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§ Mr. Barry Sheerman (Huddersfield)I beg to move amendment No. 1, in page 1, leave out line 13 and insert 'to enable payments to be made to or for the benefit of people with disabilities for the purpose of promoting their independence and freedom of choice.'.
In Committee, we were disappointed that we were not successful in amending the Bill despite the debate that we had on Second Reading and the obvious shared concerns expressed in Committee. When it came to the crucial act of voting, the Government were not flexible. On a Bill that covers many aspects on caring for the severely disabled, we hoped for some compromise and flexibility from the Government.
The key words in the amendment are
independence and freedom of choice".I note that the Minister for Social Security and Disabled People agrees with me. In the foreword of the Greenwich personal evaluation scheme, which was published recently, he said:This report on Personal Assistance schemes shows that as well as being cost-effective, some schemes offer disabled people a greater degree of independence.The Minister will know that the amendment is designed to reintroduce into the debate the important change in the way in which disabled people view the sort of help and support that they need and receive, and the way in which they receive it. That merely scratches at the surface of a fundamental change that has taken place in the sphere of disability in recent years. The debate is continuing, not only in the form of the Bill that we are discussing, but in another place, where a different Bill was recently debated which was designed to address the same subject: how people receive the help necessary for them to continue to live lives that are full and give them the opportunity to use all their potential.I do not wish to speak merely as the shadow Minister and say what I believe to be the main concerns of disabled people and those who support them. I prefer to act as a mouthpiece and tell the House the comments that have been made in favour of direct payments by the people affected by them. They have expressed their views far more eloquently than I could hope to do.
Two disabled people were quoted in Anne Kesselbaum's report, "Cash for Care". They said:
It makes us feel in control of our lives; gives us back the feeling of being people and not a pathetic handicapped family …If you have a carer you feel safe with, you know your quality of life is better. It opens things up. Your personality changes, you laugh.Some of those comments go to the heart of the subject.Jane Campbell, a disabled person, said in conversation with Lord McColl:
Employing your own personal care assistants places negotiations on a very different plane. You are not asking for favours or desperately attempting to change the (statutory) 888 home carers rota so as to enjoy another hour at that party. Instead, you are setting your schedule for the day, which you know will be adhered to by your employee, with whom you have agreed a one to one contract of employment.Whereas my traditional form of help gave me no privacy, and was often loaded with what people thought 'best for me', I now decide my own priorities, and I feel I have an equal say in how my home and my family life is run.Those are moving words from disabled people who want the sort of care on which the amendment focuses. She concludes:This is, I believe, fundamental to one's dignity and sense of belonging and contributing.A young lady, Maria, was interviewed by Jenny Morris for the Rowntree trust's report, "Community Care or Independent Living", and said:It means I can get up in the morning when I want to, go to bed in the evening when I want to, and lead the kind of life that I want to.That is a true testimony of the power given to the disabled when they can receive money from the independent living fund. I should be out of order if I strayed too far, but that example shows the amount of power that is handed to disabled people when a local authority social services department can provide cash for disabled people to allow to make their own decisions and to draw up contracts of employment to meet their needs. In the same interview, Vicky, a disabled person, said:Independent living means that I employ people, and basically that they are here to do the physical things that I can't do, which allows me to have the lifestyle that I choose.The important common factor running through all the quotations is that, given the money to employ their own care assistants, people with disabilities enter into a one-to-one, employer-employee relationship with their helper. They can specify exactly the sort of care that they want, and in what form they want it. They can specify the exact hours when they want that help. Last, but certainly not least, they can ensure that the person helping them, who spends much time in their house—and sometimes lives in it—and helps them to perform intimate functions, is someone with whom they feel happy and comfortable. Surely that is something that every hon. Member should want for the severely disabled people of our country.I do not wish to delay this stage of the Bill. I give a final quotation which illustrates the sort of horror story that can occur when a disabled person does not have full control over the care contract and those who fulfil it:
The home help came to me one day when my bed was wet and I asked her to change the sheets. She refused. She said, 'Today is not the day we change the bedlinen.' I asked if she expected me to go to sleep in a wet bed. She said, 'Well, I'm not changing it.'Clearly, that is untypical. We appreciate that the vast majority of local authority carers are genuinely caring and compassionate people. I simply point out what can happen. When it happens, the disabled have fewer powers to seek redress and prevent the atrocity recurring than if they employ their own helpers.In a recent Friday debate, my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) introduced a Bill that would have established a commission for disabled people to have their grievances inquired into and righted. That measure was voted down at the behest of the Government, so the disabled do not even have that avenue to pursue. When such a ghastly experience occurs and a disabled person is unable to have carried out by her carer the sort of basic task that I have 889 described, it is regarded by many of us as a minor atrocity, because it combines physical discomfort with personal humiliation to a quite intolerable degree.
In his Second Reading speech, the Minister referred to local authorities being in the driving seat. As the Bill proceeded through its brief Committee stage—we did not prolong the proceedings; it went through in two very civilised sessions—we got the impression that the Minister made a slip of the tongue or, if that was not the case, that he regretted what he said when he referred to the need for local authorities to be in the driving seat.
The thrust of our argument in Committee—unfortunately, we were not successful in getting it accepted—was that disabled people should be in the driving seat. The experiment conducted by the independent living fund showed that empowering people to make their own arrangements costs dramatically less than providing the service direct. In other words, when people can choose and draw up their own contracts with the people of their choice, the Exchequer can make a saving of between 20 and 50 per cent. of the cost. People make more sensible decisions than bureaucracy makes for them.
The Minister has seen the evidence. He saw much of it in the debate on cash payments in another place. Apart from the case made by the Minister in that debate, the view was unanimous, on the evidence before the other place, that cash payments are effective, are empowering and save money.
The argument adduced throughout our debates leads us to believe that, secretly, the Minister is on our side. Indeed, it is rumoured that some of his colleagues are on his side. Clearly, if they were not whipped, many Conservative Members would be with us—I have particularly in mind the all-party amendment that was voted down by the Government majority in Committee.
We are willing to believe that, but for some evil power lurking in the Treasury, many Ministers and Conservative Members would be with us. I give the Minister the benefit of the doubt on that issue. But if that is not the case, we deserve a thorough explanation today. If I am right, and it is the fault of the Treasury, we are left to wonder what sort of people are making decisions in the Treasury under Conservative rule. What kind of Treasury official or Minister would consider the research and the figures and say, "This is not permissible because it would save money"? Let us be clear: as I have explained, it would save money.
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I am talking of an innovation that is tried and tested. The independent living fund tried it for five years, and local authorities have tried it to good effect. Suddenly the Government realised that some local authorities were giving direct cash payments, and said that that was outside the letter of the law. What sort of Treasury official, in this day and age, could look at the facts, which clearly show a saving to the Government of 20 to 50 per cent., and still refuse to make a change in the law that would bring about such a saving?
Are we not, in the closing years of this century, enlightened enough to ask who the people are who are making such decisions behind the closed doors of the Treasury? Why are they allowed to be in the driving seat? This is not a question of local authorities or disabled 890 people being in the driving seat. Treasury mandarins are in control. That is why we believe that they are the evil influence. They are stopping the acceptance of consensus for an obvious sensible way forward.
The amendment would give the Government at this late stage a chance to make a change. We hope that they will respond in a positive manner.
§ Mr. Alan Howarth (Stratford-on-Avon)I apologise for arriving late for the debate, which started earlier than I had expected. Even so, I hope that I may crave the indulgence of hon. Members and make a contribution because it is an extremely important subject and I hope that, as a result of the consensus that undoubtedly exists across the Floor of the House, the Government will find it possible to concede the case for direct payments, and will respond positively.
The case for the amendment is well rehearsed and familiar. The arguments for it are so solid and the case against it so insubstantial that it seems strange that it remains necessary to debate it, but we must do so. The moral case is too important to neglect and the case in terms of practical efficiency and good value for money alone should be recognised and accepted by the Government.
The moral case should be restated, being the most important part of the argument. The principle at stake is the dignity of the individual. The argument essentially is that direct payments by local authorities to severely disabled people would enable them to enjoy as much as possible of the autonomy that able-bodied people assume as a right for themselves. The point was eloquently expressed by Lord McColl, Baroness O'Cathain, Lady Darcy de Knayth, Lady Masham and others in the debate last week in the other place on the Disabled Persons (Services) (No. 2) Bill:
The issue for us is whether we are to empower those of our fellow men and women who happen to suffer from severe physical disability to live as independently as they may and on terms as equal as possible with everyone else. What do we mean by policies of care? Is care merely to be an expression of an authoritarian and patronising attitude that says, "We who are in charge will take care of your problem. Indeed, we will take care of the problem that you are"? Or is care to be a manifestation of compassion, of a fellow feeling that impels us to act imaginatively to help someone who faces exceptional difficulties to meet his or her needs?
To give the simplest instance, are we to enable a physically disabled person to make his own decision about when he gets up in the morning and goes to bed at night? Or are we to decide that for him? Or for her? In an impressive and moving account of the transformation rendered to her life as a result of direct payments, Jane Campbell recently wrote:
Almost overnight I gained full control over my physical and to some extent mental being. Can you imagine that until the age of 29 everything I wanted to do from getting out of bed to attending an important meeting had to be negotiated? … Employing your own personal care assistants places negotiation on a different plane. You are not asking for favours or desperately attempting to change the (statutory) home carers rota. … Whereas my traditional form of help gave me no privacy and was often loaded with what people thought was 'best for me', I now decide my routines and I feel I have an equal say in how my home and my family life is run. This is, I believe, fundamental to one's dignity".Ann Kestenbaum, in the case studies that she describes in "Cash for Care", quotes Mr. M's wife, aged 48, suffering 891 from rheumatoid arthritis, heart condition and leg fractures as saying that having control of their own resourcesmakes us feel in control of our lives. Gives us back the feeling of being people and not a pathetic handicapped family.Ms K, who suffers from a spinal injury, says:Having the cash to pay for the things you need means you have standing.Jenny Morris in "Community Care or Independent Living?" quotes Jack as saying:I am a husband, a father and a breadwinner. And 10 years ago I was in an institution where I could not even decide when I would go to the toilet.… You know you can't really understand it if you haven't done it.… Your whole life changes.Jane Campbell endorses Jack's point impressively. She says:Contributing, of course, is the biggest gift that direct payments has awarded me.… I have been able to take up a demanding full-time job that is equal to my skills.She works as a training director and she chairs the British Council of Organisations of Disabled People.The moral, practical and financial arguments all reinforce each other. Jack and Jane contribute their skills to the betterment of society. They pay taxes. Jane attests that less stress as a result of less dependence on others and more control over her own body has had beneficial effects on her health.
Lord McColl, whose view on the point must carry particular weight, observed in last week's debate:
a high morale directly enhances the body's defences against illnesses of all kinds. As a result, people have fewer illnesses and thereby save the National Health Service money.The arguments in favour of independent living are familiar to the Government. My right hon. Friend the Minister for Social Security and Disabled People inaugurated the independent living fund, something of which he is proud, and justly so.The Under-Secretary of State for Health, Baroness Cumberlege, replying to the debate in the other place last week was emphatic when she said:
We fully support the aim of enabling disabled people to live independently and to exercise choice. We wish to give local authorities freedom and flexibility to meet those choices in innovative ways and to see disabled people placed at the centre of decision making.That statement is consistent with numerous other ministerial utterances and, I believe, truly reflects the spirit in which Ministers have sought to establish care in the community. What, therefore, is puzzling and deeply unsatisfactory is that Ministers, who express enthusiasm for independent living and scepticism about bureaucratic procedures and solutions, continue to refuse to allow local authority social services departments to make direct cash payments to severely disabled people.I shall examine the objections that Ministers have put forward to direct payments by local authorities. The speech by the Under-Secretary of State in another place last Wednesday was the fullest and latest rehearsal of those objections.
The Minister made the point that social services departments and the social security system have different roles. She said:
Social services departments arrange exactly that—services. The Benefits Agency provides cash benefits. It is the business of the social security system to provide cash to support individuals in need. It is not the business of local authorities."—[Official Report, House of Lords, 21 April 1993; Vol. 544, c. 1663–64.]892 That seems to me a descriptive observation rather than an argument against change. Moreover, it is not entirely accurate as a description of the status quo. Local authorities make cash payments in certain instances and they do so under recent legislation—the Children Act 1989. Local authorities make payments to children leaving care. They make cash payments to foster parents. They also make cash payments to voluntary organisations. So, the Government cannot pray in aid as a principle of administration that local authorities should not make cash payments.The Government have themselves legislated to enable local authorities to make payments to children and to able-bodied adults. I cannot imagine under what principle of administration disabled people alone should be excluded from receiving cash payments from local authorities.
In any case, even if the Minister's descriptive statement is broadly valid, that is not an argument for persisting slavishly with a fixed conception of the respective roles of different public service organisations. The Under-Secretary of State talked of the Government's fear of "imbalance", as if the existing bureaucratic structure were a thing of such beauty that its preservation had to be the paramount consideration, more important than finding better ways to help disabled people. Doubtless there were powerful reasons for that broad division of labour in the past, but society and its needs and our conception of how to meet them have moved on.
Throughout the 1980s my right hon. Friends have encouraged us to think of Government as enabler rather than provider and have encouraged those in the public service to think in terms of outputs and value for money rather than inputs.
Only yesterday, in an article in The Times, my right hon. Friend the Chancellor of the Duchy of Lancaster inveighed against the bureaucratic top-down model of governmental provision. He condemned the inadequacy of
rule-bound, hierarchical, uncompetitive old style service providers".He went on:Any organisation that governs its employees by detailed rule books in the end will promote only the best operator of rules, not the innovator or the creator. Any organisation that believes it is accountable only upwards, to those who set the rules, will treat its citizen customers as troublemakers".My right hon. Friend is right. For corroborative evidence, he need only read "Squaring the Circle", a study of needs assessment by Kathryn Ellis of the university of Birmingham for the Rowntree Foundation. She demonstrates the procrustean approach of social services staff, fitting clients into rigid categories of need, defined by pre-existing bureaucratic structures and assessment categories. Disabled clients who did not fit in and who expressed views of their own were dismissed as "demanding", "fussy", and "manipulative".My right hon. Friend the Chancellor of the Duchy of Lancaster went on to emphasise the need to delegate financial responsibility down and measure outcomes.
In The Times today, my right hon. Friend the Chief Secretary to the Treasury is reported as saying of the Government's review of the welfare state:
We will consider all options … which will have the purpose of meeting our objectives, one of which is to focus benefits increasingly on those in need … we want to ensure people have greater control of their own resources".893 So Cabinet Ministers are actively repudiating the status quo which the Under-Secretary of State was briefed to pray in aid last week.The Under-Secretary of State went on to say that local authorities are providers, enablers and facilitators of care services. That is right and as it should be. But if local authorities are to be enablers and facilitators, the Under-Secretary of State undermined her own argument against them making direct payments to clients because enabling and facilitating is exactly what that process involves.
As the House knows, the Association of Directors of Social Services is unanimous in its support for direct payments by its departments. It passed a formal resolution to that effect last autumn. It is keen to move with the times.
I spoke yesterday to Mr. David Mason, director of social services for Warwickshire county council, who confirmed his urgent hope that the Government will change their mind on this subject. As he said to me,
choice and empowerment come through purchasing power".The Under-Secretary of State raised, however, another objection, which the Government have advanced repeatedly. She said that it would be difficult for local authorities to define eligibility for direct payments. I find that a singularly unpersuasive argument in the context of the Government's policy of care in the community. The essence and great virtue of the policy is that local authority social services departments are to lead in assessing the needs of individual clients. Their daily duty and activity, enjoined on them by the Government, will be to assess need and, therefore, eligibility for help of one kind or another.But the Government have another argument to show that it could not be done. The Minister said that it would be difficult for local authorities to manage a genera', system of cash payments. That is an Aunt Sally. We are not talking about a general system. We are talking about a strictly finite and relatively small number of cases. In "Cause for Concern", published in March, Pauline Thompson provides the number of clients of the previous independent living fund authority by authority.
The largest number was in Birmingham, where there are 424; in my county of Warwickshire, there are 79; the smallest number was in Barking and Dagenham, where there are nine. Nor need the Treasury fear any opening of the floodgates. Mercifully, there are not large numbers of severely disabled people in this country and, of them, only a limited proportion want to handle their own budgets and employ their own assistants. When Kingston-upon-Thames social services department made inquiries as to how many severely disabled people might wish to take advantage of such an option, 12 said that they would.
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The Treasury continues all the same to fear that costs would run out of control. Last week the Parliamentary Under-Secretary of State said the local authorities would find it difficult to carry out the necessary monitoring to keep control over public funds. Again, that is an odd assertion. It would be easier for local authorities to monitor and control individual budgets assigned to clients than it is for them to keep control over the costs of their own in-house services. There is no problem whatsoever in requiring clients to keep funds provided by social services 894 departments and the ILF in a separate bank account and to be provided with regular statements, receipts and timesheets.
If the Treasury did not spend its time inventing imaginary difficulties, it would see that direct payments enable a given level of care to be achieved at less cost than the cost of publicly provided services. Evidence for that has been impressively marshalled by Jenny Morris, Ann Kestenbaum and Victoria Phillips. I shall not elaborate that part of the argument except to make the obvious point that there is far greater flexibility in pay rates and job descriptions for people employed directly by clients than there is for local authority employees.
My right hon. Friend the Minister for Social Security and Disabled People, in his foreword to the "Evaluation of Personal Assistant Schemes" in Greenwich by Mike Oliver and Gerry Zarb, endorsed their cost-effectiveness. That report suggests that, for its £5 million-plus home help budget, Greenwich council could have purchased 665,912 hours of work; for the same amount the personal assistant scheme could have brought 1,450,569 hours. Similarly, the personal assistant scheme could have bought twice the number of care attendant hours.
Under the scheme that the Government are now introducing, there will be an incentive for councils to inflate their costs, to bring the cost of care packages above the £200 threshold for a contribution from the ILF 1993 fund.
In the debate in another place, the Minister also raised as an objection to direct payments that they would be at odds with the idea of a flexible response to individual circumstances and that somehow they would entail the creation of a separate social security system within social services with its accompanying rigidity. That would seem to be a through-the-looking-glass argument. A wealth of evidence demonstrates that cash payments which enable clients to manage their own arrangements for assistance provide enhanced flexibility. It is one of the strongest arguments in favour of direct payments.
Ann Kenstenbaum writes:
Some of these arrangements are very flexible. Although the ILF award is assessed on the basis of regular hours of need, clients very often see their care needs in much less rigid terms. This is certainly true where care is essentially respite, allowing a family carer to have a break and get out of the house. It is also the case where a client's state of health and therefore care needs vary from one week to the next, or where a client leads a relatively active life engaging in different activities for which different hours of help are needed.She goes on to describe the problems of rigidity in the provision of services by social services departments.Mrs. B, with rheumatoid arthritis, is quoted as saying:
Home helps are bound by too many rules.… You couldn't expect a home help to be so flexible because of the other people they have to see.Mrs. J says:As a home help, she had to refuse to clean windows. Now (employed privately) if she is asked to do something, she just does it.Miss C sums up the problem of rigid practices among local authority employees:They canna do this, canna do that".Those complaints take us into the arguments against yet another objection by the Government. The Under-Secretary of State said that cash payments by the social services department would be unnecessary because the new 895 scheme ensures that in future the two parts of the package, cash from the ILF and services from the local authority, will be brought togetherso that the client receives a coherent package of care agreed jointly by the disabled person, the local authority and the new fund.But this could have been designed as a model of cumbersome, time-consuming and expensive bureaucracy. I do not believe that care packages can be most cost-effectively designed if they are made up of £200 of services and extra cash put in from the ILF.The Minister went on to emphasise that she would expect the disabled person to have
as great a say as possible as to who is to be employed to provide the care.She added:There is no reason why a care assistant should riot be personally chosen by the disabled person.I find it hard to credit that disabled clients will actually decide who is to be employed by local authorities. But if they are to have a say, why not go the whole way to autonomy? Would it not be less costly, administratively simpler and morally better for disabled people to employ their assistants?The argument to which the Minister appeared to attach the greatest weight was that, while
in individual cases disabled people may be able to use money more effectively than certain authorities"—a grudging but useful acknowledgement—there is a risk that they willadversely affect authorities' ability to match their resources to all local needs, not just those of people receiving direct payments."—[Official Report, House of Lords, 21 April 1993; Vol. 544, c. 1664–65.]That would be a powerful argument if it were true, but the Association of Directors of Social Services does not believe it to be valid. The truth is that many social services departments will find it extremely difficult to play their part in providing services to severely disabled people. To do so requires specialist resources and expertise.One of the most important and worrying findings in Pauline Thompson's recent survey is that only a minority of severely disabled people receive services from their local authority. The case for allowing severely disabled people who wish to do so to design and manage their own care arrangements becomes all the more powerful. To the extent that social services departments do not have to commit staff and time to detailed organisation of care for people with complex needs, so they will be able to address themselves more fully to the huge range of their other responsibilities.
The Minister's one other argument was that it would not be right to expand authorities' "already very full agendas" by asking them to take on responsibility for cash payments. Would that the Government had always been so concerned not to impose on local authorities. But they need not be fearful of doing so in this instance. They would be easing the enormous burden that they have laid on local authorities with care in the community.
I apologise for having dealt with these arguments somewhat laboriously. But it is an important issue, and they are the arguments that the Government have so far invited us to accept. I cannot accept them, because they disintegrate as one looks at them. I do not think that the Ministers who have advanced them believe in them either. Lady Cumberlege said that she was sad to have to reject the case made by every speaker in last week's debate. She 896 asked their Lordships not to shoot the messenger. I certainly have not meant to do that; she is held in warm personal regard.
However, it is our duty to debate the policy. If parliamentary debate is to count for anything, I hope that my right hon. and hon. Friends will heed the arguments that have been put forward from all parties and in both Houses. Early-day motion 1673 on independent living has been signed by 146 hon. Members of all parties. I hope that Ministers will respond positively to those arguments and views now because it is an urgent issue. My hon. Friend the Minister the hon. Member for Bury, North (Mr. Burt), has said that the Government's position is not irreversible. Care in the community and the new independent living fund must be established on a sensible basis. We cannot continue to defer to the obstinate obscurantism of a departmental tradition which dates from 1948.
§ Ms Liz Lynne (Rochdale)I shall not detain the House for long, as the arguments have been well rehearsed by hon. Members on all sides of the House.
Direct payments to people with disabilities will help them to lead individual lives in the same way as everybody else. We all know that, and I believe the Minister is well aware of it. I hope that the Government will change their mind about the amendment, as it will empower people with disabilities and help them to feel as if we treat them as normal human beings, because that is what they are. If we do not allow them to manage their own lives, we are saying that they do not have the same rights as us.
One of the arguments was that it is not cost-effective, but it is very cost-effective. If people with disabilities do not stay in their own homes and cannot manage their own budgets, they will probably have to go into residential accommodation and that will cost a great deal more. I hope that the Government take that on board. If disabled people do not go into residential accommodation, yet again the carers will have to cope. The carers, who carry the burden all the time, will have to meet those needs. Under new community care legislation, much respite care will be cut because of insufficient Government funding. I urge the Government to change their mind.
I do not accept that there would be a lack of accountability. It will be far easier for an individual to liaise with his or her local authority than for the local authority to liaise with the provider of services. The individual can be in constant contact with the social services department as to his or her needs and the services that it is buying in. That argument also goes by the board.
Only a small number of people are involved, and for the Government to deny them a proper standard of living is extremely heartless. Cash payments are already made under the Children Act 1989, so a precedent has been set. I hope that the Minister will tell the Treasury that costs will not run out of control. There are too few people involved for that to happen. Disabled people should be able to enjoy their dignity and to manage their own lives. That is why I put my name to the amendment.
§ Mr. Paul Flynn (Newport, West)There is unanimity on this issue on all parts of the House, and I will emphasise some of the points made with great force by other hon. Members in the belief that, as we say in Wales, "Dgtal donc a dgrr y garreg"—constant knocking breaks the stone. The stone that we have to crack is a strange and uncharacteristic stubbornness among Ministers.
897 Clause 1 gives the Secretary of State the power to make grants to the funds
for such purposes as the Secretary of State may determine.The amendment would define those purposes aspromoting … independence and freedom of choiceamong the disabled. I am sure that we will share that aspiration.The importance of the disabled receiving cash payments wherever possible is that they can make their own decisions—something very much with the grain of Government thinking on so many other issues—as to how the money should be spent and the services needed can best be provided.
The old ILF made payments direct to the person concerned, and that was a successful arrangement. The extension fund will continue to make such payments to those already receiving them, and the 1993 fund will make payments to the disabled and to third parties—and is likely to do so in most cases. The reason is that part of the money required will be provided by local authorities, which cannot make cash payments to the disabled but only provide services.
The 1993 fund trustees will probably feel that it makes more sense to deliver the full package in kind rather than part of it being paid in cash and the rest in kind. The solution is to give local authorities the power to make cash payments, as they can in Scotland. Ministers virtually conceded that that will have to be done sooner or later but, for reasons that perplex us, they have refused to do it now.
On Second Reading, the Minister of State said:
Whatever may happen in the future, at a time when local authorities are taking on so many extra responsibilities in relation to community care, it is surely a mistake to add to those responsibilities a duty to manage cash."—[Official Report, 15 March 1993; Vol. 221, c. 42.]However, local authorities will have to "manage cash", whether they are making payments to their own employees, other organisations, or the disabled themselves. Making it possible for local authorities to pay money to the disabled where they think that is right will not add to their burdens. On the contrary, it will make their task easier if some people can organise their own services rather than rely on their local authority to do that for them.In Committee, the Minister was even more forthcoming:
No one who has stayed in close touch with the work of the independent living fund can be unaware of the importance of cash, as opposed to services, to empower disabled people to have control over their lives … current legislation does not enable local authorities to dispense cash ….I suspect that that argument will be pursued with vigour by my hon. Friends, as well as by Opposition Members, who hold strong views on the matter, which will not go away. I recognise that the provision of cash maximises the freedom, the choice and the empowerment of disabled people. Current legislation does not provide for that and the Bill does not deal with it. However, I have noted carefully the hon. Gentleman's remarks."—[Official Report, Standing Committee A. 25 March 1993; c. 52.]The Bill cannot deal with that point because of the narrow drafting of its long title—hence the amendment's indirect wording. However, there is nothing to prevent the Minister from giving an undertaking tonight that that point will be dealt with by suitable legislation at the earliest opportunity. We are only asking the Minister to confront the logic of his own persuasive arguments.
§ The Minister for Social Security and Disabled People (Mr. Nicholas Scott)I recognise the importance of debating this subject, which is in many ways central to community care. However, a number of problems confront me in respect of particular amendments. As the House will be aware, we are four weeks into the new care in the community arrangements. It would be unrealistic for the House to expect me to accept this evening amendments introduced at such an early point in those new arrangements.
Nevertheless, I acknowledge the debate's importance and the powerful speeches made by hon. Members on both sides of the House in support of the narrower point—although I understand why the amendment was drafted in the way that it was—of whether cash alone, a mixture of cash and services, or just services should be the response to meeting the needs of disabled people.
If I were tempted to accept the amendment and it were passed, that would involve changes to the activities of the trustees, who have all been appointed, and would involve the Charity Commissioners. That would not be an overriding consideration, but it would present problems, given that the trustees have held their first meeting and are deciding the way ahead. For those narrow reasons—I will come to the broader issues—it would be inappropriate to accept the amendment.
§ Mr. Alan HowarthI appreciate my right hon. Friend's point about the practical difficulties of altering the terms of the trust just after it has been established—clearly the new trustees and their staff want to get on with the job on the terms already defined. However, is not the important issue of parliamentary accountability in question, in establishing the rules of the fund by way of a trust deed? Does my hon. Friend agree that it is important that there should be accountability to Parliament for publicly provided funds and that there should be scope from time to time to change the trustees' terms of reference?
§ Mr. ScottThere may be occasions during the life of the fund when, if there were strong and overwhelming feelings in the House, it would be necessary to alter the terms on which trustees settle matters. But it would be somewhat premature and untidy if, four weeks into the new arrrangements, we were to be persuaded to go down that route. Incidentally, I am not saying that I necessarily believe that the arguments being advanced at the moment will in due course be necessary, but at least for the time being I can rest on the fact that the timing would be singularly inappropriate at the moment.
The main debate that we have had today, however, is on the question of cash. Illumination has been provided by the debate in another place and by debates in Committee and the debate this evening has brought home how cash delivered by the predecessor independent living fund empowered people to make choices about the care with which they were provided. I, too, have read the reports and views of Ann Kestenbaum, Pauline Thompson and others. Nobody can read them without being impressed by the power of their arguments. They are extremely moving as well as persuasive. But I hope that the House will be prepared to accept that, persuasive and moving though the arguments may be, we are at present in a new situation. with care in the community operating in its infancy.
899 The hon. Member for Huddersfield (Mr. Sheerman) and other hon. Members have made the point that, all too often in the past, the provision of care services by local authorities has tended to be inflexible. Sometimes, as in the example quoted by the hon. Member, it has even been uncaring and unresponsive to the varying needs of disabled people. I accept that such cases are in the minority and that many social service workers and carers employed by local authorities are immensely committed to their task and carry out their duties carefully and with flexibility.
Overall, however, I believe that the attitudes of local authorities have been changing and will continue to move away from what one might call the rather authoritarian attitude that has characterised some provision in the past, with local authorities deciding the disabled persons' needs and how they will be met. That is not a total caricature of the attitude of some local authorities to the provision of care, whether it be because of budgetary constraints or because of attitudes among some professionals, who believe that they can say what is best for those in their care.
We must recognise that, under the new community care arrangements, local authorities will increasingly become enablers rather than providers in the care business. They will be looking to organisations, private organisations, perhaps specially set up to provide care, perhaps voluntary organisations that can move into the business of providing care. We already know of some national organisations that are establishing schemes for looking after the group of disabled people in their particular remit; in some ways that could be a better path than local authorities seeking to provide all the services themselves. Local authorities becoming facilitators rather than providers will therefore be a very important part of this new approach. The fact that they must spend some 85 per cent. of the ring-fenced money in the non-public sector will be an important encouragement to move in that direction.
As we discuss this matter today we share a common aim: that the people who need help and caring services receive them. I do not apologise for repeating what I have said before: my colleagues in the Department of Health and I, as Minister for Disabled People, are anxious to see that package of services are arrived at after proper consultation with the recipient of the care packages and that local authorities will assess the needs through their own social workers and will then explain to the disabled person what they feel able to provide, but ask for his views and offer to make such changes as they feel they can.
Above that package of care, if the needs are in excess of the benchmark, the independent living fund, the 1993 fund, will be able to come in and provide the necessary extra cash. That will introduce the element of flexibility which has been so important.
The cash argument is unlikely to disappear simply because I am unable to accept these arguments. I am trying to deal with the matter on its merits at the moment. I believe that we should give the new arrangements a fair and clear run-in. But nobody who has been involved in the workings of the independent living fund over the whole of its life could fail to understand the importance of cash in the lives of many disabled people. It is important that instead of the fund coming entirely to an end when community care was introduced a month ago, we were able to have both the extension fund and the 1993 fund, in order to preserve this concept.
The Government will certainly monitor the impact of the new arrangements. Bearing in mind the strength of the 900 views expressed across the House this evening, I have a feeling that I will be constantly reminded of the arguments that have been put forward and that the Government will have to reconsider this from time to time to see whether the new arrangements are bearing up or what changes may be necessary.
I thank all those who have contributed to the debate this evening. I end by reminding the House that although some examples have been put forward of local authorities being able to make cash payments, in general—Scotland is an exception—it is illegal for local authorities to make regular cash payments to individuals. They can make one-off payments in certain circumstances, but the concept of regular cash payments inherent in the arguments put forward this evening is at present generally illegal. If local authorities can devise schemes that are lawful, I will certainly not oppose their working with disabled people to work out innovative ways of giving disabled people more control over their care packages.
I have tried to respond to the debate, but, because I am unable to accept the amendments or the idea of introducing changes so early in the life of the community care arrangements, I must ask the House to reject the amendments. I hope that I do so with some tone of sympathy in my voice and some understanding of the arguments that have been put forward.
§ Mr. SheermanWe are disappointed that the Minister has been unable to accept the amendments. Sometimes one listens to the speeches of the right hon. Gentleman and one tries to decode them as he is speaking. I feel that what he has said this evening needs some decoding. There is a sense in which he seems to be saying to the House, in a very quiet voice buried somewhere in the speech, that he is convinced of what the hon. Member for Stratford-on-Avon (Mr. Howarth) said in a very good speech and that he accepts that the moral case, as debated here and in Committee, has been made for accepting the principle embodied in the amendment. So I am encouraged by that voice in the right hon. Gentleman's speech.
However, we are not very impressed by some of the reasons for failing to act now. I am tempted to quote the immortal bard and say, "It's not our fault, guy," when the Minister points out that we are a month into community care and it is all too late. He could have prepared for this a year ago. He knew that the independent living fund was coming to the end of its five years and he had plenty of time to prepare. He has had a year since the general election. So he has no excuse not to have all this up and running, thought through and implemented a long time before now. He says that it is all very difficult because we are a month into community care and all the problems there.
There is an argument to be made—I will not elaborate too much, because we will come back to it on Third Reading—that the independent living fund was seen pragmatically as a great success, a great empowerer of disabled people. The independent living fund ran with great success for five years and the principles embodied in it could have been part of the doctrine that has now been introduced.
Another point about planning is that the Government —knowing that the independent living fund was coming to the end of its five-year life and that the community care package was coming in at the same time—could have extended the independent living fund for a short time until the community care package had bedded down. That is an 901 argument that we have heard time and again from professionals—allow community care to bed for a period and access the match or mismatch between that and the independent living fund. I know that the Minister has heard that argument many times from many quarters.
The minister said that his imagination had been illuminated by the debate, but he has given a catalogue of reasons for not being able to implement any of the suggestions at the present time.
7 p.m
My final point concerns the changed nature of local authorities. It is interesting that a Minister in the present Government should acknowledge that local authorities actually can and do do a good job. The Labour party has been saying that for 14 years, long and hard. Local authorities believe that cash payment is the best way to enable and facilitate this group of severely disabled people.
Consequently, local authorities, the Association of Metropolitan Authorities, the Association of Directors of Social Services and all the other organisations that have been quoted by hon. Members on both sides of the house are telling the Minister that the most effective way for severely disabled people to be helped is by the provision of cash by local authorities. I was encouraged by the Minister's closing remark—and I will be reading his speech very carefully tomorrow—that if arrangements were made by local authorities, by way of a trust or whatever, which will facilitate certain kinds of payments, he would not wish to stop that.
That is the only encouragement that I have been given, however, so we will be pushing this amendment to a vote.
§ Question put, That the amendment be made:—
§ The House divided: Ayes 193, Noes 259.
904| Division No. 250] | [7.2 pm |
| AYES | |
| Adams, Mrs Irene | Connarty, Michael |
| Ainger, Nick | Cook, Frank (Stockton N) |
| Ainsworth, Robert (Cov'try NE) | Cook, Robin (Livingston) |
| Alton, David | Corbyn, Jeremy |
| Anderson, Donald (Swansea E) | Corston, Ms Jean |
| Armstrong, Hilary | Cousins, Jim |
| Ashton, Joe | Cryer, Bob |
| Austin-Walker, John | Cummings, John |
| Banks, Tony (Newham NW) | Cunliffe, Lawrence |
| Barnes, Harry | Cunningham, Jim (Covy SE) |
| Barron, Kevin | Cunningham, Rt Hon Dr John |
| Bayley, Hugh | Dafis, Cynog |
| Beckett, Rt Hon Margaret | Davidson, Ian |
| Beith, Rt Hon A. J. | Davies, Bryan (Oldham C'tral) |
| Benton, Joe | Denham, John |
| Betts, Clive | Dewar, Donald |
| Blunkett, David | Dixon, Don |
| Boyce, Jimmy | Dowd, Jim |
| Boyes, Roland | Dunwoody, Mrs Gwyneth |
| Bradley, Keith | Eagle, Ms Angela |
| Brown, Gordon (Dunfermline E) | Eastham, Ken |
| Brown, N. (N'c'tle upon Tyne E) | Enright, Derek |
| Byers, Stephen | Etherington, Bill |
| Caborn, Richard | Ewing, Mrs Margaret |
| Callaghan, Jim | Fatchett, Derek |
| Campbell, Ronnie (Blyth V) | Fisher, Mark |
| Campbell-Savours, D. N. | Flynn, Paul |
| Canavan, Dennis | Foster, Rt Hon Derek |
| Carlile, Alexander (Montgomry) | Foster, Don (Bath) |
| Chisholm, Malcolm | Foulkes, George |
| Clarke, Eric (Midlothian) | Fyfe, Maria |
| Clelland, David | George, Bruce |
| Coffey, Ann | Gerrard, Neil |
| Godman, Dr Norman A. | Mitchell, Austin (Gt Grimsby) |
| Griffiths, Win (Bridgend) | Moonie, Dr Lewis |
| Grocott, Bruce | Morgan, Rhodri |
| Gunnell, John | Morley, Elliot |
| Hanson, David | Morris, Rt Hon A. (Wy'nshawe) |
| Hardy, Peter | Morris, Estelle (B'ham Yardley) |
| Harvey, Nick | Morris, Rt Hon J. (Aberavon) |
| Heppell, John | Mudie, George |
| Hill, Keith (Streatham) | Mullin, Chris |
| Hinchliffe, David | Murphy, Paul |
| Hoey, Kate | O'Brien, Michael (N W'kshire) |
| Hogg, Norman (Cumbernauld) | O'Hara, Edward |
| Home Robertson, John | Olner, William |
| Hood, Jimmy | Pendry, Tom |
| Hoon, Geoffrey | Pickthall, Colin |
| Howarth, Alan (Strat'rd-on-A) | Pike, Peter L. |
| Howarth, George (Knowsley N) | Pope, Greg |
| Hoyle, Doug | Powell, Ray (Ogmore) |
| Hughes, Kevin (Doncaster N) | Prentice, Ms Bridget (Lew'm E) |
| Hughes, Robert (Aberdeen N) | Prescott, John |
| Hughes, Roy (Newport E) | Primarolo, Dawn |
| Hughes, Simon (Southwark) | Quin, Ms Joyce |
| Ingram, Adam | Raynsford, Nick |
| Jackson, Glenda (H'stead) | Redmond, Martin |
| Jackson, Helen (Shef'ld, H) | Robertson, George (Hamilton) |
| Jamieson, David | Roche, Mrs. Barbara |
| Jones, Barry (Alyn and D'side) | Rogers, Allan |
| Jones, Lynne (B'ham S O) | Rooker, Jeff |
| Jones, Martyn (Clwyd, SW) | Ross, Ernie (Dundee W) |
| Jowell, Tessa | Sheerman, Barry |
| Keen, Alan | Short, Clare |
| Kennedy, Charles (Ross, C&S) | Simpson, Alan |
| Kennedy, Jane (Lpool Brdgn) | Skinner, Dennis |
| Khabra, Piara S. | Smith, Andrew (Oxford E) |
| Kilfoyle, Peter | Smith, C. (Isl'ton S & F'sbury) |
| Kirkwood, Archy | Smith, Llew (Blaenau Gwent) |
| Leighton, Ron | Smyth, Rev Martin (Belfast S) |
| Lestor, Joan (Eccles) | Soley, Clive |
| Lewis, Terry | Spearing, Nigel |
| Livingstone, Ken | Steel, Rt Hon Sir David |
| Lloyd, Tony (Stratford) | Steinberg, Gerry |
| Llwyd, Elfyn | Stevenson, George |
| Loyden, Eddie | Stott, Roger |
| Lynne, Ms Liz | Strang, Dr. Gavin |
| McAllion, John | Taylor, Mrs Ann (Dewsbury) |
| McAvoy, Thomas | Taylor, Matthew (Truro) |
| McCartney, Ian | Trimble, David |
| Macdonald, Calum | Turner, Dennis |
| McKelvey, William | Tyler, Paul |
| Mackinlay, Andrew | Wallace, James |
| McLeish, Henry | Warden, Gareth (Gower) |
| McMaster, Gordon | Watson, Mike |
| Madden, Max | Wicks, Malcolm |
| Mahon, Alice | Wigley, Dafydd |
| Marek, Dr John | Williams, Rt Hon Alan (Sw'n W) |
| Marshall, David (Shettleston) | Williams, Alan W (Carmarthen) |
| Marshall, Jim (Leicester, S) | Wilson, Brian |
| Martin, Michael J. (Springburn) | Winnick, David |
| Martlew, Eric | Worthington, Tony |
| Maxton, John | Wright, Dr Tony |
| Meale, Alan | Young, David (Bolton SE) |
| Michael, Alun | |
| Michie, Bill (Sheffield Heeley) | Tellers for the Ayes: |
| Michie, Mrs Ray (Argyll Bute) | Mr. Jon Owen Jones and Mr. Eric Illsley. |
| Milburn, Alan | |
| Miller, Andrew |
| NOES | |
| Ainsworth, Peter (East Surrey) | Baker, Rt Hon K. (Mole Valley) |
| Alexander, Richard | Baker, Nicholas (Dorset North) |
| Alison, Rt Hon Michael (Selby) | Baldry, Tony |
| Allason, Rupert (Torbay) | Banks, Matthew (Southport) |
| Amess, David | Banks, Robert (Harrogate) |
| Ancram, Michael | Bellingham, Henry |
| Arbuthnot, James | Bendall, Vivian |
| Arnold, Jacques (Gravesham) | Beresford, Sir Paul |
| Arnold, Sir Thomas (Hazel Grv) | Blackburn, Dr John G. |
| Ashby, David | Body, Sir Richard |
| Aspinwall, Jack | Bonsor, Sir Nicholas |
| Atkinson, Peter (Hexham) | Booth, Hartley |
| Boswell, Tim | Hampson, Dr Keith |
| Bottomley, Peter (Eltham) | Hargreaves, Andrew |
| Brandreth, Gyles | Harris, David |
| Brazier, Julian | Haselhurst, Alan |
| Brooke, Rt Hon Peter | Hawkins, Nick |
| Brown, M. (Brigg & Cl'thorpes) | Hawksley, Warren |
| Browning, Mrs. Angela | Hayes, Jerry |
| Bruce, Ian (S Dorset) | Heald, Oliver |
| Budgen, Nicholas | Heathcoat-Amory, David |
| Burns, Simon | Hendry, Charles |
| Burt, Alistair | Heseltine, Rt Hon Michael |
| Butler, Peter | Higgins, Rt Hon Sir Terence L. |
| Butterfill, John | Hill, James (Southampton Test) |
| Carlisle, John (Luton North) | Horam, John |
| Carlisle, Kenneth (Lincoln) | Hordern, Rt Hon Sir Peter |
| Carrington, Matthew | Howard, Rt Hon Michael |
| Cash, William | Howell, Ralph (North Norfolk) |
| Chapman, Sydney | Hunt, Sir John (Ravensbourne) |
| Churchill, Mr | Hunter, Andrew |
| Clappison, James | Jack, Michael |
| Clark, Dr Michael (Rochford) | Jackson, Robert (Wantage) |
| Clarke, Rt Hon Kenneth (Ruclif) | Jenkin, Bernard |
| Clifton-Brown, Geoffrey | Jessel, Toby |
| Coe, Sebastian | Jones, Gwilym (Cardiff N) |
| Colvin, Michael | Jones, Robert B. (W Hertfdshr) |
| Congdon, David | Jopling, Rt Hon Michael |
| Conway, Derek | Kellett-Bowman, Dame Elaine |
| Coombs, Anthony (Wyre For'st) | Key, Robert |
| Coombs, Simon (Swindon) | Kilfedder, Sir James |
| Cope, Rt Hon Sir John | King, Rt Hon Tom |
| Cormack, Patrick | Kirkhope, Timothy |
| Couchman, James | Knapman, Roger |
| Cran, James | Knight, Mrs Angela (Erewash) |
| Currie, Mrs Edwina (S D'by'ire) | Knight, Greg (Derby N) |
| Curry, David (Skipton & Ripon) | Knight, Dame Jill (Bir'm E'st'n) |
| Davies, Quentin (Stamford) | Knox, David |
| Davis, David (Boothferry) | Kynoch, George (Kincardine) |
| Day, Stephen | Lait, Mrs Jacqui |
| Deva, Nirj Joseph | Lamont, Rt Hon Norman |
| Devlin, Tim | Lawrence, Sir Ivan |
| Douglas-Hamilton, Lord James | Legg, Barry |
| Dover, Den | Leigh, Edward |
| Duncan, Alan | Lennox-Boyd, Mark |
| Duncan-Smith, Iain | Lidington, David |
| Durant, Sir Anthony | Lightbown, David |
| Eggar, Tim | Lilley, Rt Hon Peter |
| Elletson, Harold | Lloyd, Peter (Fareham) |
| Emery, Rt Hon Sir Peter | Lord, Michael |
| Evans, David (Welwyn Hatfield) | Luff, Peter |
| Evans, Jonathan (Brecon) | Lyell, Rt Hon Sir Nicholas |
| Evans, Nigel (Ribble Valley) | MacKay, Andrew |
| Evans, Roger (Monmouth) | McLoughlin, Patrick |
| Evennett, David | McNair-Wilson, Sir Patrick |
| Faber, David | Maitland, Lady Olga |
| Fabricant, Michael | Malone, Gerald |
| Fairbairn, Sir Nicholas | Mans, Keith |
| Fenner, Dame Peggy | Marland, Paul |
| Field, Barry (Isle of Wight) | Marlow, Tony |
| Fishburn, Dudley | Marshall, John (Hendon S) |
| Forman, Nigel | Marshall, Sir Michael (Arundel) |
| Forsyth, Michael (Stirling) | Martin, David (Portsmouth S) |
| Forth, Eric | Mawhinney, Dr Brian |
| Fox, Dr Liam (Woodspring) | Merchant, Piers |
| Fox, Sir Marcus (Shipley) | Milligan, Stephen |
| Freeman, Roger | Mills, Iain |
| French, Douglas | Mitchell, Andrew (Gedling) |
| Fry, Peter | Moate, Sir Roger |
| Gale, Roger | Monro, Sir Hector |
| Gallie, Phil | Moss, Malcolm |
| Gardiner, Sir George | Neubert, Sir Michael |
| Garnier, Edward | Newton, Rt Hon Tony |
| Gill, Christopher | Nicholson, David (Taunton) |
| Gillan, Cheryl | Nicholson, Emma (Devon West) |
| Goodson-Wickes, Dr Charles | Norris, Steve |
| Gorst, John | Onslow, Rt Hon Sir Cranley |
| Greenway, Harry (Ealing N) | Oppenheim, Phillip |
| Griffiths, Peter (Portsmouth, N) | Ottaway, Richard |
| Grylls, Sir Michael | Paice, James |
| Hague, William | Patnick, Irvine |
| Hamilton, Neil (Tatton) | Pattie, Rt Hon Sir Geoffrey |
| Pawsey, James | Taylor, Ian (Esher) |
| Peacock, Mrs Elizabeth | Taylor, John M. (Solihull) |
| Pickles, Eric | Taylor, Sir Teddy (Southend, E) |
| Porter, David (Waveney) | Temple-Morris, Peter |
| Portillo, Rt Hon Michael | Thomason, Roy |
| Powell, William (Corby) | Thompson, Sir Donald (C'er V) |
| Rathbone, Tim | Thompson, Patrick (Norwich N) |
| Renton, Rt Hon Tim | Thornton, Sir Malcolm |
| Richards, Rod | Thurnham, Peter |
| Riddick, Graham | Townend, John (Bridlington) |
| Rifkind, Rt Hon. Malcolm | Townsend, Cyril D. (Bexl'yh'th) |
| Robathan, Andrew | Tredinnick, David |
| Roberts, Rt Hon Sir Wyn | Trend, Michael |
| Robertson, Raymond (Ab'd'n S) | Trotter, Neville |
| Robinson, Mark (Somerton) | Twinn, Dr Ian |
| Rumbold, Rt Hon Dame Angela | Walden, George |
| Ryder, Rt Hon Richard | Walker, Bill (N Tayside) |
| Scott, Rt Hon Nicholas | Waller, Gary |
| Shaw, David (Dover) | Wardle, Charles (Bexhill) |
| Shaw, Sir Giles (Pudsey) | Waterson, Nigel |
| Shephard, Rt Hon Gillian | Watts, John |
| Shepherd, Colin (Hereford) | Wells, Bowen |
| Sims, Roger | Wheeler, Rt Hon Sir John |
| Skeet, Sir Trevor | Whitney, Ray |
| Smith, Tim (Beaconsfield) | Whittingdale, John |
| Soames, Nicholas | Widdecombe, Ann |
| Spencer, Sir Derek | Wiggin, Sir Jerry |
| Spicer, Sir James (W Dorset) | Wilkinson, John |
| Spicer, Michael (S Worcs) | Willetts, David |
| Spink, Dr Robert | Wilshire, David |
| Spring, Richard | Winterton, Mrs Ann (Congleton) |
| Sproat, Iain | Winterton, Nicholas (Macc'f'ld) |
| Stanley, Rt Hon Sir John | Wolfson, Mark |
| Steen, Anthony | Yeo, Tim |
| Stephen, Michael | Young, Sir George (Acton) |
| Stern, Michael | |
| Stewart, Allan | Tellers for the Noes: |
| Streeter, Gary | Mr. Timothy Wood and Mr. Robert Hughes. |
| Sweeney, Walter | |
| Sykes, John |
§ question accordingly negatived.
§ 7.15 p.m
§ Mr. Keith Bradley (Manchester, Withington)I beg to move amendment No.2, in page 1, line 16, at end insert—
'(2A) Any grant made to the Independent Living (1993) Fund shall be subject to the condition that the secretary of state shall have exercised his power under Clause 15 of the deed establishing that fund to revoke Clause 4(1)(d) of that deed.'.
Mr. deputy SpeakerI understand that it will be convenient to discuss at the same time the following amendments: No. 3, in page 1, line16, at end insert—
'(2A) Any grant made to the Independent Living (1993) Fund shall be subject to the condition that the relevant maximum sum referred to in Clause 4(1)(a) of the deed establishing the Independent Living (1993) Fund shall be not less than £500.'.No. 4, in page 1, line 16, at end insert—'(2A) Any grant made to the Independent Living (1993) fund shall be subject to the condition that the secretary of State shall have exercised his power under Clause 15 of the deed establishing that fund to revoke Clause 4(1)(c) of that deed.'.
§ Mr. BradleyI am pleased to explain amendments Nos. 2,3and 4, which have been grouped together. As with amendment No. 1, it will be noted that these amendments command all-party support. Because of that, I hope that the government will yet again listen carefully to the arguments on the amendments and that they will view their consequences sympathetically, with a view to accepting them and incorporating them in the successor funds to the independent living fund. [Interruption.]
905 The three amendments cover three important areas of consideration, which—[Interruption.]
§ Mr. Deputy SpeakerOrder. A few sub-committees seem to be taking place throughout the Chamber. I am having difficulty in hearing the hon. Member for Manchester, Withington (Mr. Bradley). Will those hon. Members who are leaving the Chamber please leave quietly, and will those who intend to remain here please listen to the hon. Gentleman?
§ Mr. BradleyThank you, Mr. Deputy Speaker. The amendments are extremely important for disabled people. I hope that those hon. Members who stay in the Chamber intend to make a contribution to the debate and to support the needs of disabled people, since the passing of these amendments would improve their lives in the future.
The amendments cover three different areas, but they have been linked because of the detailed debate in Committee on these issues. At this point, we should pay tribute to the many organisations that represent disabled people. They have done an immense amount of work in support of the amendments. I must also thank the Committee and those who spoke on Second Reading. I pay tribute to Age Concern, the Alzheimer's Disease Society, the Carers National Association, Caring Costs, The Spinal Injuries Association, the all-party disablement group and many other organisations that have worked so hard to ensure that there is detailed and informed scrutiny of the legislation, in particular these amendments.
The amendments cover three crucial matters. The first is the outrageous fact that the successor 1993 fund will not apply to anyone over working age, which basically means anyone over 65. The second is that a £500 limit is to be set on the total package of care from the local authority and the independent living fund together. The third is the important fact that, if the total package of care exceeds the £500 limit, the total burden of care falls back on the local authority. The problem is that there is no opportunity for the local authority to top up the care package above the £500 limit, and I shall deal in more detail with that issue later. I want especially to talk about the important concept of the sandwich, which was introduced in Committee.
Amendment No. 2 deals with the appalling situation identified by all the groups that represent disabled people in any way—that the successor fund will not apply to anyone over the age of 65. There is absolutely no justification for excluding older people from help with the extra costs of disability. The Government's decision amounts to unwarranted discrimination and penalises people for being old and for being disabled.
Statistics relating to the old independent living fund show that one in three—or 34 per cent.—of people who received help from the fund were over 65. Therefore, under the old fund the Government recognised the needs of people over 65 but are now denying them future help from the successor fund. That must be severely condemned on Report.
Disability should not be considered an inevitable part of aging. The majority of older people are not disabled. The Office of Population Censuses and Survey's disability study showed that only a third of people over 60 have a disability and that many older people live full and active 906 lives into their 70s and beyond. For the minority who are disabled, their special needs and extra expenses do not decrease as they grow older.
The Government have made their own estimates of the cost of extending the fund to the over-65s. It is staggering that they estimate that extending the successor fund to new cases to cover people over retirement age will cost only £2 million in 1993–94, £6 million in total in 1994–95 and only £9 million in total in 1995–96. That information was provided in a written answer on 5 December 1992. In the context of the overall needs of disabled people, they are extremely modest sums in terms of the Government's total expenditure, and I urge the Government to think again about extending the scheme to the over-65s.
Again on their own estimates, the Government are expecting a total of only 1,500 cases a year to benefit from the fund. Extending the fund to the over-65s is hardly going to take public expenditure through the roof. I know that the Government have had to reign in public expenditure but, surely, the modest sums that I have mentioned could be included in that expenditure and the total package of care for disabled people.
On Second Reading and in Committee the Government argued that they thought it right to target resources on those who had become disabled earlier in life, who have higher care costs than older people and who have not been able to build savings or acquire pension rights. The Government have repeatedly stated that pensioners have had large increases in average incomes and that more people have had an opportunity to build sufficient income for their retirement to be able to afford the extra costs of disability. That is why the Government believe that they should not extend the fund to the over-65s.
However, many older people have not had that opportunity or the opportunity to benefit from the state earnings-related pension or the growing availability of occupational personal pension schemes. Many older people have been unable to acquire significant entitlement for their retirement because of unemployment, low pay, caring responsibilities or illness, so the evidence refutes the Government's argument that people over 65 have extra resources and will be able to look after themselves. That is clearly not the case. The Government should think again and try to include the over-65s in the successor fund.
§ Mr. Dafydd Wigley (Caernarfon)Does the hon. Gentleman agree that it is ironic that, because of the recent reduction in interest rates, some elderly people who have made personal provision by way of savings are finding that their savings are generating much less income and that they are now in difficulty? Does not that support his argument?
§ Mr. BradleyThe hon. Gentleman is absolutely right. It is ironic that, as inflation comes down, the amount of money on which people have become used to living also falls dramatically. Many elderly people have come to my advice surgeries recently, asking how they will manage on a reduced income which they have no way of boosting. They have their total capital on which they can receive interest and they have no other resources to help them with the escalating costs of disability as they get older. I hope that the Government will listen carefully to our arguments with a view to extending the fund to the over-65s.
As we made clear in the debate on amendment No. 1, we believe that the decision to limit the fund to the 907 under-65s was Treasury-led. The Treasury has limited the amount of money and told Ministers that they must find a way of fitting the number of claimants into the pot. I do not believe for a moment that Ministers have done so with any great optimism or welcome, but they have used age as the cut-off mechanism for reducing the money involved. I hope that Ministers will put pressure on the Treasury to allow them the meagre extra resources to extend the fund to the over-65s.
I deal briefly with amendments Nos. 3 and 4, which would avoid the arbitrary limit of £500 being set on available care. We believe strongly that such a limit flies in the face of the purpose of the successor fund, which is to allow people to live independently. If there is a £500 limit and if it is exceeded, local authorities will obviously have to consider the relative and comparative costs of independent living and residential care. If it is found that the latter is cheaper than the costs that exceed the £500 limit, there will be pressure on local authorities to push people into residential care which flies in the face of the philosophy behind community care and any continuation of the independent living fund.
There was absolute uproar about the comments by the Minister for Social Security and Disabled People In an Adjournment debate on the independent living fund, introduced by my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) on 25 February. The Minister said:
I do not believe that … there is anything offensive in our setting an upper limit beyond which it is not unreasonable that people who need help should have to look to other sources to maintain their independence in the community, or to decide, sometimes reluctantly, that the time has come for them to go into residential care."—[Official Report, 25 February 1993; Vol. 219, c. 1126.]The Minister may regret his words because of the outrage expressed by many groups representing disabled people. They know that those resources do not exist and that residential care is probably the only option. We should be doing all in our power to ensure that that is not the consequence of limiting to £500 the amount that can be spent.7.30 pm
It is crucial that we consider how the allocation will operate within the £500. There was much debate about that in Committee, but I believe that there is still confusion among local authorities, care groups and disabled people's groups about how things will work in practice.
As I understand it, the £.500 care package is split into two key elements, one of which consists of £200 worth of services provided by the local authority. The previous debate has thrown a little light on that matter, and it may now be possible for local authorities to translate that £200 into cash. We shall work closely with local authorities when we have carefully read the report of the debate, to work out how the arrangement will operate. The second element is a top-up of £300 in cash from the fund.
However, if the total package of care assessed for an individual will cost more than £500 the whole cost of that care falls back on the local authority and no contribution will be made from the independent living fund (1993) We believe that the concept of the sandwich that the Government have introduced is not real. As we said in Committee, it may be a Danish sandwich—an open sandwich with no slice of bread on the top. It will certainly not be a good British sandwich with a piece of bread, a 908 filling and another piece of bread on top. I know that we are all moving into Europe, and that Maastricht is almost behind us, but there is a limit on how far we shall push our European credentials tonight.
I want the Government to be clear about the fact that the sandwich concept does not exist, because there is no opportunity for the local authority to come back and put a top layer on to the £300 element from the independent living fund. There is no opportunity for the local authority to top up the bread base—the £200—again. It is absurd not to allow the local authority to top up the sum to £600 or £700 if the cost goes beyond £500.
I emphasise again that, if that does not happen, the real consequence may be that the individual—we are talking here about the most disabled people, whose care packages may be the most costly—and indeed the whole group will be forced into residential care because of the comparison between the costs of the package of care put together by the local authority and the costs of residential care. Because local authorities are working within cash-limited budgets they will be forced to consider seriously the residential care option rather than the option of real independence, which we should all strive to bring about, and the empowerment of the individual—that is a phrase that we have heard many times—to ensure that he or she gets the best care possible in the community.
We have advanced strong arguments both in Committee and on Report about why the Government should think carefully again about the amendments. When we discuss the future of community care and how the independent living fund relates to it we all have the interests of disabled people and their carers at heart. I hope that the Minister will respond in the spirit in which the amendments were tabled, and according to the spirit in which the Government are shifting rapidly towards agreement on cash payments. I hope that he will recognise that, within the assistance provided by the local authority, there should be a cash element and also an opportunity for the local authority to come back and top up the total package, while the £300 contribution from the independent living fund continues to be made. Most crucially, all those arrangements should be extended to cover people over 65.
§ Mr. Alfred Morris (Manchester, Wythenshawe)For the severely disabled people they seek to help, every one of this group of amendments is profoundly important. They are all about protecting independence and freedom of choice for people whose claim to the attention of this House should be the priority of priorities.
Amendment No. 2 gives the House an opportunity to debate again an upper age limit which the organisations that work to help severly disabled people over 65 condemn as discriminatory and in conflict with natural justice. The Alzheimer's Disease Society, of which I am an honorary officer, says:
We believe the age-limit for applications to the successor bodies of the ILF penalises people for being old".It makes that sad comment by reference to the cases of elderly disabled people of very high dependency which the Bill, as drafted, will totally exclude from the help they need, and the Society adds:Such age discrimination is a crude example of a Government minimising public expenditure at the expense of an extremely needful group of people".Some of the organisations that speak for elderly disabled people of high dependency feel so strongly about 909 the age limit imposed by this Bill that they are already said to be thinking of involving the European Court of Human Rights if the Bill reaches the statute book in its present form. That must be of deep concern to right hon. and hon. Members on both sides of the House. I hope that it will also persuade the Government to think again about their stance on this issue both at Second Reading and in Committee.Ministers will know that there is equally strong feeling in the voluntary sector about the maximum sum of £500 imposed by the Bill on help for personal assistance services to enable severely disabled people to live, as they undoubtedly want to live, in their own homes instead of being shut away in institutions. The Government have been told by the British Council of Organisations of Disabled People, for example, that it is actively considering a reference of this further issue to the European Court of Human Rights if the Bill goes unamended into law.
In the Adjournment Debate I initiated on the future of the independent living fund on 25 February, the Minister for Social Security and Disabled People said—I make no apology for recalling his words again—that in cases where severely disabled people need more than £500 to retain their independence, there is nothing
offensive in our setting an upper limit beyond which it is not unreasonable that people who need help should … decide, sometimes reluctantly, that the time has come for them to go into residential care."—[Official Report, 25 February 1993; Vol. 219, c. 1126.]All the major organisations of and for disabled people, as my hon. Friend the Member for Manchester, Withington (Mr. Bradley) said, have reacted with anger and disbelief to that statement. The Spinal Injuries Association, for example, which is held in the highest regard on both sides of the House, has described the statement as "most shocking" and asks whether£500 is now the going price for freedom in this country?
§ Mr. ScottThat has been quoted twice, but the fact is that that is not the only option available at that juncture. It is still possible for the local authority that would resume responsibility for the provision of care at that stage to decide, taking account of the needs and of the finances available, that it still wishes to retain the independence of that person within the community rather than making provision for residential care. That is still a choice open to the local authority at that stage.
§ Mr. MorrisI have heard about the "sandwich" concept and even more about the resource constraints on local authorities. They put it to me, as they do to other right hon. and hon. Members, that they are already finding it extremely difficult to meet their legal duties under existing law. I shall come in more detail to the difficulties of local authorities as I proceed.
The Spinal Injuries Association is not alone in bitterly criticising the imposition of the £500 limit. Other organisations have described it as "forced incarceration" and "imprisonment without crime". At the very least, I hope that the Government will accept that it will be demeaning not only for them, but for this House as well, if the question of what is permissible treatment of severely disabled people in this country has ultimately to be decided not here but in the European Court.
910 There is widespread concern and dismay not only about the ceiling of £500 which the Government are imposing, but also the effects of this policy for severely disabled people who have been receiving direct payments from their local authorities to buy in the personal help they need to remain living in their own homes. Again as the Government must know, some authorities have been making direct payments for this purpose over a long period. Will they be allowed to go on doing so? If not, will they be required to provide personal assistance themselves or to arrange for a third party to do so in lieu of the direct payments they have been making to disabled people?
If provision by the local authority is to continue, will disabled people be able to select their own personal assistants as they do now under the existing ILF arrangements? If they are not to have this right, then ipso facto the Government are seeking to create two classes of disabled people. That local authorities overwhelmingly support direct payments, the House should be in no doubt. In a recent survey by the Disablement Income Group of 68 directors of social services, it was found that 58 supported the principle of direct payments.
There is, however, an even more fundamental objection to the Government's apparent determination to end the direct payments that local authorities have been making to disabled people. It is a legal one of which the right hon. Gentleman, if no one else here tonight, must be fully aware. I say this because he will have been advised, as I was as the Minister, that when a local authority has identified and accepted a disabled person's need, it is the legal duty of the authority to meet that need. That is the legal advice given to me as the Minister, as I informed the House in the debate on the Second Reading of the Chronically Sick and Disabled Persons (Amendment) Bill at column 1923 on 2 February 1979. I have checked, on several occasions since then, that identical legal advice has been given to all my successors as Minister since 1979, including the Prime Minister when he was Minister for Social Security and the Disabled in 1987.
The direct payments made by local authorities have been made, in each case, after identifying and accepting need. Moreover, for them now to reduce or withdraw that help could put them in conflict with the law. This is because, like me, all my successors as Minister have been legally advised that for a local authority to withdraw, or even to reduce, help it has been giving a disabled person is unlawful if there is no diminution in his or her needs.
Yet this is the position into which many local authorities may be forced by what the Government are proposing. Indeed the trustees of the independent living fund (1993) are being asked to participate with local authorities in the taking of decisions that could be legally challenged. Their- power to provide financial assistance is strictly prescribed as follows:
The Trustees will negotiate and agree the financial assistance they provide pursuant to the Power (in the Deed) on the basis that:if the relevant local authority ceases to provide the Threshold Sum (as defined in the Deed) the Trustee will cease to provide such financial assistance … the Trustees may cease to provide all or any such financial assistance without notice if they think fit.So if a local authority fails to provide at least £200 a week, the trustees will cease to provide assistance and the need the local authority has identified, and for which a disabled person has been assessed, could go unmet, in straight conflict with the legal advice given to me and all 911 my successors as Minister. I am not being hypothetical but addressing an existing difficulty for many local authorities, and the legal implications are extremely serious. Indeed, in a recent survey of directors of social services, who were asked how confident they were that their local authorities would be able to provide help at the £200 level for everyone who was assessed as needing at least that much, only one director was "very confident", 25 were only "fairly confident" and 32 were "not confident".7.45 pm
Thus, many local authorities could find themselves in legal difficulties through no fault of their own. For this I do not directly blame the Minister; indeed, I was very kind to him at Second Reading in saying that this is, in truth, a Treasury and not a DSS Bill. It is incontestably a Treasury Bill in the sense that it was the Chancellor who decided how much would be spent on independence and choice for disabled people. He decided what Peter Large, speaking for the Disablement Income Group, has described as the "beggarly" sum of £4 million to be allocated to the ILF (1993); and it is the Chancellor who must take main responsibility for what the Bill proposes.
It is, however, for the Minister for Disabled People or his nominee to reply to this debate tonight and I trust that he will address the very real concerns of disabled people and their organisations. as well as those of local authorities, that I have raised. I commend the amendments to the House.
§ Mr. Alan HowarthThe House will be relieved to know that I do not intend to speak on this group of amendments at anything like the length I spoke on amendment No. 1. However, there are one or two arguments to which I wish to draw attention and others that have already been put forward which I wish to reinforce.
Amendment No. 2 concerns the ineligibility of people over 65. I appreciate my right hon. Friend's concern to provide better help to younger, severely disabled people. The whole House must endorse that objective. However, I say with respect that it is not clear to me that that provides an argument for excluding people over 65 from becoming eligible for receiving support from the new independent living fund.
After all, if the argument for supporting younger people is that they will not have had the opportunity to build up savings, we should remember that elderly people who would be eligible for support from the independent living fund would not have been able to amass substantial savings. As I understand it, they must be eligible for income support, and they would not be eligible for income support if they had accumulated substantial personal capital. I do not quite follow my right hon. Friend's argument on this point.
I find it hard—indeed, impossible—to see how we can justify denying people who become severely disabled after the age of 65 the opportunity for independent living. The Government's continuing insistence that they are not prepared to allow social services departments to make direct payments is relevant to this. I contend that independent living in the proper and full sense involves having control of one's own resources.
Although, as my right hon. Friend said during an intervention in the speech by the right hon. Member for Manchester, Wythenshawe (Mr. Morris), it would be possible for social services departments to support people 912 to live in the community, my fear is that if those severely disabled people who were so supported did not have control of their own budgets and were not able to design and manage their own care packages, they would be in danger of being effectively institutionalised in the community. That is not care in the community in the sense that any of us understand it.
I do not understand why the Government want to create two categories of people over 65: those who might in some sense—it is a strange use of the term—be regarded as "fortunate" because they became severely disabled before 65 and are, therefore, eligible for financial support from the fund, and the rest. It seems to be an arbitrary distinction and I cannot imagine any satisfactory defence for it.
If the argument is about cost, it does not seem to be a sufficiently powerful one because, on the Government's figures, the cost of extending eligibility to people over 65 to become recipients of grants from the new fund would not be exorbitant. On the Government's figures, it will be an extra £2 million in the first year, rising to £9 million in 1995–96. While I fully appreciate the importance of firm discipline in controlling the costs of the massive social security budget, the figure of £9 million of 1995–96 is effectively invisible in the context of a Department of Social Services budget of £80 billion.
Amendments Nos. 3 and 4 relate to the £500 limit. I put it to my right hon. Friend the Minister that he and his colleagues, especially those in the Treasury, need not fear the cost of lifting that limit because the numbers in question are small. In the context of total public expenditure on welfare, we are talking about something that will be hardly discernible.
Indeed, while we must always seek to find solutions that are cost-effective as well as humane, domiciliary care is cheaper and therefore more cost-effective than residential care in almost every instance. I cannot understand the argument for setting the limit, which seems to be an arbitrary one, on £500 with the combined value of the package of services from the Department of Social Services and grant from the independent living fund. On the contrary, it seems to be a waste of public resources effectively to drive people into residential care.
The most important argument is a morale one. Surely, if anything, there is a greater moral imperative to enable the most extremely disabled people to live independently in the full sense that I described earlier. I ask my right hon. Friend this question: has any similar ceiling been set for any other category of clients? I am not aware that it is so. If no such ceiling has been set, why do the Government propose to set a ceiling on the package of support from those two sources which would be available to severely disabled people?
§ Mr. WigleyI shall intervene briefly because, unfortunately, I have had little opportunity to take part in this debate, not having been on the Committee. I support the amendments which have been tabled. I shall refer to a few points that have been made and perhaps elaborate on them.
The argument against an arbitrary cut-off at the age of 65 is strong. There is a growing concern among elderly people and those organisations campaigning on their behalf that there appear to be more instances of this approach—a cut-off at a certain age, at the age of 65 or thereabouts. We are familiar with a cut-off on age with 913 regard to the mobility allowance in the past and the mobility element in the present disability living allowance. Such a cut-off causes considerable rancour. All hon. Members will have had constituents coming to them and saying, "I am aged 67 or 68. I have identical circumstances to another person who is a few years younger who has suffered a disability. He or she gets a mobility allowance: I do not."
A cut-off based on age can be unfair. We know, from the representations that we have received from organisations on behalf of elderly and disabled people, of the feeling that there is discrimination in the national health service against older people. There is an assumption that when people reach a certain point they are bound to start disintegrating and may well have to live with worse circumstances than would have been acceptable at a slightly younger age. That is causing concern.
For a cut-off at the age of 65 to be built in merely to make a modest saving of less than £10 million a year, the Government must re-examine the matter. After all, the policy relates to care in the community and the changes are meant to take into account the needs of individuals. Packages are meant to be tailored to individual needs and enable people to stay in the community. That should be equally applicable to a large number of people over the age of 65, as it is to people below the age of 65. Sixty-five is not an age at which one should expect life to come to an end or a significant deterioration to take place thereafter. Many people over 65 have an active life and a major contribution to make. The fact that some disabilities may impinge on some aspects of those lives should not mean that they are regarded as needing less support than those at a slightly younger age.
Reference has been made to the cost of disability in general. Certainly, it is a significant cost. However, many aspects of life cost more as people get older—for example, the cost of heating—and, inevitably, people of a greater age face a greater burden. That will not be helped by the imposition of VAT on fuels that the Government have introduced, which will hit elderly people especially hard. I had hoped that the Government would take on board the need to ensure that there is no unnecessary demarcation against people above a certain age threshold. The cut-off seems to be an unnecessary demarcation. I put it to the Minister that, perhaps in another place, the Government can re-examine the matter if they cannot accept the wording of the amendment tonight.
I was impressed by the argument put forward by the right hon. Member for Manchester, Wythenshawe (Mr. Morris) with regard to the possibility of legal cases. The last thing that local authorities need is to be tied down with fighting legal cases. They have enough on their hands in ensuring that client groups get the necessary services and attention and the full focus of their attention, rather than being sidetracked into such cases. We seem to be spoiling this specific ship for a penn'orth of tar. I implore the Minister to re-examine the matter.
§ Mr. FlynnThe three fine amendments deal with many aspects of the Bill, which has been discussed at various stages. The Government's view is unclear. It is difficult to deal with this uncanny situation in which hon. Members 914 from four parties are saying the same thing in remarkably similar speeches and only the Government are opposing them.
Amendment No. 2 provides an opportunity to remove the indefensible age limit. In Committee, the Minister of State defended the age limit on the ground of priorities, arguing that, first, younger disabled people were more likely to need longer-term care and, secondly, those who were disabled early in life had lost the opportunity to earn or save, have occupation pensions or provide for their own retirement. For the reasons given eloquently in previous speeches, I will not go into much detail about the faulty thinking behind those two conclusions.
The implication of the Government's thinking is still not clear. Is it that local authorities, in deciding what needs will be met, will give lower priority to those over 65 so that funding from the independent living fund is not required by that age group because their needs will remain unmet? If it is implied that local authorities will discriminate against those over 65, it makes a mockery of the whole community care strategy for elderly people.
There is an alternative interpretation—that local authorities will give equal priority to those over 65 but will bear the whole cost, rather than sharing it with the independent living fund. If that is the implication, it is unrealistic: it will not happen. In deciding what services local authorities can provide, they are bound to be influenced by the availability or non-availability of grants from the independent living fund. Therefore, in practice elderly people will receive less adequate services than younger people with precisely the same needs. That cannot be fair or just.
Where part of the domiciliary service is met by the independent living fund, the local authority will have less incentive to remove people from their home and place them in institutions. So the age limit on ILF payments will make elderly people more likely to be offered institutional care than younger people with similar disabilities. Can that be what the Government intend? Is it their view that institutions are a bad thing, but that they are good enough for the over 65s? I look forward to the Minister's reply to that question.
Amendment No. 3 deals with clause 4(1)(a) of the trust deed, which says:
No candidate shall be paid more than the relevant Maximum Sum in respect of any week".The maximum sum is £300 or a larger sum fixed by the Secretary of State. That is on top of the £200 threshold sum paid by the local authority. That makes in total a maximum of £500 per week that can be spent on any individual.8 pm
In Committee, an amendment was tabled requiring the Secretary of State to rescind clause 4(1)(a) of the trust deed, thus removing the maximum sum altogether. Sadly, the amendment was defeated. Hence we have tabled this more modest amendment, which would raised the maximum sum to at least £500, making a total of £700 when the local authority's £200 contribution was added.
The Minister of State told the Committee that there would be only a handful of cases in which the total cost would exceed £500. So the number of cases in which the total cost would exceed £700 would be very small. 915 Therefore, the effect of amendment No. 3 would be virtually the same as if there were no maximum sum. The consequences in monetary terms would be slight.
As all payments from the 1993 fund will be made at the trustee's discretion, doing away with the maximum would not mean that every application, however large, would be met in full. It would simply mean that the trustees would be allowed to decide each application on its merits. It would give them a little more flexibility, taking into account the size of their annual budget and the number of applications received. Amendment No. 3 is an eminently sensible amendment.
Amendment No. 4 deals with the concept that the Minister of State introduced in Committee. It would be helpful for the House to consider what happened on the two days of the Committee. During the first day, the Opposition Front-Bench spokesman moved an amendment to remove the £300 maximum sum. My hon. Friend the Member for Manchester, Withington (Mr. Bradley) concluded his speech at five minutes to one. The Minister of State proposed that the debate be adjourned so that he could give "a considered response" at the next sitting. Between that sitting and the next, the Minister had the vision of a sandwich which he introduced to us at the beginning of the proceedings at the next sitting on 25 March.
So the concept of the sandwich was not an off-the-cuff reaction but a carefully prepared response. He assured the Committee that the effect of the maximum payment would not be to force people into residential care. In introducing the concept of the sandwich, he said:
I shall give the Committee a concept, which should be easily understood, of how the new system will work. The independent living (1993) fund will, in a sense, be the filling of the sandwich, with bread on both sides, which will be provided by local authorities, Below £200, the local authority will have the responsibility to provide the services that disabled people need in order to maintain themselves in the community. Once the £500 maximum is reached., the responsibility will again revert to local authorities, which will have to decide whether domiciliary or residential care would be the most appropriate support." [Official Report, Standing Committee A, 25 March 1993; c. 36.]Later in the debate, the Minister had to amend his concept. Perhaps it is fair to say that he admitted that there had been inaccuracy in what he had said. Certainly, he had got the concept wrong, even if it was not inaccurate. He said that if the total cost was more than £500, far from the ILF providing the filling in the sandwich, it would not be allowed to make any contribution. Instead of a sandwich there would be two slices of bread with nothing in the middle.That is very different from the concept of the open sandwich—the rather non-communautaire suggestion made by my hon. Friend the Member for Withington. It would be a vegetarian sandwich, a dieter's sandwich or a Chelsea sandwich. It would be an entirely unsatisfactory sandwich, because it would have no filling. That is the' effect of clause 4(1)(c) of the trust deed, which amendment No. 4 seeks to remove.
It is not surprising that the Minister got it wrong. The sandwich concept is a revealing visual aid. It not only makes sense but it is the only way in which the fund could operate fairly and effectively as a support to the most severely disabled people and to the local authorities responsible for providing them with community care.
Amendment No. 4 would not affect the £300 maximum payment. If the total weekly cost of care was more than 916 £500, the ILF could still pay only the £300. But the local authority would be able to decide whether to provide the top slice of the sandwich or alternatively to offer institutional care. The Minister told the Committee that there would be only a handful of cases in which the total cost would exceed £500. So the sums of money involved are relatively small. The money would be spent on enabling a handful of severely disabled people to live independently. The view that they should be able to do so is shared by hon. Members in all corners of the House.
One hopes that the amendments, which are supported by all parties in the House except the Government—or one might say that they are opposed only by the Treasury—will be accepted.
§ Ms LynneLike other hon. Members, I shall not speak for long on the amendments. I cannot understand the reason for the age limit. There seems to be no rhyme or reason for it. The Government's figures, which have already been quoted, show that extending ILF to people over 65 would cost £2 million in 1993–94, rising to £9 million in 1995–96. That is hardly an enormous sum of money when one considers the budget with which the Government are dealing in the Bill. It can be classed as peanuts.
The Government argue that they should target resources on younger people. They argue that older people have had time to save. I argue the reverse. Many people with disabilities have not had time to save. Many of them have been unemployed. Many of them have not been able to work for their living, or they have been on low pay. Many have had caring responsibilities. It does not necessarily follow that someone who is older has been able to save a great deal of money, or even any money.
The income of older people with disabilities continues to be lower than that of people below pension age. Surveys have shown that the income of single disabled pensioners is 88 per cent. that of younger disabled people. Furthermore, older people have already suffered discrimination in the benefits system. For example, they cannot claim disability living allowance. They cannot claim invalid care allowance for the first time after reaching 65 and are thereby excluded from claiming carer premiums. Therefore, I urge the Government to change their mind.
I also urge the Government to change their mind on the £500 limit. Again, I cannot understand the reason for it. It would not cost the Government a great deal of money to remove it. The fund will assist only if local authorities provide £200 worth of services. I should like some clarification of that. It appears from Government guidelines that if the cost of meeting needs goes beyond £500, the ILF will not provide any money and the disabled person will have to rely on the local authority.
I see no justification for that. How was that £500 limit decided upon? Was it an arbitrary figure plucked out of the air? It certainly appears to have been. In an article on 4 February in Social Work Today, a Department of Social Security spokesperson was quoted as saying that fewer than 1 per cent. of current ILF clients claimed more than £500. The Minister has agreed that the number of claimants is small, so it would not cost the Government a great deal of money to remove the cash limit of £500.
Is there any evidence that residential accommodation will be a cheaper option? I doubt it very much. The 917 Minister also appears to believe that it will not be cheaper, so why will the ILF be cash-limited? I hope that the Minister will answer those questions.
In terms of caring for people with learning difficulties, the ILF client costs, on average, £140 a week. Those in residential care cost, on average, £272. Once again, no saving is involved. Surely the savings made in the vast majority of cases will more than offset the extra costs of a few exceptional cases.
I do not believe that people's civil rights should be cash-limited, but I fear very much that that is what the Government will end up doing unless they accept the amendments.
§ The Parliamentary Under-Secretary of State for Social Security (Mr. Alistair Burt)I am glad to have the opportunity to reply to the debate, which has, once again, been characterised by contributions from a succession of speakers who have a knowledge and understanding of disability and matters related to it.
Those hon. Members are beguiling in their different ways. I particularly enjoy the speeches of the hon. Member for Newport, West (Mr. Flynn). He sets up such outrageous false premises about what the Government intend to do that no reasonable individual could gainsay what he said if there was a ha'penny of truth in the case that he set out. That is why he is so beguiling. I shall seek to reassure the House that there was not a scintilla of truth in what he suggested were the Government's proposals. There is no need for us to be beguiled by his arguments.
A variety of hon. Members have spoken with their usual care and passion. The hon. Member for Manchester, Withington (Mr. Bradley), who moved the amendments, has good knowledge of this subject and we had good debates in Committee. The right hon. Member for Manchester, Wythenshawe (Mr. Morris) is well known for his experience in this subject. My hon. Friend the Member for Stratford-on-Avon (Mr. Howarth), who made a significant contribution on Second Reading, also spoke, as did the hon. Member for Newport, West, to whom I have already referred. The hon. Member for Rochdale (Ms Lynne), my constituency neighbour, speaks well on these matters for her party.
§ Mr. Alfred MorrisThe Minister has forgotten the hon. Member for Caernarfon (Mr. Wigley).
§ Mr. BurtI am a doctor's son and bad handwriting is hereditary. I did not see that I had written the name of the hon. Member for Caernarfon (Mr. Wigley). I apologise to him. He always speaks with knowledge and great integrity on this matter. I enjoyed his comments.
I preface my remarks by repeating what I said on Second Reading, because the idea that community care does not exist tends to lie behind all the amendments. It is felt that the ILF is the only thing upon which people may depend when they are in need. I stress, once again, that the ILF is a sandwich—I shall talk about that in detail later —which is additional to care that is now provided in a different way.
Community care will provide individual, specialised care for those who need it. It will be based on an assessment of need. It does not imply residential care beyond a certain financial limit, but that local authorities and those responsible for the care of the elderly and the 918 disabled will be able to consider people individually in a way that was not possible before. The ILF is a useful adjunct to that process, but the arrangements for that fund cannot in any way be considered as independent of community care. I sometimes feel that the misapprehensions about the National Health Service and Community Care Act 1990 are based on that basic misunderstanding of Government policy.
Although the three amendments under consideration could be taken together, I shall deal first with amendment No. 2. That amendment would extend the eligibility of the 1993 fund to those over the age of 66. I am unable to accept that amendment. Once awarded, payments for the fund will continue until they are no longer needed. There is no cut-off to those who have been awarded that payment once they reach the age of 66 and they will continue to receive the payment for as long as it is needed.
The community care reforms which have been made since April 1992 are designed to ensure that the care needs of all disabled people, including those who are severely disabled, are catered for by local authorities. Those authorities have been adequately resourced to meet the needs. The right hon. Member for Wythenshawe made some disparaging comments about the amounts in the ILF budget, but it is wrong to look at that budget in isolation from the community care provisions.
8.15 pm
As well as the £4 million for the 1993 fund, we will spend a further £120 million on the extension fund and an extra £26.8 million on local authorities. That amounts to spending of more than £150 million, a significant increase on current estimated expenditure on the ILF of under £100 million. In addition, the £565 million allocated for community care, once added to that total, creates a significant package. I do not believe that it is fair to isolate a small amount for the new fund and to say that that represents total funding.
§ Mr. Alfred MorrisI am grateful to the Minister for giving way and I shall intervene briefly. My main point is that local authorities have said that in very many cases they will find it difficult to find the sum of £200. If they cannot find it, the process of helping many severely disabled people does not even start. It is only what local authorities tell me and other hon. Members on both sides of the House about their resource problem that makes us speak as we do in debates such as this.
§ Mr. BurtI understand the right hon. Gentleman's point, but, like me, he has some experience of local authorities and what they say to a Government when they ask for funds. I maintain what I have already said: that the total amount that has been put into community care is considerable. I have already cited the figures. All local authorities constantly wish for more. Recently, I listened to a radio programme in which the director of social services in Newcastle said that local authorities would always want more but that they would work with what they have. The Government have made a substantial commitment to community care and I do not believe that the right hon. Gentleman's concerns will come to pass.
Given the limited resources that remain available, we believe that it is reasonable to limit the scope of the 1993 fund to people aged between 16 and 65, because people in that age group are the most likely to have longer-term care needs. Those disabled early in life have often lost the 919 opportunity to earn and save. We believe that the highest priority for independent living must be given to those for whom the usual pattern is to live and work in the community. That does not mean, however, that those over the age of 65 are abandoned in terms of receiving help or being given the opportunity for independent living.
There is no suggestion that, simply because an application to the ILF cannot be made after the age of 65, the sort of domiciliary care that might be needed or requested cannot be made available by a local authority. It can and will be. That is the raison d'être of community care. The care will be tailored more neatly to the requests of an individual. That will apply to someone who asks a local authority for care and assistance at whatever age, including beyond 65 years. The mere fact that the ILF is not available does not disqualify those over that age from the individual care and provision that they would want.
The hon. Member for Caernarfon said that he was concerned about parameters and the 65 age limit creeping in. There are good reasons and historical precedents for setting age limits. When mobility allowance was originally introduced by a previous Government, an upper age limit and a cut-off point were set, after which the allowance would not continue. This Government changed that rule to enable the allowance to continue beyond the upper age limit. There is nothing unusual or wrong in a Government setting upper limits or parameters. Bearing in mind the support mechanism that community care provides in itself, our policy of making the fund available before the age of 65, and allowing it to continue beyond that age for those who needed it, provides an answer to those who are worried about the age limit and eligibility.
§ Mr. Alan HowarthMy hon. Friend said that the independent living fund was a useful adjunct to the resources of social services departments to enable them to provide the necessary help to severely disabled people. Why is it a useful adjunct for some people over the age of 65, but not for others?
§ Mr. BurtIt is simply that there is a requirement to set parameters for the fund. For the reasons that I have given, we believe that it is right to target the resources between the ages of 16 and 65 for applicants, but we want the availability to continue, which is perfectly fair. The trouble with an adjunct is that, once set up, people see it, not as an adjunct, but as an integral part of the system. The basic system is community care, and we have produced something extra to help those who qualify.
§ Mr. BradleyPart of the difficulty of denying the fund to those over the age of 65 is that they will be denied access to £300-worth of cash, which could be tailored to their own needs. That reinforces the argument and I hope that the Minister will reconsider the argument for allowing local authorities to provide cash so that there is no discrimination between under-65s and over-65s.
§ Mr. BurtThe hon. Gentleman seeks to reopen a previous debate on cash, and I cannot respond to him. However, I stress that we see the best of community care provision coming in the independent care package, which will be available to those of all ages, with or without the independent living fund. The necessity of limiting the age of eligibility in no way denies the opportunity for local 920 authorities to provide just as individul, just as caring and just as home-based a package for those over 65 as for those under 65.
Amendments Nos. 3 and 4 deal with finance, the parameter of £500 and the sandwich of care. Amendment No. 3 would place an unreasonable restriction on the fund's operation. In the past, the ILF used to relax or restrict the rules according to budgetary constraints. It is quite proper that that flexibility should be available in future to the trustees. Trustees have a legal responsibility to ensure that the fund's resources are appropriately distributed in a manner consistent with the trust's purposes. The £500 limit is one of the parameters that has been set around the new scheme to help to focus the trustees' attention on the client group targeted by the 1993 fund. To remove their ability to reduce that limit would effectively remove some of their discretion. I cannot imagine that the trustees would want to reduce that limit, but it would be wrong to take away their power to do so.
Amendment No. 4 aims to undo the main feature of the new fund: the partnership with local authorities. Nothing stands still, but some hon. Members seem unwilling to acknowledge that, in the sphere of independent living, the world has changed and we have to move with the times. The old independent living fund had to work independently of local authorities, but now we have the new community care arrangements in place.
One of the problems that the old ILF faced was the fact that its existence provided an incentive to local authorities to offload their responsibilities on to the fund. At that time, local authorities were not ready to provide flexible and personalised care services and severely disabled people instead looked to the independent living fund for help. Now local authorities have been given a special transitional grant for community care, which in Great Britain includes an extra £27 million—rising to £100 million in 1995–96—to meet the costs of those clients who would have gone to the ILF under the old arrangements, and the costs of meeting the first £200 of services for those who receive help from the 1993 fund. That last point answers the question of the right hon. Member for Wythenshawe.
§ Mr. SheermanI know that the Minister may have a pressing engagement, but the Opposition take the new arrangements covered in the Bill seriously. The Minister should not gabble through his speech as though he had an important engagement. We want to listen to the arguments. It is not good enough for the severely disabled people in this country for the Minister to rattle through the speech with no feeling. It gives no hope for disabled people.
§ Mr. BurtEvery time I am tempted to give the hon. Gentleman the benefit of the doubt and presume that underneath that extraordinary exterior lies a reasonable man, I am proved wrong.
§ Dame Elaine Kellett-Bowman (Lancaster)I was appalled at the intervention of the hon. Member for Huddersfield (Mr. Sheerman). The only passage of his speech through which my hon. Friend the Minister rattled was that giving the terms of the deed. The rest of his speech was given at a perfectly normal speed. We understood it, and if the Opposition did not, that is their bad luck.
§ Mr. BurtI am extremely grateful to my hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman) and perhaps I would do best to take the advice of my right hon. Friend the Minister for Social Security and Disabled People and simply ignore the intervention of the hon. Member for Huddersfield.
Local authorities have been properly resourced for their responsibilities and it would be wrong for the 1993 fund to find itself taking on the full burden of a task which is the primary responsibility of the local authority. The key feature of the new fund is the partnership arrangement with the local authority. The visiting social workers of the ILF have built up expertise in the assessment of needs for people with severe disabilities which is rightly admired. But it is the local authority's social worker who is best placed to identify the resources and services available locally to translate that assessment into a viable care package. The requirement for the local authority to pay for the first £200 of services ensures that the care package is one that reflects the best that can be provided for the particular client in his or her locality.
Clients coming to the old ILF had to take as given whatever the local authority was willing to provide, and the ILF social worker would suggest a package of care to fit around and supplement those services. Under the new system, the whole package of care will be designed as one, from the start, by the fund and the local authority working in partnership.
I was asked questions about the sandwich. I do not know how the hon. Member for Withington recognises a sandwich, but we in Bury recognise a butty when we see one. The butty that we are discussing is straightforward. It has a bottom layer—the local authority provision of care up to £200, which is the basic threshold—then the independent living fund, which can be included as a discretionary element, and the top slice of the butty is the local authority's responsibility to take on statutory responsibilities for the elderly over the £500 limit. The middle element consists of the provision that can be made up by the independent living fund.
§ Mr. BradleyIf a butty in Bury consists of two pieces of bread and a filling that is removed if it goes above the £500 limit, the people of Bury will be disappointed that their Member of Parliament does not feed them better. Clearly, if the ILF element goes beyond £500, it is removed. Someone cannot eat that element and then eat another part of the local authority provision. The Minister must recognise how the system will work. We cannot pretend that someone can pass through the £500 limit and still retain the £300 from the independent living fund. Everyone, including the Minister for Social Security and Disabled People, has made that clear, and the Parliamentary Under-Secretary is trying to confuse the issue yet again.
§ Mr. BurtCulinary expertise is better in Bury than in Manchester. I always thought that a butty contained a bottom, a middle and a top. The bottom layer here up to £200 is covered by the local authority. The top layer, above £500, is also provided by the local authority. The independent living fund can be used in the middle and that is the middle of the sandwich. The care sandwich is made up of what the local authority provides top and bottom, with the ILF in the middle. That is as clear a definition of a sandwich as I have heard.
§ Mr. BradleyIs the Minister now saying that one can have £200-worth of services from the local authority, plus £300 in cash from the ILF, plus an element of service on top of that from the local authority? Is that the butty he has in mind?
§ Mr. SheermanThat is a good butty.
§ Mr. BurtWhat a Yorkshireman knows about a butty nobody can guess. The situation is as clear as I have explained. Whatever sort of concoction Opposition Members are trying to create, I have presented a straightforward sandwich of care—[Interruption.] The layer of care up to £200 is wholly local authority money. The layer over £500 is totally local authority. The middle of the sandwich is money available from the ILF. That is the care package.
I am referring not to an individual case, but to the total package of care. That involves local authority assistance below £200 and local authority assistance above £500, with the ILF working in the middle. That is the definition of the sandwich which came through in Committee and it is that which the hon. Member for Withington is seeking to distort.
§ Mr. MorrisI have some experience of living within reach of Bury. Is not it a fact that butties from Bury are usually filled with black pudding?
§ Mr. BurtAnd they are grand. I am describing the package of care in the form of a sandwich and I am not relating it to an individual—[Interruption.]
§ Mr. BradleyA Bury sandwich?
§ Madam Deputy Speaker (Dame Janet Fookes)Order. We must have fewer sedentary interruptions, or it will be a case of too many cooks spoiling the broth.
§ Mr. BurtThe case being made by Opposition Members is based on their perception that the failings of the new ILF, because of a failure of community care, will discriminate against those whom they wish to protect. I am describing where the ILF fits into the community care package for local authorities. It is only when the two are taken together that what the Government are doing becomes clear and that is the best way to reassure those who are concerned.
It is in that area that the analogy of the sandwich came into play in Committee. When it is viewed in that light, one appreciates that below £200 the cost is dealt with wholly by the local authority. Above £500 the cost is again, right the way through, dealt with wholly by the local authority.
§ Mr. SheermanThe hon. Gentleman is wrong.
§ Mr. BurtI am not wrong. It is clear that we are at odds over the concept of the sandwich. I suspect that we shall not make progress on that front, even though I have described it as clearly as I can.
§ Mr. BradleyI do not want to labour the point, but it is important for organisations outside to understand how the systems will work. Let us deal—this is the crux of the 923 matter—with an individual disabled person. An assessment is made of such a person. That assessment in total of the care required is, say, above £500. Will the Minister confirm that the total package will have to come from the local authority and that there can be no element of ILF? In other words, there will be no sandwich for that individual. The filling of the ILF is removed, with the total having to come by way of services from the local authority. Is that correct?
§ Mr. BurtI am delighted that the hon. Gentleman now understands the position. What he says is exactly right. Over the cost of £500, it is dealt with wholly by the local authority—
§ Mr. BradleyThat is not what the hon. Gentleman said.
§ Mr. BurtThe hon. Gentleman must read the Official Report tomorrow to see that I said that the whole total for those who need care over £500 is dealt with by the local authority, in exactly the same way as those who need care under £200 have their care needs met totally by the local authority. In the band in the middle, between £200 and £500, the ILF comes into play. That is the filling of the sandwich.
I see no reason why we should be at odds over the matter. My description of the way in which the sandwich concept fits into community care is right and I have explained it to the point where we have made progress, to the point where the hon. Member for Withington understands the position. In any event, if his concept of a sandwich does not include a bottom, middle and top, I do not know what sort of sandwich he has in mind.
§ Mr. BurtI suspect that I should move on and not continue to give way. Does the hon. Gentleman have something substantial to say?
§ Mr. WicksI rise simply to suggest that, when the Department makes the training video on the ILF, it does not use the sandwich analogy, in the interests of clarity, because, like many sandwiches one buys that look good, they often fall apart in the hand.
§ Mr. BurtI know that that intervention was kindly meant. I will just draw a veil over it.
The place of the ILF in the whole area of community care does not leave those about whom we are most concerned without support. It has been suggested on several occasions that the mere fact that there is a limit of £500 necessarily places those who need care above that level into institutional care. That allegation has been made by a number of Opposition Members. It is absolutely not the case.
When individuals are in the care of a local authority, it has primary responsibility for the community and residential care of disabled people. Local authorities will make the decision whether to opt for domiciliary or day care, bearing in mind the needs of the client and the costs of the option. If the disabled person would prefer domiciliary care and it is cheaper than residential care, that is surely what the local authority will provide. Where domiciliary care is more expensive, the local authority will need to decide whether it can afford to spend more to help that individual to remain in the community.
There is no logic in the argument that, because of insufficient funding, people will be forced into residential 924 care. A recent report confirmed that caring for people in the community often proves the most cost-effective way of providing for their care needs, and that applies just as much above as below £500.
§ Ms LynneIs the Minister aware that, on discovering that it will cost more to keep people in their own homes, many local authorities will opt to put them in residential accommodation, whether or not the disabled person chooses that course? That will happen because of the cash limits on community care and the fact that the Government have not provided enough money for community care as a whole.
§ Mr. BurtAs the hon. Lady pointed out earlier, only 1 per cent. of current ILF grants are in excess of £500 per week. That shows that the majority of people who require that size of award are not living independently. But they can do so. Where it is cost-effective for a local authority to use its money to keep someone at home, it will do so. But, naturally, a local authority will come to a decision about whether it is cost-effective. Bearing in mind its own position and that of others whom it has to look after, it may be impossible to provide domiciliary care. But the sheer fact of a cut-off point at £500 can in no way be taken to imply that merely because a person is above that limit he must be in residential care. Time and again, the Opposition have implied that or expressed it directly. It is not correct and it is not fair for them to do so.
This has proved to be a more lengthy debate than was originally expected. It has taken us down a road that I suspect I shall remember for many years to come. I have tried to deal with why the amendments cannot be accepted by the Government. As I have sought to make clear, we do not believe that the age limit is detrimental to those who would not be eligible for the independent living fund. They will be covered by community care in a manner too often and shamefully neglected by Opposition Members.
The £500 limit and the need for local authorities to contribute up to £200 is not wrong. Taken in the round with the other aspects of community care that the Government have introduced, it is the right way for the independent living fund to proceed. This should be recognised as a package of individual care which is a considerable advance and improvement on social security care in the past. The independent living fund will continue to provide a more than helpful and useful adjunct to community care in Britain. Accordingly, I ask the House to reject the amendments.
§ Mr. BradleyI am grateful to the Minister for his response, although I am clearly disappointed that he is not prepared to accept our amendments. I have listened to the excellent speeches from hon. Members on both sides of the House and from all political parties who support the amendments and it is a great disappointment that the Government do not see their merits.
The amount of money involved in accepting the amendments would be so small in terms of the total social security budget and so beneficial for disabled people that I find it difficult to accept that their rejection is not Treasury-led. The Minister's heart is in the right place, but he has clearly been overwhelmingly constrained by the Treasury tonight.
We shall not seek to press the amendments to a vote because it is important that these matters should be taken 925 up again in the other place in order to clarify how the fund operates in practice in relation to the local authority. Their Lordships will read the proceedings of this debate with great interest and will take up the matters in their own inimitable way when they discuss the culinary delights of the independent living fund.
I am disappointed with the Government's response, but the quality of debate has made its own points. Therefore, I beg to ask leave to withdraw the amendment.
§ Amendment, by leave, withdrawn.
§ Order for Third Reading read.
8.43 pm§ Mr. ScottI beg to move, That the Bill be now read the Third time.
We have covered a great deal of ground this evening and I do not want to reiterate those comments in my closing remarks. The Bill fulfils a manifesto commitment which we gave at the general election to maintain a fund to meet the needs of disabled people. The Bill builds on the tremendous success—which has been acknowledged in all parts of the House—of the independent living fund, which operated under the arrangements pre-community care, in the new context that has now been provided from 1 April this year.
I am happy to report to the House that the new funds are now operational with a full board of trustees. The handover from the independent living fund to the extension fund went smoothly, with all clients continuing to receive their payments, as I undertook to the House when we discussed the matter earlier. The case load of nearly 22,000 people is now being operated by the new extension fund. The new director is in post and the director and staff are now building the bridges towards the relationship with local authorities which will allow the new partnership between the 1993 fund and local authorities to work smoothly in future.
I hope that, whatever differences there may have been between us in Committee, on Report, or now on Third Reading, we can all wish the trustees, director and staff well in the work that they will be undertaking to improve the quality of life of disabled people in Britain.
The Bill also seeks to put motability on a firmer statutory footing. The motability scheme, as we all recognise—I pay tribute to the right hon. Member for Manchester, Wythenshawe (Mr. Morris) who launched the scheme in the first place—is an extremely successful joint enterprise with the Government, the voluntary sector and the clearing banks. It has served and continues to serve to increase the quality of life of an ever-increasing number of disabled people and commands widespread support throughout the House. I know that both sides of the House will wish to support the provision that puts motability funding on a statutory footing to ensure its continued financial support. Many hon. Members will remember my right hon. Friend the Prime Minister recently handing over to the recipient the keys of the 350,000th motability car, and that is a measure of the scheme's immense success and popularity.
The Bill is part of the Government's overall strategy for improving quality of life for disabled people in our society. I think that anyone would recognise that an immense amount has been done in the past 10 years. I do not 926 disguise from the House, and never do, the fact that we have a long way to go. There is still much work to be done, but any fair-minded person recognises the improvements that have been made in terms of benefits, delivery of services, accessibility of our buildings—we still have a long way to go—and the growing opportunities for employment of disabled people as new technology, in particular, enhances their ability to acquire the independence that employment can give them.
The funds that the Bill provides are an addition to the overall provision—an important one. It is a small Bill, as I said when I launched it on Second Reading, but it is very important for a considerable number of disabled people. I commend it to the House.
§ Mr. SheermanI, too, have no wish to delay the House long. We have had a good debate this afternoon and this evening. The Minister has just described the Bill as small. It is small, but it is also vital because, as the Opposition have tried to show, it goes to the core of how we treat severely disabled people in Britain—and moreover, how we treat disabled people.
Before saying anything controversial, I want to pay tribute to those who have so successfully run the independent living fund during the past five years. As a slight criticism, I would say that they have not been as well treated by the Minister as they should have been, because many of them should have been offered the chance to continue that success. However, we wish the new people running the two new funds well. We want them to do the job that has to be done for severely disabled people. There is no alternative.
I also add my voice to the praise for my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) who, single-handedly, did so much to get motability off the ground all those years ago. Perhaps, when we reach a really big number, such as the 500,000th, we will have someone important—not just the Prime Minister, but the initiator of the scheme—to hand over the key.
I shall end on a note that my right hon. and hon. Friends and Ministers will understand. It has been an important Bill and an important debate, but we consider it a missed opportunity. It was one of the few occasions when we tried something that worked. The Government introduced the independent living fund and it worked. In Committee and throughout the Bill, with no ideological preconceptions—indeed, we had cut off some of our shackles of previous years—and using only one criterion, we were asking the Government to consider how good it was for severely disabled people. The experience of the indpendent living fund left us with one important message.
Some of us have said that there are two things to which we shall never allude in any debate for the rest of our careers: we shall never talk about sandwiches—I think that the Under-Secretary of State will learn that lesson—or about empowerment. I shall mention empowerment one last time and say, yes, we have learnt through the independent living fund that we need to empower and to provide the enabling and facilitating role to which the hon. Member for Stratford-on-Avon (Mr. Howarth) referred in his excellent speech in Committee. That role is so important in the lives of individual severely disabled people.
927 In the last few minutes of the Bill, let me say what we would have accepted, what would have quietened our voices and our criticisms: if the Minister had come to the House with a different Bill, learning from that experience and building it into the new arrangement for community care and said that the Government had learnt their lesson and would empower people in a different way and that, having learnt the lessons of the independent living fund, they would now allow local authorities to give cash payments.
In other words, they should have taken the essence of the independent living fund and spread it like the mediaeval physic throughout local government social services departments, which would then have become mini independent living funds. If the Government had learnt from the lessons of the independent living fund and clone the job for disabled people in our community—
§ Mr. Deputy Speaker (Mr. Geoffrey Lofthouse)Order. This is Third Reading. I wish that the hon. Gentleman would speak on what is on the Bill. That is what a Third Reading speech should be.
§ Mr. SheermanAbsolutely. It was my peroration—the last gasp at the Dispatch Box— just to say that we opposed many aspects of the Bill constructively, we offered alternatives and tried to ensure that the Bill left the Chamber improved, having learnt the lessons of the independent living fund. We are disappointed that the Government missed their opportunity, because disabled people in the community will be less well off than they were under previous arrangements.
At the end of the day, we have had a constructive debate. Some of us learned a great deal about the opinions of the people that matter—the severely disabled people who increasingly are telling the country and the House that they want to be the vital essence in all legislation that affects their lives.
§ Question put and agreed to.
§ Bill accordingly read the Third time, and passed.