HC Deb 16 March 1990 vol 169 cc861-8

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Greg Knight.]

2.31 pm
Mr. Alan Meale (Mansfield)

Although I have drawn the short straw in the debating stakes, I am extremely grateful for the opportunity to speak about a matter that I regard as serious indictment of the House: our collective failure as parliamentarians to introduce comprehensive legislation to ensure that the day-to-day needs of disabled people—especially the severely disabled—are taken fully into account in our legislation.

Sadly, the everyday clothing needs of disabled people—particularly, as I have said, the more severely disabled—have not been recognised, either by our draftsmen or by those who have taken it on themselves to interpret regulations rigidly, in a way that lacks sympathy and understanding.

There is no doubt that specially designed clothing can dramatically increase the independence of disabled people and their general ability to participate in life. Social independence opens up a whole new world for those unlucky enough to have physical handicaps. The Government readily appreciate the need to provide for the disabled in some respects, such as housing and building design, employment, transport and mobility—although they have not always acted fully on that recognition. Why, then, do they not accept that many disabled people need special help to acquire what the able-bodied majority regard as normal everyday dress?

The second report by the Office of Population Censuses and Surveys revealed that more than 2 million disabled people in the United Kingdom estimated that they spent at least £5.20 a week for purposes connected with their disability. More than 1 million spent more than £10 per week, and 500,000 more than £15. A major factor was undoubtedly the cost of special clothing.

Worse still, having been confronted with the normal expectations of society, disabled people face the tremendous difficulties involved in purchase, alteration and repair costs. To ignore the dilemmas to which those problems lead, and to withhold support, is to accept the principle that disability equals disadvantage: such is the poverty of choice that we provide.

I shall give the Minister a few examples that illustrate the difficulties that disabled people have to face when they need new clothing. A woman aged 45 with otherwise normal statistics has a personal height of only 3 ft. She needs dresses, coats and underwear and cannot find a retail outlet to help her without huge additional costs, delays and limitations in design. Another woman with severe disabilities needs trousers, slippers and skirts to allow her to go out. She has 40 in calf measurements, which preclude her from normal retail buying. Worse still, the tailoring of such items causes lengthy delays and difficulties over fitting and design costs.

A gentleman with limited use of his hands needs tailoring to provide adapted fly fastenings to his trousers to enable him to toilet himself. That is a limited alteration, but when adapted to every pair of trousers that he owns, it constitutes an enormous difficulty. A gentleman with cerebral palsy needs a pull cord affixed to a knee-length dressing gown for use when he crawls around his home. That is not a pleasant thought for hon. Members, but it is a reality of independent limited movement to the person concerned. A severely mentally and physically handicapped woman in a children's home in Nottinghamshire requires a satin dress for her 18th birthday, an item that is impossible to fit off the peg, particularly with the difficulties that such a purchase would cause the person fitting the garment.

Those people and thousands of others regularly face major problems with their clothing needs and requirements, a factor recognised by the Griffiths report on community care, produced by Sir Roy Griffiths for the Secretary of State for Social Services in 1988, which dealt at some length with the problems of dressing some handicapped people. The problems are recognised by every organisation involved in helping disabled people. That is not difficult. Because of the nature of disability, added wear and tear to certain types of clothing is sometimes caused by something as simple as constant washing.

However, the response of the then Minister for Health in a letter to the hon. Member for Newark (Mr. Alexander) in 1989 contradicted that. She wrote: for the majority of disabled people, their needs for clothing and their need to exercise personal choice of style can be met by certain types of clothing produced for the general market or by adaptations to standard garments. In many cases that is not a true reflection of fact. None of the cases that I mentioned fits that category, nor do many others.

For example, two of my constituents in Mansfield face similar problems. Mr. and Mrs. Henshaw have a daughter now aged two, who through difficulties at birth, had to have both her legs amputated. Her parents are extremely conscientious, yet low-paid because of their profession. They have to go to Nottingham for regular limb fittings and extra help from the NHS. However, Charlotte needs special help because she is a growing child, and because she has artificial limbs her clothing has to be adapted for her disability. It is sad that she gets no help. Because she is only two, Charlotte gets no mobility allowance as it is not paid to people who have children under five years of age. That is a disgrace. My constituency is 15 miles from Nottingham and Charlotte's low-paid, conscientious and hard-working parents have to travel a considerable distance. They receive no support whatever. The Minister and his colleagues in the Department of Social Security should find time to redress that disgraceful anomaly affecting young children who need the specialist support that our laws offer disabled people. Our laws need to be adjusted to help those people.

The Minister is aware that there are about 20 clothing workshops for the disabled in the United Kingdom. They are specialists, yet they receive little or no help from national Government. In the response that I mentioned earlier, the Minister for Health dismissed the need for central Government funding and said: it is open to local authority special services departments to help fund organisations". That was a truly inappropriate response, especially as there are about 150,000 disabled people in Britain who need specialist clothing provision, which can be produced only by organisations such as the workshops that I mentioned. I particularly praise one of them, Bassetlaw Fashion Services for the Disabled, and its director, Mrs. Ann Waddingham. That small, charitable workshop covers north Nottinghamshire and other parts of the east midlands. It not only manufactures garments but alters others to individual needs, makes regular home visits to measure and fit clothing before production and carries out limited training for the parents, relatives and partners of disabled people.

The Minister is aware also that a number of hon. Members are concerned about the matter and the funding of those workshops. The hon. Members for Shipley (Sir M. Fox), for Londonderry, East (Mr. Ross), for Belfast, South (Rev. Martin Smyth) and for Newark, and my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) have all strongly said in their own way that something needs to be done to alleviate the situation. I submit that a short-term solution to the problem resides with the Minister, through his Department deciding to fund, on a limited basis, all those workshops, perhaps on a three-year research project. He undoubtedly has the ability to do that under grants that he has made available. Departmental guidance notes, to which the then Minister for Health referred in her letter, state that aid can be given to support innovatory projects of potential national significance or to develop a particular pattern of service. The Minister knows the figures. With a growing number of younger, severely handicapped people surviving longer, the problems for them can only get worse. In the long term, the Government should accurately define the funding needs of all such workshops and specifically designate specialist clothing for the disabled within the terms of existing legislation for the disabled. I argue that a short review period can only help such a process. It is useless in present circumstances to rely on local authorities—whether Labour, Tory or whatever—to fund such projects, especially since the poll tax.

I strongly urge the Government to help those workshops to develop their pattern of service, which can only help disabled people to live as normal a life as possible. The needs of disabled people demand that the Government respond positively to the difficulties that disabled people face in their lives. Because of the clothing needs of permanently and severely disabled people in that important training period of their lives—when under five—I again ask the Minister to meet his colleagues in the DSS, to carry out a review and to provide the extra help that they need in clothing provision, training and mobility assistance. I beg him seriously to consider the project that I have put forward.

2.43 pm
The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)

I congratulate the hon. Member for Mansfield (Mr. Meale) on raising this subject, which he did eloquently and clearly. I shall ensure that my colleagues in the Department of Social Security are aware of his points about mobility allowance, which is a matter for them, not me.

All hon. Members will understand the complexities of life for people with disabilities. They already have problems with movement and have the additional problem of clothing themselves at what must be a greater cost than that normally faced by you, Mr. Deputy Speaker, the hon. Member for Mansfield or me in buying clothes from a shop. Bespoke clothing, which is what we are talking about, is much more expensive than the clothing available to the ordinary citizen. I understand these problems.

As we emphasised in the White Paper "Caring for People" it is vital that all disabled people should be able to lead lives that are as full and independent as possible. That applies as much to their clothing needs as to other aspects of daily living. I refer not only to people in wheelchairs, but to those suffering for arthritis who will have as much difficulty dressing themselves as people who are premanently in wheelchairs. Some will need special clothing that is tailored to their individual disability, and production costs are inevitably higher because of the unique nature of the production of such clothes.

The hon. Gentleman said that other hon. Members have raised the subject before. The Adjournment debate of 21 October 1987 initiated by my hon. Friend the Member for Shipley (Sir M. Fox) referred to the subject. The hon. Member for Mansfield paid tribute to my hon. Friend the Member for Newark (Mr. Alexander), who has raised the subject many times. Bassetlaw Fashion Services for disabled people at Retford is located in his constituency. The hon. Member for Mansfield rightly paid tribute to other hon. Members for raising the subject.

We recognise that clothes are an integral part of the wearer's personality and individuality and his or her acceptance socially. Good, fashionable clothes increase the wearer's self-esteem and the regard in which he or she is held by others. Disabled people rightly demand a choice of clothing which, while functional, does not obviously proclaim itself as being different from the sort of clothing that they might have been able to buy in a high street shop. I acknowledge my Department's responsibility to encourage good practice.

We have provided a substantial grant, as the hon. Gentleman may know, of £340,000 per annum in real terms to the Disabled Living Foundation in London, the clothing advisory service of which is the main source of information on the subject—collecting, storing and disseminating information on all aspects of clothing for disabled people. We also support the Disabled Living Centre's council.

My Department also funds the publication of a series of books called "Equipment for Disabled People". They provide details and comments on the evaluation of a wide range of equipment and self-help devices intended to assist disabled people. One book, entitled "Clothing and Dressing", provides information on a number of factors which need to be taken into account in selecting clothing, and which help the individual to choose suitable styles.

Through its disability equipment assessment programme, the Department sponsored Southampton general hospital's assessment of the use of lower limb dressing aids, which help people to put on shoes, socks and stockings. Those are mundane problems for the hon. Gentleman and me, but of vital importance to disabled people. The programme assesses disability equipment while it is in use by disabled people under clinical supervision, and records the equipment's advantages and disadvantages. It offers guidelines on the most important aspects to be considered when such equipment is prescribed.

The programme is aimed primarily at helping disabled people, their carers, and the professionals working with them, to choose the most suitable equipment to meet their needs. It is also of value to manufacturers and suppliers. The feedback that they obtain helps them to see whether their products need to be modified to improve performance or convenience. A number of reports have been published, including that from Southampton, and they are available from the Department on request.

I look forward to attending the launch on 22 March of the clothing initiative for people living in National Health Service hospitals. I hope that the hon. Gentleman, given his interest, will be interested in coming. I will ensure that an invitation is sent to him. I know that his remarks were specifically directed to those living in the community, but his concerns could, and should, extend to people in hospital. The findings of the working party formed by the Disabled Living Foundation, the Royal College of Nursing and the King's Fund highlight the Department's concerns in this area.

The provisions for laundering, storage and purchase of patients' personal clothing for people in long-stay hospitals—especially mental illness and mental handicap ones—are often unsatisfactory. Sometimes laundry services are not available, which means that carers have to take home soiled washing. Sometimes clothing may be ruined because inappropriate laundering facilities are used, or lost when it is sent away to commercial or off-site facilities. Patients frequently have to wear stock clothes, which may be ill-fitting or of poor quality. The common usage of clothing is not a practice that maintains a sense of dignity and well-being in a patient.

The right to their own clothing is of great importance to patients living in National Health Service institutions. All health authorities should explore every avenue possible to implement or upgrade systems to enable people to wear their own clothes. A conference to be held on the day following the launch—23 March—will help Health Service personnel to improve their systems.

I now come back to the providers of clothing for disabled people and I shall seek to answer the hon. Gentleman's two questions. I acknowledge the services offered by workshops such as Bassetlaw Fashion Services to disabled people who have special requirements. But I must emphasise that, for the majority of disabled people, the need to exercise a personal style can be met by adaptations of the standard garments produced for the general market. That is not always the case—

Mr. Meale

The Minister referred to the Disabled Living Foundation. That body estimates that disabled people have to spend nine times more week by week than the Office of Population Censuses and Surveys suggested. I seem to recall that the figure was almost £50. The Minister mentioned the availability of goods. Earlier I talked about Charlotte Henshaw. When her parents buy her clothes on the open market, they have to buy clothes two sizes larger than she would need if she were not disabled as, clearly, she needs longer skirts to cover her artificial limbs. Instead of costing £13—the nominal average cost—the garment may work out at £18. In addition, there are dressmaking costs of £5 to £7 for the alterations that need to be made. That adds up to a 90 per cent. increase in the cost of that garment. We are talking about people on low wages, who spend all their money helping their disabled child. It is ridiculous for us to force conscientious parents to go to such lengths. They should be able to go to a workshop and look at fashions which can be made up from scratch from basic patterns and adapted to suit their child's need.

Mr. Freeman

Of course, the hon. Gentleman is right that it costs very much more to purchase clothing for disabled people than clothing for people who are not disabled. One can approach the problem of the high relative cost in two ways—first, by helping the purchaser and, secondly, by seeking to assist the supplier. Let me deal with the purchaser—the patient—first.

The hon. Gentleman will know that income support now provides extra help for disabled people in the form of premiums. The disability provision—from April 1990 worth £15.40 a week for a single person and £22.10 a week for couples—goes to disabled people under 60 years of age and £15.40 a week extra also goes to families for each disabled child. This additional benefit is now paid, automatically, as soon as the disabled person or child satisfies the criteria. There is no intensive questioning on the individual's personal affairs. Disabled people over the age of 60 years who qualify for it get the higher pensioner premium. From April this will provide an extra £17.05 a week for single people and £24.25 for couples.

The hon. Gentleman also referred to the cost of production. Perhaps in the time that remains, I can deal with the question of supply. The hon. Gentleman knows that my Department has no statutory power to assist, through section 64 grants, the workshops to which he referred. Section 64 of the Health Services and Public Health Act 1968 enables funds to be provided mainly to assist with the central administrative costs of national voluntary organisations in health and personal social services, and even if we wished to do so, my colleagues and I could not assist the workshops under the law as it stands. Nevertheless, as the hon. Gentleman is aware, it is open to local authority social services departments to help those organisations and they can do that under the Chronically Sick and Disabled Persons Act 1970. Local authority associations can make representations to the Department of the Environment in terms of the setting of revenue support grant levels to take into account the need, as they see if, for financial assistance or grants for workshops.

On a slightly more constructive note, I can state that under the National Health Service we provide free footwear. While that was not specifically covered by the hon. Gentleman, we provide footwear for disabled people, where that has been prescribed by doctors or physiotherapists, at a cost of £20 million a year to the taxpayer. I know that many of those items cannot be described as high fashion.

However, in widening the debate about clothing, we will be considering our arrangements for the supply of footwear under the NHS to see whether we can help patients a little more, particularly with regard to their fashion desires, and perhaps acquire less standard items of production. We must consider those matters to see whether we are getting value for money and whether we are satisfying patients' demands. I cannot give the hon. Gentleman a timetable for such a study, but we will be launching one.

Mr. Meale

All disabled people are grateful for the excellent service that is provided for them. However, footwear provision is slightly different from clothing. There are many ranges in every size of shoe and those are easily manufactured and supplied. On the other hand, clothing must be specially designed, particularly for severely disabled people to meet their living requirements. A man suffering from cerebral palsy who drags himself round on the floor in his home needs specially adapted clothing to help him. Shoes and clothes are entirely different, although I welcome the Department's concept of at long last trying to develop a fashion approach to the needs of disabled people.

Mr. Freeman

The hon. Gentleman anticipated my final remarks. I agree with him. I clearly said that shoes are not clothing, but it is a step—to use a perhaps inappropriate expression—in the right direction. The hon. Gentleman made a well-argued case and stressed the need for the Department to research the activities of the 22 workshops around the country.

The Department's research management division can mount studies to examine the features of those workshops which appear to contribute to their success. For example, they can study the good relationship between workshops and local authority social services departments. The research management division can do that with a view to establishing guidelines for further support and ways in which financing might be augmented.

Given the hon. Gentleman's arguments, I will undertake to see how the Department could assist in research. That is a sensible and modest first step to help people whom, I agree with the hon. Gentleman, need our consideration, sympathy and support.

Question put and agreed to.

Adjourned accordingly at two minutes to Three o'clock.