CHRONICALLY SICK AND DISABLED PERSONS BILL

HL Deb 09 April 1970 vol 309 cc239-315

3.15 p.m.

THE EARL OF LONGFORD

My Lords, I beg to move that this Bill be now read a second time. I count it a great privilege to bring before the House a Bill which carries the hopes of so many thousands of disabled and nondisabled persons, and to which the disabled themselves have already made so great a contribution. I am proud to do so at the invitation of Mr. Alf Morris, who initiated the Bill at very short notice. He carried it through another place with the co-operation of all Parties and won much public sympathy. The Government showed much good will in another place, quite irrespective, of course, of Party considerations, and I have no doubt that all these things will be in evidence here.

However, if that is true and if, as I believe, there is a lot of good will for this Bill, it does not in any way diminish the significance of our discussions in this House. No one would wish our part to be reduced to a series of pious platitudes of good will towards the disabled, or of mutual self-congratulation. There is widespread agreement that this Bill must be strengthened in important respects if it is to serve the purposes which I believe we all have in mind. It will be wise for me to refrain from indicating precise Amendments until we have heard the speakers to-day, including of course the Minister, who is so well equipped, not only by her office but by her personal knowledge and sympathy. We are already grateful to the Government for their assistance with drafting, but to some extent that places on the Government the responsiblity of indicating or interpreting the meanings of some of the clauses.

The wide and varied qualifications of those who are to follow me need no eulogy from me, but I think the House will wish to give a welcome of special warmth to our maiden speakers, the noble Baroness, Lady Darcy de Knayth, the noble Baroness, Lady Masham of Ilton and the noble Viscount, Lord Ingleby. And may I say of all of them, and also, of course, of the noble Lord, Lord Crawshaw, that they have proved that affliction, while it can degrade, can also ennoble, and it can be translated, as they have proved, into service for others. We also extend a warm welcome to the right reverend Prelate the Bishop of Bath and Wells, another maiden speaker who is to take part in the debate. My Lords, I will try to be fairly brief— not as brief as I intended when I first began contemplating this speech, but decidedly bearably brief. However, it is not altogether easy in the case of a Bill which contains so much variegated detail. I think there is discoverable behind the Bill a general philosophy which no doubt will be expressed in slightly different ways by different speakers and which I hope to put in a form that will be generally acceptable.

My Lords, we are determined that henceforward, so far as lies in human power, the disabled shall no longer feel themselves to be second-class citizens in their own country. We are determined that they shall no longer suffer, as so many do, from a dread sense of isolation. We are determined that through this Bill they not only shall acquire a new sense of independence but at the same time shall obtain an integration within the community, a feeling of belonging fully to it, just like everybody else. Moreover, we are determined that they shall not be just passive beneficiaries of these welcome changes but shall be as actively concerned in administering the results as they have been in promoting the Bill. For the first time we are insisting that the problems of the disabled shall be looked at and treated as a whole, instead of allowing the provision for the disabled to emerge from the efforts of nine different Departments as a sort of un-thought-out residual legacy. This is an historic occasion. The Bill before us is a fundamental Bill of Rights for the disabled and for the community as a whole. It represents a real step forward in sanity and human understanding.

I come now to our general method of giving effect to the philosophy stated. Most, though not in fact quite all, of the benefits of this Bill are available to some disabled people in some parts of the country, but in future they will all be available as of right. I cannot say that too often. We are going a long way to establish the mandatory instead of the permissive principle. No longer will the disabled have to go round cap in hand, hoping for largesse from well-meaning individuals or bodies. The benefits will belong to them as a matter of law—in every way a healthier relationship.

I have said that we are going a long way to substitute the mandatory for the permissive principle. It will be noticed, however, that in Clause 1, for example, the benefits are to be provided as far as is "reasonably practicable". Many who support the Bill are worried about this language, this qualification. I confess that I share their apprehension. May it not be that the slack or recalcitrant local authorities will find in this qualification a method of evading their duty? I recognise, as anyone must, that we are not dealing with an easy problem here, and I am sure the Minister will set that out before us. Speaking for myself, however, I must express the hope that before the Bill leaves the House it will be clear to all, beyond all doubt and question, that in practice the Bill is mandatory at the crucial points. We must see to it, for example, that Clause 1 is as strong as Clause 2, where the qualification that I mentioned does not operate and which is therefore mandatory beyond dubiety.

Now, very briefly, for the clauses of the Bill. Clause 1 is concerned with information and is vital. We can all appreciate the fact that the disabled themselves should be more fully informed than now about the facilities available. What is more surprising to newcomers to this Bill is the very inadequate know- ledge which is apparently possessed at the present time by local authorities about the extent of disablement in their areas. With the best will in the world, it is inconceivable that without adequate knowledge the local authorities can do their duty by the disabled. If they do not know how many there are, or who they are, or where they are, they obviously cannot do a proper job.

I strongly recommend to the House, if they have not seen it, the article in the Sunday Times last Sunday by Mr. Jack Ashley, M.P., who himself was cruelly smitten by disablement and has responded by heroic exertions on behalf of others disabled. Some local authorities, Mr. Ashley points out, combine few facilities with dubious claims to abnormally low percentages of disabled. Some say they have only 1.4 disablement per 1,000 of population, compared with 10.4 per 1,000 acknowledged by others. There must be something wrong there—those are my words, but Mr. Ashley's implication. They will be jolted, he says, by a duty to discover how many disabled people live within their area. The Bill can fairly be described as a beginning of wisdom in our dealings with the disabled generally, but that applies with special force to the information demanded under Clause 1.

Clauses 2 and 3 greatly strengthen the responsibility of the local authorities for providing suitable welfare and housing for the disabled. They relate to the essential nature of the Bill, and in particular they make sure that the disabled should, wherever possible, be enabled to earn their own living, and in any case to live in their own homes.

The next group of clauses, Nos. 4 to 6, concern access and sanitary facilities. Again this is essential, and other speakers, I know, will dwell on this aspect from many points of view. These clauses relating to access and sanitary facilities are essential to keep the disabled as normal members of the community. They must no longer be debarred by their handicap from public buildings such as town halls, libraries and art galleries, nor from shops, cinemas, theatres and railway stations, nor from offices or factories where they might well be able to work if there were parking places, ramps, lifts and suitable sanitary facilities. I confess that I am not very clear how far the purpose which I have now stated is in fact carried out by Clause 4. Perhaps the Minister will help us here. There is in the Bill an obligation to provide access for the disabled laid on: Any person undertaking the provision of any building or premises to which the public are to be admitted … I put this question to the Minister, having given at least 24 hours notice: does this include the ordinary factory or office or shop or other place of work? We certainly hope for enlightenment from my noble friend.

Another group of clauses, Nos. 7 to 13, concern advisory committees on war pensions, housing, national insurance, industrial injuries, youth employment, transport users' committees and other users' councils. Surely we are all, in principle, anxious that the disabled should themselves be adequately represented on these bodies. We are anxious, surely, that such councils should not be concerned only with doing things for the disabled; we ask that they should also provide a means for the disabled to do things for themselves. The benefits one has in mind are not only physical but psychological, and, I would venture to say, moral and spiritual. But how far do the provisions of the Bill in its present form make sure that all that happens? It is at least open to doubt, although I agree that there is strong reference to the representation of those who have worked among the disabled and who know the needs of the disabled. But that is not quite the same thing as referring to the representation of the disabled themselves. That, again, is a matter into which we shall want to go very closely.

As regards Clause 13, it has been put to me by a gifted lady, herself disabled, that this clause should be strengthened. It deals with employment. She writes to me: There are a number who, like myself, have suffered feelings of deep despair "— I am sure she would not use that language lightly— on being told that there is no possible job for them, or being sent to fill unsuitable posts. Among them are those who have not had my good luck in finding work through private channels. I believe this calls for the attention of highly skilled vocational psychologists as well as fuller training of other personnel involved. I am sure that when we come to Clause 13 on Committee stage there will be a good deal to be said about that subject.

Clauses 14 and 15 deal with the separation of the younger and the elder patients in hospitals and local authority homes. The House will be aware that no clauses raise more poignant issues than these. I have myself recently met a lady—she has appeared on television— who was packed off to a geriatric ward when she was 16 and shut up there, or, if you like, stuck there, for 24 years. That kind of thing, we are all agreed, cannot in future be tolerated in a civilised country. There may be some difference of opinion as to how exactly we ought to cope with this problem, but those who are advising me are agreed, as indeed I am, that a fairly simple rule can be applied here. We should say explicitly that no one should be sent to a geriatric ward, whatever his or her age, unless he or she is considered after a medical examination to be suitable for a geriatric ward. In other words, we should make sure that no one is in a geriatric ward unless he is really and truly a geriatric patient. I hasten to say that no criticism is intended here of geriatric wards for geriatric cases. We all ought to be aware of the excellent work which is being done by so many geriatricians, and I am particularly glad that the noble Lord, Lord Amulree, so distinguished in the field of geriatric work, will be speaking early this afternoon.

In another place, the Minister indicated that when the Bill was published the Government would try to see what could be offered under this heading. Naturally, we shall eagerly await the words of the Minister. But if we are really going to try to help the young chronic sick (and one uses this expression, of course, in a very wide sense) we must insist not only on the negative rule, that they must not be closeted with geriatric cases, but on a positive provision that if there is no suitable accommodation for them at the present time it should be created forthwith. Until that is done, until some place is actually provided which is better for the young people than these geriatric wards, this part of the Bill, however it looks on paper, will be a nullity in practice.

Clause 16 relates to chiropody services. Clause 17 is the first in the part of the Bill dealing with miscellaneous provisions. Clause 18, on which at least one great expert (and I think more than one) will be speaking, deals with research and development, which of course are quite indispensable. Clause 19 deals with the war disabled, about whom the noble Lord, Lord Harding of Petherton, will speak with major authority. Clauses 21, 22 and 23 deal with an institute of hearing research, with the education of deaf-blind children and with those suffering from autism and dyslexia.

There is something of an impression that this Bill deals only with those who are handicapped or, perhaps, totally inhibited in their movements. That, of course, is quite incorrect. This Bill sets out to deal with all the disabled as defined in Clause 24. I am bound to say, however, that to the layman—and nearly all of us are laymen—Clause 24 is pretty vague. I would defy the average parents, or indeed the average citizen, including myself, to know the meaning of Clause 24 or its significance. Surely here, if anywhere, when we are defining the disabled whom we are going to help under this Bill we, the public, should at least know what is intended and where our rights stand. I have given the Minister notice of a question or two here, and I should now like to press them on her.

First, am I right in thinking that the Bill does in fact cover the mentally handicapped in general? And how far, if at all, does it cover those who are mentally disturbed? I can easily think of other questions, but these are two to be going on with. If in fact 'the mentally handicapped, and some at least of the mentally disturbed, are to be included, as we very much hope will be the case, surely it is essential from the point of view of the general public, particularly those who are involved, to put it in plain words in the Bill. It is not enough that we should get a general impression of the meaning.

My Lords, I could mention a number of matters—possible new clauses—some of them discussed elsewhere, which will no doubt be the subject of Amendments at the Committee stage. I simply take one as an example—a clause covering the case of young people who suffer from grave defects of vision and possess only 5 or 10 per cent. of sight. No doubt there are a number of new clauses which noble Lords will have in mind; but with so much wisdom to follow, I must con-clude my remarks.

I have no fears at all that, in this House of all places, this Bill will receive a cordial reception. I am convinced, as are most of us—perhaps all of us—that when it passes to the Statute Book, as I have no doubt it will, we shall be inaugurating a new era in our attitude to the disabled, and, however far we look ahead, I think we cannot set a limit to the benefits accruing. But do not let us anticipate too soon. Do not let us assume that it is now all over bar the shouting, and that it does not matter very much what happens in our discussions here. There is hard work to be done in the House of Lords on this Bill, and there is close scrutiny to be given to it in the form in which it reaches us. All that will be welcomed. It will be fervently appreciated by the promoters and, most of all, by all the disabled themselves. For the first time under this Bill the disabled will begin to obtain an adequate say in their own destiny, and a chance fully to contribute to the life of the nation, as they desire and as they deserve. My Lords, I beg to move that this Bill be now read a second time.

Moved, That the Bill be now read 2^a, —(The Earl of Longford.)

3.36 p.m.

LORD SANDFORD

My Lords, I rise to support the Bill and to congratulate its sponsors in another place on securing as its sponsor in your Lordships' House the noble Earl, Lord Longford, who is as admirably suited to the role as he is respected and esteemed by us all. Indeed, I would say that there are few omens more favourable to the passage of the Bill than that it is being introduced by the noble Earl, and, moreover, is being launched by no fewer than four maiden speeches, to which we all look forward with great expectations. I hope that when the noble Baroness, Lady Serota, who is to follow me shortly, has spoken we shall know more than we do now about the real attitude of the Government to further legislative provision and to greater assistance, particularly greater financial assistance, to the disabled. I hope that she will have succeeded somewhat in closing the gap between what Her Majesty's Government say and what they do in this particular field.

One would have thought that if an Act of Parliament such as this was needed, it really was the duty of Her Majesty's Government to introduce it; but in fact they have left it to private Members. In the past year or so, Mr. Prior introduced in another place the Disabled Persons and Miscellaneous Provisions Bill, which was rejected. Mr. Gordon Campbell introduced a Disablement Commission Bill on March 28 last, and that, too, was rejected. This Bill—lucky third time! — has been sponsored in another place by Mr. Morris. It was welcomed whole-heartedly (to use the words of the Joint Under-Secretary of State for the Department of Health and Social Security) by Her Majesty's Government, but since then it has been pretty severely knocked about, and 13 of its 33 clauses have been clipped off altogether. It seems a shame to do anything to spoil the warm and cosy bipartisan glow which this Bill has already engendered, and I hope will continue to engender. But I believe that it will be in the interests of all the disabled if we can move fairly briskly from expressing our general desire to be helpful—the pious platitudes to which the noble Earl, Lord Longford, referred—and come to grips at once with just what is to be done, by whom, for whom, and how, and at what cost.

That brings me straight to my first point, which has already been touched upon by the noble Earl—the question of definition. This Bill began its life in another place without any direct reference or definition of what persons are included and what persons are not included in the term, "chronically sick and disabled". This is a grave and serious omission and, naturally enough, was widely commented upon and criticised in another place. By implication, it applies to persons with gross physical handicap of limbs, involving the use of invalid chairs. But are persons less handicapped, but handicapped in that kind of way, outside the scope of the Bill? By implication, the deaf, the dumb and the blind are within the scope of the Bill; but what degree of disability is needed for the Bill's provisisons to apply to them, and who carries out the assessment?

When the Bill was introduced in another place there was no reference, implicit or explicit, to mental disability of any kind. Since the Report stage there has been, and Clause 22 introduces into the Bill autism and Clause 23 dyslexia, both mental disabilities. Since the Report stage there has been introduced, at Clause 24, an acknowledgement of the need to have some further definition, but at the moment we are still being asked to legislate without any. I must ask either the noble Earl who has introduced the Bill here, or the noble Baroness, the Minister of State, or both of them, to say more about definition to-day, and in some way or other to give us a firmer and clearer framework of definition in which to work when we next tackle the Bill in Committee, when precision really will be needed.

The noble Earl, Lord Longford, spoke of the trend established by the Bill from permissive to mandatory provisions, and said that the Bill might be used as a stick to beat the laggard local authorities that are doing less than their duty towards the disabled. Well, there are various views about the virtues and the vices of imposing more and more mandatory legislation on local authorities, but I should have thought that there was an absolute unanimity of view that if there is to be mandatory legislation it must be clear and precise beyond peradventure; and in this Bill that means knowing from the start exactly who it is we are talking about and who it is we are legislating for.

Of course legislation on its own in any field is never enough, and I should have thought that, looking back over, say, fifty years in this field of the care and welfare of the disabled, one would find that some of the greatest benefits to the disabled began to flow not so much directly from the post-war legislation that founded the British National Health Service and the British Welfare State but from the Ministry of Health Circular No. 32 of 1951. That was the circular which gave comprehensive guidance to local authorities on the discharge of their duties to the disabled under the legislation to which I have just referred. There has been nothing like that circular since then, 19 years ago. I would suggest, and I would invite the noble Baroness, the Minister of State, to say whether she would also agree, that the moment for a second edition of that circular is now close at hand. It is needed for, I think, four reasons: first of all, and obviously, to get a wholehearted response from local authorities to the provisions of this Bill when it is enacted; and secondly, because of the very welcome developments in treatment, facilities, services, and provision for the disabled that have been made in the past 19 years, to say nothing of the effects of the legislation, albeit fragmentary legislation, that has been enacted over that period in one Bill or another and which all now, in my view, need to be expressed in a more consolidated form. But I suggest that another comprehensive circular by the Department to local authorities is needed chiefly for two further reasons.

The first of these is to take full advantage, on behalf of the disabled, of the many impending changes in the administration of the Health Services, in the structure of the local authority personal and social services, in the establishment of social work departments, and in the reorganisation of local government. I believe it would be good, and not before time, to see some greater sense of purpose and direction being given, in all this upheaval in the Health Service and the Welfare State, towards securing that these very necessary changes take place not just for their own sake but for the sake of some of the patients and the clients that are to be served. I should like to see the needs of the chronically sick and the disabled high on the list of priority for attention by the new area teams of social workers, by the proposed new Health Boards and by the new units of local government, when all these come into being. I believe that a brand new version of the 1951 circular on those lines, based upon the latest legislation and springing from this particular Bill, would be the best way, and a good way, of securing this aim.

But—and this brings me to the end of what I wanted to say—there is one further reason, and perhaps the main one, for desiring a new and authoritative statement of policy by Her Majesty's Government on behalf of the disabled: and here I refer to the development of county associations for the disabled. Disabled and chronically sick people are, in the nature of things, one of the groups in our society least able to help themselves, though probably of all citizens the most willing and the most desirous of helping themselves so far as they possibly can. This means that if our expressions of concern for their welfare are to bear fruit, all available suitable local resources must be tapped in their aid and used as efficiently and effectively as possible. This in my view involves the maximising of voluntary effort on their behalf—voluntary effort of every kind, in every local community. The right structure for promoting this development is the local voluntary county association, or county borough association, for the disabled.

I, for one, warmly welcome the increasing tempo with which the Central Council for the Disabled and its associates (both in the disablement field and in other fields) are tackling the development of local associations dedicated to the care and the welfare of the disabled. If my suggestion of a fresh and comprehensive circular from the Government following the enactment of this Bill, and based upon it, gains acceptance, I hope that it will commend warmly to local authorities the practice of giving grants as generously as possible to county associations for the disabled, so that they may extend and develop their work where they already exist and be brought to birth where they do not. Such action, I believe, is the best action Her Majesty's Government can take, both to give practical effect to this Bill and, what is really more important, to provide able-bodied citizens with practical ways and means of helping some of their disabled fellow citizens; of helping them to do what they all want to do, namely, to live as normally as they possibly can and make their own best contribution to the common weal.

3.49 p.m.

LORD AMULREE

My Lords, I want to thank the noble Earl, Lord Longford, for the way in which he introduced this Bill to your Lordships. There is really not a great deal more to be said on the points of general principle of the Bill, and I do not propose to follow him in any general discussion of its terms or what lies behind it. But I should like to support the noble Earl in the first criticism that he made of the Bill, which is that it makes permissive the work of local authorities. It does not make it mandatory for them to ensure that they know what is going on. I always feel that, if you are going to have permissive legislation on this kind of matter, it gives a very good escape clause for a local authority which does not want to do a great deal and only wants to do enough to keep within the eyes of the law.

Secondly, I should like to suggest— it does not come in the Bill, but I am sure the noble Baroness will agree that this is right—that there should be the fullest dissemination of information from the central department of what are the gadgets, devices, new forms of chair, ball-bearing armrests and so on, which are good for the disabled in all sorts of ways. This information should be made easily available both to the consultants who see these people in hospital and to the general practitioners who have to advise them.

There are only three further points that I should like to mention. First, there is the question of the chiropody service which is referred to in Clause 16. There are a certain number of disabled persons who find it difficult to visit a chiropodist, so that the chiropodist should visit them. I think that is at present done by local authorities who have chiropody teams, but I should like to make sure that there is no difficulty about chiropody being conveyed to disabled persons in their homes.

This also applies to physiotherapy. There, again, we are in a difficult position, because it is obviously far more economic, not only from a money point of view, but also from the point of view of the time of the physiotherapist—and there are not a great many of them in the country—that people should visit them rather than that the physiotherapists should have to travel out to the country. For a long time now, I have been associated with a body called the London Area Mobile Physiotherapy Service, which does a lot of work visiting in their own homes people who, for some reason or another, are not able to visit the department. In the years 1949 to 1951 there was a successful scheme under which this work was paid for by the North-East Metropolitan Regional Hospital Board. But in 1951, for some reason, the scheme was stopped by the Ministry of Health. One would like to see that sort of scheme brought back again, because quite a number of patients who come under the care of the mobile physiotherapy service are youngish people; that is, people under the age of 65. It is possible, from time to time, for patients of the Regional Board to be treated, but that is done in special circumstances and I think the cost has to be met out of a special fund.

The same point applies to persons who come under the care of the local authority. But here again there has been a certain amount of difficulty because the local authority is not supposed to treat, only to care. One wonders whether the line is not sometimes drawn a trifle too rigidly between those two quite inseparable needs of that type of person. One would like to see some encouragement given whereby patients who come under the local authority are able to obtain physiotherapy if it is required.

I should now like to refer to Clauses 14 and 15, which deal with the separation of younger people from the old chronic sick. I was pleased to see that in 1968 the Ministry of Health issued a circular to Regional Hospital Boards, management committees and boards of governors wherein they emphasised the necessity of not admitting young people into geriatric wards—and by "geriatric wards" I do not mean wards where sick people go in for acute treatment, but wards containing long-stay patients for whom there is no recovery and who may be there for a very long time. I was pleased to see that at that time the Minister indicated that Regional Boards and boards of governors should make separate provision for these people.

I quite agree that that provision is extremely difficult to make. The number of young chronic sick in the country is about 4,000, so it is going to be very difficult indeed to nurse them in separate units, as it were, which will be near enough to their homes for their friends and families to visit them. But would it not be possible to arrange this in a different way? If you have hospitals, no matter what kind, big or little, one or two beds should be kept for these people when their treatment has finished, or something should be built in the grounds or curtilage of the hospital, so that the people can be taken care of in small departments or hostels. I agree that it might not be economic from a staffing point of view, but we have to get round that problem in some way, because, after all, these places are for the benefit of the patients and not primarily for the benefit of the staff.

There is another method of doing this —because a large number of these chronically sick young people are suffering from nervous, neurological, diseases and have probably been under the care of a neurologist in hospital. It seems quite possible that neurological departments should be extended to include hostel accommodation where reasonable care can be given and these people can be treated under the care of the neurologist to whom they went in the first place. The only time I saw that occur was when I visited the Star and Garter Home at Richmond, where there is one ward full of multiple sclerosis patients. But of course they are in a slightly different category, because the people in the Star and Garter Home are all ex-Service men and they come under rather different conditions from those of the normal type of patient.

As regards the person who should take care of these young chronic sick patients, one of the best people to do that is the physician in charge of the geriatric department, because he knows something about the care of long-stay patients. But he should not have these young people nursed in his own department: they should be put into separate wards, so that they are not mixed up with the elderly, the mentally confused and the incontinent. During the time that I was involved with a geriatric department, I firmly refused to admit young people. I admit that that made me somewhat unpopular with some of my colleagues, but I am sure that it was the right tiling to do. One finds a certain number of people in their fifties who suffer from a degenerative disease such as a stroke, and they probably get better treatment if they come in for treatment to the geriatric department, which is more expert at treating that kind of case than a general ward dealing with younger people. But for the really young it is a very wrong principle, and I am pleased to see that the Government, in the circular to which I have referred, accepted that.

It is very difficult to find places for young people. I have experience of the Royal Hospital and Home for Incurables at Putney. There we do not take old people; we take youngish people. But even there the average age of admission is about 55. The other difficulty there, of course, is that, although we have 250 beds, when people come in they remain until they die; so the rate of admission is extremely small. We admit about 10, or at the maximum 12, patients a year. So the Home does not make a very big impact on the problem of the young chronic sick. There is a similar hospital at Streatham; and there is the Jewish one; and I think there is another up in the North of England. But, as I say, they do not make much impact on the problem. For this reason I am very pleased to see that this Bill makes provision for this treatment, and I am sure the Government will support it.

Finally, my Lords, I should like to mention one aspect which I think is extremely important in the care of the young chronically sick and disabled, particularly those who live at home; that is, the work of the voluntary services. We simply could not get on without them, and they are to be encouraged. A voluntary worker can do things which a paid worker cannot do; and I very much hope that when this Bill gets on the Statute Book every provision will be made to enable voluntary workers to do the best they can for the nation.

4.2 p.m.

THE MINISTER OF STATE, DEPARTMENT OF HEALTH AND SOCIAL SECURITY (BARONESS SEROTA)

My Lords, the measure which my noble friend Lord Longford has introduced into this House to-day, with the humanity and compassion which has characterised a lifetime of service to the cause of the handicapped and the disabled, has indeed many remarkable features. Not least among them is the warm and general welcome which the Bill has received both in Parliament and in the country generally; and Members of another place, both as Ministers and as individuals, have given every possible assistance to its passage—assistance which I am sure we all agree will continue as it progresses through it various stages in this House.

The enthusiasm which the Bill has engendered has, I think, quite rightly been reflected on my honourable friend who conceived it and upon honourable Members of all Parties who supported him, and in many cases gave him great help. I understand, too, that he had powerful help from the Central Council for the Disabled, acting as the focus of a number of voluntary bodies working for groups of disabled people throughout the country; and I also see this as encouraging evidence of the continued vitality of the voluntary movement, including, I am glad to say, groups representing the handicapped themselves. They have continued the work that they pioneered over the years, and they continue to contribute in terms of identifying need, in mobilising resources to meet gaps in the statutory services, in fostering co-operation between the different professional groups involved and, perhaps most important of all, in educating the public.

Another remarkable feature of the Bill which has been touched on by the three noble Lords who have already spoken is its scope. The noble Earl pointed out that it affects no fewer than ten Departments if one includes the special interests of the Scottish Home and Health Department, the Welsh Office and the Treasury; and it has opened up such a wide range of possible topics going well beyond the actual clauses themselves that I am sure the House will not wish me to attempt to cover them all at this stage of the debate, especially when we have such a long and distinguished list of speakers to come and when we are all looking forward particularly to hearing for the first time from four Members of your Lordships' House so singularly well qualified to contribute to this debate. Indeed, the scope even within the Department of Health and Social Security goes well beyond my own health and welfare responsibilities; and there will be other opportunities, in Committee and in the later stages, when noble Lords who speak for other Departments will, I hope, be dealing far more competently than I can with matters which are pertinent to their own responsibilities. I would only add at this stage that, since the interests of the chronic sick and the disabled are indeed as wide as life itself, their interests must and do impinge on the work of every Government Department. Neither I nor other Ministers should be content, I think, to be relieved of responsibility in favour of a Ministry for the Disabled.

Those of us who have been following the Bill closely in another place will have seen how skilfully, conscientiously and thoroughly it has been worked upon and revised. Here, I would not agree with the noble Lord, Lord Sandford, when he said that it had been " knocked about"; nor, I think, would the sponsors take that view. As the noble Earl has said, I believe that we in this House will look at it critically, as we should; and in commending it to your Lordships I am confident that we shall do so in our usual constructive way, and will aim to consolidate and to strengthen the progress already made with this important measure. Those of us who are closely connected with the services for the chronically sick and disabled and are aware of the defects in these services which are not already tackled by this Bill may well be tempted, of course, to devise new and specific solutions for inclusion in the Bill.

There are, however, three points which I suggest we should bear in mind which might help us as the Bill proceeds through the House. First, the right solution to a particular problem may be to improve certain general services provided for those who are and for those who are not chronically sick or disabled, and not necessarily to legislate for particular groups. Secondly, our resources, both human and material, are not unlimited, and we cannot do everything at once; there have to be priorities. Finally, the Bill before us I think contains a considered view of priorities and results, as I said a moment ago, from the very careful and indeed considerable work which has been performed on it in another place.

I have chosen to speak at this stage of the debate in order to make clear to the House the Government's general attitude to this Private Member's Bill, and I have no doubt that the debate in which so many expert and distinguished speakers will participate will range fairly widely. There will be many points, both of principle and of detail, which noble Lords will wish to address to the promoter of this Bill. There may well be general issues on which it will be thought right that the Government should express their views. I shall not attempt at this stage to anticipate them all, but will, with the leave of the House, try to reply generally to them towards the end of the debate. The examination of the Bill in its succeeding stages will enable us to look at them all and to deal with the matters of detail which may be raised. But I must take this opportunity to repeat that what has struck me most forcibly is the reception that the Bill has received. It contains, I think, a very clear message to central Government Departments, to hospital authorities and to local authorities, that wherever their functions impinge on the interests of the sick and the disabled, they need to take special care. That is the general theme, addressed at all levels and to all parties; and I believe that we shall all do well to have the implied criticism in mind.

I feel the more able to welcome this Bill because it coincides so clearly with the Government's intentions over the broad range of the services concerned. In spite of the strictures of the noble Lord, Lord Sandford, I think I can justifiably claim that my Department have not been unmindful of these special needs and that the Bill lends further emphasis to policy already in process of development. And here I am grateful to the noble Lord, Lord Amulree, for the remarks he has just made about the general trends in health and welfare policy in this field. As he reminded us, my right honourable friend the last Minister of Health called on the Hospital Service to give a due and early share of resources to geriatric and psychiatric patients; and he also referred in some detail to guidance given then to hospital committees about the needs of the younger chronic sick, about whom anxiety has been so much expressed in the debates on this Bill.

I know that noble Lords will be glad to hear that we intend this summer to follow up the progress that has been made since my right honourable friend issued his circular. My right honourable friend the Secretary of State for Social Services has in these last months, I think all will agree, concentrated public attention on the needs of the handicapped and has given priority in his thinking to the needs of the mentally handicapped. As I told the House when we had a debate on this subject not long ago, we are now working intensively on a State-ment which I hope will be published this summer setting out proposals, both short-term and long-term, for much-needed improvement in these services.

My Lords, since 1964, I understand, some 15 homes for the younger physically handicapped have been built in England, and five more are in the pipeline—I am speaking of local authority provision. In the three-year local authority building programmes which we have recently approved we have included some 19 more homes. I should like to tell the House that as a deliberate act of policy we have included in that programme every such home put forward by a local authority, as well as a number of special centres. A further advance, this time of a preventive character, will be the activation of Section 45 of the Health Services and Public Health Act 1968, which gives local authorities a general power to promote the welfare of the elderly. We have not forgotten the financial side, as the provision in the National Superannuation Bill for an attendance allowance— which has been welcomed on all sides— for the severely handicapped illustrates. These are but a few of the measures which the Government have taken in this field. Other Ministers, I know, can give as good an account in the fields of housing, planning, employment and education.

The Bill offers us all valuable pointers to forms of action that ought to be pursued in the future. When we and the hospital services, and the local authorities, come to implement it, we shall have to look at its provisions in the wider framework within which its provisions have to fit. There will be questions of priority to settle, and a great many details to work out. The most precious and, I think, the scarcest resource in this field is the availability of skilled manpower. In my view, the quality of the services that we provide for the sick and the handicapped will always ultimately depend on the people who provide them. We shall also, as the noble Lord, Lord Sandford, has reminded us, need to take account of other changes which will affect these services, and the Local Authority Social Services Bill will provide for the unified administration of comprehensive personal social service responsibilities of local authorities for other groups.

I hope that the noble Earl, Lord Longford (I always think of him as the father of this new service, if he will forgive me for referring to him in this way), will believe that this new Bill will give a fresh emphasis to the need to help the handicapped individual in the context of his family and the community. This is surely the direction in which we all want to move. Our proposals in the second Green Paper for the future reorganisation of the National Health Service will also, we believe, facilitate working arrangements between the personal health and social services in this particular area of concern.

The noble Lords, Lord Sandford and Lord Amulree, and the sponsor of the Bill drew our attention to what I consider the most crucial overall issue, a question which has exercised so many minds; namely, who are the chronic sick and the handicapped with whom this Bill deals? How are they defined? Chronic sickness and disability are a continuum, ranging from trivial handicap to completely helplessness. Sooner or later, all of us who live on into old age suffer from some degree of physical or mental impairment. There is really no sensible point at which one can segregate a group. What makes definition even more difficult is that the effect produced is not necessarily related to severity. To many, arthritic fingers are little more than a nuisance and a trouble but clearly would be a disaster to the life and career of, for instance, a professional pianist. Such a disaster would fall immediately upon his employment prospects, and superficially there would be no obvious indication for welfare or education services to come in to assist. One must therefore surely try to concentrate on the effect of the sickness and disability, the handicap that results, and on the whole situation in which the individual finds himself. Definitions therefore go with, and vary with, services rather than with people.

One must also accept in the cause of humanity that sharp dividing lines should be avoided except where precise rights and obligations are prescribed. For-tunately—and I hope that noble Lords will agree—the Bill as drafted avoids some of these pitfalls. A number of clauses refer back to principal legislation, on employment and welfare, for example, for the disabled or, in Clauses 1 and 2, the welfare of the handicapped where working definitions already exist. In many other clauses either a definition is, in effect, provided for the clause or it is self-evident. Nevertheless (and here I understand that the noble Earl was concerned), experience may throw up a later need, and Clause 24 empowers the Secretary of State, as a longstop measure, if I may use that term, to make regulations defining expressions used in the Bill, in any clause of the Bill.

The noble Earl asked me for a clarification of the position under the Bill of people suffering from mental illness or handicap. I can certainly assure him that they are covered by every clause where a problem involving mental handicap could arise. For example, Clauses 1 and 2 refer back to the National Assistance Act, which covers both the mentally and the physically handicapped people. Should this ever be question, there is provision for it to be resolved by the Secretary of State, who can, under Clause 24, define these expressions as widely as he and Parliament think are appropriate. Therefore we are not, I suggest, under the necessity now—although we can do so in Committee—of considering precisely the effect on different groups of different clauses.

The second general point that I should like to touch on before concluding is the role of the voluntary services in relation to the needs of the chronic sick and disabled. I believe that this will be one of the themes of the debate. I see these services to-day not as part of the outdated concept of charity to the deserving but as services providing sheer, devoted, practical hard work, without reward, for one's fellow human beings. There was certainly a time, not so long ago, when one could truthfully say that national and voluntary organisations, by fulfilling their traditional role of pioneering new developments, contributed more to the welfare of the handicapped at home than did the statutory bodies. That time in passing, but it is still true that in some parts of the country what is called a statutory service is given by voluntary bodies as agents of the local authorities.

It is salutary at this moment, perhaps, to remind ourselves that it is only some ten years since all authorities had imposed on them the duty to provide a welfare service. Now the social services will became increasingly staffed by professionals as the number of trained workers grows. These changes, in my view—I have said this before in this House and I am not ashamed of saying it again—will mean more, rather than fewer, opportunities for voluntary service if we are to have what I believe the social services must have—that is, maximum participation of individuals and groups—and if we are to develop community-based social services on the lines recommended by the Seebohm Committee. I myself, within the Department and in the light of this Bill and other Reports, am at present considering what new form of partnership can be developed between the Health Service and the voluntary services. I know that the whole question of partnership between voluntary and statutory bodies, and close co-operation between them, is one of the essential areas which we need to consider and develop, especially in relation to this Bill.

As I said a few moments ago, I shall try to deal with other points raised on particular issues in the Bill and particular clauses when I come to speak, with the leave of the House, at the end of your debate; but, my Lords, I hope that the general observations which I have just made will help the House in its consideration of the Bill. Once again, I commend it to your Lordships. With all other Members of the House I shall listen with the closest interest to the views expressed. I shall, as will all your Lord-ships, listen with very special care to those who this afternoon will be addressing the House for the first time; and I shall do so—perhaps this may reassure them a little at this moment—in the knowledge that they will undoubtedly be received with the traditional warmth and generosity that this House always extends to its new Members on such an occasion.

4.21 p.m.

THE LORD BISHOP OF BATH AND WELLS

My Lords, it is a real honour to be allowed to speak, and to make one's maiden speech, in support of this forward-looking, forward-thinking humanitarian Bill. I can assure your Lordships that my maiden speech will be suitably short. I believe that the sponsors of this Bill once called it, "a collective essay in helping the disabled ". Many Members, organisations, individuals and chief welfare officers and their associates have had a hand in formulating it, and it is a welcome supplement to the Governmental legislation affecting the chronically sick and disabled which is either under consideration or anticipated. I hope that when its provisions are implemented, the Bill will provide guidelines for service in an area where there is plenty of scope for young people to show imagination, idealism and action. This applies to the voluntary workers— a point which has been made already by noble Lords and by the noble Baroness— as well as the statutory workers, I hope that it will open up a whole new field of service, especially for young people.

The Bill covers much ground, but there is the omission of definition which has already been noted, and one is grateful for the promise of a statement from the noble Baroness. But one cannot help being anxious about what is, perhaps, the most vulnerable of the permanently disabled who are, of course, those who are seriously mentally subnormal. As I come from a part of the world where people have been rather involved in these matters recently, I hope that I may be allowed to say a word on the subject. It was not difficult to see why an Amendment to the Parliamentary Commissioner Act 1967, moved during the Report stage in another place, to provide one such officer to deal specifically with complaints affecting the chronically sick and disabled was not accepted. The physically disabled should have no more difficulty in getting their complaints heard than do other groups, and it is certainly undesirable to single them out as a group. But for the thousands of mentally disabled in the hospitals for the subnormal there is at present, apparently, no channel of communication through which the wrongs of individuals can be exposed and dealt with. This is not only a deplorable situation for the small minority of individuals who suffer from wrong handling, but also a great disadvantage to all the staffs, the majority of whom are doing a most wonderful job in very difficult conditions indeed.

We cannot rapidly provide all the new buildings and staff needed to right the situation, but we could let light in on it, and so help the staff and the hospital management authorities. Should not priority be given to providing a Com-missioner, or a Governmental inspectorate, independent of the hospital management authorities, to whom representations could be made, either by those patients capable of making them or by the staff on behalf of the patients, which the staff would be very ready to do? This, it seems to me, would expose the difficulties of the staff and would awaken the public conscience to the need for emergency action in support of the staff. Once the staff were off the defensive, the worry about ill-treatment by the exceptional individuals would, I believe, be very largely resolved.

My Lords, my second point, regarding the great anxiety about the separation of the younger from the older hospital patients has been covered. I would only add this, if 1 may. To my mind there seems a real danger in requiring hospital boards to make returns to the Secretary of State about the number of persons under a certain age who are inappropriately accommodated in geriatric wards, because it could result in making it even more difficult to get non-senile patients into hospitals. If, on the other hand, it resulted in more facilities for younger or rather less senile patients, that would be a great advantage. One way the community could help to achieve this would be by showing support and understanding of the problems confronting hospitals which have inadequate buildings and insufficient staff.

May I make one rather small point though it may seem important to the disabled? The Bill requires the provision of sanitary conveniences for disabled people when they are away from home, and this provides an opportunity for the community to exhibit common courtesy and humanity. Where a local authority find that it is not practicable or reasonable to provide for the disabled in this way, I suggest that it would be a very " good neighbour " service (though lacking entirely in public glory) to furnish a list of lavatories at street level, in houses, shops and other buildings, which disabled people could use.

The listing in Clause 2 of the specific provisions for persons concerned who cannot afford them is a tremendous advance. This gives a lead in the setting of standards which recognise the right of everyone to something more than the basic needs necessary to keep body and soul together. At the same time, I think that it will undoubtedly arouse again the continuing public anxiety about whether welfare is reaching those who most need it. The addition of television, made in the Report stage debate, is going to be a tremendous boon. I hope that when the provisions come to be implemented, it will be possible to provide colour television for those with failing eyesight and those who really need it. Television will be a blessing to many lonely people and a compensation for the deaf. For the housebound and the lonely it can bring in the outside world, the joys as well as the difficulties of others, and do something to counteract the morbid introspection.

My final point, my Lords, concerns the provision in Clause 1(2) requiring information to be published about the welfare services and for individuals receiving one service to be told about the others. To my mind, that is of more than purely practical value. It can hardly be stressed too often, and in as many ways as possible, that is is absolutely right and proper for every citizen to make the fullest possible use of the statutory welfare services provided by the community for him. It is quite understandable why some, especially among the elderly, try to maintain a dignified independence, at whatever cost; but there is a right and proper "take-up "of welfare and of supplementary benefits. On behalf of all Christian opinion, I wish this Bill well. I think that its success, in part at least, will depend on how well we can sell it and its benefits to those who really need them.

4.32 p.m.

LORD FRASER OF LONSDALE

My Lords, the House will wish me to express our warm thanks to the right reverend Prelate the Lord Bishop of Bath and Wells for his maiden speech to us to-day. I am told that he is a fisherman. That commends him to me. I am sure that if in future debates in our Chamber he follows his practice to-day, he will throw a straight line, and I hope that many of his flies will be taken. I was interested in his sympathy especially for those who may be cut off in establishments for the care of those who are mentally disabled. I think that he has put his finger on a very interesting human point.

The country, certainly the two Houses of Parliament, are grateful and have shown themselves to be grateful to Mr. Alfred Morris, and we in this House to the noble Earl, Lord Longford, for introducing this Bill. I am sure that we in this House are glad that the other place has passed it through all its stages and sent it up to us. The noble Earl said that in this Bill we had gone a long way towards creating in this matter a mandatory aspect rather than a permissive one. I should like to ask him, when he is considering his action in Committee stage, to consider whether that is wholly so. We are compelling the creation of a register of all the disabled. That will have to be done. We are giving the Secretary of State the power to compel local authorities to tell him what they are doing. By implication, therefore, it might be assumed that they are doing some-thing. But I did not myself see any power compelling anything to be done in many fields, and I would ask the noble Earl to have a look to see whether this Bill is as mandatory as many of us could have wished to see it and as, indeed, the original Bill was when it came to another place.

One word only on definitions. There is a state of mind, a state of mental health and vigour and vitality, which governs the actions of men, and it is not wise to tell too many people that they are disabled, if you are not compelled to do so. It follows, then, that definitions should be strict and tight, so that they do not encourage people with minor disabilities which, with courage and stead-fastness and help from others they come across in their daily lives or in their employments, they may overcome, lest you let them feel that they must rely upon the Government or the local authority or somebody else to help them out of their troubles. On the other hand, there are some clearly defined cases and categories of persons who must need help and who, if they are given help, can do very well in this world. Therefore, I suggest, for many reasons, that if there are to be definitions they should be closely and tightly scrutinised and should not be too widespread. However good-hearted the Government, or any Government, are, and however good-hearted the nation is, there is a limit to the resources, human and financial, that can be made available. To put it vulgarly, to spread the butter over too wide a piece of bread means that we shall spread it too thinly to be of value to anybody.

This is a Second Reading debate and therefore I am not going to touch in any way on the provisions of the Bill, which can come up for scrutiny in Committee. I would only make one or two very wide observations. I do not see any provision in the Bill which encourages or which almost makes it mandatory for the local authorities and others—the hospital services and all concerned—to make use of the voluntary agencies wherever they can. I will give just one example in the blind world which I know so well. Forty years ago—I think only old doctors will know this, and I do not suppose there are any in this House—there were 30,000 or 35,000 blind children under the age of 7 or 8 years, certainly under the age of 10. Now there are not more than can be counted on the hands, because of an extremely simple treatment given at the time of birth. Your Lordships may know that practically nobody is born blind but these children become blind at the moment of birth through ophthalmia neonotorium, which hardly exists now, and there is only a handful of blind and of blind and deaf children in the country. Let us thank God for that!

But what can a local authority do for one blind child or for one blind and deaf child? They cannot do anything directly. They must go to the Royal National Institute for the Blind, which has done extraordinarily well for the nation in providing a national home where the ten, twenty or thirty children —and these are all there are—can be properly dealt With. Therefore the Bill should not merely encourage but, I think, should compel local authorities to co-operate with each other and with the voluntary societies in order to make use of some of these services for individuals, which they could not possibly do in their own territory and could not be expected to do.

I have only one other thing to say. It is my observation of life that persons in high places, and persons whom you meet in the street and in your daily life, are extraordinarily kind, and that they wish to do their best to help any disabled person they come across. But they are very shy about it. This applies, if I may be forgiven for saying so, more particularly to the English: the Celts are far more forthcoming and far more extrovert. The English are retiring and reticent, and sometimes they do not come forward to help disabled people as eagerly or as swiftly, although it is in their minds to do so. The reason for this is a good one and not a bad one, so I do not make any criticism of the people in England. As I say, they are retiring, quiet, kindly people, who do not like to embarrass the person to whom they want to offer help. Let them forget about the embarrassment and give the help.

3.41 p.m.

BARONESS DARCY (DE KNAYTH)

My Lords, I should like to ask the indulgence of the House for my maiden speech and say what an honour it is for me to speak on this particular subject. I wish to give my fullest support to this humane and extensive Bill, which aims to do much to improve the care of the chronically sick and disabled and to broaden the scope of their lives. It plans to sweep away many of the obstacles to mobility. Apart from Clause 17, however, which deals with the use of invalid carriages on pavements, there are no definite or immediate provisions to increase mobility from the transport aspect. While I welcome Clause 18 as a long-term effort to assist mobility, I would point out that there are three classes of disabled person for whom the invalid tricycle is no solution and who would benefit enormously from the provision of a four-wheeled vehicle.

First, there are the haemophiliacs. I believe that the new invalid tricycle, the P5, will be less likely to cause bruises resulting in internal bleeding. It will not, however, enable the haemophiliac to have a companion at hand who can if necessary go in search of help, and perhaps even save his life in the case of a severe haemorrhage. The number of haemophiliacs in this country is small—in the region of 100 people—and the difference in cost between a four-wheeled and a three-wheeled vehicle is £28 10s. 0d. a year. I feel that this outlay would compare favourably with the cost of keeping and treating a haemophiliac in hospital, quite apart from the humane consideration of sparing him further injury.

Secondly, there is the disabled wife with children below school-leaving age. I myself am a widow with three young children, and because I am disabled and in sole care of them I am entitled either to a small car or to a considerable grant towards the upkeep of my own car. This is in addition to the conversion grant and the other concessions allowed to most disabled drivers. The disabled wife is in virtually the same position as the widow, the divorced or the separated woman. Life for the disabled is expensive, and the disabled wife receives no disability pension, although if she is sufficiently disabled she will now qualify for an attendance allowance through her husband's contributions. The couple are therefore unlikely to be able to afford a car; and even if they can, the husband probably needs it to get to work.

The disabled wife cannot accompany her children to school, and she has to leave young children at home if she goes shopping in her invalid tricycle, because passengers are forbidden. If they cannot afford a car the family can never go out together, and this places a strain on the marriage. I know of one disabled wife with an eleven-year-old son who is mentally handicapped. He cannot read or write or understand the value of money. She cannot leave him alone in the house while she goes shopping; but, on the other hand, she cannot arrange with him to meet her anywhere. The family doctor feels that it is important for her son to be taken out and that it would aid his development; but without a car, which they cannot afford, this is impossible. This may be an extreme case where a second member of a family is being deprived of his right to develop himself to his full potential, but it is certainly not an isolated one.

Thirdly, there is the disabled passenger: the man who is sufficiently disabled to qualify for an invalid tricycle but too disabled to drive himself, and who has to be driven by an attendant. Many of these people work, and a vehicle is essential to take them to work and, of course, to interviews for possible jobs. An ordinary car which the disabled passenger could enter by means of a hoist, or a van converted to carry him still sitting in his wheelchair, would enable him to go out and earn his living and to join in the life of the community. Since the persons in this category are so disabled that they depend on others to help them in all the mundane operations, such as washing and dressing, I feel that it is especially important that they obtain this measure of independence. They already have to spend more on expensive aids than do the less severely disabled; and, furthermore, because they are not technically " disabled drivers ", they do not even qualify for a conversion grant for their own car, exemption from road tax or yellow badges with parking concessions.

Their plight is well illustrated by the cases of those with multiple sclerosis or other progressive diseases. When these people are sufficiently disabled they qualify for an invalid tricycle, with tax exemption, parking concessions, free maintenance and petrol allowance. But as soon as they become too disabled to drive it the invalid tricycle is removed, and with it all other concessions to aid mobility. These disabled passengers are the only remaining group of persons sufficiently handicapped to qualify for an invalid tricycle who receive no Government assistance towards outdoor mobility. They are in fact being treated in every respect as able-bodied private motorists. Taxes on private motoring are increased on the ground that it is a luxury, which for the disabled passenger it plainly is not. Unless some assistance is given very soon to this group, those who have managed to mobilise themselves may well be taxed off the road.

The disabled passenger cannot be a useful member of society until he can go out and earn his living; the disabled mother cannot pull her weight until she can properly look after her family. Both these classes already fare less well than most other groups of disabled persons: the disabled wife and mother because she has no disability pension; the disabled passenger because he is so severely handicapped that he has to buy expensive aids, and is also subject to the same motoring taxes as the able-bodied driver of a private car. The haemophiliac is exposed to unnecessary risk because he cannot carry a passenger who. if the need arose, could perhaps save him from severe injury, or even death.

My Lords, this country, I believe, does more than any other towards caring for and rehabilitating its disabled. It is surely illogical to spend time, skill and money in equipping them to re-enter the community and then ultimately to deny them the means of rejoining and contributing to that community. I feel that some provision should be made for these groups, and that it should be made in the present Bill, which I support with all my heart.

4.49 p.m.

LORD PLATT

My Lords, I have been asked to speak at this stage in the absence of the noble Baroness, Lady Plummer. This puts me in a certain amount of difficulty, not least because I am in the habit of preparing my speeches about one speech before the time at which I am to speak, and this leaves me a little unready. Secondly, it puts me in the difficulty of adequately thanking the noble Baroness, Lady Darcy de Knayth, on her most excellent and, if I may say so, practical maiden speech. It is unusual in this House to have two maiden speeches one following the other, which my intervention obviates, and so your Lordships will have to put up with me for a few minutes.

Another of my difficulties is to decide on this extremely important and interesting subject how much should be done by voluntary aid, by expression of opinion and so on, and how much can be achieved by an Act of Parliament. This, fortunately, is a Second Reading, in which we may discuss principles and ideals without any immediate consideration of what amendments may be appropriate to the Bill at a later stage. One can cover general and fairly wide discussion on the principles of the Bill and, if your Lord-ships will excuse the pun, I hope I shall avoid what the noble Earl who opened the debate referred to as "pious platitudes ".

Many noble Lords have already drawn attention in various ways to the needs of the disabled, many of which would appear to be looked after, as well as they can be, in the Bill in its present form. I know that my noble friend Lord Stamp, in his speech later on in the debate, will be calling attention particularly to research and development in the field of aids of various kinds for people with various disabilities. I shall therefore avoid that subject. I shall confine myself, briefly, to perhaps four matters, the first of which is information. This is referred to in Clause 1(2) of the Bill. This is regarding information as to the number of disabled people in any area who need to be cared for, and information to those people of the services available to them. But more surprising, as the noble Earl pointed out, is the comparative lack of information in many cases to those very people who ought to be at the service of the disabled. A great deal needs to be done to improve this situation.

Secondly, I should like to call attention to the comparative inefficiency of the service in many ways. This is from information that I have derived largely from people who themselves are disabled. The service has the best of intentions, but it does not always work out as it should. If I dare to mention the subject, a great many noble Lords in this House are disabled in one way or another. Possibly a good many of us have dentures—certainly most of us have spectacles. If there was, for instance, a delay of three months in the supply of a new denture or spectacles, we should have cause for complaint. Yet I understand that delays in the repair of apparatus, splints and artificial limbs are by no means unusual. There seems to be another delay in up-to-date information (information again!) on the latest devices which can help specific people. The pamphlets which are issued from time to time from the Department are, according to my information, very often quite out-of-date. Grim, old-fashioned irons of various kinds tend to be supplied where much more elegant devices could have been used.

Thirdly, I think there is a need to encourage—and exactly how this can be done I am not sure—people of high quality, people of original mind, inven-tors, research workers, bio-engineers, and so on, and also people with the technical expertise to carry out these ideas to enter this field where there seems to be no very clear career structure, and where possibly the conditions of pay are inadequate. It seems that this is an area which could be looked at with great advantage.

Finally, I speak as a member of the music panel of the Disabled Living Foundation in saying that a good deal more might be done in the way of encouraging particularly music, because that is my interest, and also other social activities. There are perhaps many people (although not enough) willing to look after the physical troubles of the disabled, but there are not enough to look after the social needs. Particularly is this noticeable at the leaving school period. At school they may have been well provided for, in one way and another, but it is in that interim period where they are trying to enter an adult life that the shortage occurs. Those were the four points that I wanted to make. I am afraid that I have made them inadequately by speaking eighth instead of fourteenth. May I again congratulate the noble Baroness on her maiden speech.

4.57 p.m.

BARONESS MASHAM OF ILTON

My Lords, I also should like to congratulate my noble friend Lady Darcy de Knayth. I was in hospital when she was brought in after having lost her husband, and I should just like to say that she is a very gallant Member of this House.

May I ask for your Lordships' indulgence as I try to put some of the problems of the chronically sick and disabled before you. This seems to be an appropriate Bill on which to make my maiden speech, as I myself am a disabled person. It is a great honour for me to be here in this most historic and respected House, and I feel that this honour is shared by all those people who have to spend their lives in wheelchairs. I hope that if and when they encounter difficulty over obtaining positions in life, they will remember this day and take heart. Being the youngest and the most junior Life Peer, I feel very humble speaking to-day to your Lordships, who are so much more experienced than I am.

The attitudes of people towards the disabled never fail to amaze me. Last week, when travelling by train from Leeds to London on a very cold day, I would have welcomed a cup of coffee. As the attendant serving coffee had passed by the carriage in which I was a passenger, he was told by a passer-by that I should like some coffee. I was told that the attendant would be along in a moment. He never came. On arrival in London I took a taxi to my destination, and when I asked the driver, who had been most helpful, what the fare was, he said: " Have this one on me ", and he would accept no payment. In local government one comes across these conflicting attitudes. In one area there will be a "couldn't-care-less " attitude towards the disabled, while in another area one finds consideration and helpful attention. It is because of this that the Bill is necessary.

Many of your Lordships will have had experience over the years of the many problems of disabled people. I should like to stress how very much more expensive life is for the severely disabled. I myself, as a paraplegic, feel the cold; healing is an expensive item. A person wearing callipers will wear out several pairs of trousers in a year. Nearly every time I get in or out of a taxi I ladder a pair of stockings. Very often dressing is difficult, and clothes receive a great deal of wear and tear. When travelling more help is needed, and there is there-fore extra tipping to be done. Chronically sick people may need special diets, resulting in extra cost. Shopping can be difficult, as some supermarkets do not allow wheelchairs; the disabled housewife will therefore have to take what she can get.

During the twelve years in which I have had to use a wheelchair I have seen great progress in the interest shown to the disabled by some local councils and voluntary organisations. Voluntary work in this field is economically good for the country and should be encouraged. As there are over 200 such organisations I feel that it is necessary to have a focal point, so that valuable information can be shared and not wasted and so that the complaints of the disabled are centralised. I therefore welcome new Clauses 10, 11 and 12.

We all know that disabled people do not need pity but rather the opportunity to lead as normal a life as possible. Mobility for a chair-bound person is essential, as my noble friend Lady Darcy de Knayth has already said. I find it most disturbing that we who are less disabled than some others have more con-cessions than they do. Wheelchair-bound people who cannot use public transport and are too disabled to drive themselves receive no help towards out-door mobility. Less severely disabled people who can drive themselves are en-titled to an invalid tricycle and associ- ated benefits, which include road tax exemption. The more severely disabled are excluded from help merely because they are more disabled, and they feel that this anomaly is cruel and causes hardship.

Many such people have used their life savings to buy and adapt a vehicle so that they can be driven in it. Some of these people have been forced off the road by motor tax and insurance. Confined at home, they find it difficult to get work and thus become a financial burden on the State. And as occupation is essential for the happiness of all disabled people, they also become dejected and frustrated. Vehicles and parking facilities for these disabled passengers are the turning point to their freedom. All people who have struggled against the odds of life need incentive above all else. I trust your Lordships will look with favour on the new Clause 5: Mobility of disabled persons.

Two things in life I abhor are segregation and discrimination, and these I find in the field of the disabled. With the move to develop large comprehensive schools, is it right to segregate disabled children in special schools? Are they not going 1o become more isolated and different from other children? We know that children who are severely disabled often need special methods of education and treatment. Could not special units be incorporated within the comprehensive schools, so that these children could share some: activities with able-bodied children? At a youth leadership course where I was giving a talk the other day I was told by the young people that they felt they would be more able to help disabled people if they had learnt to live with them at school. Phab clubs, where physically handicapped and able-bodied children come together and share youth activities, have proved that young people need each other. Their success might well influence our future thinking.

There are disabled people living alone, or with another disabled person or an elderly relative, or with children. A telephone for such people is a lifeline in times of trouble, eliminating isolation and alleviating loneliness. I should like to tell your Lordships about a young woman from Bradford who suffers from chronic rheumatoid arthritis. She was living in a room in a terraced house, up three high steps, with her elderly mother who is partially paralysed as a result of a stroke. In the early hours of the morning the mother had another stroke and fell half out of bed. The daughter, who could not sit up unassisted, lay for two hours in agonised suspense until, at 7 o'clock, she attracted the attention of the paper boy by hitting the window with her long-handled fork. The mother died on the way to hospital. Had the daughter been able to telephone for help a great deal of suffering could have been prevented. I hope that at a later stage it will be possible for your Lordships to discuss Clause 2(1)(h), omitting the word "special".

It would be difficult for me to close without mentioning that section of the disabled of whom I have greatest know-ledge: paraplegics and tetraplegics—that is to say, spinal injury cases. This is a group which, due to the accident rate of our modern society, is on the increase. Due also to medical advancement, those with high lesions, who would have died a few years ago, are now living. If in the early stages these people do not receive the specialised treatment which they can obtain only in spinal units, they are very often damaged both physically and psychologically for the rest of their lives. It has been my misfortune to wit-ness several cases where patients have remained in general hospitals after being admitted there at the time of injury.

One of these was a young man who had sustained a neck fracture from a truck accident. When he had been in a general hospital for fifteen months, I was contacted by a relative who had heard me talk on paraplegia. When I visited him I found him suffering from pressure sores and infection. Within two weeks of being transferred to a spinal injury unit this patient was feeding himself; hitherto he had not been able to do this. He had to spend a year having intensive treatment to his sores before rehabilitation could proceed. Altogether, this young man spent some 18 extra months in hospital than he need have done.

I came across another case, that of a man aged 26 who sustained a fractured back while working in the building trade. He was admitted to a nearby county hospital where he remained for eight months. He was then transferred to another gen- eral hospital further away than the nearest spinal unit. He had appalling pressure sores and was in a very low psychological condition. When at last he was transferred to a spinal unit his sores were so intensive that it took two years and many operations before healing was complete. This patient was a low lesion paraplegic, and had he received the correct treatment at the time of injury he could have returned to work, and to his wife and two children, within six months. I received a letter from the wife saying: I hope your efforts are not in vain and someone may benefit from Kevin's experience. I hope that your Lordships will find it possible to add a clause to the Bill to safeguard these people by ensuring that they have specialised treatment.

I end by emphasising that the disabled need opportunity to help themselves, so that they may gain the independence which they cherish above all else. When your Lordships consider this Bill, I hope you will not allow economic pressures to overrule the humanitarian aspects. My Lords, I thank you for having listened to me.

5.8 p.m.

LORD GRENFELL

My Lords, this is the first time in over thirty years in your Lordships' House that I have had the privilege of congratulating a maiden speaker. This, for me, is a very proud and moving moment. The noble Baroness has overcome all her misfortunes and has risen to great heights in paraplegic sport and in all other sides of life which we, who are not handicapped, took for granted when we were her age. But, above all, my Lords, she has had the courage and compassion to over-come everything in helping others who are also handicapped. I know the whole House will join with me in saying how proud we are to have her with us, and indeed the noble Baroness who spoke before her and those who are going to speak afterwards, and in looking for-ward to many speeches from them all.

My Lords, may I first of all apologise to the noble Earl and the House for the fact that, owing to a long-standing engagement, I may not be able to be present at the end of this debate. The whole House will welcome this Bill, and thank the noble Earl for explaining its clauses. I propose to speak on only two clauses, those relating to autism and dyslexia. I give a hearty welcome to these clauses as they highlight the concern in the country regarding both these distressing complaints and the suffering they bring to parents and children alike.

If I may, I will first say a few words about autism, and then shortly describe dyslexia, with both of which I have an intimate knowledge through the Invalid Children's Aid Association. A short time ago we had an interesting debate on an Unstarred Question on autism by the noble Lord, Lord Beaumont of Whitley. Since that debate I fee! that we define autism rather too narrowly in the fact that certainly I, and I think other noble Lords, spoke of the "with-drawn child" and did not embrace the psychotic and other highly disturbed children who need just as much care and education as those about whom we spoke.

On reading the Bill I was at first a little worried by the words, "autism or other forms of early childhood psychosis", but since then I have taken advice and I feel that these words cover the problem so long as local authorities treat the clauses with the greatest sympathy, and indeed with action. The problem of the education of these children cannot be solved either in training schools for the mentally handicapped or in the E.S.N. schools. The specialist teaching required if a child is to be brought back into the community demands a far greater teacher-student ratio, and experienced teachers, than is possible in any of these schools.

In the I.C.A.A.—the Invalid Children's Aid Home—at Banstead for autistic children, which I spoke about in our last debate, we take children from about 7 years of age until they are 13, when experience shows that those who need more specialised education must be moved as they tend to disturb those of younger age. It would hence appear that we must plan for a primary and secondary education for these children. We have found it exceedingly difficult to place the child after 13 years of age, and I would urge the Government and the local authorities to consider the whole planning of an education which at the best will return these children to normal education, and at the worst will relieve the parents of that intolerable burden which in some cases has entailed locking all doors, not to prevent burglars getting in but, even when the family is in, to ensure that the child does not get out and endanger itself or cause trouble to someone else. I trust that local authorities will take this clause very seriously and so relieve many parents; of deep anxiety and unhappiness.

Owing to the spread of cases over the country it would appear advantageous if local authorities considered together the best location for schools, bearing in mind the importance of retaining the family link. This co-operation between local authorities is no new concept, and I am sure that co-operation will pay real dividends in staffing the schools and finding the best people to teach the children in the most suitable locality.

My Lords, I now turn to Clause 23, which again I welcome with enthusiasm. The word "dyslexia", interpreted for the understanding of lay people like myself as "word blindness", has for many years been a subject of controversy in the medical profession; that is, as to whether it was a physical disability in children or just a number of children who had decided that they were incapable of reading or writing. Dr. White Franklin, consultant pædiatrician at St. Bartholo-new's Hospital, felt convinced that dyslexia was definitely a medical factor in children and that they could be assisted by special education. In 1963, the Invalid Children's Aid Association under Dr. Franklin's chairmanship, and with generous grants, set up a centre situated at Coram Fields. The primary aim of this centre was to undertake research into the nature and cause of severe reading difficulties, to see whether a specific disability could be identified.

From our research there can be no doubt whatsoever that there are children who, although their I.Q. is high in other subjects, have the strange disability of being unable to place the letters in a word in the right order visually, and hence are unable to read, and hence to write. The House will realise what con-sternation this causes the parents and, above all, the frustration caused to the children, who not only cannot understand why they cannot read but are also, in spite of their performance in other subjects, held back and even derided by their fellow pupils—and we all know how cruel children can be to each other. I think we have proved that at least we have given confidence to the children, proving that it is not their plumb stupidity that is holding them back, and also proving to their teachers that the whole future of these children should not be jeopardised by the fact that they cannot read and hence cannot write. We believe that a great many children will overcome this disability by education and will make real progress, although spelling may remain uncertain. Heaven only knows that many of us, and undoubtedly myself, need a dictionary handy when making up our speeches. Our experience is that a great deal more can be done in the schools, given a better understanding of the problem by the teachers.

We are convinced that although the main work must be done in the schools and through the Department of Education and Science, there is a real need for the continuation of a centre like the one set up by the Invalid Children's Aid Association to act as a reference centre for cases of special difficulty, to continue improving methods of assessment, and to make scientific studies of the effectiveness of different methods of teaching. The Association has approached the Ministry in this context and we hope to come to an agreement. Our present Director of the Word Blind Centre, Mrs. Naidoo, has decided that she has new fields to conquer in this complex subject, and I would draw her name to the attention of the Ministry, as she has a great knowledge of all the problems attached to word blindness and would be of infinite value as an adviser and administrator in this field.

Finally, my Lords, in reading the Bill many of the handicaps will be obvious, but certainly those contained in the clauses of which I have spoken need diagnosis. I have spoken before on the subject regarding the mentally handicapped, and I become more and more convinced that early diagnosis in centres where parents can bring their children when there is a doubt is of paramount importance. There is an old saying that, "A stitch in time saves nine". I would say that a diagnosis in time will save a child and its family from a lifetime of frustration and unhappiness. It is well known in our country that we can face up to reality, but uncertainty in the family circle is hell. Anything that we can do to ensure the future of the children and their parents will be well worth while.

5.20 p.m.

VISCOUNT INGLEBY

My Lords, I think I must be making history in making my maiden speech in the company of two such delightful Baronesses also making their maiden speeches. I speak as someone who uses a wheelchair a good deal and also gets about a bit on crutches. Therefore, I should like to talk mainly about access and mobility, because this is something on which I feel I can speak with a little experience. I welcome very much Clause 4, which deals with access to new public buildings, but I should like to ask the noble Baroness, the Minister of State, whether this applies to new buildings of education, new schools, colleges and universities: because I feel that it is very important that disabled people who want to pursue their education should not be confronted with unnecessary difficulties. I was up at Oxford, but I was not able to attend many lectures because nearly all of them were held in rooms up masses of steps; and noble Lords will not be surprised to learn that I did not get a particularly good degree at the end of it.

I should like to say a word or two about existing public buildings. Some of them, such as Leeds Town Hall, are very difficult indeed for people either in wheelchairs or on crutches. There is an enormous flight of stairs outside, and no handrail; and at the side of the building there are three broken flights of stairs, and again no handrail. I must admit there is one at the back. To somebody like myself, a handrail makes an enormous difference. I should like to ask whether it should not be compulsory on all buildings to which the public are admitted for at least one entrance to have a handrail; and, where possible—and it is not always possible, because sometimes the slope is too steep—they should have a movable wooden ramp for the use of wheelchairs.

May I talk for a moment about public conveniences, which are dealt with in Clauses 5 and 6? Here again I would ask the Minister whether these clauses cover places of education and places of employment—because this is such a very important matter. In Leeds, so far as disabled people are concerned, "public inconveniences" would be a rather better term. Most of them are down very many steps, and for disabled people are really out of bounds. It would be a big job to alter them but one thing that would greatly help people in wheelchairs would be to have one or two of these places with a door that opened outwards, instead of inwards. Another way of helping would be to have it suitably marked on the outside. This leads me to the need to provide adequate signposting where special facilities for disabled people are provided, because if such facilities are not adequately signposted the disabled people will not know about them.

May I say a word about public swimming baths? Swimming is often prescribed for disabled people, and indeed is often the only form of exercise they can take. It is wonderful to get into the water, to feel the water take the weight of your limbs, and to achieve a degree of freedom that is not possible on dry land. Many public baths are too difficult for disabled people; the cubicles to change in are too small, and the difficulty of getting over wet slippery floors on crutches really is too much. I would ask whether local authorities could not take a look at their swimming baths and see whether perhaps one or two changing rooms could be provided handy to the pool, with a rail leading from the changing room to the pool itself.

I very much welcome Clause 2(l)(c), which provides for recreational facilities for disabled people outside their own homes. One of the difficulties that besets disabled people is that of getting out of the main stream of life, into a bit of a backwater. I know this from my own experience. One tends to sit at home too much, and that perhaps explains why I have taken three and a half years before making my maiden speech.

5.27 p.m.

LORD CRAWSHAW

My Lords, it is a great privilege for me to congratulate my noble friend Lord Ingleby on his masterly maiden speech. Of the four of us sitting here, he is the most experienced of us all, and so what he says on this problem is backed by great wisdom and knowledge. I also shall be talking about access a little later, and I shall be sup- porting everything that he said on that subject. He and I have previously discussed problems about attendance in your Lordships' House. I hope that I have been able to convince him that there are no great pitfalls, and I am only too delighted that he has come and joined our ranks of speakers. He has a very wide range of interests, and I hope that we shall have the pleasure of listening to him on this and other subjects in the future.

I would also, if I may, as the first speaker from this mobile Bench, congratulate my noble and fair friends on their magnificent speeches. I feel that their wisdom and eloquence, and glamour, which they have already brought and will bring to this House, will be a tremendous addition. And so far as their speeches this afternoon are concerned, I appreciated the point that both of them made about the odds stacked against those people who are too disabled to drive themselves. Perhaps I might also thank and congratulate my noble friend Lord Longford on being the father of the Bill in this House. I know from other experience what he does for the less fortunate members of the community, and I agree with others who say that there is nobody better qualified to take on this task. I should also like to thank Members of the other place, particularly Mr. Alfred Morris, for the consideration and compassion they have given to it.

I welcome the crusading spirit behind this Bill designed to help disabled people to maintain a sense of dignity and independence. I believe it is a cause in which we can all share. Disablement is purely a lottery, and I see no reason why it should make people in any way second-class citizens. There is no doubt that life for disabled people becomes more expensive, and in most cases there is a reduction in earning power. I want at this stage to say a word or two about employment. Clause 13 of this Bill in some ways: takes up the theme of the 1944 Disabled Persons Employment Act; in other ways it goes a good deal wider. The 1944 Act was conceived in time of war and recognised, first, society's obligations to those injured in war, and the vital contribution that disabled people could make to the war effort. I believe that this spirit still prevails, though perhaps it varies from district to district. However strongly it prevails, I hope that this Bill will continue this theme and will set out to give the disabled the tools to do the job and help the country in time of peace.

But the principle of economic return is not the only governing factor. As I see it, the main concept of the National Health Service is that it should be a safety net to catch those badly smitten by accident or disease. Perhaps we need not be too sorry for the person earning £40 a week or more who has to pay two shillings for a prescription, but I think we should, if possible, try to increase the £350,000 to be spent next year on research and development to help the disabled, even though it may not be strictly economical.

A word or two about other individual clauses. I welcome Clause 1 which strengthens the local authority procedure for ascertaining the number of disabled people and publicising the available facilities. In the same way that some firms are excellent in employing and helping more than their 3 per cent. quota of the disabled, so some local authorities make extraordinary efforts to solve complicated human problems. In my area of the Midlands I can vouch for the great efforts which are being made in my own home town of Loughborough, and particularly in the town of Ilkeston. This Bill aims to standardise on the best of these local authorities, such as the ones I have mentioned, and I hope that ways will be found to keep the less enlightened local authorities up to the mark. I hope, as did my noble friend Lord Sandford and the noble Lord, Lord Amulree, that the importance of the work that voluntary organisations can do will somehow be recognised in the Bill. I was pleased with the assurances which the Minister gave on this point. I realise that the disabled do not want to be patronised, but organisations such as the Multiple Sclerosis Society, which was founded by Mr. Richard Cave, a Principal Clerk in your Lordships' House, are made up of ordinary, good-hearted people and do a tremendous job. I think that local authorities should have powers to pass on certain services to these voluntary agencies.

I want to say a little about access. Access to the rooms in one's own home is, of course, vital; so I welcome Clause 3, which provides that the housing authorities will make special provision. Clause 4 refers to access to public buildings. I may say that of all public buildings your Lordships' House is one of the best in this respect. I want to stress that all practical measures should be taken to provide at least one level approach entry to new buildings catering for the public and, if possible, to make certain conversions of existing buildings. Steps can be, and often are, an absolute obstacle, and steep ramps are a hazard for crutches. These provisions cost no more if they are included from the beginning of a scheme. Many dimensions have been worked out by a group known as Access for the Disabled, who believe that, for instance, doors should measure not less than 2 feet 7 inches across. They have also examined the problem of the size of lifts, which of course are the best form of vertical access.

The noble Earl, Lord Longford, mentioned the problem caused by lack of access to factories and offices, and how this restricts employment opportunities. I understand that in Standing Committee in another place it was suggested that this be tackled by amendment to the law relating to shops, offices and factories. I do not think that that point has so far been pursued. Apart from the question of entry to hospitals, Government buildings and, as my noble friend Lord Ingleby, mentioned, schools, universities, theatres and so on, many disabled people are keen sports followers, and good access should be provided into the various sports arenas and grandstands. I personally am interested in racing, cricket and football. Some racecourses are quite good, but I feel that more could be done at the planning stage when new stands are being built, especially as public money builds the stand. Last year I went to the St. Leger at Doncaster and found that although a new stand had been built it was not easy to get anywhere to see the races.

On the whole, our cricket grounds are some of the best; but football grounds vary. At the last match I went to see, some able-bodied St. John's Ambulance men "carted" me way up to the top of the stands to watch Leicester City. I enjoyed the match very much, but I think they felt the strain when they got to the top. On football grounds, turnstiles are hopeless, and I hope that provision will be made for other forms of access. Car parking is a common problem, but it is more acute for the disabled. I hope that wider provision will be made for the disabled to park in restricted areas. My noble friend Lord Ingleby mentioned the provision of accessible public sanitary conveniences. I want to endorse what he said, because this is a real problem which can easily prevent disabled people from circulating at all. Again, the group, Access for the Disabled, has done a lot of work on this problem which I hope will be referred to in Committee. I think my noble friend Lord Ingleby said that he found Leeds station pretty hopeless. I find St. Pancras Station also pretty hope-less in this regard.

At present, over a million people in this country are denied amenities and work by the inaccessibility of buildings. I sometimes feel that architects should be made to spend a week in a wheelchair before they get their A.R.I.B.A. or F.R.I.B.A. In this connection I was pleased that the Central Council for Disabled and the R.I.B.A. have announced two new architectural awards, designed to focus architects' attention on the needs of the disabled. I want to support the plea made by the noble Viscount, Lord Ingleby, that where facilities are provided they should be sign-posted.

Closely tied to the question of access to buildings is access with or to transport, which one of my noble friends mentioned earlier. I should like to support the plea that she made for a wider issue of four-wheeled vehicles. I was recently talking to Mr. Graham Hill, whom your Lordships will know as a formidable racing driver. He is a "cool customer", and not frightened by most lethal machinery, but he said that recently he had been asked to do a road test on three-wheeled vehicles and that they scared the wits out of him. I personally have always avoided these vehicles like the plague, and have been fortunate in driving a car. But of course a car itself is not fool-proof when one is alone.

That point leads me to press for better access to public transport, which is not mentioned in the Bill. Of the various forms of public transport I personally find that the best provision is made by the larger airlines and the larger airports, London Airport being the best, who keep fork lifts and narrow chairs which go up the aisles of aircraft. But one does not fly very often, and British Railways are not nearly so well equipped. Here, all corridors and doors are too narrow for an ordinary chair. I have not found the narrow chairs that are used on airlines. This means the use of the guard's van. Although this is perhaps not quite so nice as a compartment, it is quite all right on a mild day, but on returning home late at night on a three-hour trip, after a late sitting in your Lordships' House and when the temperature has dropped to about 20 degrees below freezing, I personally have found the guard's van distinctly "parky". If that is to be the accepted means of transport on the railways, I would put in a plea that they should be able to be heated. I think my life has often been saved by sharing pots of tea with the guard; and at this stage I should like to pay tribute to the staff of British Railways whom I have always found to be most helpful and considerate.

On the roads, what is known apparently in its full title as a "stage carriage omnibus"—in other words, a bus—is hopelessly inaccessible, as I think it is also for ambulant disabled, who I believe are not treated with the same patience as those with wheelchairs. I think my noble friends will agree that London taxis are almost diabolical. Ships and car ferries are also poor, on the whole, and the Underground really does not bear consideration, because the steps involved are innumerable. Finally on the forms of public transport, access to cloakrooms is usually non-existent. I should like to see some provision in the Bill to ease this position, and I would suggest a section comprised of clauses dealing with each form of public transport. My Lords, I have spoken quite long enough. I think I have said enough to show that there will be a great deal to come out at Committee stage; and I hope your Lordships will give these points your consideration.

5.42 p.m.

LORD WELLS-PESTELL

My Lords, there was a long period some years ago when I was totally paralysed, and your Lordships will understand if I speak with some feeling and particular and peculiar interest in the debate to-day. I can well understand the point that the noble Baroness, Lady Masham of Ilton, made when she referred to some of the less important difficulties that people like myself, who have both legs in calipers, find in respect of the wearing out of trousers. But, of course, that is a relatively unimportant thing.

I think that this Bill is one of the most important Bills to come before your Lordships' House in recent years, because the attitude of society to the chronic sick —and, if I may say so, particularly to the disabled—has been quite appalling. I do not believe that any serious attempt has been made by any local authority in the United Kingdom to assess the size of the problem. It is perfectly true that some local authorities have claimed that within their area only 1.4 per 1,000 of the population come under the category of chronic sick and disabled. I suggest that in areas where these low figures exist it is because there has not been a real attempt to find out what the real situation is. This is one of the things that causes me some anxiety, because the third line of Clause 1 of the Bill calls upon local authorities "to take such steps as are reasonably practicable".

With great respect, I say that we must make it much more rigid when we come to the Committee stage, because I am perfectly certain that a good many local authorities, if they cannot opt out, will certainly carry out the minimum amount of investigation rather than the maxi-mum. Local authorities have had plenty of opportunity over the years, as have the Regional Hospital Boards, to go into this matter, and many of us know that in some places the boards and the local authorities have been asked to do this but nothing has been done. I think it must be mandatory on local authorities to take these steps if we are really going to understand the nature of the problem, and what has got to be done by society, through the local authorities, to meet the needs of the chronic sick and the disabled.

The noble Viscount, Lord Ingleby, and the noble Lord, Lord Crawshaw, referred to the clause dealing with conveniences. In case there is a misunderstanding, I want to talk about lavatories, because I believe that the vast majority of people do not realise the difficulty that many paraplegics like myself experience. Some of us can never be very far away from a lavatory, and wherever I have lived one of the things I have always had to do, when going from A to B, is find out exactly where they are to be found. The noble Lord, Lord Crawshaw, is perfectly right when he says that this is a "very convenient House", and that is why I spend so much of my time here! I think we can afford to joke about this. But when I lived in Suffolk—and this is a problem that does not exist int he big towns—when I was going from my small village to Bury St. Edmunds, one of the things I had to know was where I could stop. I was not the only paraplegic in that area who was in a similar position, because people often do not understand that when you suffer from this particular problem, and the paralysis that results, you cannot exercise the same form of control as normal people. I know of more than one disabled driver in Suffolk who carries a trowel round in his car, because very little provision is made on our roads to-day. One finds lavatory facilities available on our motorways, but on the ordinary minor roads that cars use there is little or no provision at all. What I should like to see in the Bill, if it is possible—and I address these remarks to my noble friend Lord Longford as distinct from the Minister—is a mandatory obligation on the appropriate authority to see that such lavatory facilities are available on our minor country roads at reasonable intervals.

I should like also to refer to the position of voluntary societies. It is true that much of what has been done, if not completely, for the chronic sick and the disabled has been done by voluntary societies. It was not until I found myself in this position that I began to realise how much is being done by voluntary societies. I hope again that local authorities will, in some way or other, be required to co-operate with these voluntary societies. If I seem to be very critical of local authorities, it is because I feel at the back of my mind that there is a stop in their mind about working with voluntary societies. I am chairman of a voluntary national organisation that provides television and radio for bedridden and housebound people. Some six weeks ago my committee felt that we were not really touching the problem, and so on the 18th of last month the secretary of the organisation wrote to the directors of Welfare in Inner London inviting them to meet my committee yesterday to discuss how, with their help, we could reach more housebound and bedridden people. Two of the directors of Welfare never bothered to reply. One wrote and said that he could not come—and that is perfectly understandable: the date may not have been convenient. Some of them wrote to say that they would not be able to come themselves, but would send deputies or members of the staff. But of those who promised to come, only half turned up.

This is something which we were hoping to expand for the benefit of the bedridden and the housebound; and I believe that we shall come to grips with this problem, even when there may be an Act on the Statute Book, only if we use all the facilities and skills available in the community. I believe that there are many voluntary organisations which have a good deal of expertise, and a good many skills, which a local authority will find of paramount importance. So I hope that somewhere in the Bill we can get this in, so that these skills and this know-ledge which voluntary organisations can supply will be used in the future.

If he will allow me to say so, I think my noble friend Lord Longford was perfectly right when he said that this is a Bill of Rights for the chronic sick and disabled. It may be as important to the chronic sick and disabled as the Charter of Human Rights is to mankind as a whole, because the chronic sick and disabled have been outcasts of our society far too long; and I speak only to welcome this Bill.

5.52 p.m.

LADY SEMPILL

My Lords, I, too, should like to welcome the Bill before us, largely because its approval will bear witness to the great deal of fine work which is already being done by enlightened authorities under their permissive powers. Since the last war we have seen truly miraculous advances in medicine, particularly in efforts to help the disabled. That the Government should now provide legislation to catch up with these tremendous advances in science and medicine is, I am sure, welcomed by everybody whose interests lie in the care of these people. More important, it will help to ensure a fuller life for those who have been handicapped by sickness or accident.

The object of the British Council for the Rehabilitation of the Disabled, a society of which I am a member, contains two sentences. The first states: In medicine there is a duty to preserve and to improve physical function and to appraise capacity for work. The second states: In government there is a duty to retrain lost industrial faculty, or to train alternate faculty. I am glad to see that the Bill before us seems to embrace both of those ideas. Apart from legislation, which goes a long way in dealing with these problems, others still exist and more will appear as time goes on.

I should like to support my noble friend Lord Crawshaw in his plea for practical steps to improve access to public buildings. Doors of council houses too, should be built to a certain specification in order to allow access for wheelchairs. What we are all aiming at is a chance for those who are capable of being trained to do a job of work. Sometimes the most apparently hopeless cases illustrate what can be done in this field. A man I know of through my society suffered an accident in which he broke his neck. The result was that he was completely paralysed from the neck downwards. He owned a small motor engineering works and service garage in the North-East of England, and for 17 years he lay completely immobile while his wife straggled to keep the business going. His mind was still alert but he could do nothing to help her. Eventually, a panel of my society's engineering experts got to work on the problem. They rigged up closed-circuit television and radio-communication for him, and to-day that man is again running his business, from his bed.

I think there is need to bring much of the present permissive activities of local authorities under legislation, and here I refer particularly to further education and training;. Again, resettlement officers who help the disabled are dedicated people and should be given a proper status. Such powers are available, but are spread over such a wide range of departments and authorities that many disabled candidates who could be reemployed are uncertain, frightened and frustrated. A disabled person not only has physical disability to overcome, but also has to conquer the mental sense of uncertianty brought about by his or her inability to keep up with the rest of us in normal day life. But experience has shown again and again, not only here but in all advanced countries, that a disabled person, properly assessed in the first place, adequately trained in the second place, and given the right facilities, is just as productive as an able-bodied person, and sometimes more so.

5.56 p.m.

LORD SEGAL

My Lords, I feel that this afternoon we have been privileged to share in an experience that is rare, and probably unique, in your Lordships' House. We have listened to four maiden speeches of such quality, and given in such special circumstances, that I doubt whether at any other time a debate has taken place under these conditions. But for the advances in medical science during the last 30 or 40 years, these lives would probably have been sacrificed, and this afternoon we have had an opportunity of realising—and I say this very humbly indeed—what very valuable lives they have been.

I speak from memory, but I think that after the First World War the mortality from paraplegia was something over 90 per cent. Just before the Second World War, the figures were completely reversed; and to-day not only is the mortality well below the figure of 10 per cent. (I think it is now quite exceptional), but largely due to the advances in modern medicine, in antibiotics and the magnificent pioneer work done in hospitals such as Stoke Mandeville—and I know full well how deeply the noble Baroness, Lady Masham, has reason to feel indebted to Stoke Mandeville Hospital, if she will allow me to say so—we are able to realise to what an extent the community has been able to benefit.

Having said that, I should like to agree with every word that has been said about the enormous effort that is still required. I think we are all conscious of how far short we still are of what we want to be able to do in this matter. I was particularly glad that the right reverend Prelate the Bishop of Bath and Wells made reference in his excellent maiden speech to the plight of the mentally handicapped, which was also mentioned by my noble friend Lord Longford. They implied that there was an element of doubt as to whether mental illness or mental retardation was included within the scope of this Bill. I was glad that the noble Baroness, Lady Serota, said that it was included: but how I wish that mental illness and mental retardation had been specifically mentioned in the Bill! If the noble Baroness will forgive my saying so, they are merely admitted by implication, just because autism and dyslexia are specifically mentioned. Although I have very few faults to find with the Bill, I think one must say that in Clause 22 which refers to … special education facilities for children who suffer from autism or other forms of early childhood psychosis", the phrase "early childhood psychosis" can mean as much or as little as anyone intends it to mean. Why can it not be extended, through a wider term, to cover the whole field of mental handicap in whatever form it exists in children?

Having expressed these criticisms, I should like to add in the warmest possible terms my own welcome for this excellent Bill, and to say how specially gratified I am to see my noble friend Lord Longford, who is one of my predecessors as chairman of the National Society for Mentally Handicapped Children and whose deep interest in the welfare of all sick and disabled members of our community is so well known, acting as sponsor of this Bill in its passage through your Lordships' House.

This Bill is so admirable in its intentions and so far-reaching in its scope that I must perforce confine my remarks to only one or two of its clauses. May I say how very warmly I, too, support Clause 14 on the separation of younger from older patients? My only criticism of its wording is that the age of 50 is somewhat arbitrarily chosen. One can recognise fully the enormous administrative difficulties which this clause must entail in the running of a hospital, but the principle is a most important one. Where gross instances are brought to light of children or young adults being cared for in hospital in undesirable surroundings, the remedy must be applied swiftly and with the minimum of administrative delay.

There is another point about which I should like to ask my noble friend who is to reply. In the Second Reading debate on this Bill in another place the Minister in charge announced that the Government's social survey would be completed in the middle of this year. May I ask my noble friend whether the progress of this enormous and painstaking survey is up to schedule, and by roughly what date its report can be expected? So many tens of thousands of anxious chronic sick and disabled persons are waiting with hope and expectancy for this report that it would be a welcome relief if some tentative date could be announced by my noble friend when she comes to wind up this debate.

I should also like to add a word or two about the problems of definition. We all realise the difficulties, but, as the Minister in another place went on to say: Who are the chronic sick and the handicapped? Like the elephant, they are easy to recognise but hard to describe".—[OFFICIAL REPORT, Commons, 5/12/69, col. 1917.] I suggest that a great stride toward would have been made if, in the first in-stance, the interim report of the social survey could confine itself to the elephantine cases of disability, both physical and mental, which everyone is clearly able to recognise and which require assistance, sometimes very urgent assistance, without having to wait for their definition.

May I also add that definition of a disabled person becomes particularly difficult in the case of mentally retarded children? When I first became associated with the work of the National Society for Mentally Handicapped Children I was eager to see established a register for the mentally handicapped, on the same lines as the register of blind persons. I thought that that would provide us with valuable material by which to assess the extent of the problem and guidelines for research projects and for communal care. But I soon found out that such a register was almost an impossibility. Extreme cases were easy enough to locate, but it was the vast borderline area between the mentally retarded and the educationally backward that was so difficult to assess.

The most strenuous opposition of all came from parents, who would insist that their child was only slightly backward at school and not mentally retarded at all. It was this which rendered an accurate register almost impossible to envisage. Only recently I came across a mother who insisted that her son was suffering only from petit mal or minor epilepsy. On further inquiry, it transpired that he had been a case of gross mental retardation since birth. Such cases are becoming fortunately less and less frequent, and the strange mediaeval stigma against mental retardation is gradually dying out. So may I put in a plea that the great work of assisting the vast army of chronic sick and disabled persons which this Bill seeks to undertake is not held up by any undue wrangling over difficulties of definition?

There is one other matter on which I should like very briefly to touch, and that is Clause 17, which refers to research and development work on equipment to improve the mobility of disabled persons. Many speakers have already dealt with it, but one of the greatest and most imaginative steps ever taken by this country to improve the lot of disabled persons was the provision of motor vehicles. No fewer than 20,000 invalid three-wheelers have been provided, and over 7,000 cars. How I wish these figures could have been reversed! One of the most heartening statements which emerged from the debate in. another place was that a new type of vehicle, with automatic gears, was being produced so that the whole of the driver's attention could be focused on the traffic ahead.

Nothing is more tragic than to come across a disabled person whose motor invalid chair has been put out of action through a minor collision in traffic. I have met quite a few such people, suffering from major depression, almost as if something very real and very vital had gone out of their lives. From being a person who has been thrilled at being able to escape from the prison of perpetually living within four walls, and being able to see the countryside or spend a day by the seaside by his own efforts in a motor tricycle, even after a minor accident such a person can be trans-formed overnight into a nervous wreck, with a loss of confidence which can have grave physical as well as mental repercussions. Being taken with a party of disabled persons in a bus on an outing is not the answer: the people concerned are deprived of that sense of pride in their own personal achievement, and they feel hurt at having once more to fall back and feel dependent on others.

What is needed here, my Lords, is a four-wheeled vehicle: not an invalid three-wheeler, which brands them at once as disabled persons, but a four-wheeler, with an automatic gear and, if possible, with dual controls, so that they can take their wives, or husbands, and children on an outing as a normal family unit, with someone, if necessary, able to take over control of the car if the disabled driver begins to show signs of fatigue. The slight extra cost involved would be far more than repaid in the more frequent use of the vehicle and its greater serviceability. But far above everything else would be the wellbeing and the mental elation of the disabled person in being able to share a little in the blessings which normal, healthy people are able to enjoy.

I was particularly struck by Lord Crawshaw's reference to the accessibility of your Lordships' Chamber: but what about access to the Public Galleries of this House? The other place is well equipped with lifts giving access to all the Public Galleries. Could we not make a start to set our own House in order and have lifts installed, so giving the disabled public access to our own Galleries in this House? I sometimes find that I have the greatest difficulty myself in getting up to the Strangers' Gallery on my own two feet; so why should we not provide facilities for the disabled in our community also to have the opportunity of listening to our debates?

My Lords, I have touched upon only one or two of the marvellous new opportunities which this great Bill can create for disabled persons. It has been acclaimed everywhere as a charter for one of the most valuable, most deserving, as well as one of the most deprived, sections of our community. Its passage into law would be a red letter day in the history of our social services. We can only wish it well and each help in his or her own individual way to speed its passage through to the Statute Book.

6.10 p.m.

LORD HARDING OF PETHERTON

My Lords, I have two interests in this Bill: a major and general interest, as Chairman of the National Fund for Research into Crippling Diseases, and a minor and personal interest as the recipient of a small war wound disablement pension. The purpose of the National Fund for Research into Crippling Diseases is to raise money by voluntary subscriptions (and it is now running at a six-figure amount annually) for research into the cause and cure of crippling diseases and into the rehabilitation of the victims of such diseases. With such objectives we are, of course, deeply interested in all the measures contained in this Bill; so, on behalf of the National Fund, I should like to express our deepest appreciation to Mr. Alfred Morris for introducing this Bill in another place, to those who supported it there and to the noble Earl, Lord Longford, who so ably introduced it to your Lord-ships this afternoon. With the knowledge of the problems of the disabled that I have acquired through my association with the National Fund over a good many years now, I most strongly and sincerely commend to your Lordships all the provisions of the Bill.

I have learned from personal experience and from watching other people that what the disabled wish and need more than anything else is to be more self-supporting, more mobile and more independent. That has been most strongly reinforced by the views so ably expressed this afternoon by the disabled Members of your Lordships' House who are sitting in front of me now. I was glad to hear not only the Minister's expression of appreciation of the work of the voluntary bodies but also the words she used when she said that she thought that in the future the work and efforts of the voluntary bodies would become more, rather than less, important.

As an old soldier, I am particularly interested in the problems of the disabled war pensioners, men who were my comrades in arms in two World Wars and in minor campaigns between them and since. I should like to say a few words in support of the war pension clauses of the Bill which are Clauses 7 and 19. Clause 7 deals with the central advisory committee and provides for broader representation on that committee by increasing the number of local war pensions committee chairmen who will be members. It also provides that the advisory committee shall meet at least once a year. Some chairmen of local committees are already members of the central advisory committee; they are the people with the more direct experience of the problems and difficulties of the war disabled. Increasing the number of war members of the central advisory committee is a measure which I warmly welcome.

Clause 19 deals with war pensions appeals. It makes three major changes and improvements in the Pensions Appeal Tribunals Act 1943. This is not the time or place to go into the details of those three improvements, but I would stress to your Lordships that they are significant and that they are important from the point of view of the war disabled. I hope that neither Clause 7, to which I have referred, nor Clause 19, containing these important and significant improvements, will be modified or weakened when they are discussed at the Committee stage.

6.17 p.m.

THE DUKE OF ATHOLL

My Lords, like all other speakers in this debate, I greatly welcome this Bill. I am sure that it is a great step forward in. the care of the disabled in this country. Speaking personally, 1 am really trying to implement the spirit behind Clause 4 with which I am in entire agreement, as I am convinced that it is important to the disabled to feel that they can do what other people do. But I hope that something can be done about the English of this clause at a later stage of the Bill. I really think that it is one of the worst examples of the Parliamentary draftsman's art that I have ever come across. I am slightly cheered by the fact that it was introduced only on the Report stage in another place. There was hardly a debate on it at that time; so I feel that in this House we should be able to improve its English without altering its meaning.

There is one thing further which remains on Clause 4. I am slightly worried by the fact that there does not seem to be any time limit within which people who invite the public to enter their premises will have to make pro-vision for the disabled. It seems to me that this is a weakness, because unless you put a time limit on a matter of this kind people tend to do nothing and to say, perhaps, that it is too difficult or too costly this year and to put it off year after year after year. Then, as we all know, nothing happens. I appreciate the difficulties; but might it not be possible to insert some sort of time limit in this clause so that people who own these premises and buildings really will have to get moving and do something about it.

My Lords, I am not primarily interested in speaking about Clause 4, but I should like to make an inquiry of the noble Earl who sponsored the Bill. I should like to thank him and all his helpers for bringing this Bill forward; more especially because although, when the Bill was first introduced in another place, it did not include Scotland the greater part of the Bill, at any rate, does now apply to Scotland as well as to England and Wales. But I should like to inquire why Clauses 1 and 2 do not apply to Scotland. From reading the debate in another place, I gathered that the reason for this was that the Government felt that Section 12 of the Social Work (Scotland) Act 1968 was adequate. But one of the groups, the Disablement Income Group of Scotland, who have been in touch with me, are not at all happy about this because they feel that Section 12 of the 1968 Act is woolly and nothing like as precise as are Clauses 1 and 2 of this Bill.

Perhaps your Lordships will forgive me if I read the "bones" of Section 12 of the Social Work (Scotland) Act, since I imagine that many of your Lordships will not have it in front of you. It reads: It shall be the duty of every local authority to promote social welfare by making available advice, guidance and assistance on such a scale as may be appropriate for their area, and in that behalf to make arrangements and to provide or secure the provision of such facilities … as they may consider suitable and adequate, and such assistance may be given to, or in respect of, the persons specified in the next following subsection in kind or in cash, subject to— two later subsections. The second half of the subsection, which concerns us, states: The persons specified for the purposes of the foregoing subsection are … a person in need requiring assistance in kind or, in exceptional circumstances constituting an emergency, in cash, where the giving of assistance in either form would avoid the local authority being caused greater expense in the giving of assistance in another form, or where probable aggravation of the person's need would cause greater expense to the local authority on a later occasion. My Lords, it seems to me that Clauses 1 and 2 of the Bill we are considering to-day are so much better, and so much more precise, than Section 12 of the Social Work (Scotland) Act that it would be an advantage if we could extend those clauses to Scotland as well. I hope that this may be possible at a later stage in the progress of this Bill.

When Clause 2 was introduced in another place on February 4 The Times said that this clause would place our country in the forefront of nations in the matter of its provisions relating to the chronically sick and disabled. Why should England and Wales steal ahead of Scotland in this way? I think it is somewhat unfair and I hope that it will be rectified later.

I should like to refer to Clause 11. I think education of the disabled is extremely important. The only personal experience I have had of this is that we employ a young spastic as a telephone operator in the estate office, and I should like to commend the immense amount of trouble that the G.P.O. went to in training him and finding suitable equipment that he could operate. It has been a great success and he is extremely good. I think it very important that people like him should be given these opportunities, especially those in rural areas where there is not the problem which is encountered by people in cities of getting to and from work. That is one of the most difficult things for disabled people to do.

I should like to put a general question to the noble Baroness who is to reply on behalf of the Government. What form of publicity is to be used to get the provisions of this Bill home to the disabled? I think this is extremely important, as many of the disabled, for obvious reasons, are not so much in touch with the world as some of the rest of us. I hope that the Ministry—I am sure they will—will make every effort to get the provisions of this Act (I am anticipating that the Bill will successfully negotiate your Lordships' House) home to those who are disabled and who will be very much affected by them. My Lords, I thoroughly support this Bill.

6.24 p.m.

LORD STAMP

My Lords, I should like to join with other noble Lords in congratulating the four Members of your Lordships' House who have made their maiden speeches to-day. They made memorable contributions and we now look forward to hearing them frequently. In joining with other noble Lords in support of this Bill I should like to consider broadly one aspect, namely, research and development for the benefit of disabled persons and the ways in which it could be extended and applied, rather than to take up any specific points in individual clauses. I hope that will not be considered out of place at this late stage in the debate.

At a meeting of the Parliamentary and Scientific Committee last May there was a discussion on medical engineering, a subject that is being recognised as of increasing importance and covering a wide range of application of engineering technology to medical problems. From the most unsophisticated beginnings it has developed into one of the major growing points of medicine. It is a science that blurs the dividing line between medicine and engineering, a science that in recent years has given us such special aids as the heart-lung machine, artificial kidney machines, plastic joints and heart valves, and also a bewildering array of diagnostic aids and surgical equipment which, because they never capture the public imagination, never make the headlines.

In its widest sense it includes not only the development of apparatus, devices and spare parts designed to help those with specific clinical conditions and obvious deformities, or to assist the clinician and the laboratory worker in the investigation, or the nurse in the care of the patient, but also the invention and development of equipment and devices— in some cases more properly described as gadgets—designed to make life easier and more comfortable for the invalid, bedridden and aged, whether in a geriatric ward or at home. The noble Lord, Lord Amulree, referred to them. It might be extended still further to include devices designed to prevent accidents, such as those which so often result, for example, in a broken femur or other bones in the elderly, leading to incapacity and disablement.

Research and development along these lines may not strike the imagination in quite the same way as that which has a specific palliative or curative aim, but I hope to show that its long-term and over-all results may prevent or alleviate an even greater amount of discomfort and suffering. At the present time research and development are being carried on, as we have heard, under the auspices of certain Government Departments and also in the universities and other institutes, largely through the support of charitable organisations. I must confess that I found it rather difficult to find out in any detail what is being done through Government agencies, and it is to be hoped that the Report referred to in Clause 18 will meet the need for more information.

So far as charitable organisations are concerned, the National Fund for Re-search into Crippling Diseases, to which the noble and gallant Lord, Lord Harding of Petherton, has referred, has played a leading part in encouraging research and development under its Director, Mr. Duncan Guthrie, as can be seen from its annual report. As far back as 1959 it set up a Committee for Research on Apparatus for the Disabled, under the chairmanship of Sir Harry Platt, in order to look into the possibility of using new materials, especially plastic and metal alloys, and new techniques for the manufacture of aids for the disabled at a time when only a handful of people were thinking along these lines.

I should like to go into a little more detail about the Fund than did the noble Lord, Lord Harding. It has recently published—and heavily subsidised—a four volume book, Equipment for the Disabled. This contains information on the development of equipment for the disabled; research in progress in various centres, both as to programme and those carrying it out; the evaluation of design, prototypes or finished product, and also the effectiveness of methods used for testing the equipment. It is also very much concerned with the problem of implementing these innovations, as this is so often the bottleneck. Another section of the book is concerned with providing information for the user, particularly with regard to aids for daily living. The book has been published in loose leaf form to enable additions and emendations to be made at regular intervals.

A large part of research and development has been directed to the more spectacular aspects of medical engineering: as, for example, the alleviation of the suffering of the victims of the thalidomide tragedy and of paraplegics, involving such projects as the design of improved artificial limbs and the immoved wheelchairs that we have been hearing about this afternoon. Even in these fields there is much room for improvement. For example, I have been asked to make a special plea for research into improved designs for walking aids —I think the noble Lord, Lord Platt, has already mentioned this—in particular caliper splints, which I am told are antediluvian. There is also the very urgent and wide-spread need for other lines of research, more particularly for the benefit of the aged.

It was this aspect of medical engineering that Mr. Heinz Wolff, Director of the Division of Biomedical Engineering at the National Institute for Medical Re-search, Hampstead, stressed when he spoke at the meeting I have mentioned. As he has; pointed out, the country is faced with a major increase in the aged population, many of whom have been kept alive by modern medicine—or by " death control", as he calls it—without necessarily being competent to look after themselves. Such people, therefore, require care, which can only be provided either by the social services, by charities such as the Women's Royal Voluntary Services or by their families.

It is, however, a fact that families are becoming smaller and becoming dispersed, owing to the mobility of labour, and there appears to be difficulty in recruiting an adequate number of social workers of all kinds. In consequence, the provision of adequate care for people who are old or slightly disabled must become an increasing problem for society, and may reach very serious proportions in the next 20 or 30 years. A part of the remedy could be the provision of technological aids to be used in the home in order to extend the period of independence. Many gadgets that would be suitable for this have been devised by charitable organisations, by local enthusiasts or by other highly motivated people, but have only rarely been employed on any appreciable scale. At present, it is entirely up to the enthusiasm of the local medical officer of health or general practitioner—or even the patient's family—as to whether any of these devices are provided at all.

A massive concerted attack on this problem is overdue. This might be in two phases. The first would be to find out the number of people concerned and the extra period of independence that might be gained by the provision of simple aids. The second would be to make a full study of these technological aids. These would include the simplest devices, such as a pair of tongs to extend the reach of the arm—particularly useful to those confined to wheel chairs. Other developments would be concerned with mobility around the home, such as getting on to the lavatory, getting in and out of the bath unaided, moving from bed to wheel chair, and also the means of communication with others. It would include, too, more complex devices for automatic cooking or food production; or medical devices, such as a sphincter stimulator to cure incontinence. The incontinent grandmother can be a major burden to a young family, but if her incontinence could be cured, she would become a valued, built-in baby-sitter.

The problems involved, however, are very much greater than just identifying the type and number of devices and gadgets that are required, and developing and improving them. Social habits must be studied. To give an example, it is no good attempting to train a docker who has become disabled in domestic chores such as cooking. He has never done this and will never do so. Social habits die hard. There is also the need to produce the devices at an economic cost; and here industry must help. There is the need to disseminate knowledge about them as widely as possible, as the noble Lord, Lord Platt, has already pointed out. A major problem also to be overcome must be a decision as to whether the provision of these devices is to be the responsibility of the local authority, the Department of Health, or how the responsibility is to be shared. The reorganisation proposed in the Green Paper might help to abolish this distinction.

In the second phase, one would have not only to produce and supply these gadgets but also to train home visitor bio-engineers, who would study the problem of the individual patients or family and recommend which of the devices should be provided. There might perhaps be a standard kit of, say, 20 to 30 items that could be made available on a national scale. It must be emphasised that some of the devices, which apparently take over the activities of a voluntary body, such as the Meals-on-Wheels service, are not intended to abolish the personal contact but are intended rather to release social workers to engage so far as possible in personal contact, instead of battling through crowded streets in little vans.

My Lords, this may seem a very ambitious programme, but it is essential if the problems facing the next generation are to be met. While it may appear to be expensive, increased expenditure by one Government Department would be offset against savings realised by another. As in many fields of endeavour affecting the social services, some method of inter-, as well as intra-, departmental book-keeping is essential. There must be an overall saving if the introduction of such devices into the home were to defer sending a person into an institution, as it might well do, for perhaps 12 months or even longer.

I do not wish to minimise the importance of further advances in the more spectacular fields of medical engineering, but for the reasons I have given, I believe that more emphasis should be placed on aids for the disabled, whether young or old. This does to some extent involve a re-thinking of values, so as to put this type of research in its proper perspective. The intellectual snobbery that equates complexity with importance must be overcome.

To implement all these proposals requires what the Americans would call a "dedicated institute", and perhaps one of the new universities could develop this as one of its major objectives. In so doing, it would be rendering an incalculable service to the country and in the most direct way employing technology for the benefit of man. Such a university department would be responsible for the initial research and the identification of devices that are required; the design of the devices themselves; the appropriate contacts with industry; if possible for demonstrating to the appropriate Government agencies that the results are a paying proposition; and, finally, for training the staff which would actually be responsible for analysing individual home situations. This is not to say, of course, that all such research and development should be centralised. But there is a clear advantage if a major part of it can be concentrated under one roof, so to speak—for example, in one university centre which would regard the work as one of its main objectives.

The concept of an institute devoted entirely to this work is not new. In 1968, the Swedish Government, in collaboration with a voluntary organisation for the disabled, founded the Swedish Institute for the Handicapped. The Minister of Health and Social Affairs, Mr, Sven Aspling, introducing this Bill to the Swedish Parliament, made the following comments, among others, about the new institute, which I feel are relevant to the debate to-day. He said: The Swedish Institute for the Handicapped should have an important co-ordination task in setting up a programme for research and developing work in the field of aids. The institute shall assist in spreading the activities in a better way to projects for various kinds of handicapped persons. As a central co-ordinating institute it should be in the position of giving priority to certain projects and to stimulate those activities which are most important. The institute should also see to it that the findings of research and development work result in practical projects. By analysing the needs of the handicapped for various kinds of aids, the Institute should provide firms and other interested parties with competent advice, making possible manufacturing and marketing. I find that this task is of utmost importance as the production of special aids to the handicapped often is made only in limited series. The institute that he set up is under a board, development council and director, and has three main departments: first, a technical department, concerned with project planning, research and development and marketing; secondly, an information department, concerned with education, films, conferences, exhibitions, publica- tions, international contacts, technical services and so on; and, thirdly, an administrative department with the usual functions. My Lords, here is one country at least that is taking the problem very seriously, and it provides a shining example to others. There are signs in this country that the importance of the subject is being more widely recognised. For example, the Royal Society is taking an increasing interest in these problems, and after what has been said this afternoon I feel quite sure that the Government will do likewise.

I hope, my Lords, that I have been able to contribute something of value to the debate this evening. If we are to make the effort that the situation demands we must " think big ": any inertia that there may be must be overcome, and administrative difficulties must be surmounted. The provisions of the present Bill, admirable though they are, must be only the beginning.

6.41 p.m.

LORD ROWALLAN

My Lords, I do not wish to detain your Lordships at this late hour, but I think it is only fair to draw attention to the valuable; pioneer work which was done among boys and girls by the Scouts and the Guides. Many of the therapeutic agencies used to-day were developed in Scout troops, and, above all, they have proved the value of keeping these children as part of the world and not apart from the world. I always remember one impossible feat, to all intents and purposes, which was done by a small boy. He was a spastic in an ordinary troop. His companions were all making crystal sets in the very early days of radio, and he determined that he would do the same. It took him minutes to enter the screwdriver on to the head of the screw, but as he turned the set on for me to hear, again taking almost minutes, the triumph in that boy's face was an inspiration, and it will re-main so to me for the rest of my life. I shall do everything I possibly can to sup-port this Bill in every way.

6.42 p.m.

LORD RAGLAN

My Lords, I do not want to keep your Lordships for more than a minute or two, because there are four cripples present in the House who cannot move in and out during the debate as we can. But I think I have an important point to make.

THE EARL OF LONGFORD

It appears that the noble Lord is incorrect, and that they can move in and out.

BARONESS SEROTA

But not quite so easily.

LORD RAGLAN

As my noble friend says, not quite so easily as we can. My noble friend Lord Longford mentioned the problem of the definition of " disability ". There are four clauses, Clauses 20 to 23, referring to the deaf and hard of hearing, the dual handicap of blindness and deafness, autism, early childhood psychosis and acute dyslexia—which is also referred to as chronic dyslexia—but, as my noble friend Lord Segal pointed out, the mentally handicapped are not mentioned: in fact, he said that they were omitted by implication. I am connected with the Institute for Research into Mental Retardation, and I feel this omission very hardly. I appreciate that one cannot go on adding clause after clause on the definition of " disability ", and I am wondering whether my noble friend and the Government would earnestly consider whether they could not leave out all such definitions from the Bill. Otherwise, the list of clauses will get too long, and there will still be people who will consider that they have not been treated fairly. Apart from that, I support the Bill wholeheartedly.

6.44 p.m.

LORD DRUMALBYN

My Lords, per-haps I might also intervene for one moment. I hope that my intervention can shorten the proceedings on the Bill, because what I want to say to the noble Baroness, Lady Serota, is this. I support what my noble friend the Duke of Atholl has said about the inclusion of Scotland in Clauses 1 and 2 of the Bill. I would say, frankly, that we should like to have a reply to that suggestion from a Scottish Minister. We quite understand why the noble Lord, Lord Hughes, is not here this afternoon; no doubt he has winged his way back to Scotland on his many other duties.

Briefly, the point is that we want to make certain that the powers in Clauses 1 and 2 apply to Scotland under the Social Work (Scotland) Act, as it is now. If they do not, we should like to amend the present Bill. We quite understand the point that, in so far as England is con- cerned, the merging of the two Ministries into the Department of Social Services means that one Minister controls only the Health side and the National Assistance side. But, as the noble Baroness will know, part of the duties of the Minister of National Insurance, as he then was, have been transferred to the Secretary of State for Scotland so far as residential accommodation is concerned. There does not seem to be any reason why a further transfer should not be made, if it is necessary, in order to secure for disabled people in Scotland the benefits of Clauses 1 and 2. Perhaps we can discuss that point in Committee.

6.46 p.m.

BARONESS SEROTA

My Lords, I am grateful to the noble Lord for lightening my burden in that way. This has been a long and, I think, a most valuable debate, in which, as always in your Lordships' House, the expert and the humane have mingled in many speeches. The House is indebted particularly to those who have taken this occasion to speak for the first time, some of whom at least are armed with special experience of overcoming difficulties which none of us can envy. I feel that our maiden speakers to-day have not fallen into the trap about which the noble Earl, Lord Longford, warned us in moving the Second Reading of the Bill, but have spoken with a directness and forthrightness about the practical issues of day-to-day life for the disabled. This has greatly impressed me, and I hope that it has impressed all your Lord-ships, as well.

A number of major themes have emerged: access, particularly to public buildings of all kinds; mobility; information, both to disabled persons themselves and to authorities responsible for providing services for the disabled; and also the vital question, in terms of future developments, of research. It is not for me to reply to all the different points that have been made; indeed, this is a Private Member's Bill, and to my noble friend Lord Longford falls the honour of replying to the debate. However, it may help the House if I say a few words about some of the major points that have emerged.

The noble Baroness, Lady Darcy de Knayth, reminded the House—and I am glad she did—that in our modern society mobility is really of the essence. Many of the problems that we are facing to-day arise from the rapidly changing nature of our expectations of life, particularly in relation to mobility; and in the case of the disabled the need to enable them to live their lives to their full potential and to go about their normal way of life, be they mothers, fathers or any other kind of person fulfilling their role as an adult citizen.

In the context of mobility, several noble Lords made reference to vehicles that are provided for the disabled. It is understandable that those of us who are anxious to improve a service should at times be inclined to emphasise its existing deficiency. I certainly would not attempt to disguise the fact that the vehicle service is less than perfect. The noble Baroness at one point in her speech emphasised to the House that the services provided in this country in this field are the finest in the world. The noble Lord, Lord Segal, reminded us that there were some 20.000 badly disabled people who were able to get about at a cost which only amounts to the fuel that is consumed by their vehicles; the vehicles are supplied and maintained free of charge. Free storage is made available for them, and if one is off the road for any reason —and I have had many letters about these matters—a temporary replacement is provided.

There are imperfections, and the first problem that faces one, certainly as a Minister in my Department, is that there are some disabled persons who could benefit from three-wheelers but who do not qualify under the existing rules. We intend to do something about this problem when more money can be found, and the possibilities are at this moment of time under scrutiny. I can only say that the consideration which we are under-taking at the moment is not intended to divert attention from the present problems, and we are in this sense certainly not the slightest bit ashamed of our record to date. This Government have doubled the expenditure on vehicles for the disabled in the past five years. That, by any measure, is a good achievement. More people have vehicles now and the vehicles themselves are better.

Mention has been made of the improved vehicle that is now being developed; a new model with a bigger engine, fitted with automatic transmis- sion, which is soon going into production. The prototypes have been well received and I think the new three-wheeler will set a very good standard for vehicles to be used by the disabled. There are those who say that all our problems in this field could be solved if we withdrew the three-wheelers and supplied cars instead. That is not true, because there are many disabled people who cannot get into low-built, modern small cars, let alone drive them. That is why we have concentrated on the new design of the three-wheeler.

The other point made by the noble Baroness and other speakers so effectively was one with which we all have the greatest sympathy, and I would not attempt to disguise my sympathy with the point that there are some people who suffer from a whole range of diseases and who are so disabled that they cannot drive any of the vehicles we provide. The suggestion has been made that they should have vehicles issued so that relatives and friends could drive them. This proposal is one which I do not think a single Member of your Lordships' House would find unattractive. The problem is purely one of cost; it would amount to millions of pounds. This, then, is a matter for the public, for the public in the end decides the resources that the Government allocate to any aspect of the social services. There arc many alterations that we could make in provision of this kind if resources were unlimited. Although it gives me no pleasure whatsoever to say so, it is simply not possible at this moment of time— and I think this would be true, regardless of Party—to provide the kind of service proposed for those who are so disabled that they cannot drive themselves in the immediate future.

I promised the noble Lord, Lord Amulree, at the outset that I would answer his pointabout physiotherapist and chiropody services. These relate to a number of points made by noble Lords about the need to provide services for the disabled wherever possible in their own homes. I know that the noble Lord keeps a special eye on the physiotherapists and that they are a vital part of our general medical services. They are at the moment, as he also knows, based on hospitals. We are aware of changes and developments in the services, and changes in needs. I am aware of the arguments that have recently been debated on the deployment of physiotherapists—whether they should visit in homes or be hospital based—and these will undoubtedly be reviewed by the Working Group that is at present reviewing the work of the remedial professions. I am sure that note will be taken of the points that have been made in this de-bate, and that they will be followed through. Chiropodists, on the other hand, do give service in the home, and there are 162 local authorities who make such arrangements.

We all listened with the closest interest to the noble Baroness, Lady Masham of Ilton. I was particularly interested in the point she made in relation to services for paraplegics. We all agree that patients should be admitted at the earliest possible moment to units which can deal with their special problems, and also that there is a need to develop services to meet their special needs. I am sure it is right that the resources of these units should be called upon at the earliest possible moment. I am sorry, my Lords, to keep returning to our maiden speakers, but it was one of them who reminded us of the effect of road traffic accidents on the Health Service and the growing number of injured people for whom we are caring in our hospitals. One of the sights that I find so disturbing when I visit hospitals is that the only young men of between 18 and 30 years of age that you see in hospital to-day are there as a result of road accidents. You see long-stay wards full of young men— orthopædic cases recovering from major road accidents. I wonder whether we ever count the cost of increased speed and mobility and what it means, particularly to those members of the younger generation who became accident casual-ties. I believe that we in this country provide very good services for the paraplegic—far better than are provided in other parts of the world. Units have been developed in recent years, and although their geographical distribution may not be ideal, they cover the country. If the noble Baroness has any particular problems and difficulties that come to her notice in this field, I can assure her that I shall be only too happy to discuss them with her.

Turning now to the question of access, I will draw my right honourable friend's notice to the point that the noble Viscount, Lord Ingleby, put to us on access to educational buildings. This is a point which I am sure we shall return to in Committee. He made his point from knowledge and experience and it is a matter which noble Lords may wish to discuss later. Turning now to information, I have been asked a number of questions on this subject relating to circulars to local authorities, the timing of the Government Social Survey, and what kinds of information we are going to make available so that handicapped people can be aware of the services to which they are entitled. Clearly, when this Bill receives Royal Assent, as I know it will, we shall be sending out a circular to local authorities and advising them of its contents and the need to implement it. We feel that the best time for a full circular setting these new developments in the context of the newly organised social service departments to be set up following the Seebohm Bill will probably be most effective if it is issued after we have the results of the Government's Social Survey; but there is nothing firm on this matter yet.

I have noted the points that noble Lords have made about information both to disabled people and to local authorities and voluntary organisations. I have found them extremely valuable and we will bear them in mind as part of our thinking. Replying to Lord Segal, we hope that the Government's Social Survey will be completed by the autumn, but it will take a little time, as I am sure he will appreciate, to assess its results fully and then publish them. I was grateful to the noble Lord, Lord Harding of Petherton, for his welcome particularly to Clauses 7 and 19; and I am sure the noble Earl, Lord Longford, will be equally pleased to know that he has the support of Lord Harding in the purposes and provisions of this particular Bill.

My Lords, I realise that it is not possible, nor indeed is it appropriate, for me on this particular occasion to reply to all the points that have been raised. I look forward to hearing my noble friend sum up the debate. I have merely tried briefly to indicate some of the answers to the questions that affect services for which the Government are responsible; and as no doubt your Lordships will be hearing too much from me at the Committee stage, I think I can only conclude by once again wishing this Bill well and a smooth, and I hope not unduly long, passage during Committee and remaining stages. I hope that we shall send it back to another place improved, but perhaps not too greatly extended, as my anxiety is to get this Bill on to the Statute Book.

7.2 p.m.

THE EARL OF LONGFORD

My Lords, anyone who cares, as we all do, for the disabled must be greatly heartened by the course of this debate. It is usual to express gratitude on these occasions to the speakers; and that I do as it is polite and Christian. But I do not think they will be looking to me for gratitude, because in fact all those who have spoken have spoken from deep conviction, and it is really my own feeling at the moment that there is— something which is overwhelming—this tremendous community of outlook between all those who are concerned, whether they are disabled or not yet disabled, or whatever they may regard themselves as being. That has been the overwhelming impression made on my mind to-day.

I know that those who have promoted this Bill, and all the disabled, will be immensely encouraged when they read the account of our proceedings. I certainly will not follow the possibly ironical advice given me by the noble Baroness when she suggested that I might suitably sum up the debate. I have no intention of attempting any such thing. I should hesitate to pick out any names at all, because that would be invidious— they have all spoken so well—but I think it is perhaps right to make special reference to those who represent large bodies of opinion in this House, such as the spokesmen of the Conservative and Liberal Parties, and the right reverend Prelate, whose maiden speech we welcomed so much.

I will come to the remarks of the noble Baroness in a moment, if I may, because, as always, I admired her style and also her message; but, as she has said, this debate will be for ever memorable from the fact that we have listened to four speeches from what the noble Lord, Lord Crawshaw, called so well the "mobile Bench". I thought that was a good rebuke in advance to the noble Lord, Lord Raglan, who implied that they were essentially static. But, as was explained to me by one of them in an aside, it is not out of necessity that they have stayed here throughout all the speeches; it is out of good manners, interest and design. It would indeed have been rather upsetting for us if they had, so to speak, taken to their wings and wheeled away—or possibly frightening for the Front Bench if they had suddenly moved forward. In any event, they have made very remarkable contributions.

Although I do not intend to deal with any of the issues raised today on their merits, I cannot help thinking that the special value, appreciated so widely by us all, of the contributions from those who are themselves disabled is a very strong argument for making sure that the disabled are in fact represented on these Committees. At present, as I indicated earlier in the debate, there has to be representation of those who have knowledge of the disabled. There may be many people in this House who have knowledge of the disabled, but I do not think anybody can deny that those who are actually disabled themselves are in a class of their own when it comes to describing the problems of the disabled; so do not let us forget them when we are discussing the question of representation of disabled people on these Committees.

All of us who are concerned with this Bill are, I am sure, grateful to the Government, and to the noble Baroness in particular. As she says, it is a Private Member's Bill, but we look forward to very close co-operation. That does not mean that we do not consider, as I said at the beginning, that the Bill must be very considerably strengthened. Having heard all that has been said to-day, I realise that there are quite a number of additions and modifications of which I myself was not aware before but which are clearly desirable. But, of course, I see the point of the noble Baroness when she says, or implies, that there is a limit. This must remain the same Bill. We cannot try to turn it into something totally different. But let us send it back, as I would hope, very much improved and strengthened, but still as the Bill that is usually known as the Alfred Morris Bill.

It is hardly for me at this moment from this place to indicate to those concerned with the Amendments what should be done. clearly there is much to be done, and we must, so far as possible, co-ordinate our efforts. That does not mean that Peers have to be in a way dragooned into some co-ordinated group and that nobody is going to be allowed to have his own personal opinion. That would be quite beyond my power, even if it were my wish. So no doubt a number of Peers will bring forward ideas entirely on their own. Certainly it is highly desirable that as many of us as possible should try to put our heads together between now and the Committee stage in bringing forward Amendments. My Lords, I do not wish to say any more, except that I believe that this has been a day of great hope for the disabled and all who care for them. I commend the Second Reading of this Bill.

On Question, Bill read 2^a, and committed to a Committee of the Whole House.