§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Arbuthnot.]
2.32 pm§ Mr. Alfred Morris (Manchester, Wythenshawe)This debate is about the urgency of the need to end a specific, blatant and now totally indefensible injustice to people—children and adults alike—who are among the most severely disabled in Britain today. What they seek, but cannot achieve without the help of this House, is every other citizen's undoubted right to independent personal mobility—the freedom to go beyond their own front doors.
With backing from the Muscular Dystrophy Group of Great Britain and Northern Ireland and from more than 100 other voluntary organisations, I have tabled an early-day motion in the following terms:
That this House calls urgently for the provision of indoor/outdoor powered wheelchairs to all permanently disabled adults and children requiring them for independent mobility, in accordance with recommendations made by the DSS Working Party chaired by Professor (now Lord) Ian McColl in 1986.Judging from the strong and immediate all-party response that my motion received, the subject is one of urgent concern to right hon. and hon. Members in all parts of the House. More importantly, though, the motion is of paramount concern to thousands of severely disabled people who see themselves as victims of state-sanctioned discrimination. That is the only way properly to describe the failure to fund occupier-controlled, electrically powered, indoor-outdoor wheelchairs for disabled people, who are forced to stay trapped in their own homes without them.It is estimated that at present there are approximately half a million permanently disabled adults and children in the United Kingdom who require a wheelchair of one kind or another for basic mobility. The state provides wheelchairs free of charge, and without any means testing, for the vast majority of them. This creates the presumption that the state acknowledges a duty to provide the means of independent mobility for all its disabled citizens. But for a significant proportion of permanently disabled people—as many as 40,000 to 50,000 children and adults according to the latest study—the range of chairs commonly available fails to meet their needs. Their disabilities are of such severity that they simply do not have the upper body strength to self-propel the manual wheelchair the state will provide, and the indoor electric-powered wheelchair, which can also be obtained free of charge, is simply not powerful enough to take them across the thresholds of their own homes and allow them to live their lives in the way that millions of other citizens can do, as of right, each and every day.
They never go beyond their own four walls independently, unless they can raise enough money to buy chairs themselves and that is seldom easy for people, so many of whom are locked in the benefits system and unable to work because they cannot get to work. The only other way for them to achieve independent personal mobility is to face what many of them see as the indignity of seeking help from charities. They seek the help of charities like the Muscular Dystrophy Group, whose recently launched "Batteries Not Included" campaign to secure mandatory state funding for indoor-outdoor powered wheelchairs has placed new emphasis on this injustice.
1124 When, in 1986, the working party chaired by Professor, now Lord, Ian McColl made its recommendations, it seemed that at last the inequity of a system that gave no help to those most in need would be finally swept away. McColl clearly recommended that indoor-outdoor powered wheelchairs should be made available through the state system. His report was unequivocal in claiming that the sole reason for continuing to deny access to these chairs was "financial". He condemned this as blinkered and flawed because it took no account of the invisible economic effects of fully empowering disabled people to contribute to the economy on the basis of equal opportunities.
The report envisaged a sound and common-sense policy of turning more and more tax users into taxpayers. It was a report, then, that called in compelling terms for a complete overhaul of a system that was outdated, financially near-sighted and a betrayal of those most in need. Yet eight years on there has been no change in the wheelchair service in England and Wales. Indeed, the dismantling of the old network of artificial limb and appliance centres—ALACs—and their replacement by a devolved system of administration by individual district health authorities has resulted in still more glaring anomalies, inconsistencies and inequities.
The Minister may say that it is now for local health authorities and trusts, and them alone, to decide whether to supply indoor-outdoor powered wheelchairs, but most other people will insist that the Government cannot simply wash their hands of a problem that is so crucial to the most needful of severely disabled people. They demand an act of leadership from Richmond house.
As the Minister must know, the fact that a few isolated authorities in England and Wales offer limited funding for the wheelchairs we seek only heightens the mounting sense of frustration and anger felt by severely disabled people who live in adjacent authorities where no such option is available.
The case of Wesley Maynard of Dorset, who has just emerged from a two-year period of isolation, tells the story in human terms. The increasingly debilitating nature of the form of muscular dystrophy which affects him meant that he could no longer operate a manual wheelchair. The state was not prepared to offer a powered alternative which would take him out of his home. Not only was Wesley's life cruelly restricted by his immobility, but his children's lives were, too. In Wesley's own words:
It's not fair on the boys. At weekends we should be out and about, having fun together. The beach is only a mile away, but it may as well be a hundred miles for all we'll see of it.Fortunately, Wesley's story has a happy ending. Recently, thanks to grants from the Muscular Dystrophy Group and a number of local fund-raising organisations, he finally received the necessary funds to purchase an indoor-outdoor powered wheelchair.The Muscular Dystrophy Group's files are full of similar stories of people whose lives have been completely transformed by the acquisition of indoor-outdoor wheelchairs. The charity's excellent report into the wheelchair service contains testimony from many individuals as to the dramatic effect of having an indoor-outdoor chair on their quality of life.
Richard Plummer, from West Brompton in London, says: 1125
The chair has completely transformed my life. The ability to go out, when and wherever I want, is a new experience for me".Michelle Howard from Swindon says:When I got into my wheelchair, I realised what freedom meant. It was like having my legs back; in fact it was better than my legs—my legs working without the rest of me would be useless.Finally, and most succinctly, the words of Andrew Doddington, a 13-year-old from Norwich who has muscular dystrophy, who simply declares:My wheels are my freedom.Yet for every story of freedom achieved, there are others of freedom denied. Again, the Muscular Dystrophy Group's own files are full of examples. Catherine Alexander, for example, is a bright and inquisitive four-year-old from the Wirral. At present her mobility is severely limited. When it comes to exploring the world around her she is dependent upon others and reliant upon a pushchair she has now outgrown.Mark Thorpe is a 32-year-old from Harwich, whose current powered chair, paid for by voluntary sources, is now eight years old and totally unreliable. Mark recalls the period before he got his first powered chair as one of isolation and despair. Quite rightly, he dreads the imminent prospect of being trapped in his home again and reliant on others for basic mobility.
The list goes on and on. Indeed, since 1986 the Muscular Dystrophy Group alone has provided grants for powered wheelchairs to well over 1,000 adults and children, representing an investment in excess of £2 million. That money had to be diverted from the charity's primary objective, which is the funding of vitally important research into the cause and potential treatment of this debilitating and harrowing condition. Many severely disabled people take on the arduous and often hopeless task of raising funds themselves. They write letter after letter to local and national trusts and charities, waiting for the reply to fall through their door that might prove the financial key to opening it for them.
On both sides of the House, their plight is seen as shaming our society. How can it possibly be right to perpetuate a system under which, in proportion to individual need, the more disabled one is, the less help one receives? It is a system that piles handicap on handicap, leaving disabled people doubly disabled, and is morally unacceptable.
Again, is it right that a child in my Manchester constituency must remain isolated and dependent upon others for basic mobility when his exact counterpart in Motherwell, where state funding for indoor-outdoor wheelchairs has already been agreed, enjoys full independence as of right?
Why is individual need less important than where one lives in determining eligibility for help? As the Minister knows, that has been the case since 1992, when the Scottish Office made ring-fenced funding available for indoor-outdoor powered wheelchairs.
The Scottish experience provides the one glimmer of hope in this whole shaming and scandalous affair. Far from demonstrating that funding for indoor-outdoor powered wheelchairs would prove administratively and financially too difficult to contemplate in the rest of the United Kingdom, in fact it clearly demonstrates the opposite. The state-financed system now operating in Scotland has proved wholly viable. The Scottish scheme also 1126 contradicts the only argument ever offered in defence of current policy south of the border that to make funding available for indoor-outdoor powered wheelchairs would open the floodgates to new applicants on a scale that would be financially prohibitive.
Indeed, a recent memorandum from the Scottish Office makes it clear that the Secretary of State now accepts that current eligibility criteria are too narrowly drawn. The memorandum recommends a relaxation in the criteria now operating in Scotland, with no mention of any fear of being deluged by new applicants.
For the period 1994–95, the sum of £1.2 million has been set aside in Scotland for the specific purpose of providing indoor-outdoor wheelchairs—a sum which is obviously proving more than ample to meet current applicants' needs. Simple arithmetic, multiplying the figure of £1.2 million in proportion to population statistics for the United Kingdom as a whole, produces a national annual figure of just £12.25 million to extend the system to the rest of Great Britain.
This is wildly at variance with the Government's own figures. As long ago as 1986, the McColl report called for a budget of £30 million for national funding of indoor-outdoor wheelchairs, but that figure, in the light of Scottish experience, now seems to have been cautiously high.
Just £12.25 million is surely a small price to pay to secure full rights of citizenship, freedom of mobility and economic liberation for the severely disabled people whom this debate is seeking to help.
I take pride in being associated with the Muscular Dystrophy Group and the other 100 organisations which are collectively mounting the "Batteries Not Included" campaign, with most of which I have been associated for more than 25 years. On their behalf, and for the thousands of needful people whose lives can be transformed, I now most strongly urge the Government both to acknowledge, once and for all, the state's duty to guarantee independent personal mobility for all its disabled citizens, and to end the now plainly indefensible policy of overt discrimination.
In the introduction to "Batteries Not Included"—the report which inspired this debate—my noble Friend Lord Attenborough of Richmond-upon-Thames, the Muscular Dystrophy Group's president, states:
Independent mobility is not the privilege of the able-bodied or of those with the necessary financial means. It is a fundamental right—and a duty lies with society as a whole to ensure that this right is available to all.Establishing a system to provide indoor/outdoor wheelchairs would cost so little and buy so much. All that is lacking is a strong voice calling for change and the political will to make that change.There are now many thousands of very strong, very insistent voices calling for change. Is it not about time that we in this House heeded their call by summoning the political will to make that change?The hon. Member for Battersea (Mr. Bowis) shared many debates with me before he became a Minister—we were invariably on the same side—and he has shown his humanity on many occasions in the House. I hope very much that he will be able to offer a positive reply today—one that will give some hope to people who so very urgently need our help.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)I am grateful to the right hon. Member for Manchester, Wythenshawe (Mr. Morris) for his final words and I am grateful for the opportunity to answer the debate. The House is well aware of the right hon. Gentleman's tireless campaigning over the years on behalf of people with disabilities. As he says, I too have been involved in many campaigns, often alongside him. So I welcome this opportunity to share some thoughts with him on the points that he aired today.
There are a number of ways in which people with disabilities can receive help with their mobility. The benefits system provides a mobility component in the disabled living allowance. People can use this to meet their own needs for getting around, or may put it towards the lease or purchase of a car, or, if they are on the higher level of mobility component, towards the purchase of indoor-outdoor powered wheelchairs under the Motability scheme. In addition, the Department of Employment has power to award money to resolve mobility problems so that a disabled person can start work. Access standards for new non-domestic buildings also play their part in increasing mobility.
Clearly no description of the cross-sector aspects of mobility would be complete without mention of public transport. A number of initiatives are currently in progress covering buses, air travel, taxis and the pedestrian environment. Perhaps I can underscore that last point. Like the right hon. Gentleman, I have been involved with people in wheelchairs and people who have visual impairment, so I know how difficult life can be as a result of poor planning and thoughtless practices. Dark-painted lamp posts at irregular intervals do not help. Shop goods spilling over on to the pavements, cars and bicycles parked on kerbs or across ramps, and tools and workings left unguarded can all be lethal. It does not take Governments to get these right; it takes all of us to think, and to think disability.
Accessible transport within a barrier-free pedestrian environment should address the needs of all the population with mobility difficulties, without, of course, focusing on any one group to the exclusion or detriment of others. The Department of Transport is given valuable support in pursuing developments in this area by the Disabled Persons Transport Advisory Committee. The committee was set up under the Transport Act 1985 to advise my right hon. Friend the Secretary of State for Transport on the transport needs of people with disabilities. People with disabilities make up the majority on the committee and cover the whole spectrum of disability needs. They bring together a wealth of experience and expertise in transport matters.
"Co-ordination" is a word that is increasingly used in the context of accessible transport, and it is an area in which I think there is enormous scope for further development. Many local and health authorities are now beginning to realise the value of pooling accessible transport resources so that statutory transport provision, for example, to day centres, hospital appointments, special schools and so on, can be combined with other sorts of door-to-door transport services either using community transport or dial-a-ride vehicles, or using local taxi services where they have suitable, or suitably modified, vehicles.
Many would regard my responsibility in the area as the most basic and important to the mobility of many disabled 1128 people. I am responsible for the wheelchair service. The service has a proud history. It has grown from issuing some 76,000 wheelchairs in 1979 to issuing 170,000 last year.
For many years, the artificial limb and appliance service was run centrally. In 1986, the McColl report of the committee chaired by my noble Friend Lord McColl reviewed the service and proposed sweeping changes in the way it was run. As a result, responsibility for artificial limbs and wheelchairs was transferred to the Disablement Services Authority from 1 July 1987. The main function of the Disablement Services Authority was to prepare the service for integration within the national health service, which took place in April 1991.
Following integration, as the right hon. Member for Wythenshawe said, the money to be spent on disablement services was earmarked to ensure that it was not put to other uses, and to accustom the NHS to running the service. When that arrangement ceased on 1 April 1993, the NHS became entirely responsible for running the service.
The result of the changes is to integrate provision of wheelchairs with other services for disabled people so that local health authorities and disablement services centres can ensure that the health needs of their populations are met. They are closest to the people they serve and so are best placed to respond sensitively to their needs. Choice is improved, as disablement services centres may buy any wheelchair on the market within their overall budget.
Since devolution of responsibility, each health authority has made its own arrangements for the service. Generally, people who need a wheelchair are referred by their GP or consultant to a local disablement services centre. That centre is contracted to provide the person with a suitable wheelchair. Therapists at the centre prescribe the appropriate chair from a range of types on NHS contract, from a manual chair at £130 to a powered indoor chair costing £750. Alternatively, of course, they can order on the open market what is required. When necessary, special seating and attachments are also provided. Chairs are maintained under local agreements and the disabled person pays nothing for the service.
Powered indoor chairs are provided for severely disabled people, who normally live alone, to help them move about their home. Powered chairs that can operate both indoors and outdoors are more versatile and, of course, more expensive, at about £2,500 and ranging up to £20,000. As with standard wheelchair provision, health authorities have to decide whether to issue them in the light of local priorities and resources, and a few have allocated funding specifically for the purpose.
As the right hon. Gentleman knows, the provision in Scotland is different, as it is with a number of services. In England, we have taken the view that local units are best placed to meet the needs of local people, as in other areas of health and social care provision. The changes in Scotland are recent and I shall watch them with interest and watch the progress of their three-year programme very carefully.
For the future, we expect the demand for wheelchairs to rise. In 1978–79, almost 270,000 were in use. Recent figures show that well over 500,000 wheelchairs are now in use. The current cost of the wheelchair service is nearly £40 million a year. The House will realise from that that there have been many improvements and changes in the organisation of that service over the past few years. I am 1129 keeping the new arrangements under scrutiny to ensure that our aims—to improve the service and make it more responsive—are achieved.
We have received a number of suggestions for fuller development of wheelchair provision over the years, including, for example, the introduction of a voucher scheme. Under such a scheme, disabled people would be able to use a voucher to the value of their NHS provision and top that up, if they so wished, with or without help from family, friends or charitable organisations, to purchase a more expensive wheelchair. That scheme has attractions, especially to disabled people who are active, able to look after themselves and not otherwise ill. There are, of course, a number of practical considerations to be worked through and we would need to be sure that costs would not be prohibitive.
I hope that the right hon. Gentleman will be encouraged to learn that, as a result of correspondence I have had with my hon. Friend the Member for City of Chester (Mr. Brandreth), I have today asked the Department to look afresh at the issue, so that I can decide whether a scheme would be affordable and to the benefit of users generally. I am setting up a departmental working group to look at all aspects of such a scheme and to take evidence from experts. That will report to me by the end of October.
I should also like to draw the attention of the House to a report which was launched recently on the subject of cross-sector benefits—the indirect benefits which accrue from the provision of independent mobility and accessible transport. The report, carried out by Cranfield university and funded by the Rowntree Trust, draws attention to the 1130 costs which accrue, for example, to the health service and to social services when they have to provide services to overcome a lack of mobility.
One example is the cost of a doctor leaving his or her surgery to attend a patient at home because that patient has no means of independent transport. That is costly. The economics of the issue is not straightforward or easy to tackle, but I am pleased to say that the Department of Transport will be setting up a joint working group with other relevant Departments to explore some of the issues and the implications that it has for long-term funding.
Helping people become more mobile spans the policy interests of a number of Government Departments and carries benefit not only for disabled people themselves, but for society as a whole. Mobility is essential if disabled people are to realise their potential and contribute to the social and economic fabric of the communities in which they live and work.
The right hon. Gentleman is impatient for change, and he is right to be. No change comes from passive waiting. I can tell him that I am an impatient Minister. I, too, want change for the better for people with disabilities, and I want it to have happened yesterday. I know, as he knows, that we can only achieve so much at a time and that we can only afford so much at a time. Many priorities for action and spending compete with each other. Nevertheless, step by step, we are making progress. We must not raise hopes that cannot be fulfilled, but we can and we do set our sights on the horizon as we strive together to enable people with disabilities to live life to the fullest possible extent and to be full members of our society.
§ Question put and agreed to.
§ Adjourned accordingly at Three o'clock.