§ Motion made, and Question proposed, That this House do now adjourn. —[Charlotte Atkins.]
11.15 pm§ Helen Jackson (Sheffield, Hillsborough)The reason for my seeking this Adjournment debate is to highlight a problem that is well known to every Member of the House, and to suggest some solutions, which entail a co-ordinated approach being taken by Government, and spending that triggers longer-term savings. What I am after is fast-track access to a Government-backed incentive scheme for the installation of level-access showers as a major contribution to the goal of independent living for everyone.
Poor housing is sometimes seen as a Cinderella issue in the House, yet we all know that comfortable homes make for better health, safer communities, more independence and increased dignity of life. I am focusing on a particular aspect of the home: the need, and I suggest that it should really be seen as a right, for everyone to be able to bathe daily in warm water in their own home. Access to hot water is recognised as an emergency repair for landlords, but the hot water is no use if the individual cannot get in and out of their bath.
This is a particularly Anglo-Saxon problem. In warmer countries on the continent, and indeed in many parts of the developing world, showers— level-access showers—with the drain in the floor are the norm. In England, however, lounging in the bath became fashionable, so much so that the bath became a far more accepted piece of bathroom furniture than a shower. The problem was made worse when showers became fashionable because they were always installed over a bath, so that the stiff joints and infirmity that prevent access to the bath also prevent access to the shower. Surely in these days of central heating we could follow the example of warmer countries and redesign our bathrooms.
How many of us in the House have letters from constituents pleading for help? I quote from one:
My husband is 80 and I am 78. There is no way I can help him in and out of the bath as I am only 4ft 10.How many constituents are there whom we never hear from but who are struggling with a daily wash at the basin in a chilly bathroom because they are unable to climb into the bath, but have never applied for an adaptation? The number of friends to whom I have spoken about this debate who have had a friend or relative in that situation has certainly surprised me. How often have we had profuse letters of thanks from disabled people whose life has been transformed by the installation of a level-access shower?More seriously, how often have we heard from constituents whose application has been turned down? A housing office turned down a constituent of mine
because she said he was able to have a strip wash and was not incontinent.It is commonplace for such cases to be classed as non-urgent, and even if people apply for help they can wait for years before they are considered for a bathroom conversion. The delays can mount up.The first problem is discovering how to make the application. Some 30 per cent. of those questioned in the Joseph Rowntree survey in August 2001 had a problem 692 gaining access to a disability grant. The second problem is waiting for an assessment. In many authorities, that has to be carried out by an occupational therapist, but they are in short supply, which can lead to a wait of eight months or more. The time that it takes for the occupational therapist to submit a report and for the authority to consider the recommendation can vary widely. If the recommendation is yes, there is another wait for the builder to assess and carry out the work, but if the answer is no, because the individual can manage a strip wash, the application may become non-urgent and take an additional 18 months at least. I have known people to wait three years: that is simply not acceptable in the new century.
Some 1,370 individuals are waiting for bathroom adaptations in Sheffield alone; some 658 of them are classed as non-urgent. The council recently allocated a welcome additional £500,000 to reduce the numbers, but I am not sure how that will affect the non-urgent cases. The 2001 Joseph Rowntree survey found that the most common reason for applications for major adaptations is the inability to bathe. Age Concern found that nearly a quarter of applicants mention bathing as the main reason for needing alterations to their homes.
I believe that I am speaking to a Minister who is sympathetic to my argument. The Government recognise that people want to live in their own homes and communities as they get older and are a little more unsteady. They also know that moving to residential establishments can be distressing, sad and hard for relatives and carers. The Minister's colleagues in the health team also have a huge interest in speeding up the number of bathroom adaptations to relieve the problem of bed blocking. The Community Care (Delayed Discharges Etc) Bill, which recently went through the House, has put pressure on local authorities to respond, but speed is crucial when a hospital bed is needed by someone else. It is often the bathing facility at home that is the biggest block to a patient's discharge from hospital.
In preparing for the debate, in addition to speaking to my constituents I consulted the Union of Construction, Allied Trades and Technicians, the Federation of Master Builders, the Institute of Plumbing, the Bathroom Manufacturers Association, Age Concern, both locally and nationally, the National Housing Federation, the Chartered Institute of Housing, Shelter, public health officers, the Chartered Institute of Environmental Health, disability organisations, Barnado's, which had specific concerns about disabled children, Sheffield local authority and its social services department, and the local primary care health trusts. They all gave me wholehearted support.
I want to attack the issue from two directions. Clearly there are ways in which we can make the grant systems more accessible and better funded, but if bathrooms were normally designed to include a level-access shower, rather than one over the bath, the problem would be hugely eased. Just as in the 1980s, when the provision by the Government of insulation grants for owner occupiers or private and public landlords raised the standards for all housing and made a significant input into energy savings across the country, a more universal approach to level-access showers in our bathrooms could make all our houses last as our homes for longer.
693 I pay tribute to the movement for lifetime homes, which is to be wholly supported. In one of its press releases it quotes someone as saying:
The ability to gain access to the whole house is wonderful. I'm no longer a prisonerin my own home. The pepper-pot approach to funding one-off bathroom adaptations is not as good value for money as further reform of building regulations and house improvement regulations that assume that bathroom design will include a sealed corner with a plug in the floor and a shower in the wall. It is a little like the proponents of diesel motor cars who argue that if diesel fuel had been discovered first no one would ever have used petrol for the internal combustion engine. We should note that the high-level and rather posh bathroom design journals include pictures of children, elderly people, adults and families using level-access showers, making bathing easy and efficient for the whole family.In consultation with interested bodies, we have discussed the way in which a level-access shower grant scheme could work. There could, for example, be a modest flat-rate grant for universal access subject to building regulation checks, which would offer an incentive to owner-occupiers, tenants and landlords alike. For many, a simple incentive contribution like the old insulation grant would be all that it would take for large-scale work to be done. The Government could also consider issuing further guidance on housing improvement schemes, whether in the private landlord or housing association sector, so that level-access showers were considered an element of the work normally undertaken, and consider providing a financial incentive to achieve that.
That incentive would be additional to the existing disabled facilities grant scheme for people whose disabilities or hospital discharge mean that their needs require urgent attention, or installing a shower could be combined with other extra building work throughout their home. Another aspect that the Government may consider is the need in every case for an occupational therapy assessment, as that often leads to delays. Perhaps we should recognise that a simple request for help is often all that we should require. There should be a clear directive from the Government to local authorities about what should be classed as non-urgent and a further reminder should be given about the mandatory nature of disability facility grants. In some areas, the requisite six-month period applies in the private sector but not where housing stock is publicly owned. I believe that that is the case in many of the larger metropolitan authorities. As the prospect of years of waiting drives people who have a little cash to spare to invest in the work anyway, the Government have a duty to offer an incentive. My constituent Mr Chisnall struggled for many months following his wife's stroke to get help so that work could be done. Eventually he had a shower installed at his own expense, and in his words it has "transformed their lives".
Finally, installing the showers would offer a stream of useful work for local accredited builders and plumbers. The Federation of Master Builders believes that the industry could cope and has made many useful 694 suggestions about quality control, simplicity and speed. As we await the publication of the draft housing Bill and the draft disability Bill, the Government have a chance to consider how such a proposal may be developed. I would be delighted to meet the Minister again with some of the bodies that I have spoken to after this debate to consider the issues further. We can be quite certain about one thing—my proposal would receive active and enthusiastic support from the public throughout the country, and bodies working with the elderly, the disabled and disabled children. Like me, they believe that it is simply unacceptable in the 21st century to fail to ensure that everyone has the opportunity of a warm all-over wash or shower to maintain dignity and independence in their home.
§ The Parliamentary Under-Secretary of State, Office of the Deputy Prime Minister (Mr. Tony McNulty)I congratulate my hon. Friend the Member for Sheffield, Hillsborough (Helen Jackson) on securing a debate on such an important subject. I thank her for describing me as a sympathetic Minister. I hope that she still takes that view by the time that I have finished speaking. I am grateful to her not least for bringing to my attention the problems encountered by some of her disabled constituents in Sheffield concerning delays to the installation of level-access showers. I agree with her absolutely that those delays are wholly unacceptable. In this day and age, such facilities are an absolute must.
To pick up one of my hon. Friend's points, I should like to make it clear that the Government's overall position remains that access to a bath or shower is a mandatory right for disabled people who are eligible for a disabled facilities grant. We consider the grant programme to be very important in assisting disabled people to remain in their homes and live independently for as long as possible.
That is why, when we recently reviewed local authority powers to provide assistance for housing renovations and adaptations, we decided to keep DFG as a mandatory right for eligible applicants. That is also why we have kept the money ring-fenced; it can be used only to help the disabled. My hon. Friend will know that we have unhooked much of what we give to local government, but we felt that it was important to keep DFG ring-fenced. For all other types of renovation assistance, we have given—I think quite rightly—local authorities much greater local discretion on how their funds are allocated. We cannot send a message that such a grant should be a mandatory right for those disabled people eligible and at the same time somehow retain flexibility.
In addition to preserving the mandatory DFG, we have since coming to power significantly increased the resources available to the programme. The Government meet 60 per cent. of the grant paid by local authorities, which must find the remainder from elsewhere in their budgets. In 1997–98, central Government resources available for DFG totalled £56 million for England, but the budget for 2002–03 is £88 million.
Securing additional resources for the programme is also one of the priorities for the Office of the Deputy Prime Minister, and we are considering it as part of our work on preparing the communities plan. We will 695 announce our conclusions in the next few weeks as well as announcing the DFG allocations to local authorities for 2003–04.
The problems in delivering a first-class adaptations service go wider than the DFG programme. Both housing and social services authorities have responsibilities to meeting the needs of disabled people in their area, either for advice or for the provision of equipment or adaptations. There is therefore a need for close co-operation between the two departments, and Government guidance has stressed the need for jointly agreed policies and procedures on how the various services should be delivered. In general, as my hon. Friend has said, it has become established practice for social services to provide equipment and minor adaptations, and for the DFG programme to deliver major adaptations such as stair-lifts and level-access showers, which may require structural alterations.
All owner-occupiers and all tenants, including those of the local authority, are eligible to apply for DFG, but the Government do not subsidise the local authority to carry out work on its own stock, so it is important that the authority also budgets carefully and makes resources available to provide an adaptations service to its tenants that is at least as good as that to owner-occupiers.
The local housing authority has additional discretionary powers, which it can use to top up the mandatory DFG system. Indeed, we have just legislated to simplify those powers under the Regulatory Reform (Housing Assistance) Order 2002. The order gives local authorities much greater discretion on how they provide assistance for housing repairs, improvements and adaptations. Those powers could be used to provide specific forms of adaptations and to speed up delivery—providing, of course, that the local authority is able to make the necessary resources available.
Owing to the complexities involved, we have been working closely with the Department of Health to produce new best practice guidance to authorities on how an effective adaptations service can be delivered. I am pleased to tell my hon. Friend and the House that we will in the next few weeks be publishing new draft guidance for consultation.
Let me turn to the specific issue of the provision of level-access showers under the DFG programme. As I said, it is a mandatory right for disabled persons to receive a grant for the provision of certain facilities to their homes. Section 23(1)(f) of the Housing Grants, Construction and Regeneration Act 1996 provides that grant must be paid to facilitate access by the disabled person to a room with a bath or shower, and to facilitate the use of such a facility by the disabled occupant.
In deciding whether to approve a DFG application, the local housing authority must consult with social services. In practice, that usually means that an occupational therapist employed by social services will assess the disabled person's needs. This must be with regard to the provisions of the DFG legislation that I have just quoted. If the disability of the applicant is such as to prevent access to the existing bath or shower, a new accessible adaptation will have to be provided, usually by means of a level-access shower. I entirely accept my hon. Friend's comments that that part of the process— 696 the occupational therapist's assessment of the applicant—is in many cases the cause of the delay. That needs to be looked at.
The DFG legislation is also specific about the timetable for delivering the adaptations. Under the 1996 Act, the local authority is required to respond to any full grant application for DFG within six months. The local authority may delay the payment of any grant in cases where it has exhausted its annual budget, but for no longer than one year after the date of the full application. Government guidance states clearly that such delays should not occur in urgent cases where there is a serious health risk to the applicant. I accept my hon. Friend's point that often people go through the process of applying for such adaptations in times of adversity or trauma—for example, after a partner has suffered a stroke, as in the case of her constituent, which my hon. Friend quoted. Such cases should be treated as urgent.
I am aware that many local authorities use various methods of prioritising DFG applicants to highlight cases where urgent action is necessary. This is a sensible procedure which the Office of the Deputy Prime Minister encourages. I am also aware that some local authorities do not give very high priority to access to a bath or shower. Although that is a matter for the local authority, I must emphasise that it cannot lawfully override the mandatory right of a disabled person to have access to a shower or a bath.
Further delay can also occur because there are a number of procedures that have to be completed before a full DFG application can be made and the six months' clock starts to tick. It is at this stage that delays of two or three years can begin. An assessment by social services must be undertaken, and the applicant must submit tenders for the work to be carried out. Guidance from the ODPM has emphasised that the procedures should not be used to delay applications unduly, and we will repeat this advice and set out target times for the complete adaptation process in our new guidance. The guidance will state that waiting times for any adaptation of more than 250 working days, from the point of initial inquiry to completion, are unacceptable.
I have described the DFG process in some detail in order to point out that the legislation in place adequately provides for the provision of level-access showers to disabled persons who cannot use existing facilities. These mandatory provisions apply to disabled persons in the private sector as well as to tenants, including those in local authority-owned stock. It is for local authorities to honour their statutory duties.
Nationally, we have provided additional resources for DFG to ensure that that can happen, and in Sheffield's case we have provided all the DFG resources that the council has asked for and it is now taking action in that regard. In relation to their own stock, the Government provide authorities with significant resources to invest in council housing. These resources are not hypothecated to particular items of expenditure. It is for an authority to decide how much of those and other available resources it should allocate to renovation, improvement or other work such as adaptations for disabled persons, having regard to its legal obligations. I am pleased to hear from my hon. Friend that Sheffield council has decided to allocate additional resources for that purpose.
697 My hon. Friend also raised the issue of what more can be done in the design of new homes to facilitate the provision of level-access showers where needed. I take her point about that being a peculiarly Anglo-Saxon problem that is not of much concern or interest on the continent.
Since late 1999, part M of the building regulations has provided that new houses must make provision to manage the needs of family members who may become disabled. New homes are now required to include reasonable provision for disabled people to gain access to and make use of them, and a WC and washbasin should be provided on the same storey as the entrance. We keep the building regulations under review. We are currently reviewing the relevant sections that apply to non-domestic buildings and we may wish to review the sections covering domestic buildings at a future date, but my hon. Friend will understand that I can give no precise undertakings to that effect tonight.
However, I can say that, following the changes made in 1999, the Joseph Rowntree Foundation published a guide entitled "Meeting Part M and Designing Lifetime Homes", which contained a foreword by my right hon. Friend the Minister for Local Government and the Regions, then Minister with responsibility for construction. The guide sets out a lifetime homes standard that includes a wheelchair-accessible entrance-level WC with drainage provision enabling a shower to be fitted. I can do no more than quote from and heartily agree with my right hon. Friend's words in the foreword:
This guide highlights the benefit of a little extra thought and care that needs to go into housing design in order to add the flexibility and adaptability found in lifetime homes. A number of 698 local authorities also encourage use of Lifetime Home standards and house builders may also wish to go beyond Part M, as a minimum regulatory standard as they strive for excellence.I completely endorse that view. As my hon. Friend said, if the lifetime home standards are endorsed, they will eventually eradicate the problems. The Office of the Deputy Prime Minister is encouraging new home builders to go for the lifetime standards model.These are important matters and my hon. Friend has raised some important ideas. I shall not stand here at 11.40 pm and say, "Yes, they're all lovely and I'll go off and implement them", but I am more than happy to meet her and some of her colleagues—I fear that if she brings along the entire list of consultees, there will be no room in the Department, let alone my office—further to discuss this important matter. DFG has worked well in the past and it will continue to do so. Many of the issues that she highlights, including lifetime standards, delays and others are worth exploring further and I shall happily discuss them with her and some of the consultees with whom she worked.
I congratulate my hon. Friend again on securing the debate and raising these important issues, which concern a range of people in her constituency, mine and everybody else's. Such people very often fall through the cracks and disappear for want of strong voices. She is clearly a strong voice in support of her disabled constituents and raises issues whose importance is writ large throughout the country. I hope that we can together take matters forward and turn a good system into an even better one.
§ Question put and agreed to.
§ Adjourned accordingly at seventeen minutes to Twelve o 'clock.