Disabled Persons (Services) (Hansard, 24 June 1992)

§ Mr. Andrew Rowe (Mid Kent)

I beg to move, That leave be given to bring in a Bill to empower local authorities to make certain severely disabled persons accountable for expenditure on their care plans. This is a modest measure designed to assist the Government to solve a problem that has caused them embarrassment more by an accident of history than fault of their own. The problem is that some men and women who are severely physically disabled, with relatively little control over their bodies but with their minds entirely unimpaired, want to remain in charge of their own lives to as great an extent as possible. They want to be able to decide for themselves when they get up in the morning or go to bed at night, decisions which for most of us are part of normal adult life. Yet under present arrangements, whereby local authorities have to provide the domiciliary care staff that are needed to allow disabled clients to live in the community, it is impossible to guarantee such freedoms.

Take, for example, the case of Ms. C, who has a senior position in a company running training and education courses throughout the country. Sometimes she has to ask her care assistants to arrive at 5 am to ensure that she is up in time for a meeting. Sometimes she has to stay away overnight and take a personal assistant with her. No local authority provided service can offer that degree of flexibility and control. Yet until recently Ms. C has been able to make her own arrangements because the local authority has been paying directly to her the part of her total care budget that is needed for domiciliary care. She has recruited, trained and deployed the staff that she needs and accounted for the money to the local authority.

Why "until recently"? I am sure that you can imagine the shock, Madam Speaker, which went through the system when almost the first guidance issued by the Department of Health under the new community care legislation was to warn local authorities that by allowing such arrangements they were breaking the law. The National Assistance Act 1948, echoed in the national health service Acts of 1968 and 1977, makes it illegal for local authorities to make cash payments to individuals, and the Government have no choice but to remove from some of the most disadvantaged people in Britain the one freedom which they most treasure. That is the problem which the Bill seeks to address.

As you would undoubtedly be quick to remind me, Madam Speaker, a ten-minute Bill may not stray into territory such as giving local authorities the power to make direct payments, ideal though in my judgment it would be if they could. It is a severe limitation. I am proposing a device to improve the present position, but I know that it is very much a second best.

The limitation is well shown by the case of Mr. A. His local authority allows him to employ staff and manage them on a day-to-day basis, but the authority pays them and they are subject to the employment practices of the authority. The effect of its shift systems, for example, is that he cannot choose when he will go to bed. Nor can he suddenly alter the arrangements to fit in with an unexpected change in his schedule.

What a contrast with the case of Mr. F. He receives about £15,000 a year. It is paid into a separate bank 267 account and out of it he meets all the payments for his personal assistance. The account is open to the local authority to inspect at any time and at the end of each year Mr. F presents an audit of his account to the local authority. It is a simple system that is cheap to administer. It retains the statutory responsibility of the local authority and makes it easy for the authority to assume direct control if Mr. F, for whatever reason, found that managing his affairs in this way was too much for him, but affords him the dignity and independence that we would all seek for ourselves.

My proposition is, by contrast, inferior but is all that I can propose in the context of a ten-minute Bill. I propose that such disabled people as are assessed as able and willing to shoulder the responsibility of recruiting and employing their own staff should be allowed to do so up to the financial limit decreed by the local authority. They should then arrange to have the bills paid by the local authority, but the responsibility for the staff contracts would be theirs.

We have a parallel in the House. The office costs allowance is available to Members to make such arrangements as seem best to them to meet their needs and those of their constituents. The bills are handled by the Fees Office, which exercises some scrutiny over the payments to ensure that they do not depart from the rules that have been laid down. In this way we are in charge of our own offices, but the interests of the taxpayer are safeguarded. For the few clients that I envisage it is an unnecessarily cumbersome system, but is better than the position that we are left in by the recent guidance from the Department.

The Bill is modest, but the principle that it enshrines is fundamental to community care. Community care is partly about enhancing the dignity of those who need public care. It is also about enhancing choice, developing personal responsibility and encouraging the growth of personal capacity. It must, therefore, be right to allow those disabled people who have the capacity and the desire to take control of the most personal part of their care arrangements to do so.

268 When the National Assistance Act reached the statute book 44 years ago, the relationship between those who needed care and those who gave it was very different from what it is now. I know that Ministers know that. Nobody who listened to Ministers, hour after hour, in the National Health Service and Community Care Bill Standing Committee has any doubt about where their hearts lie. I know that my hon. Friend the Member for Suffolk, South (Mr. Yeo), who is on the Treasury Bench today, shares their views.

My Bill aims to take the first step towards enabling disabled persons to cut off the shackles imposed upon them by long-dead Acts of Parliament and to restore to some severely disabled persons the dignity of making their own decisions in an area of their lives where no public authority, no matter how benevolent, can hope to treat them as well as they can treat themselves.

I hope that the Government, who have done so much already to increase the control that disabled people have over their own lives and who have introduced the citizens charter to carry that work forward, will give my Bill a fair wind or, even better, go the whole way and allow direct payments in carefully selected cases. When I worked on the Social Work (Scotland) Bill 25 years ago, we wrote into it section 12, which allows cash payments in special circumstances to be made by local authorities to people in their care. I feel that that is a better precedent in 1992 than the National Assistance Act of 1948.