward to Committee to be considered and improved. I acknowledge that some areas might need rewording to achieve the Bill's objectives. All of the sponsors recognise that. We want the Bill to go forward so that those objectives can be achieved in the 1383 most efficient, effective and cost-effective manner, the main objective being the services that we are trying to give.
I add my thanks to the representatives of several organisations such as MENCAP, MIND, the Spastic Society and the Royal Association for Disability and Rehabilitation, which have helped considerably in preparing the Bill.
The hon. Member for Tooting (Mr. Cox) said that we must always remember that we are discussing people. There is a tendency—I am guilty of it, as are all other hon. Members, and the Bill is, too—to refer to "the disabled" or "the mentally ill". We are talking about people. Many mentally and physically handicapped people feel a little resentful when they are classed generically like that. If we can, we should always refer to them as mentally handicapped people or mentally ill people. It is a good discipline and leads to better analysis.
The Bill has three objectives, which are all worthy. One is the improvement of representation and the establishment of rights. The second is the planning of services and the third deals with consultation. Representation is very important. If disabled people are able to represent themselves, that is the ideal. All well and good if they can represent themselves. We should do everything that we can to enable them to do so and to knock down the barriers, physical and others, that sometimes prevent them from being able to represent themselves.
Many disabled people, particularly those with a mental handicap, might not be able to represent themselves, and might never be able to represent themselves. Many of those people, particularly older people, may have few to speak up on their behalf. Some may be in long-stay hospitals or institutions and have only a handful of visitors, or not even any visitors, during the year. Therefore, they are in the hands of the staff. I pay tribute to the staff, who almost invariably show kindness and consideration to those people.
If individuals need someone to speak up for them, we must make sure that there is representation and advocacy of their needs. That is particularly relevant when people are moving from long-stay hospitals into the community. It is important that their wishes and needs are taken into account and that there are people to speak up for them.
§ Mr. Thurnham
Will the hon. Gentleman include children in long-stay mental hospitals, who have lost touch with their parents? The difficulty is to know who is responsible for them, because the National Health Service does not have ultimate responsibility for a child's life. It is important that, order clause 11, the names and addresses of the children are listed, as well as the local authorities, which should take responsibility if the parents have lost touch with the children. If parents have not seen their child for years, it is important that the local authority accepts responsibility for the child. I should like a list of local authorities responsible for the children to be included.
§ Mr. Wigley
The hon. Gentleman makes an important point. I am sure that we shall deal with it in Committee.
It is important that there is someone speaking from the child's point of view. In some circumstances where, regrettably, the parents may not be able to do so, have lost interest, or have died, there is a need for someone to do that. There could be dangers sometimes if the local 1384 authority takes that responsibility unto itself, because the local authority would have to represent the child against itself. The person representing the child must be genuinely independent, and his first priority must always be the need of the disabled person, be that person a child or an adult.
Representation and the advocacy of the needs and interests of disabled people should be a fundamental right. We should look at the wording of the Bill in Committee to ensure that we are establishing a fundamental right.
One aspect of the Bill that worries me is clause 1(1), which states that any disabled personmay be represented by a representative whom he has authorised".Two things cause me concern. First, the word "may" always causes difficulty in the House, and we ask whether it is strong enough. That is nothing new, and I am sure that we shall examine it in Committee. Secondly, I refer to the words "whom he has authorised". The client group that most greatly needs representation on its behalf is the profoundly mentally handicapped. They may not be able personally to give authorisation. We should ensure that the wording of clause 1(4) is adequate, so that those who most need the Bill are not left out or ignored. That matter needs attention.
Another important area in the Bill is the improvement that it provides in the procedures to assess the needs of disabled people and to plan services. By defining disabled people's needs and identifying them specifically in a coherent manner, there is a better chance of ensuring that those needs are met and the services are available for them in the right place and at the right time. Many organisations that deal with the needs of disabled people have referred to that. I should like to quote from a letter from Sir John Cox, director of the Spastics Society, who says:The Society is increasingly concerned with more multiply severely handicapped people, many of whom live at home with their parents, with little or no contact with statutory authorities. A co-ordinated assessment of need will help to provide a framework for progress for them by helping to strengthen the hand of disabled people and their families.That is evidence from the Spastics Society, which is involved in that work. I commend those words to the Minister, because they help to answer some of the misgivings that he has expressed, reflecting discussions that he has had with local authority representatives. We need a balance, and the views of organisations such as the Spastics Society and MENCAP should be heeded.
Many disabled people do not get the support and services that they need, and nor do their families. Indeed, they sometimes miss out even when services are provided under statute. Part of the reason for that is lack of resources. There will always be a lack of resources, so we must maximise our use of them on selected priorities. Resources must go where our mouths are. Part of the reason is ignorance of services available to disabled people, and part of the reason is the system's failure to match the needs of disabled people with services.
I have an example of that in my village. A mentally handicapped man is being cared for by his mother. She is getting quite old and finds it increasingly difficult to look after him as he has become physically handicapped as well. Although they were in our midst and we knew about them, nobody had told her about mobility allowance which she could have got several years earlier than she did. We all know of similar examples. Services are available and it is possible to get help but there is a breakdown in 1385 communication. We must overcome that. We need a system that ensures that the people do not fail to get services because of ignorance of them.
We must plan services properly. There is an acute problem for young mentally handicapped people leaving school or full-time education. I think particularly of 16-to-19 year-olds. We heard Brian Rix, the secretary-general of MENCAP, talking on the radio this morning about a young mentally handicapped person from Gwent who went to an institution in Scotland. His parents gave up their home and moved up there to be close to him, but, as they arrived, he was discharged without any planning for the future.
We all know of parents of mentally handicapped people being acutely anxious about what will happen when their child's time at school ends—whether there will be any work opportunity, an opportunity in an adult training centre or any social life. Often, such people's social life has revolved around the place of education. Parents are also anxious about whether they will receive enough support to look after their child and whether their children will be able to lead an independent life, and can hope to have their own home and possibly to marry.
Such things should not be thought to be irrelevant to young mentally handicapped people. The system should ensure that they have such opportunities and, if they are unmarried, the opportunity to live as adults with two or three others of the same age in a group home. There should be services and support to facilitate that rather than make such people increasingly dependant on aging parents who grow less able to cope. Without that provision, such people can less easily be integrated into the community in middle age after their parents die. There must be planning at the appropriate time. Clause 3 provides for that. I hope that, with improvement, it is accepted.
Another group is a cause of concern—the ageing parents of adult mentally disabled or mentally ill children, or brothers, sisters, or spouses caring for them. The perennial question is, "What will happen when we are dead?" Their predicament is worrying and becomes worse with time, just as it becomes ever more difficult to cope. We should ideally be able to ensure that such people develop independent living in the community. Some families might not want that. If so, we must provide support services that increase gradually with time so that their position does not become impossible. We all know of people for whom it has become impossible. We must face the fact that circumstances might well become intractable without planning and gradually increasing support. The Bill addresses itself to that as well.
Disabled people must play a larger part in the planning of services for their benefit. We, the "do-gooders", often do what we perceive to be right and fail to consult those who are affected. We can often get constructive and enlightening replies if we ask what they need. More than that, we should provide an opportunity for them to be involved in the decision making process. That is an important development. Clause 10 helps in that direction, and clause 12 is also relevant. As for the objective of screening developments of public policy, whether of central or local government, we should screen all our decisions for their implications for disabled people, as we monitor those decisions for their effect on other groups.
§ Mr. Thurnham
Will the hon. Gentleman also include in that the need for medical research into the causes of 1386 handicap which goes to the point when conception occurs? If medical research could help at that stage, it could avoid later difficulties.
§ Mr. Wigley
I was using the term screening to mean looking at the implications of decisions for disabled people, just as we consider their effect on women and other interest groups. That should be built in, and the Bill aims to build it in in relation to town and country planning procedures. That is an advantageous step forward. it is already done in the GLC area and could be done elsewhere. The hon. Gentleman's point is absolutely right. It is much more desirable to prevent mental or physical handicap, but that goes beyond the realms of the Bill. However, it is worth noting that 141 hon. Members have supported the motion on the prevention of congenital handicap.
Many local councils have individually welcomed the provisions of the Bill. I am aware of the comments made by the Association of County Councils and, to a lesser extent, the Association of Metropolitan Authorities. I have received a letter from the ACC, which opposes the Bill. Did it consult properly with all its members? Did it receive comments from all member authorities, and do all those authorities take that view? I suspect not. With measures, including my Disabled Persons Act 1981, there is a danger that some bodies will give an instant reaction, and say, no on principle and because they do not want any change that makes impositions. It is perfectly valid for them to point out any increases in bureaucracy so that we can try to minimise them, and to point out the resource implications as we should be aware of changes that will require more resources. But let us have a positive attitude. We are not merely trying to pass laws to make impositions on authorities. We are here to improve essential services, and to improve minimum standards to the best practice that already exists. Those bodies should support that, not decry it, as they have done.
The Minister said that local authorities must be free to order their priorities and not have them prescribed from the centre. That comes a bit rich from the Government, given what has happened during the past three years in terms of the Government's direction of the resources that local authorities can use. But if we ask for priority to be given to a group, whether it be the mentally handicapped, the mentally ill or the elderly, we must accept the accompanying resource implications. As we work to integrate the mentally handicapped and the mentally ill into the community, we must accept that we shall need additional resources. Hon. Members on both sides of the House advocate this because it is the right policy. If it costs a bit more in public expenditure, we should go to the people and ask them to pay it. If we did that, we would obtain their support.
The Bill is timely and welcome, and if it reaches the statute book it will make a material change in the well being of families and individuals who must cope with disability, including mental handicap, physical handicap and mental illness. It deserves the support of hon. Members on both sides of the House, and I wish it well.
§ Mr. Andrew Rowe (Mid-Kent)
I begin by striking the only note of discord that I shall make in my speech, because I wish to get it out of the way quickly. The right hon. Member for Manchester, Wythenshawe (Mr. 1387 Morris), whose record in this area is respected by all and for whom I have a high regard, should not be allowed to get away with the suggestion that a straight comparison of the amount of money paid by local authorities on, for example, home helps is sufficient to attribute a good reputation to those which pay a lot and a bad reputation to those which pay less.
I drive to work every day through the borough of Lambeth and I see the results of the extraordinary depredations that that council has made on its ratepayers for many years. Many businesses have closed. Clapham used to be the centre of an enormous thriving industry, which has been almost driven out of London. I compare Lambeth with a district council in my area, which has held its rates steady for more than 10 years, as a direct consequence of which businesses have been attracted to the area, unemployment is beginning to decrease and the amount of resources available to spend on provision for the disabled is beginning, at last, to increase.
I ask myself whether some boroughs are being extraordinarily generous with other people's money. A great difficulty in my area is that the demands made by the so-called generous boroughs are a direct disadvantage to our district councils, which would dearly like to have more money to spend. I am, I might add, not wholly satisfied with the Government's allocation of rate support grant to my county and, therefore, my district councils. It would be better if the Government considered more carefully the way in which they reward local authorities that have faithfully carried out Government policy.
I shall leave that partisan note and pass on to the excellent Bill. It is fortunate that politicians develop thick skins, because the compliments showered deservedly upon the hon. Member for Monklands, West (Mr. Clarke) would have made an ordinary person turn bright scarlet and remain so for the entire debate. But I am delighted to add to what would be the embarrassment of anyone who was not a professional politician.
I am chairman of the all-party parliamentary panel on the personal social services, and I am delighted to follow the hon. Member for Caernarfon (Mr. Wigley), who is one of my fellow officers. It is important to remind the House of this new panel, which has existed for about 15 months. It was the brainchild of the social workers who, having discussed ways in which the dilemmas, difficulties and opportunities of social workers and the personal social services could best be presented and understood in Parliament, made available to us the services of a part-time research assistant. The House has responded by providing an all-party parliamentary panel, which takes an interest in social work and the personal social services. We work closely with other groups, about which I shall say something in a moment.
The Bill deals avowedly with crisis prevention and partnership. I re-emphasise the fact that the present lack of co-ordination not only among local authorities but, more importantly, among different services leads to carelessness—in the strict sense of the word—and to the wasting of resources.
When I was first a civil servant in the Scottish Office, my assistant secretary made an interesting case for prisons being returned to local authorities, not because he felt that it would necessarily add enormously to the provisions for serious criminals but because it would bring home to local 1388 authorities and to the local community the costs involved in putting people in prison. A genuine dilemma is posed by our present administrative divisions. For example, if a local authority can shift responsibility for something to, for example, the NHS, that is off its hands and on those of somebody else. The fact that it costs more to keep people in the NHS is something of which they are aware, but feel that it is not their business.
I congratulate the Government on having extended the arrangement for joint finance, which is an indispensable aid to making sense of the way in which we handle the overlap between local authorities and the NHS. In my area of Maidstone, the health authority is carrying out a very energetic and enlightened campaign to get a whole range of patients out of psychiatric hospitals and back into the community. This is being facilitated considerably by the arrangements for joint finance. This is an admirable policy, and I hope that when the time comes for the present arrangements to expire, the policy will be looked at carefully to see whether the time is yet ripe for it to be wound up or whether it should be extended for a while.
The Bill is about restoring power over their life to handicapped people, and this is enormously important. In this, the element of representation is almost indispensible. I am sure that every hon. Member has experience of being made to feel like an inanimate object in the presence of experts. I remember vividly the experiences of someone whom I know well. When he was in hospital, he was appalled when a specialist swept in to his room with 12 students, stood the students round the bed and said, "This, gentlemen, is a straightforward case." The dehumanisation, and the feeling that thereafter the students would go away and talk about him behind his back was extraordinary, and I have never forgotten hearing about it.
All the time there is a "de-skilling" of patients by a combination of their anxieties and the doctor's attitude. They come along desperately worried about some aspect of their lives, whether their health or disability or that of their loved ones. They come seeking help and are far too ready to lay aside common sense and experience and leave everything in the hands of the specialist. The specialist may be one of two kinds. He may be utterly humane but paternalistic and think that he must assume the burden of telling the patients exactly what should be done or, far more often than we realise, the specialist is extremely anxious.
I used to teach students and, when I was confident of a subject on which I was teaching, I was only too glad to allow questions from, and discussion with, my students, but, when I felt that I was on pretty shaky grounds and had prepared the lecture only superficially, I filled the entire time allotted by speaking—a feeling with which hon. Members may not be entirely unfamiliar. This happens in the interaction between the clients, or patients, and the specialist. To have a representative there to hold the balance—somebody who is slightly detached—is an admirable proposition and I very much hope that it will be pursued.
May I also re-emphasise the point that was very well made my the hon. Member for Monklands, West that the contribution of the disabled to society is still grossly underestimated. I have told the House on previous occasions that I am proud to be a trustee of Community Service Volunteers. In that position I have learnt vicariously that it is the young volunteer who is engaged in the very interesting and exciting experiment of living 1389 in a house with a severely handicapped person who gains from that experience. Quite frequently that young volunteer will admit only too readily that what he or she had to contribute at the beginning was little more than the unskilled work of providing a pair of hands and that they have absorbed from the handicapped person an experience of life and an expansion of their whole understanding of life that will be treasured long after the experiment is over.
Another question is that behind the Bill and integral to it is the need for training. May I remind the House that a debate is taking place about the training of social workers? In statutory terms the House has very little to say about that debate. I think that I am right in saying that the Central Council for Education and Training in Social Work is entitled to make what recommendations it likes and to some extent to adapt the formal curriculum for social workers without very much interference from the House. However, it is a matter of the greatest importance. It brings sharply into focus the role that we expect social workers to play in our society. Frequently we put social workers into an intolerable position by demanding from them things which it is quite unrealistic to demand from them and then pillory them when they fail to deliver our wholly unrealistic expectations. Those wholly unrealistic expectations are frequently fuelled by highly skilled but over-ambitious social work trainers. They may feel confident that they could deliver those expectations, but they are dealing with students who frequently will find it quite impossible to do so. We need to look very carefully at the way in which the training of social workers is undertaken.
Furthermore, there is a very large number—I believe that it is over 70 per cent.—of staff in residential social service establishments who have had virtually no training at all. It is a horrific proposition that we should commit people, perhaps for the rest of their lives, to the care of untrained staff. We need desperately to look carefully at that proposition. One of the things that training needs to do is to provide these workers with confidence to handle their own doubts and difficulties and to share them with the client, and with their representative, in ways that will allow the client to make a much better plan for his own life than the life that these people, who are not very confident, frequently feel that they have to make for them.
Although this has nothing to do with the debate that is taking place within the social worker profession, we desperately need to expand and improve the training of the whole community so that it understands these very serious problems. In that connection I pay a high tribute to the posters of the Spastics Society. It has done a remarkable job in raising public awareness of the contribution that can be made by handicapped people. There should be very much more of that kind of activity.
It is also true that a great deal of discrimination against the handicapped results from unfamiliarity. People are afraid of saying the wrong thing, so they say nothing. They do not want to cause offence, so they simply ignore them. One reason why I applaud the move away from institutional care to community care is that by putting people frequently in touch with the handicapped, they will become familiar and more confident in their dealings with them. We need to help them in that, so the Government might consider extending the assistance given to voluntary organisations and others in raising public awareness of the contributions to society that the disabled can make.
In our consideration of the Bill, we should not be afraid of expanding considerably the contribution of volunteers. 1390 For example, many representatives could, quite properly, be volunteers. I say that for two reasons. First, during the past 85 years the average working life has halved. I believe that by the year 2035, it will have halved again. There will be an enormous reservoir of time that could be used for that sort of work. There is a great deal of evidence that there are people hungry to make that sort of contribution.
Secondly, I believe that volunteers are often the best people to represent other people. Professionals constantly must bear in mind that the person with whom they are battling today may be the person with whom they will have to co-operate on another case tomorrow.
§ Mr. Thurnham
On the difference of approach between voluntary organisations and local authorities, I refer my hon. Friend to Catherine Macaskill's book which contains 20 case studies of families who wanted to foster or adopt handicapped children. Half of them applied to local authorities, while the other half applied to voluntary bodies. The half that applied to local authorities were rejected, and only when they applied to the voluntary bodies were they able to adopt or foster. That shows the contribution of voluntary organisations. I believe that local authorities still suffer from the belief that the fear of handicapped people is something with which most people cannot cope.
§ Mr. Rowe
Local authorities face considerable difficulties, partly because of their statutory responsibilities, so they are more cautious. It is not only the voluntary bodies that make a contribution, but volunteers. The volunteer can commit himself to an emotional attachment for an individual, something that might be regarded as bad practice for a professional social worker.
The attention that the Bill pays to carers is absolutely right and, of great importance. I remind the House that the parliamentary panel, in conjunction with other all-party groups, has tabled an early-day motion drawing attention to carers. It is a very important subject and I hope that it will receive the support of the House. My private hope is that, eventually, this country will come to the concept of a minimum income, which would be of enormous assistance in resolving many of the problems.
I have wandered widely in my speech but I hope that I have given a clear sign of my personal support for this admirable Bill.
§ 1 pm
§ Mr. Robert N. Wareing (Liverpool, West Derby)
First, I warmly congratulate my hon. Friend the Member for Monklands, West (Mr. Clarke) on his choice of subject for his Bill. As others have already said, it is difficult, when one takes a high place on the ballot, to make a decision between laudable causes which come to one's notice. I commend my hon. Friend's Bill as very much in the spirit of the Chronically Sick and Disabled Persons Act 1970, which was probably the most humane piece of legislation to be placed on the statute book this century. That measure owes everything to the work of my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris).
I came to the House this morning in the hope that the Government would show that they were not willing to subject my hon. Friend to the shabby treatment we saw on 18 November 1983, when the full forces of the Government were launched against my Bill to amend the 1391 Chronically Sick and Disabled Persons Act. My Bill would have given more life to that Act and would have ensured that the disabled were not discriminated against. At that time, right hon. and hon. Members will remember that Conservative Ministers were unofficially whipped to return to the House, and all bar eight Ministers cancelled their engagements that day to dishonour the name of the House.
I warn my hon. Friend the Member for Monklands, West that, although he will hear Conservative Members use the rhetoric of compassion, the Minister's speech this morning echoed the real voice of the Government. No doubt they will allow the Bill to have a Second Reading, but they may try to denude it of its essentials in Committee. I recognise that the Minister with responsibility for the disabled is unable, because of the genuinely difficult task that he faces in his office, to be in the Chamber today, but it is worth reflecting on his speeches when there was a Conservative Opposition. The hon. Gentleman was very much a skinhead in Opposition, but in Government he has proved to be a skinflint. When he spoke for the Conservative Opposition, even Torvill and Dean would have qualified for the mobility allowance if he had had his way.
The Bill is important in seeking to give representation to the disabled, especially to the mentally handicapped in their bid to obtain their just rights. The take-up campaigns by various local authorities have revealed that many of our people are not obtaining the benefits to which they are entitled. With many organisations imperilled by the Government's legislation to abolish the GLC, the Merseyside county council, the West Midlands county council and the other bodies which carried out take-up campaigns, it is all the more necessary that those who are doubtful about their rights should be adequately represented before tribunals and local authorities.
The Bill would bestow vital obligations upon local authorities to provide care, and upon managers of hospitals when patients are discharged to inform local authority social services departments of the need to provide for such patients. I know that many of my constituents in areas such as Croxteth, where there is entirely inadequate provision for those leaving hospitals in the Liverpool and Sefton areas, would benefit greatly should the Bill reach the statute book and be implemented in the way in which my hon. Friend seeks.
I have strong feelings about clause 5, because of my own practical experience. During the last three years of my mother's life she was blind and entirely dependent upon me. I had a full-time job as a lecturer in further education and I worked difficult and unsocial hours. I know what a relief it is to be able to obtain help to allow one the relief of a holiday.
My wife's sister had a stroke some six years ago and has been completely dependent upon her husband, whose health is not of the best, ever since. He has to devote every minute of every hour to looking after his wife. He has to see that her food is cooked and the groceries are bought, he must provide for her needs when she visits the toilet and look after her every night, with little assistance from the local authority. How relieved he is when occasionally a relative or someone else can sit in with his wife allow him to breathe in the fresh air and feel free from the onerous duties that love has brought his way.
1392 When the Minister talks about the cost of community care and the cost that the Bill will bestow upon local authorities, I hope that he will remember how much my sister-in-law's husband saves the National Health Service and how many people in his situation are similarly saving public funds.
I remind the Minister that in its 1983 manifesto the Conservative party said:Most people who are ill or frail would prefer to stay in or near their own homes, rather than live in a hospital or institution, helping people to stay in familiar surroundings is the aim of our policy.The Bill challenges the Government to put their money where their mouth is.
It is essential that, in many areas of social legislation, people should be informed of their rights, and the Bill seeks to do just that. Organisations for the disabled such as the Spastics Society and the Disablement Income Group, have published an excellent pamphlet called "Getting the best out of your Act"—the Chronically Sick and Disabled Persons Act 1970. I hope that, as far as possible, the Government will try to give such information to the people so much in need.
Disabled people feel that they are discriminated against. My Bill sought to outlaw discrimination, but there are many kinds of discrimination. Simply to be disabled and unable to discover one's rights—whether one has a right of appeal or is being dealt with correctly by the local office of the Department of Health and Social Security—is a form of discrimination. Such people are in a doubly difficult position.
The Minister has an opportunity to tell us how he has carried out his promise to the House when my Bill was debated in 1983, when I was told that education and persuasion was the way to deal with discrimination. How much have the Government spent in attempting to eradicate discrimination by education and persuasion?
The Bill will do much to eradicate discrimination by merely providing for information to be made available, but the Government's record cannot be looked on with favour. In Committee we cannot expect much real help from the Government to ensure that the Bill's principles are carried through. Indeed, the Government's record in relation to the disabled since 1979 has been disgraceful. The record has been full of broken promises since the Conservative party's research department produced a document in February 1979 which stated:Conservatives have singled out the disabled for priority within the social security budget.There has been a complete rundown in the incomes of disabled people. In November 1980, there was a 5 per cent. cut in the real value of invalidity and sickness benefits. The Social Security Act 1980 abolished the earnings-related supplement to short-term benefits. In July 1982, when a much higher proportion of disabled people than able-bodied people were unemployed, unemployment benefit for the disabled was taxed. In 1984, the real value of heating additions fell. They are now under threat from the Social Security Bill which has recently been published. Dental and ophthalmic charges and prescription charges have been increased.
Hon. Members may ask, "What has that have to do with the Bill?" These cuts in benefits have meant that disabled people must lean more and more on local authorities at a time when those authorities have been uner vicious attack through financial cuts by the Government.
1393 Under the Chronically Sick and Disabled Persons Act 1970, disabled people are entitled to help with holidays, telephones, aids to daily living, adaptations to accommodation and transport to educational and recreational facilities. Too few local authorities provide such facilities. Even with the best will in the world, local authorities cannot provide the necessary services, although many try hard.
Between 1979 and 1984, 41 local authorities increased spending on personal social services by less that 10 per cent. and 84 local authorities—two thirds of the total—increased expenditure on personal social services by less than 20 per cent. There is a great discrepancy between different parts of the country. As my right hon. Friend the Member for Wythenshawe pointed out, there is a discrepancy in the provision of home helps. In the much-abused London borough of Camden, there are 14 home helps per thousand people and in Wiltshire—about which there is little abuse in the House—there are 5.5 home helps per thousand people.
The authorities that want to provide for the needs of disabled people should be given the means to do so. It is no use Ministers genuflecting in the direction of compassion if they are not willing to provide the funds that will enable local authorities to act. Too often we hear Ministers passing the buck to those same local authorities that are subjected to reductions in rate support grant. RSG has fallen from 61 per cent. of expenditure in 1979 to 48 per cent. this year. There cannot be cuts of that dimension without harming essential social services.
It is not local councillors who have failed to implement the Chronically Sick and Disabled Persons Act 1971 and who are appealing to the High Court against the decision of a district auditor; it is those who wish to implement such legislation. Under this Government, local authorities have to decide not only between what is discretionary and what is legal but between what is legal in one case and what is legal in another. That is why deprived people in many areas are becoming even more deprived.
If the Government believe that disabled people form too small a proportion of our community to consider, we should remind them that they are a large constituency—5.5 million people.
I agree with my right hon. Friend the Member for Wythenshawe: people are becoming more aware of the problems of disabled people. Disabled people's organisations must continue to agitate to maintain the morale and confidence of those whom they seek to represent. It is only in that way that we shall have legislation of the type for which we are pressing today.
The Labour party recognises the needs of disabled people, in its manifesto. It is creating the Socialist Disability Action Group, which I hope will soon represent disabled people as an organisation affiliated to the Labour party.
I hope that the Government will not, here or in Committee, tell my hon. Friend the Member for Monklands, West that there is insufficient money, and will not repeat what the hon. Member for Hornsey and Wood Green (Sir H. Rossi) said in 1982, when he told the House that there were insufficient resources to provide for disabled people.
In this rich country, what sort of society is it where millions of pounds can be gained by buying and selling shares in Westland within the period of the stock exchange fortnightly account and where we can afford £2 billion on 1394 tax relief to rich people since 1979, but not afford the means to allow our disabled brethren to have a normal and decent life? What sort of a society is it where we have to have flag days for scanners to screen for breast cancer and to raise funds for kidney machines? What sort of a society is it that allows that to happen? Many people would like to see flag days for Trident, cruise and Polaris. I suggest that there would be few givers.
I hope that the Government will look favourably, at least today, on the Bill and will not repeat the shabby treatment of November 1983. That discredited them in the eyes of many disabled people. It made many of them politically aware of the type of Government with which we are dealing.
Many Conservative Back Benchers feel compassion for disabled people. We have heard speeches from some of them today, such as the one by the hon. Member for Exeter (Mr. Hannam). I hope that those Back Benchers will press the Government to ensure that destructive amendments will not be tabled in Committee and that we shall find on the statute book a measure to reverse the trend of recent years, which has been to destroy and undermine the standard of living of 5.5 million disabled people.
§ Mr. Colin Moynihan (Lewisham, East)
My one criticism of the debate today is that some of the speeches have been wide-ranging and lengthy. Perhaps the best service that I can render the hon. Member for Monklands, West (Mr. Clarke) is to keep my comments short to enable other hon. Members to speak.
It is a particular pleasure and honour to speak on the issue because, as hon. Members know, I was prevented from speaking for a while because of my position as a parliamentary private secretary in the Department of Health and Social Security. It was sometimes difficult to restrain myself from speaking on issues that I felt strongly about. I know that on this issue that applies to my hon. Friend the Member for Gillingham (Mr. Couchman), who would like to contribute to this debate.
I congratulate the hon. Member for Monklands, West on providing a Bill that is a framework for progress. That is to be welcomed by both sides of the House. I think that he would want to pay tribute, not just to the people covered directly by the Bill, but to many of those who voluntarily work to provide the services to the disabled throughout the country, not least in my own borough of Lewisham. There has been an enlightened approach in that borough and I pay credit to the social services department in Lewisham for its approach to the issue.
The Bill provides closer co-ordination for the provision of community care and services to the disabled. That is much needed at the present time. In many cases the local district health authority has not been closely associated with, or aware, of the procedures of the Department of Health and Social Security or the housing department and I have been involved in bringing such people together to achieve the co-ordination that the Bill seeks to promote. The Bill does that in the best way by involving the disabled themselves. I strongly welcome that. It is another step towards the closer communication that is needed to solve the problem. It is all the more important when regional health authorities have a long-term aim to provide a comprehensive adult mental illness service, with each district ultimately closing the larger mental hospitals. 1395 The right for the disabled to have a say is important. The Bill goes further than that. It does not give them just a partial or nominal say but a full one. That must be welcomed. One of the subjects that should be highlighted and considered as a result of the debate is loneliness. Loneliness is a subjective feeling and is in no way confined to people with disabilities. Sharing experiences and giving the disabled the right to have a full say would do much to alleviate the problem of loneliness. With the responsibility that they will receive comes interest and involvement. That provides a remedy for their problem of loneliness. I perceive that the Bill will be important not just in terms of communication and entitling disabled people to rights but to solving one of the great problems that exists with disabled people who feel alienated from the solution to their problem of loneliness. I congratulate the hon. Member for Monklands, West on directly tackling that problem at the same time as providing an important onus on the state to ensure greater rights and responsibilities for disabled people.
I should like to mention the vital role of public education in this area. We have discussed that role on many occasions in the House. For many years the prime necessity has been for public education to move towards acceptance of disabled people as people rather than as exceptional cases. It has also moved towards the integration of those people with the able-bodied of our society. The first and most important place for that process of education to occur is in our schools. I praise my own education authority, the Inner London education authority. It is rare for me to have an opportunity to praise ILEA, but I am delighted to be able to praise it for its input into the important area of education among our youngsters. It realises that the excellent initiative that is taken towards integration is of the utmost importance for public education in society. I wish other local education authorities would follow its lead in that area.
I refer to the importance of the right to be consulted, It is important to recognise what lies behind that view. There is increasing awareness by carers and the public of the needs, abilities and aspirations of disabled people, but it is not enough. We have to go further. That awareness is to be praised, but by involving those people in the decision-making process in areas affecting them, we shall make real progress. The debate is the beginning of the road in that direction. It is progress well beyond the rights of consultation in section 15 of the Chronically Sick and Disabled Persons Act.
Participation through consultation and the establishment of the right of representation do not necessarily lead to the integration and equality that I seek. The disabled are not a homogenous group. They all have different and important needs and requirements and, equally, different ideas about what they require. We should celebrate the Bill because the fact that they have different ideas about what they require will be covered by the much fuller representation to which they are entitled under it. That will happen when as I dearly hope, the Bill becomes law with the minimum number of amendments to it.
Community care is one of the most important initiatives to have been picked up from previous Governments and developed by the Government. While I was a junior parliamentary private secretary at the Department of 1396 Health and Social Security, I had the opportunity to see how community care initiatives were being properly and constructively developed.
Extra costs will be incurred. That point has been rightly made. The costs will be in addition to what is spent on day centres, adult training centres an occupational therapy departments, which will have to be increased with the policy of community care. It is better not to pursue community care policy than to underfund it or do it badly. The Select Committee was right when it stated:Community care on the cheap would prove worse in many respects than the pattern of services to date.Therefore, it is important that we continue with the commitment to community care and fund it properly. I am sorry that this point has not been raised more vigorously by my colleagues on the Back Benches. There is no doubt that we have put a tremendous amount of effort and increased resources behind community care in the past six years. In the past 10 years the number of community psychiatric nurses has increased to 2,000 from a mere 663, and the number of day centre places is now over 9,000 compared with 6,500 in the middle of 1978. It is important that that increase in resources continues.
With increased resources and the policy of community care comes a critical consultation process, which will now be improved radically by the Bill. I welcome that because it is no good having the state deciding how to process community care if at the same time we cannot take complete account of the individual needs of each and every person who is going from a mental hospital into the community or being given the opportunity to go to a new home, having been institutionalised. The Bill goes a long way towards achieving that.
I congratulate the hon. Member for Monklands, West on his Bill and I hope that everyone in the House will secure its safe and swift passage through the House.
§ Mr. Bruce George (Walsall, South)
I shall try to stick to the 10-minute limit imposed by my hon. Friend the Member for Monklands, West (Mr. Clarke), who is assuming the guise not only of promoter of the Bill but of the chief person who is whipping his colleagues into meeting his requirements.
§ Mr. George
Indeed, on both sides of the House.
Reflecting on having been in the House for nearly 12 years, I have come to the conclusion that on few occasions have I succumbed to the lure of attending a debate on a Friday on a private Member's Bill. The push and pull at midnight on a Thursday generally leads me to my constituency. My presence today, and my support of the Bill and participation in the debate are not only testimony to my admiration of my hon. Friend the Member for Monklands, West but the result of my empathy with the many organisations and individuals who have asked me to support his Bill.
The debate might not push today's Westland shareholders' meeting off the front pages. Nor perhaps will it gain as much publicity as debates on pornography or abortion. But I assure right hon. and hon. Members present, if they need any assuring, that many millions of people are awaiting the House's decision today. I refer to the sufferers and those who care for them. We should not 1397 measure enthusiasm for the Bill or indeed the need for it in terms of column inches or minutes of air time on radio or television.
Perhaps not everybody who will benefit if the Bill becomes law is aware of the Bill's existence, let alone some of it provisions. That covers one of the principles embodied in the Bill—the concept of representation of those who are unable to articulate their views to authority. I dutifully, ritually and warmly congratulate my hon. Friend the Member for Monklands, West on his initiative. I rarely display the sin of envy, but I have tried for 12 years to get a place in the ballot for private Members' Bills and have not even got on the bottom rung of the ladder. The nation eagerly awaits the workings of the law of averages which I hope will display itself next time so that my long-awaited piece of legislation can deservedly reach the statute book.
I shall not talk in general about the problems of the disabled, services for the disabled, the need to improve the Chronically Sick and Disabled Persons Act 1970, the need for maintenance benefits, the need to abolish discrimination against the disabled and the need to improve access to buildings despite recent building regulations, but confine myself to the Bill. I was not at all happy with the Minister's response. I shall he charitable and say that he does not believe what he said but dutifully reproduced what his senior colleagues wanted him to say. The Minister is high on principle but low on practice, and principle will not help the hundreds of thousands of people in need.
I regret that the concept of divide and rule extends even as far as underprivilege—the Minister said that if the group to whom the Bill addressed itself came from legislation, it would be to the detriment of other underprivileged groups. I am unhappy that one group of underprivileged must he played off against another to benefit.
The Minister conjures up and nurtures the national antipathy towards the bureaucrat by implying that this is a bureaucrat's charter. Perhaps I am being unfair to the Minister, but he seemed to imply that the bureaucrat, not the disabled, will benefit from the Bill. If so, why do so many groups who represent the mentally disabled and the physically disabled participate in the process of legislation by working closely with my hon. Friend the Member for Monklands, West?
The Minister also said that the Bill would damage local democracy. This is not the occasion to be openly partisan, but those words came rather strangely from the Minister in view of the Government's attitude to local democracy. The Bill should not take away the right of local authorities to decide what is in the interests of those whom they represent. The Minister's response is not at all helpful. He talked of sceptical neutrality. I only hope that the neutrality that he displays is the neutrality that the Government have shown towards the American-Westland deal. Perhaps my hon. Friend will welcome such neutrality. I hope that a group of hon. Members will not simply do the bidding of the Government and emasculate the Bill.
If there is a criticism of the Bill it is that it does not go far enough. That reflects my hon. Friend's sense of realism. He knows what he can get away with. However, even his limited objectives may expect too much in the light of the Minister's response. The Minister criticised my hon. Friend for covering only some of the disadvantaged. 1398 If my hon. Friend had applied a broader brush approach, he would have been dismissed for being Utopian and too broad in his concept. There is no way that he can win.
We must ensure that there are proper provisions for those in need. Much progress has been made since 1969—I like to refer to it as the year "1 BA"—one year before Alf. Enormous progress has been made since the Chronically Sick and Disabled Persons Bill was enacted, but we still have a long way to go to achieve a proper attitude among public officials and a proper legislative framework, and we are light years from getting proper funding for the disabled and the needy. If this Bill reaches the statute book more or less intact, it will be a further step towards our goal.
The Bill helps to achieve a proper balance between the public and private sectors, and between voluntary and public organisations, which we need to do. The needs of the disabled will be catered for by both public and voluntary sectors functioning effectively, and it is important that the legislation secures that.
Hon. Members should read the evidence given to the Social Services Select Committee by the Association of Educational Psychologists—perhaps they are the bureaucrats who are being castigated—and the Select Committee's report on community care which, contains 101 recommendations and represents one year's work, that is one pigeon hole filled by a lengthy report. The evidence shows how important it is that assessment is made. It states:It is our professional experience that the families of mentally handicapped children are deriving great benefit from the recent improvements in the education and care of their children. The vast majority of parents wish to look after their handicapped child in their own home. Such commitment should be encouraged and indeed strengthened by the provision of facilities such as short stay hostels, short stay fosterings, counselling and on-going support and by on-going support and training for parents in matters relating to the care of their offspring.We must seek support for individuals who can look after their own children with proper support. The evidence continues:However, a variety of accommodation … should be available to meet the individual needs of mentally handicapped adults for whom living with their parents is not possible. It is essential that the families of handicapped adults have access to advice and support which they perceive as being tailored to meet their own personal needs.We must break away from the old-fashioned approach where having a disabled child was seen as a form of divine retribution, and the child was sent to some institution tojoin the field of cabbages".as a local friend of mine described it. The child would grow up there and probably die there. Expectations have changed and the provision of services has improved immeasurably. We must nurture voluntary organizations far more successfully.
I have a close relationship with the local MENCAP organisation and the Parkinsons Disease Society in my constituency which have an enormous volume of experience. They work with the local authority, require national and local funding, and can articulate the views of their members and stimulate a national debate. Supporters of the Parkinsons Disease Society are working on great research papers, and are trying to get the Government and people interested in developments in Hungary. What is happening there should not be dismissed because it emanates from the other side of the Iron Curtain. It is not strictly a cure or a treatment for Parkinsons disease; it is 1399 known as conductive education. I have read papers and spoken to enthusiasts, and I hope that this form of treatment, which provides a structured therapeutic educational programme for Parkinsons disease patients, will be seriously considered. In Birmingham, the Parkinsons Disease Society is spending money in an attempt to inculcate new attitudes among sufferers and in the Government. It is an example of a voluntary organisation that should be helped financially more than it is now.
My local MENCAP branch, with which I have close contacts, said in a recent report:National MENCAP is committed to a policy of providing for people with mental handicap within the community. We support that policy.It continues—this is where the Bill is so important—by saying:No longer should large mental subnormality hospitals cater for the offspring of despairing parents. A wealthy and civilised country, as ours is, should ensure that the needs of people with a mental handicap are met within normal society. Thus we see that our efforts will increasingly be placed in co-operating with the District Health Authority and the Council Departments involved in developing housing, educational and leisure services for adults.This is a fine Bill that deserves support. If it passes this plenary session, I hope that it will not be emasculated in Committee but will be strengthened. I hope that we can send to the Government our message of support. From the sponsors of the Bill, one knows that it has cross-party support. It will reflect badly upon Members of Parliament who sit on the Committee dealing with the Bill if at the behest of the Whips, they try to do it down and to leave nothing except the title and the principle. The physically and mentally disabled deserve more than we have given them so far. The Bill must be acted upon. I congratulate the sponsors, and especially my hon. Friend the Member for Monklands, West, on his initiative and good fortune. He needs our support.
§ Mr. Roy Galley (Halifax)
It is unfortunate that a series of unnecessarily partisan points have been made during the debate to bring a discordant note into our proceedings. It would have been pleasant had the House been united in applauding the principles of the Bill.
I congratulate the hon. Member for Monklands, West (Mr. Clarke) on introducing the Bill, which is an important part of the gradual process in recent years of improving the lot of physically and mentally disabled people. It is inevitably a gradual process, and progress has certainly been made. If one considers the information on resources and the availability of services during the past five or six years—whether one considers Health Service provision, social services provision, the number of social services, the claims for social security or improvements to social security rules—one sees that the Government have a record second to none in help for the disabled. The policy of community care and its application is an advance for the disabled. I am especially pleased with the Bill because it is a great improvement upon the naive and potentially counter-productive approach set out in the Bill introduced last year by the hon. Member for Liverpool. West Derby (Mr. Wareing).
As a member of the Select Committee on Social Services, I am pleased that the Bill seeks to implement 1400 several key recommendations in its report on community care. One of the most vital recommendations was that no one should be discharged from hospital without a practical individual care plan, devised jointly by all concerned, communicated to all those responsible for its implementation, and with a mechanism for monitoring. To a large extent, the Bill brings into effect that and other key recommendations of the Select Committee. It is a matter of regret that there are not more members of the Select Committee present today.
The individual treatment of the disabled is the key to the success of our community care policy. If the policy does not succeed and if we are not sensitive to the needs of individuals, and work out a plan for each that will work, the whole policy will fall into disrepute. If there are a series of incidents where people are cast into the community with inadequate provision, the basis of our policy will be questioned. That would be regrettable, because the policy is a great improvement in the treatment of so many of the needs of the disabled.
I hope that the hon. Member for Monklands, West and the Committee will take into account one or two points about the precise content of the Bill. On the whole, these are relatively minor matters, and the principles of the Bill are accorded agreement by both sides of the House. However, in certain aspects, it is rather bureaucratic and it will be easy for local authorities to hedge round some of the provisions with detailed regulations that could be counter-productive to the effects that the hon. Gentleman wishes to bring about. I do not say that from a sinister motive but because I am concerned that the disabled, their families and representatives could be inundated with a barrage of incomprehensible paperwork that could be counter-productive in helping them in their needs.
It is important that there are guidelines and some clear understandings about who may be representatives and what the role of those representatives will be. It may be difficult to build into the legislation specific provisions to overcome the difficulties that I see, but there is a danger of people being manipulated in a particular direction if a specific group sets itself up, almost as a business, as professional representatives of disabled people.
The major voluntary groups have to be involved and are likely to have the necessary detachment and experience to help disabled people. There are groups that do good and are well-meaning, but have a particular slant in their philosophical, religious or moral code of life that may work for some individuals but not for others. It is important that the authorisation procedures for representatives include elements that will guard against some malfunctioning of the system.
There is also a slight danger that a number of statutory solutions may result in the mentally ill and the mentally handicapped being moved from one type of institution into a different one, nearer to the community but not necessarily within it. This is the concept of what the Americans delightfully call "trans-institutionalisation". I hope that the establishment of statutory procedures such as those set out in the Bill will not, as they could, lead to such "trans-institutionalisation".
Clauses 1 and 2 in particular, but other parts of the Bill as well, give me cause for concern about the needs for, and the right of, families, as well as the disabled, to be consulted. I have no doubt that most health and local authorities will consult. There are references in the Bill to the needs of families and the rights of parents and children 1401 to be consulted at appropriate times. Families have an important role to play in the overall concept of care for the disabled and I should like some inclusion in the Bill of statutory rights for those involved to be consulted at other points.
It is most welcome—and it is a matter to which we shall have to pay increasing attention in the next few years—that the Bill attaches importance to the 5.5 million carers. We must balance the needs of the carer, the disabled person and the extended family in any assessment that is made. I hope that the Bill will spur on the development of a range of respite care. The Bill could have a good spin-off effect in that direction.
I doubt whether it would be possible or right for statutory bodies to provide with sufficient flexibility the kind of respite facility that is needed, but they have a vital role to play in the co-ordination, encouragement and grant-aiding of that kind of provision. Within the imaginative and wide-ranging central funding initiatives that are currently undertaken by the Department of Health and Social Security it may be possible to lay particular emphasis when allocating funds upon the provision of respite care.
The result of advances in respite care may be that many carers will feel able to care for their relatives for a longer period of time if they know that occasionally they will receive help and a break from their onerous duties. To be cared for in the home is likely to be to the advantage of disabled people. To be able to continue in a family environment is very important for them.
Finally, I turn to a small point in the Bill that is of considerable importance. It continues the trail blazed last year by my hon. Friend the Member for Newbury (Mr. McNair-Wilson) in his Hospital Complaints Procedure Act: the provision of specific rights for patients. Our system does not provide sufficient protection for patients. We have sought, so far unsuccessfully, to find a number of financial mechanisms within the National Health Service that will result in a more responsive operation that can more readily be adapted to the needs of patients and that allows the voice of patients to be fully heard. If we cannot find the financial mechanisms, we must continue the search for them. It is important to introduce into legislation a statutory right for patients to be consulted and to have their complaints dealt with. It is another important side effect of the Bill that I welcome wholeheartedly.
§ Dr. Norman A. Godman (Greenock and Port Glasgow)
I am pleased to welcome this Bill and I am happy to congratulate my hon. Friend the Member for Monklands, West (Mr. Clarke). I almost said "my hon. Friend the Member for Gartcosh" because he is so closely associated with Gartcosh in the minds of all my constituents on account of his deep concern for the people employed there. He has also long been known for his deep concern for those who suffer from that particularly debilitating handicap of blindness. Therefore I am pleased to be taking part in the debate upon his Bill.
Part I relates to the assessment of the needs of disabled persons. There is a need to define clearly in part I what is meant by the needs of both the disabled and their families. The identification of needs must have as its aim the object of enabling the disabled person to participate as fully as 1402 possible in his or her family and in the community. The definition of needs should, therefore, include economic, financial, social, education and employment needs.
During the last few days I have spoken to a senior psychiatric social worker, Mrs. Tricia Godman, and. Miss Ann MacLean, a senior social work manager in the Strathclyde regional council's social services department. Both of them have considerable experience of working with the disabled. Clauses 1, 2 and 3 are eminently sensible. They seek to protect and promote the interests of the blind and the physically and mentally disabled.
It is important that social work departments are equipped with the skills to conduct the assessments spelt out in clause 3. Perhaps some specialisation should be encouraged, and, at the very least, given the range of needs of the young disabled, social workers may require some form of in-service training. Basic grade social workers will be involved in the important work of assessment, and they should be committed to the interests of that client group.
Miss MacLean told me yesterday that the Strathclyde regional council social work department planned to set up assessment teams to deal with the needs of young people who were physically or mentally handicapped or blind. Such a team would have among its members a social worker, the school teacher involved and an educational psychologist. I welcome that development. Educationists and others who train social workers will need to take cognisance of that. The hon. Member for Mid-Kent (Mr. Rowe) outlined the implications for social work training contained in the Bill.
The two senior social workers both welcomed clause 4. They say that there is nothing more disastrous than a person—especially someone suffering from a mental disorder—being discharged from hospital with no warning of and no preparation for what may be an intensely difficult transfer to the community. Both social workers welcomed the need for prior notification spelt out in the clause and the need to plan discharge from hospital, especially for those suffering from psychological illness or mental disorder.
Too many people are discharged with no social skills and no experience or understanding of the DHSS regulations or provisions. That is an important requirement for those discharged from psychiatric institutions. Few, if any, undertake rehabilitation programmes. That is disgraceful. If my hon. Friend succeeds with his Bill, as he should, he will earn the immense gratitude of many patients, their families and their professional carers. Clause 4 will enable social workers to assist the disabled to settle in the community following their hospitalisation.
Clause 5 provides much-needed assistance for those millions of people who may be called informal or family carers—the parents, brothers, sisters, sons and daughters who give so much of their lives to disabled members of their families. It has already been pointed out that those family carers save the state a great deal of money. Just think of what would happen if they decided to forgo those immense burdens.
Clause 5 should deal with the problem that often confronts social workers when they discover the existence of a mentally disabled person only if his or her family carer is taken ill or, even worse, dies. That often involves a mentally disabled person in his or her 40s or 50s who has been cared for since childhood by parents who have grown old and who may still be carrying that awesome burden 1403 while in their 60s, 70s or even 80s. It is vital that decisions concerning the care of middle-aged people are taken while their elderly parents are still able to participate in that decision making. Many of these elderly family carers are plagued by worries about the care of their handicapped sons or daughters when they themselves are unable to perform that duty. An old lady in my constituency said to me recently that she was desperately worried about the care of her middle-aged son following her death. Her fear was that he would be filed away in some uncaring institution.
We should recognise that carers should be given holiday breaks from the difficult task of caring for their disabled family members. The Bill will perform a service for elderly carers of disabled relatives as well as for many others. I hope that it will have a safe passage and that its provisions are given the widest publicity by central Government and local authorities.
§ 2 pm
§ Mr. Tom Clarke
I seek leave to reply to some of the issues which have been raised during what I think has been a splendid debate. I thank right hon. and hon. Members on both sides of the House for their contributions. I thank especially those who have taken part and those who have offered constructive criticism. Hon. Members on both sides of the House have shown that it is not true that Fridays are necessarily unpopular. They have shown by their presence in the Palace of Westminster that they support the main thrust of the Bill.
My right hon. and hon. Friends will understand that in thanking them for their support I confine my response to three contributions. First, I should like to thank the hon. Member for Exeter (Mr. Hannam) for his first-class speech and for the excellent support that he has given to the Bill. I am sure that his work in this area is much appreciated by hon. Members and by those beyond the House. I thank the hon. Member for Caernarfon (Mr. Wigley) for his speech and for his input into the Bill. He mentioned a number fo organisations, and I agreed with every word that he said. My difficulty is that the organisations have been so helpful, as the hon. Gentleman appreciates, that it would be impossible for me to put on record my gratitude to them while trying to enable a decision to be taken on whether the Bill should receive a Second Reading by 2.30 pm. Nevertheless, my gratitude is firm.
I turn to the most important contribution to the debate, which was made by the Minister for Health. He seemed to sum up his own response to the Bill by saying that it was one of "sceptical neutrality". That is a pity, especially after a debate in which it has been made clear that, although there is constructive criticism of some parts of the Bill, it is the will of the House to place the Bill on the statute book undiluted so that it can make a contribution to solving the problems of the disabled. The House wants to see progress, and it would be a great pity if the Government attempted to thwart that objective. I hope that the Minister will bear in mind what has been said in that respect during the debate.
As an ex-local government man, I am sorry that the Minister appears to have been influenced so profoundly by the last-minute letter of the Association of County Councils. When he mentioned the Association of 1404 Metropolitan Authorities, I am sure that the Minister wished to remind the House that it is supporting the Bill. In my view, the ACC did not make its best effort. It may be that it is suffering from a lack of resources, but there was nothing very constructive about what it had to say.
If the Minister is bearing in mind that advice, I hope he will consider a few points. First, it is overwhelmingly evident that prevention is not only better but cheaper than cure. Secondly, he should accept that good administration is cheaper than bad. I hope that he will also agree that too often those who pretend to oppose bureaucracy are in reality offering excuses for unacceptable lethargy.
The duties towards disabled people mentioned in the letter already exist to a great extent. I am trying to assist the association and other councils to keep within the law. They should not blame me for giving them that opportunity by spelling out the needs which exist and by imploring those public bodies and others involved to accept that disabled people are entitled to be represented or to express their views on the kind of society in which they live and the kind of services that they think they should be receiving.
I know that the Minister would never dream of letting councils take their own decisions, on the basis of the kind of autonomy he talked about today. I know that if members of the GLC were here they would have welcomed today's approach, but that attitude does not apply to the Minister's view on the DHSS. There is no way that he would tell each office in whatever geographical area they are located that the matter will be left to them. Therefore, I found the Minister's response on that point surprising to say the least.
I do not want to go overboard, because I am still trying to convince the Minister that he should be Mr. Nice instead of Mr. Nasty. Were he here, my right hon. Friend the Member for Cardiff, South and Penarth (Mr. Callaghan) would have said that the Association of County Councils in its letter was, to say the lesst, over-egging the pudding. The Minister fell into the trap of exaggerating the administrative nature of the Bill, especially when he referred to clause 6. That will become increasingly clear as the matter is debated in Committee.
In the spirit of good will which exists in the Chamber today, I want to say that, if the Minister is asking the Bill's sponsors for constructive discussion on his amendments, that is fine. We would all accept that. What we could not accept is any attempt to destroy the real meaning of the Bill; any attempt to knock the heart out of the Bill and therefore to disappoint the millions of people whose needs have been identified by hon. Members on both sides of the House, who look, and rightly so, to the House of Commons for leadership in relation to their needs.
The Bill is not a blueprint for bureaucrats; it is a charter for the consumer within existing legislation. It offers a fair deal for disabled persons; they, too, are ratepayers. When the Minister comes to give quiet, sober and reflective consideration to those points, we as a House might even be able to convince him that he should remove from his mind the sceptical neutrality which he advances as an argument today and put in its place the positive merits of positive commitment.
Question put and agreed to.
Bill accordingly read a Second time, and committed to a Standing Committee pursuant to Standing Order No. 42 (Committal of Bills).