HC Deb 25 February 1993 vol 219 cc1120-6

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

11.17 pm
Mr. Alfred Morris (Manchester, Wythenshawe)

This inevitably has to be a short debate, but it is one of crucial importance to many thousands of the most severely disabled people in Britain today. The independent living fund came into existence to deal with the extremely worrying consequences of the Government's decision to end the special allowances that were available to help disabled people to remain in the community under the supplementary benefits system. By reference to case after case, we demonstrated that if new help was not quickly made available, more and more severely disabled people then living independently in their own homes would have to go into institutional care, almost certainly at far greater cost to the taxpayer than that of enabling them to continue to live at home. Then, as now, the issue was the undoubted and incontestable right of disabled people to live in their own homes instead of being shut away in long-stay institutions.

From the outset, the Disablement Income Group—DIG—worked with the then Department of Health and Social Security to make the independent living fund an effective means of achieving its purpose. What the ILF proved beyond any question was the very urgent and essential need to repair the gap created by the ending of the supplementary benefits system, but last November the fund was closed to new applicants, with reserved rights for existing recipients of help.

From 1 April, there will be new arrangements. Two bodies will then be established. The first will continue to pay severely disabled people who applied to the ILF before 26 November last. The second body will pay, from 1 April 1993, new applicants who are of working age and whose costs of care at home exceed those of residential care. Local authorities will then be expected to provide domiciliary services equivalent to what they would have spent on residential nursing care and the ILF will be responsible for topping this up.

Help for new applicants will be subjected to a ceiling of £500 per week. That is totally unrealistic. No individual should be forced into institutional care against his wishes, and the ceiling of £500 will result in the Government having to spend more, not less, taxpayers' money.

The Greater London Association for Disabled People recently rang four residential homes at random in four different London boroughs. Their charges were £510, £605 upwards, £800 and £925 per week. Those figures speak for themselves. "Too Little—Too Late", based on research by the Royal Association for Disability and Rehabilitation and the Disability Alliance, spells out the consequences of the announcement of the original ILF's closure last November.

In a letter about this debate from Peter Large of DIG, who has won the respect of both sides of the House, he tells me: We have been so worried by developments—or sometimes the lack of developments—that we wrote to the Prime Minister expressing grave concern. I have to say that his reply did not reassure us. We remain deeply worried about the prospects for severely disabled people". He goes on to say: There are now even worries about future payments to existing beneficiaries … There is great concern that payment mechanisms will not be ready. You might seek from the Minister a categorical assurance that no existing beneficiaries will have to wait for payment after 31 March when the ILF ends. You can imagine our distress to see the threat of the ILF being throttled to death. From an acknowledged expert in the ILF's work, himself a severely disabled person, that is very strong criticism in regard to the future of the fund.

When he announced the closure of the original ILF to new applicants, the right hon. Gentleman said on 24 November that the new fund would ensure a continuation of one of the most significant features of the ILF—an element of cash payments to individual disabled people to control provision of part of their care. He revealed on 2 December how "pitiably small"—I use Peter Large's words—that element would be when he said: A total of £4 million—on a UK basis—will be made available in 1993–94 to enable the new fund to provide cash payments to new applicants from the most severely disabled people of working age. Government figures are that 1,500 people each year will qualify for cash payments. This compares very disturbingly with the 22,500 the ILF will have given cash payments to this year. Moreover, as a percentage of an individual's overall package it will be very small.

To quote the Association of Metropolitan Authorities, the Association of County Councils, the Association of Directors of Social Services and organisations of disabled people in a joint statement: This makes a nonsense of the Government's recognition of the importance of cash payments and will lead to muddled personal assistance provision for severely disabled people. Even more pressing than the question about existing beneficiaries after 31 March is what is to happen to severely disabled people who ask the ILF for help between now and 1 April? For the Minister to reply that they must look to their local authorities would be to ignore the reality that many do not have adequate resources and do not give sufficient priority to the needs of severely disabled people.

Another very important question is whether the £117 million available for existing claimants will be enough to ensure that anyone whose condition deteriorates, or whose costs increase, will receive increased help; or will they have to wait for other claimants to die to secure help with their higher costs? That would be a major scandal, yet the fact is that £117 million looks certain to be significantly less than will be needed.

The director's job specification suggests that the ILF's successor body will decide whether its help is the most appropriate. How will this be decided? Will some existing beneficiaries be referred to their local authorities when they seek more help? Will some be sent into institutions? Is this how the budget will be met, or will more money be made available? And how will reassessment of needs be made if someone's condition deteriorates?

Will the successor body be run by the same staff who now manage the ILF? The answer to that question appears to be no. The current director is to be replaced; so too may some other senior staff. Existing DIG-nominated ILF trustees have not been approached about future service. They have both wide experience and expertise, but is it going to be used?

When will the new trust deeds be published? Meanwhile, can we be assured that there will be no change in the conditions for using ILF payments and, more especially, no change that would restrict beneficiaries in making their own arrangements for buying-in care of their choice? That is also a very important question. Still further questions are these: How will disabled people secure benefits from the new agency? Will they have to apply to their local authority or will the authority apply for the award on their behalf? Will the award be made to the disabled person or the local authority? In regard to the local authority's contribution in services to help a disabled person to live independently at home, will the value of the authority's service be assessed on the basis of hours or pounds?

We already know that, if the director of the ILF's successor body decides against making an award, there will be no right of appeal.

The Spinal Injuries Association argues cogently that a system of direct payments from local authorities to individual disabled people is essential. Their case is strongly endorsed by many highly respected organisations and individuals, including the hon. Member for Mid-Kent (Mr. Rowe), who I am very glad to see in the Chamber this evening. The Association of Metropolitan Authorities, the Association of County Councils and the Association of Directors of Social Services—all deeply knowledgeable about the delivery of services—want local authorities to be empowered to make direct payments.

The Minister himself said in the foreword to a very recent evaluation of personal assistance schemes in Greenwich that as well as being cost effective, such schemes offer disabled people a greater degree of independence when compared with traditional forms of provision. Organisations working to help severely disabled people now want him to live up to that foreword.

The Minister will know of my association, as an honorary officer, with the Alzheimer's Disease Society, in whose humane work I take pride. The society says: The sudden announcement that the fund would stop receiving applications after 25 November was a major shock. The Minister was told by the society that the gap between the closure of the fund and launching the successor body would entail great hardship for prospective applicants who contact us daily about the demands of caring for a person with Alzheimer's disease. Much hardship has already been inflicted on carers and severely disabled people alike. If the Minister wants that confirmed, he should speak to Jill Pitkeathley of the Carers National Association.

We know that the successor body will not accept people over working age, and that is seen as wholly unwarranted discrimination against elderly people of high dependency. Is it too late for the Minister to reconsider his decision to exclude them?

If Peter Large cannot answer the questions I have posed in this debate, I can think of no one else who would even attempt to do so on the basis of available information. Already there are thousands of disabled people who lack essential help in consequence of the Minister's announcement in November. They include many who have been denied help from the ILF due to delays in the Benefits Agency's processing of their claims for the higher rates of disability living allowance and attendance allowance. In addition to the hardship that they are suffering, they bear a profound sense of injustice as victims, they argue, of the Government's own failure. With wide-ranging support from right hon. and hon. Members on both sides of the House, I most strongly urge the Minister to address the hardship that they suffer and the injustice that they feel, in a clear and positive response to all the concerns of severely disabled people I have sought to articulate in this debate.

They insist that the Government must very urgently review their decisions which are seen as having been dictated by the Treasury, not by a genuine resolve to promote independent living and full social equality for severely disabled people.

11.30 pm
Mr. Andrew Rowe (Mid-Kent)

I am most grateful to the right hon. Member for Manchester, Wythenshawe (Mr. Morris) for allowing me to intervene briefly in the debate. Far from trying to cover the extensive ground that the right hon. Gentleman has already covered with such expertise, I shall make one simple point. It is a point with which my right hon. Friend the Minister is already familiar, and I suspect that, when the Treasury is not listening, he is supportive.

There is a small number of severely disabled people —it is easy to draw up a statutorily tight definition of them —who have been in the habit of receiving direct payments in cash so that they can hire and fire and make their own arrangements for their caring staff. That is immensely valuable to them. It allows, for example, a very severely disabled lady who came to the House not long ago to look after her parents, who require sporadic and unpredictable attention. It allows a number of severely disabled people to make the kind of flexible arrangements that allow them to hold down a job and to travel to and from meetings and conferences—again, those demands are unpredictable.

I am deeply anxious that the new arrangements, however they are set up, may make that difficult to continue. Severely disabled people have already said to me how anxious they are about the possibility that, in addition to their care manager, who has every right to know the details of their condition, there will be an intermediate body, too, to help them to make their own arrangements, so that another body will know all about their condition. If the new body is not to know all about people's condition, what is the point of the additional expense, confusion and difficulty involved in introducing an intermediate body?

I believe that it would coincide precisely with all the principles that the community care reforms were intended to secure—such as independence of choice and self-determination—for direct payments in cash to be made to a small, defined number of severely disabled people. I hope that my right hon. Friend will be able to look sympathetically upon that idea.

11.32 pm
The Minister for Social Security and Disabled People (Mr. Nicholas Scott)

First, I congratulate the right hon. Member for Manchester, Wythenshawe (Mr. Morris) on his success in achieving the Adjournment debate, and I thank my hon. Friend the Member for Mid-Kent for his contribution.

Before I deal with the detailed points raised by the right hon. Gentleman and by my hon. Friend, I pay tribute, albeit briefly, in the warmest possible terms to both the staff and the trustees of the independent living fund for the way in which they have conducted the fund during its existence. When we discuss the legislation for the successor bodies, there will be another occasion on which I shall be able to perform the same task at somewhat greater length. I am deeply appreciative, and I am sure that everyone who has been involved with the fund and has watched its success in meeting the needs of a group of severely disabled people in our society is grateful to the staff and trustees.

May I first of all deal with the specific point raised by my hon. Friend the Member for Mid-Kent—whether, in essence, social services providers should be able to deliver cash instead of services to a distinct group of people who need support. I have to say at the outset, whoever may or may not be present, that I can see some difficulties about this. There could well be difficulties about defining the particular groups who may be eligible for payments rather than for services, and some quite important decisions Would have to be made about the control of cost in those circumstances.

Having said that, I understand and have some sympathy with the point that my hon. Friend has made. I can understand the frustration of many disabled people at the inflexibility of some of the arrangements that are made for them, designed to meet not their particular needs but the undoubted constraints and convenience which local authority social services departments find that they have to meet.

The tradition has been for local authorities to be service providers, but I hope that my hon. Friend will understand when I say that already I can see that pattern changing. Local authorities are no longer themselves necessarily providing all the services but are the facilitators, the purchasers of services for people from other sources. Many of the voluntary bodies are now going into the business of providing services that local authorities will be able to offer. My hon. Friend may think that this is but a small step away from the concept that he has in mind in this area. It is a matter that we will want to keep under review as we see how things develop, but I will not forget the important point that he has made.

The independent living fund, as we all know, was introduced as an interim measure. I am mildly aggrieved by the right hon. Gentleman's suggestion that it was in some way a mean-minded measure by comparison with the arrangements that had hitherto been made by means of the domestic care additions under the old supplementary benefit regime. Under that regime, I would remind the right hon. Gentleman, 6,000 people were getting those additions at a level substantially below what the 22,000 people that the ILF has been providing for are getting in cash terms.

I do not believe for a single moment that we can be accused of injustice or mean-mindedness in the way that the ILF has been operating compared with any arrangements which existed before. By the time it is handed over in April, some 22,000 cases will be on the ILF's books, with an average award of over £100. It has helped those severely disabled people who did not want to go into residential care but who could not live in the community without a considerable degree of domiciliary support to maintain their independence. That is something that we can all applaud and welcome. I do not believe that it would have been right to seek to continue the supplementary benefit arrangements, which were set at much lower levels of care needs than the ILF.

I remember very well, because I had recently embarked on my job as Minister of State for Social Security and Disabled People when we launched the ILF, that many argued that it was wrong for this to be given to an independent body; they wanted it to be part of the regulated system. My own view is that the success of the ILF has proved that a system based upon individual assessment and on the discreation and judgment of independent trustees has been a considerable success, and has been able to respond much more flexibly to the needs of individual disabled people than any regulated system might have done. That is why we have built on this approach of individual assessment in deciding what the successor arrangements should be.

I think that it is fair to say that the arrangements after April must change. There will be an entirely new set of circumstances with the introduction of a community care system. Local authorities will have the responsibility to produce community care packages for elderly disabled people and others, and to ensure that services are delivered to them. Having come to the conclusion that that is where the main responsibility will lie, the Government decided that there was a level of costs beyond which it would not be reasonable in ordinary circumstances to expect local authorities to go on delivering care.

I believe that a reasonable level has been set. If it is necessary for extra help to be provided by the successor body, it will be open to the social worker who assesses the needs of disabled people to say, "We can provide services up to this level but we believe that a further level of care is necessary," and then to turn to the independent living fund. A joint assessment can then be made by the local authority social worker and the new ILF to ensure that the appropriate services can be assessed and delivered. The payment from the ILF will continue to be in cash. The local authority will, as under present arrangements, deliver its part of the bargain in the form of services. Cash help has been an important part of the ILF concept.

The right hon. Gentleman referred to the 22,000 cases that will be handed over to what we shall call the independent living extension fund in April. Those people will continue to be paid in cash. I am confident that the cash limit provided for the extension fund in the coming years will be sufficient to enable the fund's trustees to ensure that precisely the same arrangements exist. That means that if someone, sadly, finds that he needs extra help to maintain his independence within the community, it will be open to the trustees to increase the level of support, as they are able to do now. That should give real reassurance to the thousands of people who are presently recipients of help from the ILF.

I referred briefly to the 1993 fund and set out the arrangements that are being made. As the right hon. Gentleman rightly said, the new fund will be restricted to those of working age. The elderly—those who are beyond working age—will not be within the purview of the fund. I have crossed swords with the right hon. Gentleman on this issue before. Limited resources are available to the Government—if there were unlimited resources, we would take a different view—and we have to determine priorities.

In the time that I have held my responsibilities, I have deliberately sought not to exclude the elderly from help and support, but to tilt the balance towards the younger disabled, the people who had not the opportunity, because their disability was present from birth or early in their working lives, to build up the savings, pension entitlement and the other things that people with a full working life can provide for themselves in their old age. Therefore, within the resources available to me in the independent living fund 1993, it is right to make that judgment.

The fund will be able to organise in essence a discussion with those of working age who are eligible, so that there may be a tripartite settlement, as it were, between the customer, the local authority social worker and the social worker for the independent living fund. The local authority will be able to provide the first £200-worth of services to the individual concerned, and the fund will be able to provide a balance of up to a maximum of £500 in total.

I do not believe that, in those circumstances, 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. Obviously, at all times I have to balance the responsibility of providing resources for those who need help and the interests of the taxpayer, so I believe that to set an upper limit is acceptable.

The new arrangements should work well and should provide a sensible way forward, in combination with the Government's arrangements for care in the community, to ensure that a substantial number of the most severely disabled people in our society continue to have help through the independent living fund.

Question put and agreed to.

Adjourned accordingly at fourteen minutes to Twelve o'clock.