CHRONICALLY SICK AND DISABLED PERSONS: WORKING OF 1970 ACT

HL Deb 26 May 1971 vol 319 cc1174-252

4.4 p.m.

Debate resumed.

LORD WELLS-PESTELL

My Lords, I hope the noble Lord, Lord Cullen of Ashhourne, will not think me impertinent if I congratulate him on his maiden speech and say that as a maiden speech it was in the best traditions of your Lordships' House. It was brief and to the point, it made a valuable contribution to our discussion this afternoon and. above all else, it was non-controversial. I understand that the noble Lord, in his time, has been an amateur tennis champion, and perhaps he will understand me when I say that 1 am sure I am voicing the view of your Lordships that he has won his first match with many games in hand and we hope it will not be long before he plays another.

My Lords, I want to be brief this afternoon, but I should like to say that I think it will be to the everlasting credit of the last Government that the Act which we are discussing to-day found its way on to the Statute Book. I also believe that it will be to the everlasting credit of this Government if they continue to take steps and make a sincere and sustained effort to see that the Act is fully implemented by all local authorities. I listened with considerable interest and some sympathy and appreciation to what the noble Lord, Lord Aberdare, said about what has been achieved so far, but we must bear in the forefront of our minds that the successful working of this Act will depend not so much on the Government—although, of course, it depends very largely on them—but on the way in which local authorities do what is required of them in the Act. I feel that the Government should have moved a little faster in this matter than they have, but I realise that this is a matter of feeling.

We have been reminded that we are coming up to the first anniversary of the Royal Assent to this Act, and Section 1 has yet to be implemented although we have been told by the noble Lord, Lord Aberdare, that the appointed day has been fixed. Section 1 of the Act is quite clear. It lays a responsibility upon the local authority to inform themselves of the number of persons within their area to whom the section applies, and to the need for the local authority to make a register of people who are likely to benefit under the Act.

I will not burden your Lordships with Section 2, which again is quite clear. I could not accept the explanation of the noble Lord, Lord Aberdare, for not having fixed an earlier date than October 1. I should have thought that very soon after the passing of the Act the local authorities could have been encouraged to have started compiling their lists, rather than waiting until October 1 this year, knowing full well that for many of them this is a gigantic task and one which will take them a long time to do.

I also wish to draw the noble Lord's attention to the circular which he and his right honourable friends sent out on August 17, 1970. I think this is quite shocking. Dealing with Section 1—and this is a circular which was sent out by four Government Departments to local authorities, commenting upon an Act—it says: It is not "— and I repeat the word " not "— a requirement of the Section that authorities should attempt 100 per cent. identification and registration of the handicapped. I think that is quite bad, and I will give my reasons. The noble Lord may not agree with me. The reasons given in the circular are that this registration would be difficult. But local authorities exist to overcome difficulties. That is their role; and if they cannot perform it there should be people who can.

The circular goes on to say that it would be an expensive and time-consuming exercise—but this is the role of the local authority, and what they are there for: to look after the needs of the people within the area whom they seek to serve. If they are told it is not intended that they should attempt 100 percent. identification and registration, surely this could be construed by some local authorities—and I believe it is so construed—as an invitation to them not to bother too much about the register. From my knowledge of some local authorities, I believe that many of them will in fact act upon it. This statement in the circular could go some way to undermining the value of the Act. I believe it to be an unfortunate sentence. I hope that the Government will look at it because I am sure that they will be, in the course of time, sending out other circulars in which perhaps this could be put right. I do not know whether it is fair to ask the noble Lord, Lord Sandford, to comment on that matter when he comes to speak, because it may not be possible for him to do so in the time available.

The need for a time limit in respect of the compilation of the register of the chronically sick and disabled is in my view important. When the previous Government were in power, I moved an Amendment calling on local authorities to compile their registers and to submit them to the Secretary of State within 12 months. That Amendment was defeated. I should like to ask Her Majesty's Government whether they would consider fixing a time limit, so that within a period of, say, one year the Secretary of State could get some idea of what the position is in all local authorities throughout the country, and what is likely to be required. This would give the local authorities a year, if a year was fixed as the period—and I agree with the noble Lord, Lord Aberdare, that it is quite an onerous undertaking. We do not know the size of the problem. We think we know roughly its size, but we really do not know the full extent of it. I believe I am right: in saying that the City of Manchester, which has quite a reputation for its vast and comprehensive network of social services, did not realise the full extent of the situation concerning the chronically sick and disabled in Manchester until they undertook a careful investigation of the problem; and they intend eventually to have personal visits made.

Some local authorities, I recognise, have got off the mark quickly, and are to-day in possession of information which they have never had before: they know that there are many more people in their area needing help of whom they did not know a month or two ago. I do not want to comment this afternoon on the achievements of some of the more progressive of our local authorities. I have reason to believe that some of my friends will be comenting on what certain individual local authorities have achieved. I want to take what is perhaps a more critical, and maybe, in the view of some of your Lordships, a more pessimistic view of the situation. I am concerned, however, with those local authorities who are moving slowly and those who are not moving at all. I should like the Government to state quite clearly that the services provided in Section 2 are mandatory. I do not think that all local authorities believe that it is a statutory obligation on them to provide the services set out in Section 2 when needed.

A large number of local authorities are dragging their feet, and I know from personal inquiries that I have made of some directors of social services that some arc not proposing to implement Section 2 at all. If your Lordships will forgive my being personal for a moment, I am chairman of a national voluntary organisation that has been providing for 31 years, since 1938, radio and television to bedridden, housebound and aged poor. Since this Act came into force, we have been inundated by some 40 or 50 local authorities wanting to know how they can get radio and television from our voluntary society. In the course of conversation, several of them have said quite definitely that their local authority has no intention of implementing Section 2. I want to ask the Government whether it is possible to find out from local authorities what they intend to do, because the success of the Act will depend in the last analysis on what they do, and not so much on Government circulars or directions.

Although, as the noble Lord, Lord Aberdare, quite rightly said, we are dealing with a small section of the community, I am sure we all realise that it is doubtful whether we should find in the community a group of people who more urgently need the help of those who are more fortunately placed than the chronically sick and disabled. Many of them are cut off day after day, week after week, month after month from the outside world, save for an occasional visit from a friend or a relative who pops in and pops out with great speed. Many of them never have another face in the room; many of them never hear another voice in the room. But this Act could end that situation for a large majority of them. I hope that the Government will see their way clear, at a fairly early date, to find out what local authorities are doing, so that we can have some measure of those local authorities who are not proceeding in the matter at all.

In my discussion with certain directors of social welfare as to why the scheme is getting off the ground so slowly, various reasons have been given to me. They talk about the cost involved—and the noble Lord, Lord Aberdare, has dealt effectively with that matter. They have complained—if " complained " is the right word—about the additional work in which it will involve the local authority, and of the increase in staff, which again means money. Several of them have complained that it has come on top of the implementation of the Local Authority Social Services Act 1970 and the Children and Young Persons Act 1969. I hope that the Government will take steps to impress on local authorities that they have this statutory obligation under the Act to provide certain specific services for the chronically sick and disabled.

I am grateful to the noble Lord, Lord Aberdare, for spelling out what the Government are prepared to do in terms of money. I think it is so important that I am tempted to ask the noble Lord, Lord Sandford, whether he could see his way clear to cross the t's and dot the i's on what the noble Lord, Lord Aberdare, said, because I think the Money Resolution by which Parliament gave financial backing to the implementation of Section 2 of the Act needs to be spelt out very clearly and precisely. I think it is necessary to tell local authorities—and from that point of view the community—that there can be no saving of public money by failing to provide adequate local services for the chronically sick and disabled: in fact, it may well prove to be a money-saver, because if this Act is implemented, as the last Government felt and this Government feel that it should be, it may make a good many disabled people less dependent on institutions and institutional living. It is the responsibility of the Government to see that their enactments are properly carried out, and again I ask them to be watchful of this matter.

There are many reasons why local authorities should be asked for progress reports at regular intervals, and I think there are reasons for the Government making certain that any financial support given under the Money Resolution is used for the purpose for which it is given, and not, as has happened in the past, as I think the noble Lord, Lord Aberdare, knows only too well, in order to keep the rate down. I do not know how it is possible to ensure this, but I ask the Government to see that money given to local authorities to help the chronically sick and disabled is used in that direction only and that none of it is whittled away in other directions.

4.20 p.m.

BARONESS DARCY (DE KNAYTH)

My Lords, may I first of all thank my noble friend Lord Ingleby for giving us this chance to consider how effective this Act has been during its first year of life. I should also like to congratulate the noble Lord, Lord Cullen of Ash-bourne, on his very interesting maiden speech. The noble Lord, Lord Wells-Pesten, has spoken ably about Sections 1 and 2 and I shall confine myself to saying just a couple of things about the area in which I live. An assessment has been made to determine the sort of numbers involved based on the population of Berkshire in the light of the Government Social Survey, and the Director of Social Services feels that the problem is not going to be as great as some people seem to fear. He does, however, foresee a serious situation arising in a few years' time with regard to another matter which is worth mentioning here as this Act includes the mentally handicapped.

The problem he foresees is that of mentally handicapped people living at home who, thanks to medical science, will now outlive their parents. There will soon be a great need for hospitals for these people, many of whom can go out to work but who need someone to help them with the daily running of their lives. That is for the future. There is of course at this very moment a tremendous need for hostels for the physically disabled who go out to work—both for the completely independent and for those who need a certain amount of help.

I should like to make one point about the means test. This varies from area to area, but the underlying principle is the same. In Berkshire it applies only to such things as televisions and telephones and to adaptations costing over £100. Some rather complicated calculations are involved, but one point is quite clear. It is stated that if the person has assets of more than £600, then no grant should be given to him by the county council except in special circumstances. This sum seems to me unrealistic and to be out of touch with the cost of living these days, particularly when one remembers that life for the disabled is inevitably more expensive and their employment situation much more precarious. Surely it is time to change from a poverty-orientated means test to one based on the needs of the person being considered.

The Director of Social Services had, I thought, a good plan for spreading information about the welfare services available. This was to send out a booklet with the rate demand, which would ensure that every household received a copy. He also felt very strongly that the disabled should be helped to help themselves, by giving all the information possible about the most suitable equipment available. It is indeed vital that the person is given the right type of equipment for his particular need. The voluntary organisations are helping very much to achieve this. Noble Lords have already mentioned the Disabled Living Foundation's information service; and there is also the mobile exhibition run by the Spastics' Society. I was delighted to hear the noble Lord the Minister say that the whole question of aids and equipment is under review.

One Amendment relating to information which was very strongly supported by many noble Lords, including the noble Lord, Lord Sandford, was a new clause calling for better information to prescribers. It was withdrawn only when the Minister gave firm assurances that the Department was considering the best ways of disseminating information. Has the situation changed since those assurances were given? There seems to have been a slight improvement, although I am told that welfare workers and the disabled themselves are still occasionally told that a particular item of equipment is not available through the National Health Service, when in fact it is. Some items not previously listed now appear in the Handbook of Wheelchairs and Hand-Propelled Tricycles, but two of these really need to be illustrated; namely, the Talley alternating pressure pad and the ballbearing armrests. Incidentally, the latter are described in a most discouraging way which would deter most people from prescribing them. There have been no changes in the Handbook of Motor and Electric Tricycles. The Epic is still the only powered wheelchair featured, although several other types are available through the National Health Service which are more suitable for some people. They are indeed prescribed by those who know about them but the point is that too few people do know about them.

Very few people appear to realise that since 1966 the Department of Health has agreed to make Possum equipment available through the National Health Service. Possum can be operated simply by sucking and puffing, or indeed by any residual movement the user possesses, and has helped extremely disabled people, who would otherwise have been totally incapacitated, to communicate with those around them, to gain some degree of independence, and in many cases to do a worthwhile job. The South-West Metropolitan Regional Hospital Board has recently circularised general practitioners in its area with information about Possum. It would be an excellent plan if other Hospital Boards or the Department of Health would follow this example.

Information is also the subject of Section 22, which calls for an annual report on research and development on equipment that might benefit the disabled. When the Joint Under-Secretary of State introduced this clause in its new form in another place he expressed the hope that it would include information from abroad and from voluntary organisations where-ever possible. I certainly hope that this report will not be as threadbare of information as the Handbook to Prescribers; that it will indeed contain information from abroad, and from fields other than those specifically concerned with helping the disabled.

Simple technology, if applied with imagination and thought, can answer many of the needs of the disabled. New materials will mean that aids such as calipers can be lighter and more streamlined as well as stronger. So I hope the report will take into account work going on at places such as the bio-engineering workshop at the Royal National Orthopædie Hospital at Stanmore, and the Bath Institute of Medical Engineering, mentioned by my noble friend Lord Ingleby, where doctors, engineers and technologists co-operate to bring a multidisciplinary approach to problems. We must remember that the report is to include any equipment that might improve mobility. Anything which might lead to a solution of the mobility problems of the more severely disabled should be followed up. Unless something is found soon, the more severely affected thalidomide children will join the ranks of disabled passengers. But that is for the future. What about the present? Has the mobility situation improved over this past year? One section of the Act which was particularly welcome was Section 21 (the new badge scheme) because it gave help for the first time to those too disabled to drive themselves. The noble Lord, Lord Cullen, said he gathered that it was to be implemented very shortly. I should like to ask the noble Lord the Minister who is to wind up for the Government exactly when this will be.

I also want to ask the noble Lord to explain the Government's attitude to the use of powered wheelchairs out of doors. Some models may not be entirely suitable for use on pavements, but several types issued by the Department of Health are suitable for careful limited outdoor use. Every disabled person receiving a powered wheelchair from the Department has to sign an agreement that it is for indoor use. Before the Act was passed, it was of course illegal to use these chairs on pavements, but the Department used to interpret the conditions of supply liberally to include " within the curtilage of the residence "—that is to say, in the garden. Under Section 20, it is now legal to take them on pavements. Some models issued by the Department may not be completely suitable for this; but why, if the Department allows their use in the garden only, does it not say so, rather than getting the user to sign the " indoor use " agreement? The user also has to agree to surrender the chair immediately if instructed to do so by the Ministry. As a member of the Joint Committee on Mobility for the Disabled. I know that this situation has distressed many people who hoped to gain a little more freedom once this Act was passed. One is left wondering why, if these chairs are unsuitable for use on pavements, the Department does not issue ones that arc suitable.

Many Amendments relating to mobility were withdrawn following assurances that the vehicle service was to be thoroughly reviewed. What has happened since these promises were made? Subsequent Answers in another place indicated that the Department still lacked statistics, but now, with the publication of the Government Social Survey, we can look forward to a thorough review. Results of previous reviews have never been published, but I certainly hope that this one will be. The Joint Committee on Mobility have firm views on what this review should be like. They hope, first, that it will be thorough and based on sound statistics from the Survey; secondly, that it will assess the needs of the disabled passenger as well as the disabled driver; thirdly, that it will take account of the family responsibilities of the disabled, and their medical and social needs; fourthly, that it will take account of where they live and what they earn and how disabled they are; fifthly, that it will include a costed analysis of alter- native schemes, including a mobility grant scheme, for helping the disabled with their outdoor mobility. Surely a mobility grant scheme would solve all these problems, give the individual disabled person a choice, and avoid the costly administrative overheads involved in running a vehicle and repair service.

So the fact is that there has been as yet no change in the vehicle situation. Those who are sufficiently disabled to qualify for a three-wheeler, but too disabled to drive themselves, are still without any financial help and still paying vehicle excise duty. I should like to point out that there is an opportunity now, in another place, to give some help to these people, for there is a chance that Section 11 of the 1964 Finance Act can be amended to provide exemption from vehicle excise duty for these disabled passengers. It seems to me ridiculous that a person should be excluded from any outdoor mobility help merely because he is more severely disabled than others. Surely this state of affairs cannot last much longer? I certainly hope it will not.

There has been no change in the position of the disabled mother. She must still travel alone without her children; she cannot even take them to the doctor or the dentist; she has to leave young children alone in the house while she goes shopping. The children, the marriage, the entire family suffer. Surely the invalid vehicle service should no longer be based on the concept of " an extension to an artificial limb ", as it has been termed by the Minister in another place, and even more strangely on the requisite of our ability to drive. Surely it is now time to approach the service in terms of providing mobility both for the disabled themselves and for their friends and families—and providing it irrespective of whether or not the disabled themselves are too disabled to drive. My Lords, it is not much use providing the disabled person with an extension to an artificial limb if in the process you amputate the disabled person from his family, and in turn amputate the family from society as a whole. If people are isolated from the community they cannot develop to their full potential, and until they do this they cannot give of their best.

4.32 p.m.

THE LORD BISHOP OF ROCHESTER

My Lords, I venture to intervene briefly in this debate, not because I can lay claim 'to 'the specialist knowledge or experience of some other noble Lords who have already spoken, but perhaps because (the welfare of chronically sick and disabled persons is a pant of the day-to-day ministry of clergy and ministers up and down the country. Moreover, in an increasing number of places it is, I believe, seen by members of the Churches and other voluntary bodies as a rewarding field of personal service. Many such people were greatly heartened by the passing into law a year ago of an Act which seemed to be in line with the current development in social policy of making the neds of the individual the paramount consideration. The consequences of such a policy are to try to adapt services to meet the needs of individuals and to promote local and personal services wherever possible, reserving institutional care for cases where there really is no alternative.

Another way in which I think the 1970 Act encouraged many people was that it was made clear (that the services to be supplied were to be an entitlement by right of citizenship and in no sense a charitable dispensation. Therefore I think it was to be expected that the passing of the Act would raise 'hopes that in those areas where the provision of facilities had been patchy or wanting, to say the least, there would be a fairly swift improvement. We here realise 'that there is always bound to be a considerable time lag, even when notice has been given of an appointed day, but I do not think we should he 'surprised that there are reports of perplexity and disappointment, where individuals seeking information about the provisions of 'the Act have not only been refused it but have been given no reason for the refusal. I welcome the Minister's announcement this afternoon about an information leaflet, and I hope this will be widely distributed.

My Lords, many social service departments find it 'hard enough to cope with those who ask for their help, without seeking out others who may have similar needs but who, for one reason or another, have not yet asked for help. The noble Lord, Lord Aberdare, referred to the obligations under Section 1 of the Act which will lie upon local authorities in the near future, and some of the difficulties that may confront them in fulfilling the particular responsibility of making a survey and of making information available to all those concerned. If the task of making such a survey and of providing the information of the facilities available is beyond the resources of the existing staff of a social service department, and if it is found quite impossible to increase that staff sufficiently soon to get the survey under way, surely here is another opportunity for a partnership between voluntary and statutory bodies.

I happen to have spent 12 hours on Sunday in a group of parishes where there is a highly organised and well supported scheme for providing voluntary social service of many kinds. A large number of volunteers are involved, under trained leadership, and I was told that with the possible help of some social work students it would be quite possible for the necessary survey to be made in that community by volunteers, and that within that community there already exist the necessary channels whereby information could be conveyed to all those for whom it was intended.

An imaginative use of volunteers under good leadership would only involve a local authority in the essential organising and administrative supervision. The partnership of voluntary and statutory bodies in the service of the community is a feature of our national life of which we are justly proud. The full and speedy implementation of this Act will, I believe, only come about if there is such a partnership and if it is allowed to grow and is firmly based on mutual respect and mutual understanding of the role of each partner. It is possible for a voluntary organisation to be taken advantage of, just as it is for statutory provision to be neglected. Respect and understanding will only be assured if there is the fullest possible co-operation between all concerned. I would venture to hope that the Government, in seeking to ensure that the will of Parliament is fulfilled in respect of the welfare of chronically sick and disabled people, will do everything they can to encourage statutory and voluntary bodies to work closely together. Neither can do all that is required unaided. Both together could do so much more than is being done now.

4.39 p.m.

LORD CRAWSHAW

My Lords, I think your Lordships would agree that not every Act works exactly as Parliament lays down. An Act is not necessarily the worse for that, and in this case I think we have an instance where the Act has been extremely valuable propaganda and in that way has already proved most effective. I personally have found greatly increased interest and awareness among the general public. As has been said already, this is a happy reunion on the anniversary of the passing of the Act, and I am sure your Lordships will envy the company I keep on these occasions. I am delighted, too, to welcome my noble friend who made such an excellent maiden speech, and to emphasise that this whole matter is far from what in modern jargon is known as a " closed shop ". After all, it is a matter which can affect everybody, and we are all delighted when some new person takes an interest in the subject.

I agree that the report of the Office of Population Censuses and Surveys has revealed an enormous problem. Three million people, excluding under-16s and the very elderly, are seriously impaired in this country. So I do not think I can quite accept the view expressed this afternoon that we are talking of only a small section of the community: I am afraid that it is too large a section, and unfortunately it is an increasing section. Too many of these people are kept for too long in hospital. There are three points that I want to make about the hospital service. The first is that it is bad for people to be institutionalised. Referring again to your Lordships' recent debates, I do not think I need explain the symptoms and the effects of over-institutionalisation. All I need say, having been here on several occasions late into the night, is that an excess of this numbs the senses and saps the fibre.

The second point I would make on hospitals is that there is, as your Lordships know, a chronic shortage of nurses, not only in this country but in the rest of the world; and this shortage will get worse unless something is done to improve the conditions in which they work. A famous national hospital well known to all of us, and I expect to most of your Lordships, the Stoke Mandeville Hospital, tell me that, because of lack of staff, two wards have been closed for over a year. This is a very serious situation in a hospital that is known world-wide, and I am sure that it is not the only one affected in this way.

My third point on hospitals is that the average cost, apparently, of keeping a patient in a National Health Service hospital is £2,839 per annum—a large sum by any standards. This leads me to suggest that the provisions of Section 2 of this Act are vital in an attempt to combat these three factors. Apparently many local authorities are concerned as we have heard this afternoon, that the cost of providing services will represent a substantial burden on the rates. But surely through the payment of rate support grant the greater part of the expenditure will fall on the Central Government. I agree with the noble Lord, Lord Wells-Pestell, when he said that wherever the money comes from there is no overall saving of public money in failing to implement Section 2. Saving small amounts of ratepayers' money wastes far more taxpayers' money.

Before I leave the subject of hospitals, I would just make an observation which I heard argued effectively the other day by a well-known former Minister of Health, Mr. Enoch Powell, who maintained that the central organisation leaves much to be desired and that the whole system of hospitals should be examined. This is not the time or place to do that, but I believe that it would be a well worthwhile exercise. I should like to see the expenditure on hospitals and on Section 2 of this Act come out of the same pocket, because in that way people would get a much clearer picture and be able to understand that saving is robbing Peter to pay Paul.

I should like to express my appreciation of a campaign run by the People Sunday newspaper, which did a very good job of publicising this Act and trying to get it implemented. Its present impression, with which I would agree, is that on the whole local authorities are doing their best, but some of its readers have been told by the local authorities that there are no funds to deal with their requests. Surely, again because of the rate support grant, this cannot be true. I agree with the noble Lord, Lord Wells-Pestell, when he said that a further clear directive is needed from the top to the local authorities.

I agree with what has been said about the importance of Section 1. I should have liked it to come into force before October, but now that the date is fixed I quite accent it. But I must stress that it is vital that this date is adhered to, because if for some reason there is some further putting off I think it will be the greatest disappointment and tragedy to a whole lot of disabled people to whom hope is a real and important factor. I realise that the date could not he fixed before October because of the appointment of the local directors of social services, and I am glad to say that in my part of the world, the Midlands, Leicestershire, there is progress. The director of social services there has met representatives of all the voluntary organisations and they are being asked to supply names to the register.

We must not underestimate the enthusiasm, the experience and the resourcefulness of the voluntary organisations—and indeed they were the driving force behind this Act. Now that some services formerly provided by them come under Section 2 of the Act, I hope that they will be able to take on new roles; for example, as representatives on the various committees, spurring local authorities to discharge their obligations, and acting individually in their own spheres to try to get the principle of the access sections accepted.

That leads me on to the question of access. Here I should like to address a few remarks to my noble friend the Parliamentary Under-Secretary of State, Department of the Environment. I am always rather impressed by that rather long title, and I tried to think of a suitable abbreviation the other day. Bearing in mind his interests outside this House, I thought possibly the one that fitted him best was, " the noble Lord, the Lord of Creation ". I have mentioned the value of propaganda, and I think that this is particularly effective in the question of access. In my view there is no overall pattern emerging, but everyone is doing bits and pieces, and the climate is definitely changing. Certainly there have been great improvements in the Houses of Parliament. The British Museum extension provides access, and I know that the noble Viscount, Lord Eccles, is very much aware of the problem. Public conveniences are starting to live up to their names. Not being able to see the St. Leger, I complained about a race-course. Now I can report that the race-course concerned has made a considerable improvement.

More doubtful are some rather odd regulations at other places. I know that at Earl's Court many people have been prevented from seeing various exhibitions and shows by some regulations which, though they may be valid, were not fully understood by the people who were waiting to see those shows. I hope that my noble friend Lord Sandford may be able to explain the position in this and other cases. Theatres and cinemas also seem to have strange regulations. When one goes there one has to sit in one of the seats, and not in one of the gangways, and there is no doubt that should there be a tire the people who had to leave by wheelchair would be the last to get out. It is not a very enviable situation.

Places of employment are not covered by the Act, which I always thought was an omission; and of course the whole question of employment is a vital issue, as my noble friend Lord Ingleby has said. My final thought on this question of access to buildings is that no planning permission for public buildings should be granted unless access for the disabled is provided. I hope that my noble friend Lord Sandford may be able to confirm that this is a proposition which can be carried out.

During the discussions on the Bill before it became an Act I mentioned the question of access to public transport, and during the Committee stage I withdrew an Amendment after an assurance from the noble Lord, Lord Hughes, who was replying for the Government, that he would issue a circular to operators and manufacturers of public transport equipment. I am hoping that the assurance given then will be taken over by my noble friend Lord Sandford because, after those opening shots last year, I think it is now time for increased pressure. I know that there are difficulties. But I am hoping that, after what I read this morning was the profit made by British Railways, they will use some of it to give me a little better transport than I enjoy in the guards' vans at present. After all, even if the figures for the nationalised industries cannot be interpreted as profit, as taxpayers we all subscribe to them, and I believe that public transport as a public service should be available to all. Before I leave that aspect, may I say that I think I was misconstrued last time when I complained about London taxis? I in no way meant to complain about the personnel involved in any form of public transport: I find them extremely helpful. It is the tackle they are compelled to use that causes me a great deal more doubt.

My noble friend Lady Darcy has dealt very adequately with the question of vehicles, and I can only support very strongly all that she said. I do not want to argue the merits and the faults of three-wheeled vehicles versus four-wheeled vehicles, but many people, including Mr. Graham Hill, with whom I have discussed this subject fairly often, believe that the three-wheeled vehicle is inherently dangerous; and I can well see that. I am not fortunate enough to drive a car, but I should hate to come 90 or 100 miles down the M.1 to your Lordships' House in a three-wheeled vehicle, because it simply would not be stable enough to complete the trip. My noble friend beside me says that I should not be allowed on the M.1, so there again there is a definite restriction. We feel that it is a relic of a Victorian approach, and the sooner the situation changes the better. We also feel that the four-wheeled vehicle would open up great opportunities for disabled passengers who are discriminated against at the moment in a most unfortunate way. If anyone thinks that severely handicapped people cannot work, and therefore do not really need transport, I wish they would meet Mr. Peter Large, who is here this afternoon. He is an excellent administrator, was the greatest help to all of us in our speeches on the Bill, and is an inspiration to a great many others.

My Lords, I should like to finish by echoing what has been said about the car badge scheme. I hope that this will be universally recognised by every authority in the country, and not only in certain areas. I also hope that it will be implemented as soon as possible. I am grateful to your Lordships for all the interest you have shown in this subject during the last year or more, and I only hope that this great interest will be reflected by further positive action on the part of Her Majesty's Government.

4.56 p.m.

LORD AMULREE

My Lords, when I made a speech on the Second Reading of this Act last summer, I referred to the fact that I had thought for some time it would be a very good plan if the Government provided an allowance for people to take care of their elderly relatives in their own homes. Imagine my surprise, therefore, when the National Insurance (Old Persons' and Widows' Pensions and Attendance Allowance) Bill came before us not very long after that, to find that part of the Bill provided for this. I do not claim for myself any credit for this, because I am sure that it was decided long before I made my speech. But I was extremely pleased to see it happen, and was more complimented still when Her Majesty's Government invited me to become Chairman of the Attendance Allowance Board, which post I was very pleased to accept.

I was pleased to hear the Minister talk of the progress which has been made in the provision of schemes for the care of the younger chronic sick and disabled person, because this is what they require. They are extremely difficult matters to work out properly, because the number of young chronic sick is not very large and it is very difficult to arrange that they should be somewhere near their friends and family. So it does the Government a great deal of credit that 455 extra beds should have been provided for those people in this comparatively short time. From another point of view it relieves some of the pressure on the geriatric services in the country.

Here I should like to say a word about the meaning of the word " geriatric " which has gone badly wrong in the last few years. When the geriatric services first began, immediately after the war, they were in places where people went for active treatment and not for custodial care. They have now come to be taken to mean what were the old chronic sick wards of the Poor Law, where people lay quite neglected and uncared for. I only want to make that mild protest to try to get the record put right, because geriatric services should mean active places where acute medicine is practised and where people get back on their feet, and not places where people are uncared for till they die.

One point which I raised on Second Reading was the question of mobile physiotherapy, so that active treatment could be given in their homes to patients who, for some reason or another could not go to a department of a hospital. That could be quite an important factor, because it might prevent people becoming disabled and chronically sick. I know that there are a certain number of arguments against that, the biggest one being that the services of the physiotherapists are rather valuable and it is better that they should be concentrated in the hospitals. The noble Baroness Lady Serota, who then replied for the Government, said that a working group was reviewing the work of the remedial professions with this object in view. When he comes to reply perhaps the noble Lord could tell me whether anything has come out of that.

Another point which I think is of great importance was brought to my attention first of all by a disabled person himself; namely, that when people become acutely disabled—say, for example, paraplegia following a fractured spine—they should be told immediately what services are going to be available for them when they recover. They should be encouraged to think that they are going to recover and are going to go back to work, and they should be told that there will be quite a lot of help given them from that point of view. Here, I should like to say how grateful we are to the noble Lord, Lord Cullen of Ashbourne, for what he has said about the facilities and services available to the disabled. I am quite certain that more of this needs to be told, and more of this kind of information needs to be spread about the country. Finally, I think it is extremely important that when patients are discharged from hospital a note of their present condition should accompany them whether they are going back to the care of their doctor or into their own care at home. It is important that there should be some kind of continuity in this respect.

In this large report which I see in front of the noble Lord who is to reply there are several categories of disability mentioned, and I should like to come down to a very low one, Category 16, which includes the mentally senile. There, I think it is indicated that more of these people are being kept at home who, because of the enormous strain they impose upon their relatives and their friends owing to their disability, should go into some kind of hospital. Surely one of the troubles there has been the fault of the mental hospitals, which since the passage of the Mental Health Act, 1959, have steadfastly refused to accept these long-term disabled elderly folk whose correct place is in such hospitals. So I wonder whether a certain amount of pressure could be brought to bear on the mental hospitals to make them wake up to their responsibilities and take more of these people. It was comparatively simple before the passage of the Mental Health Act to get these patients transferred; now it is very difficult.

My Lords, we have been told that Section 1 of the Act comes into force on October 1. I hope that in addition to getting a register prepared there will be done something which I think is even more important that that: that wide publicity will be given to the facilities that are available at the present time from the local authorities and from the voluntary organisations for all disabled persons. The Minister mentioned that a leaflet would be published. I trust that that will he a really full document and that it will be widely distributed so that nobody can plead ignorance of what facilities are available. There is one suggestion I should like to make to the noble Lord before I sit down. When people are badly disabled—for example, patients with paraplegia, to whom I referred—they receive constant demands from various bodies, quite properly, for medical certificates. A case in point—and one always comes back to individual patients—is of a young man I know who has a fractured spine. He is a paraplegic, but he is a very young and determined man. I think the noble Baroness, Lady Masham, met him and talked to him one day, with me. What he suggested was that it should be possible for such people to be given a book of medical certificates so that they do not need to keep returning to the hospital or to their doctor for another certificate. If a book of certificates could be issued from which they could extract one when required, to show it to the appropriate authority, this would certainly save a great deal of trouble for them, particularly if they are in full-time employment and have to travel long distances to get their certificates.

Finally, I agree entirely with what has been said about how important it is that voluntary services and the local authority official services should work closely together. That, I am sure, is the only way we can get a really proper working of this Act of Parliament. It is not going to be an easy one to implement fully as it is, but it cannot be done at all if the voluntary bodies are not brought in on a big scale right from the start.

5.7 p.m.

LORD HARDING OF PETHERTON

My Lords, as chairman of the National Fund for Research into Crippling Diseases, I should like to address myself particularly to Section 19 of the Act; but before I come to that I should like to say how delighted I am that the noble Lord, Lord Cullen of Ashbourne, has decided to break a long silence to speak in support of the proper implementation of this very important Act. On this question of research, and referring to Section 22 of the Act, that section requires the Secretary of State to lay before Parliament each year— a report on the progress made during that year in research and development work carried out by or on behalf of any Minister of the Crown in relation to equipment that might increase the range of activities and independence or well-being of disabled persons, and in particular such equipment that might improve the indoor and outdoor mobility of such persons ". With your Lordships' permission, I should like to expand on the question of medical research in this context of the disabled rather more widely than is indicated in that particular section of the Act. I would submit, without in any way detracting from the great importance of the other provisions of the Act, that research into the prevention and cure of any form of disabling or crippling diseases is all-important on the basis that, always, prevention is better than cure.

As your Lordships know, the main official supporters of medical research in this country are the Medical Research Council and the University Grants Committee, and both are dependent on public finance. If one looks at the sums which have been spent by these two bodies over the last few years, one could at first glance come to the conclusion that a considerable increase in the expenditure was being made. Arithmetically, that is so; but then one has to take into account two factors: first, the effect of inflation. of rising costs in terms of salaries and wages and accommodation; and, secondly, what is not so generally known, rising costs in the provision of the equipment and other facilities needed for research.

I do not think it is too remote from practical reality to say that the further research proceeds, the more costly it becomes. Research leads to research and. although in some cases research leads to conclusions and practical results which reduce the cost of the services to be rendered or the research to be carried out, in other cases it increases these costs and so it is an escalating factor. This, I think, is not always fully realised. If we are to provide those people who are devotedly working in carrying out research into the prevention and cure of crippling diseases, those two factors must be recognised and fully accepted, and this is to some extent paradoxical. In other words, the more research you do, the more costly the future research becomes, and you discover ways and means whereby if the finance is available you can continue the research and produce definite and practical results.

As your Lordships will know, the allocation of funds for medical research is done, as I said just now, through the Medical Research Council or the University Grants Committee. On this aspect of medical research the University Grants Committee has, on my advice, suffered more than our M.R.C. The University Grants Committee is, of course. concerned primarily with teaching, more than with research, but I am sure that your Lordships who look closely at this subject will agree that a university department is an appropriate place for research. It is appropriate because, so to speak, the academic brains are available in the university circle. It is also appropriate because there you have the young men and women who will be interested in going beyond the normal practice and will adapt themselves and prepare themselves for being effective research workers in the future.

With some pride and some diffidence I should like to tell your Lordships what has been done by the National Fund in the way of establishing Research Chairs and so on in the various universities and other establishments over the last ten years or so. In the University of London, Chairs have been established in virology; at the Royal Post-Graduate College of the Medical School at Hammersmith in orthopædics; at the University of London, in neurology; at the Institute of Psychiatry, which is part of the University of London and, jointly. the Muscular Dystrophy Group and the Multiple Sclerosis Society. in neuro-chemistry; at the Institute of the University of London, and in Oxford two research Chairs, one in pædiatrics and the other in clinical neurology; and. finally, in the West Indies, a Chair of rehabilitation in orthopædics at the University of the West Indies. I claim, on behalf of the voluntary organisation of which I have the honour to be the chairman, that this is a formidable achievement: but it hardly does more than attack the fringes of the problem. There is an immense amount to be done in these fields of medical research.

In this country, we have a tradition of successful medical research. There are names like Hunter, Jenner. Lister and Alexander Fleming to testify to this. In the United States of America, President Nixon has recently announced massive financial support from the Government for cancer research. While not for a moment do I believe that money necessarily means good research, I would maintain that there is a strong case for the Government to take a fresh look at the priorities it accords to medical research, particularly in this field of the prevention and cure of crippling and disabling diseases, when making future allocations to the University Grants Committee and the Medical Research Council. This not only has a moral and a social application, but, I would submit, has an economic application as well,

because the more that you can prevent disablement from occurring, the more you can enable disabled or crippled people to lead a useful and practical life and, the more you will turn them from being users of the taxpayers' money into contributors to the rates and taxes. Therefore I should have thought that this would have a direct appeal to the economic aspects of running this country. Briefly, I would suggest that in this field of medical research there is a strong case, both on social and moral grounds and on economic grounds, for Her Majesty's Government to review, and review favourably, the allocation of public funds made to research for the future benefit of those people who may be born disabled or, by accident or mischance, become disabled during the course of their lives.

5.17 p.m.

BARONESS SUMMERSKILL

My Lords. I should like to thank the noble Viscount for enabling us once more to focus attention on the needs of the chronically sick and disabled. Age and disablement have always been with us, and perhaps it is because of their inevitability and familiarity that those in authority are slow to grapple with these social problems. From what we have heard to-day, it is quite clear that authorities throughout the country are regarding this matter as not one of great urgency. We have to remember that we are living in an era when healthy, clamourous youth demands priority, and it is not surprising that age cannot compete in news value with the demands of youth.

We have heard to-day a great deal about research and hospitals, and I believe that our young medical students and our young nurses who, quite understandably, are part of this wonderful youth saga, must be reminded that as our expectation of life increases so does the age of patients admitted to hospital increase and that the sharp demarcation between the acutely ill and those admitted to geriatric wards is becoming dim.

I would invite those who are allied to the medical world to read this week's first leader in the British Medical Journal. This article on the first report of the Hospital Advisory Service makes some observations that are appropriate to this debate. I should like to put it on record, because I am sure that all those who have spoken will be encouraged to find that the journal of the medical profession is giving great attention to the two debates, this one and the one that was held in another place last week. It says this: The trouble is that the community, through the successive Governments that have represented it, and the great majority of individuals generally turn away from the unpleasant reality hoping that someone else will remedy it at no extra cost. It is all too easy to imagine that the appointment of a commissioner, the provision of an advisory service, the devising of a new administration are an adequate substitute for the human will to get things done. I think it is common to all the speakers to-day that we are desirous of seeing things done. It goes on to say: Nor is it only public indifference that is to blame for the neglect accorded to old and incontinent patients and the mentally handicapped. The medical profession likewise shows too little concern for the unfashionable specialities. The Director of the Hospital Advisory Service says he has heard comments from senior staff to the effect that the services for the elderly should take second place; that the needs of the chronically sick are far less important than the needs of the acute patient, and that less money and effort need be spent on this part of the service. If the medical profession treat the aged, the disabled and the chronically sick as second-class patients, is it surprising that we find the local authorities reluctant to implement the Act? Undoubtedly, there are some callous authorities who will be delighted to learn that there is really no urgency.

It is this failure to relate the provisions of the Act to the needs of the chronically sick and disabled which calls for criticism to-day. For that reason, if I had to choose the staff of a local authority for this work, I would put the appointment of a dedicated, energetic public relations officer as the first in my order of priorities. But however excellent the P.R.O., he or she is hampered unless all to whom the Act applies can be identified.

We were told on Second Reading that registration would make heavy demands on the staff; but without registration this Act is only partially effective. If the human will is there, the staff have the means whereby they can secure a great deal of information. Separate registers are already kept for the blind, the deaf, and such other disabled as may be prescribed by the Ministry of Health. Compulsory records are kept of the chronically sick and disabled by every general practitioner in the country. Consequently, the necessary information is already available; and it was satisfactory to learn in another place on Friday that the Minister proposes to demand more energetic action. But if there is no compulsory registration, the inefficient authorities will be provided with a loophole through which once again they can escape their responsibilities. We must all realise that during the last year since the Act has been on the Statute Book, some authorities have adopted a callous attitude. We have already had examples of the failure to make exhaustive inquiries, when some authorities claim that they have only 1.4 disabled per thousand of their population and others claim that they have 10 per thousand.

Unless we insist that registration shall be compulsory, an incomplete register will be attributed by the local authorities to the refusal of the individual to be registered. In fact it is more likely to be due to the negative attitude that stems from bitterness and suspicion which are often the companions of loneliness and disability. These are the people who have over the years assumed a hard shell. They have been lonely. They have not been approached; they have a sense of isolation, as the noble Viscount has said. Of course they are not receptive to some stranger who goes to them and says, " We want to put your name on the register." These people need a special approach. Within that shell, they are longing for sympathy, for care, for understanding and appreciation.

My Lords, I suggest that the advice of the general practitioners should be sought. The general practitioner is seldom rejected by the patient, because he has been known for years by the disabled and the aged. Therefore they have faith in him. I feel that if the local authorities secure his co-operation, and that of the appropriate welfare and social workers, there will be little difficulty in securing a comprehensive register. After all, a doctor who attends a patient in some serious illness does not believe in saving a man from drowning and then leaving him on the bank of the river: he is there all the time. He has been trained to be compassionate. The doctor knows—his experience has taught him—that often a patient who is disabled or who is aged and has arthritis—which malady, as the noble Lord, Lord Aberdare has rightly said is an absolute curse of this country—will manage to get to the surgery, will manage to get to the chemist and get the prescription; will then get home and manage even to climb the stairs. But as the years pass they cannot manage this and they have to depend upon a child or some other person to fetch their shopping. From that moment, these individuals gradually become recluses. It may be said, " What about the neighbours? " Well, my Lords, in congested cities like London the neighbours now and then report to each other that they have not seen so-and-so for some time. A busy doctor, with a packed waiting room, also probably feels that he has not seen so-and-so, but thinks that perhaps he or she has moved elsewhere. And so the person becomes forgotten.

These " forgotten " people may prove unco-operative but they are the very ones who should be registered, because they are immobile and consequently out of touch with available help. This is the very core of the problem. To give it up by saying, " We knocked at the door, but somebody called out from behind it saying, ' Go way!'" means that the callous authority will write on their register: " No answer; they did not want us." But if that individual is approached by the doctor or the doctor's assistant, or by means of a message coming through the door from a member of one of the professions ancillary to medicine—perhaps the physiotherapist—saying: "I have come from the doctor with a special message for you ", and asking for the individual's co-operation, the attitude of these people will be entirely different.

I confess that I found it very difficult, when I read the debate on Friday, to understand some of the things that were said. It indicated to me, for instance, that those in authority, in high places, arc completely out of touch. When I read that the Minister was advised of the introduction of chemical closets for the disabled and that he was prepared to get 1,000, in the nature of an experiment which needed testing out, I was astonished. My Lords, progressive authorities have for many years provided chemical closets. I saw them years ago and I thought that I must have made a mistake when I read the speech. I could even remember the colour; it was a pink and a blue one that was shown to me. I telephoned to the Hornsey Old People's Welfare Council and said, "Did not I come to you a few years ago and discuss the whole question of chemical closets; and did you not say that you had introduced them, and actually showed them to me?" The organiser said, " Yes. I think we started five or six years ago with them, and they are excellent." Yet we were told in another place on Friday that the Minister will buy 1,000 of them with a view to testing them out. As they have been used for this purpose for many years, I think this is a small indication of the lack of initiative of those authorities who have failed to use this very important addition to the furniture for an old person. And I do not think there is anything for noble Lords to laugh about, even about closets.

One cannot over-emphasise the importance of domiciliary assistance. I give pride of place to the domestic help. I was glad to see that, again on Friday, the Minister appreciated her value. He said that if he had a magic wand and was granted one wish he would implement her activities. The Minister has a magic wand; he is the only one who has a magic wand. If he wishes he can transform the Cinderella of the health services into an adequately rewarded ministering angel. It is no good the Minister telling us as he has done, what great value he attaches to the home help; we want to know what he is prepared to pay her. I hope that the noble Lord, Lord Sandford, when he winds up the debate, will say that, while we have all paid lip service to the home help, who is not corning forward to do this work—dirty, unpleasant and sometimes repulsive work—because she is paid a miserable few shillings an hour, the Government are prepared to do something more to help her. I want to know whether they are going to say that the home help is a key figure who will be helped. By helping her, of course, the Government would not only be improving her status, which is very important for her, but at the same time would be helping the chronically sick and disabled who are dependent not only on her care but on her cheerful company.

5.33 p.m.

THE COUNTESS OF LOUDOUN

My Lords, the Chronically Sick and Disabled Persons Act has been so broadly drawn that there is a great deal of confusion generally as to how the Act can be used to help the mentally ill. Several questions have been asked about this in another place, but I feel that a more precise definition by the Department is necessary. The mentally handicapped seem to be fairly well covered, and the needs of the old who arc senile, or who are suffering from some mental disability, are also fairly clear. But what plans has the Minister in mind for the much more difficult area of chronic schizophrenia arising in middle age? Also, what about the mentally sick who are chronically disabled? These problems must be faced. It is no use pretending that they do not exist. I should like some information from the noble Lord who is to wind up for the Government as to the Government's intentions with regard to these groups.

Much has been done over the last few years to try to establish smaller units rather than enormous hospitals. This has had varying results, but much information and knowledge of the problems involved have been and will continue to be acquired. There is no doubt that a large number of patients in subnormality hospitals today would be better off in community care hostels or in their own homes under supervision, although I personally feel that there will always remain a group for which this will be impossible. If local authorities could pay more attention to the housing needs of handicapped people, and give them more assistance in their own homes, this would help to ease slightly the appalling overcrowding and understaffing in mental and subnormality hospitals and would also, of course, be a saving of ratepayers' and taxpayers' money. The extra money that has been allocated to local authorities for these hospitals, although not enough, will also help to ease the burden. Here I think a word of appreciation would be appropriate for the army of home helps who all do such a magnificent job. I think they could well be better paid. And of course, I must mention the voluntary workers, on whom the hospitals and social services rely more and more and whose help will become even more necessary as these schemes gather momentum.

Now I should like to say a few words with reference to Section 26 of the Act, which deals with autism. I am sure that most of your Lordships are aware that autism is a condition beginning in early infancy which has now been recognised by experts throughout the world as having a certain clinical unity. The most important of the handicaps in early infantile autism, is a severe impairment in the development of language, affecting both speech and gesture. In the most severe cases there is no understanding or use of spoken or gestured language. When the handicap is less profound comprehension improves with increasing age, and speech develops slowly and with characteristic abnormalities. There is considerable variation in the degree of handicap. but there is inevitably some intellectual retardation which can be severe. All this leads to behaviour disorders which can be very distressing to all concerned.

The National Society for Autistic Children, founded in 1962 by a group of parents who were deeply dissatisfied with the provision then made by the authorities for the education and training of their children, has done much on its own. It has set up its own schools. Five are already opened and three more are expected to open this year. It has organised training courses and information services for parents and professional people, but it is a small group and recognises that it cannot possibly provide a national service. Although the first essential is early diagnosis and assessment of the child's needs, the next essential is advice to the parents on the management and upbringing of their autistic child. Home teachers are already provided for young deaf children, and parents of young spastic children can obtain specific instruction in management at places like the Wolfson Centre. Some similar arrangement is required for the parents of autistic children.

With help, which many families at the moment do not receive, it is possible for the child to be kept at home where it will grow up to be able to enjoy life and remain outside an institution. Most of the schools, training centres and hospitals available for mentally handicapped children at the moment lack staff, buildings and equipment which would enable them to help autistic children to reach their maximum potential. Huge areas of the country, involving many hundreds of autistic children, have no facilities at all for their help. The South-East is best served with 22 of the 32 educational units available. Special attention also needs to be given to the problems of autistic adolescents who need education and vocational training well beyond the ordinary school-leaving age. I think the reply given on April 6 of this year in another place by the Secretary of State for Social Services to Mr. Driberg was quite inadequate. Nearly all autistic children will remain handicapped throughout their lives, but proper education can help them at the very least to fit into the community and, above all, to find some interest and enjoyment in life. Much has been accomplished, but even more needs to be done.

5.40 p.m.

LORD PLATT

My Lords, so much has already been said, and very well said, by others, that I shall be highly selective in the points that I shall make. In the first place, I should like to say something about statistics. My notes are not very complete, but I think it was the noble Viscount, Lord Ingleby, who quoted recent statistics which show up such enormous discrepancies between one local authority and another. The discrepancies are so large that without having examined them more carefully—even if I had done so I might have come to no conclusion—it is difficult to say how much they really mean. Surely, the question of identification is extraordinarily important. If, for instance, one local authority has identified only a proportion, say a quarter, a half or even only two-thirds of its disabled population, the amount it spends per individual will accordingly appear to be much larger than it actually is.

Secondly, referring to Section 1 of the Act—and I assure your Lordships that I am not going through the Act section by section—surely the question of information is all important. I was greatly pleased to learn from the noble Lord, Lord Aberdare, that a booklet of information is shortly to appear. I should like to be further assured that it will be kept up to date. If the noble Lord, Lord Sandford, would care to add to his remarks I should like to know exactly whom it is intended that this booklet should reach. It is so important that the relevant information should reach, first, the people affected and, of course, their families; and, secondly, the people who have to prescribe the help, equipment and aids of various kinds.

I was impressed by the suggestion, or the statement—again my notes are not sufficiently complete to enable me to identify who made it; it might again have been the noble Viscount, Lord Ingleby —that some notice should he sent round with the rates. This seems to me to be a splendid idea. It could be done once a year, or even once in two years. A simple slip of paper could contain a notice calling attention to the aids which could be given to disabled people. The majority of the leaflets would, of course, quickly reach the wastepaper basket having been sent to homes where there were no disabled. But in homes where there were disabled people I am sure that they would be seized upon immediately. Although most of my post goes into the wastepaper basket, I would immediately seize on a leaflet which allowed me to expect a large pension for retired professors of medicine, or something of that kind. When such a publication refers to one's particular problem one reads it.

I was very glad to note that a number of noble Lords have mentioned the Disabled Living Foundation. It has a splendid information service at its aids centre in Kensington High Street. Here, my Lords, I have to declare an interest, though not a financial one. I have a small position on this Disabled Living Foundation and I have been interested in it for a good many years. I am dignified by the term of " Adviser " to their music group. The group does notable work in encouraging music among disabled people, choirs and so on, and in devising cunning methods by which people with physical handicaps may use instruments which they would not otherwise be able to play. It is one of the ways, too, in which the disabled can come more into society, and we all acknowledge the importance of that.

It seems to me that if information was periodically supplied to disabled people, it would move local authorities to be sure that they carried out their duties under Section 2; a point which was made particularly by the noble Lord, Lord Wells-Pestell. Skipping to Section 16, which deals with the placing of disabled people in employment, that is extremely important; and the aid centre of the Disabled Living Foundation shows a number of cunning devices whereby very severely disabled people may do useful work; for instance, in the domestic field, sewing, embroidery, typing, telephony and that kind of occupation. There are, I believe, a number of people running quite lucrative businesses from their beds.

My Lords, I must refer to Section 17 of the Act, though I knew that it would be well dealt with by the noble Lord, Lord Amulree. It refers to the young chronic sick. I should hate to put priorities on some parts of this Act, because that might mean that less attention would be given to other parts, but if I had to put a priority on a section I think that this would be my priority No. 1. Although doing too little for the disabled is bad enough, and doing nothing at all is even worse, the putting of young chronic sick into wards with geriatric mental patients is really doing extreme harm—and the worst kind of harm, because it is harm to the personality.

The noble Lord, Lord Harding of Petherton, called attention to Section 22 and the question of research. The noble Lord read out the whole of the section, but I should like to read only certain parts of it. It says: The Secretary of State shall…lay before Parliament a report on the progress of research and development by or on behalf of any Minister of the Crown. I was one of those responsible for the passing of this Act, and in retrospect it seems to me that that is a rather inadequate requirement. It is simply to lay before Parliament. It is not said whether Parliament does anything about it when the report is laid. It seems to refer only to research and development carried out by or on behalf of any Minister of the Crown. I suppose that the amount of research actually carried out by a Minister of the Crown would be comparatively small, though he might promote a lot of research, so that limits it to " on behalf of " a Minister of the Crown. I hope that the report of the research which I think will be due at the end of the year will go a little further than that.

Here, my Lords, I must declare another interest, in that I am vice-president of the Bath Institute for Medical Engineering. I should like to say unashamedly, having declared my interest, what an important institute I think this is. It has certain very notable advantages. One is that its premises are actually in the grounds of St. Martins Hospital. It has doctors and surgeons on its staff who can see the need for the various aids to the disabled which the Institute can produce and can try them out. Medically, of course, Bath has traditionally a large population of people who are disabled in one way or another, particularly with rheumatic diseases. It also has a university, which is noted for its strength in technology and engineering. Thus there is a combination of talents which may not be readily equalled anywhere else. It is doing work, of course, in other fields of medical engineering—for example, in monitoring devices for the concentration of anesthetic vapours—which have no immediate bearing on the disabled. But it has another advantage over some research institutions: that it is ready to take up ideas of other people and looks upon the development of those ideas and making them practical as one of its important duties, when so many research workers are only interested in the ideas which spring from their own heads.

These are the only points that I want to make. I am only too conscious that I have left out large and important fields such as the deaf, the blind, the dyslexic and the autistic, but only because I know that others like the noble Countess, Lady Loudoun, have already referred to these and that others who are following will mention them.

I conclude by wondering whether your Lordships would agree with what I have always felt myself—namely, that I would much rather be blind than severely or totally deaf. Blind people have their friends, their social contacts and their conversation. You talk to a blind person as to any other friend. They can listen to music. But the deaf person is isolated. It is a pain to go and see a deaf person and try to shout out some triviality about it being a nice day, which you perhaps have to repeat four times, and do not make yourself understood. You do not readily go again. I think my view is right.

5.52 p.m.

LADY RUTHVEN OF FREELAND

My Lords. I shall not detain your Lordships too long, because we have listened to many excellent speeches and there are many more to come. I have only two points to mention. Before I do so, may I offer my humble congratulations to the noble Lord, Lord Cullen of Ashbourne, for his most excellent and interesting maiden speech?

My two points have already been spoken about and nobody could have spoken better about them than the two speakers who did so. The noble Lord, Lord Wells-Pestell, spoke on the question of what local authorities are going to do. Like him, I am completely convinced that most local authorities do not consider this matter seriously. We only have to read in Hansard the report of the debate in another place on Friday to see how many bad local authorities we have, how lazy they are and that they do not take kindly to this sort of thing. I think that it will take a great deal from the Secretary of State to force them into putting these requirements into effect and keeping them up to date. The noble Lord, Lord Wells-Pestell, said this in a much better way than I have, so I will not add any more on that aspect.

My other point concerns autism. I should like to support all that my noble friend Lady Loudoun said on this subject. I have had the opportunity of working in a number of psychiatric hospitals for a good many years, so I have seen a certain number of autistic children and young people. In the last ten or twenty years, a new treatment has been discovered and it is extraordinary to see the difference between what is being done to-day and what was being done some years ago.

I have a friend who has an autistic son. He went to school but, of course, he did not go to a school for autistic children. This boy is now 22. He had some fits in adolescence and has deteriorated a good deal since then. He is now in a closed ward in hospital for his aggressive behaviour, but will return to an open group ward once this is brought under control. At the moment he is on large doses of tranquillisers. I compare him with a little boy I know of 8 or 9 in a hospital in the area where I worked. He is a nice little boy, with a high I.Q., but he is very aggressive. Before he came to us he had been in a big London hospital, where I believe he caused damage amounting to at least £2,000. We had a padded cell built for him and he had to have four nurses, because he had not only damaged everything he could damage but he had hurt himself and could not be allowed with other children. The last time I saw him, about a month or six weeks ago, after he had been seen by a great authority on autistic children who advised certain treatment, he was with three other people in the dining room of the hospital, talking to his nurse. He was not quite intelligible. I could understand only a word or two of what he was saying, but the nurse obviously understood everything he said. This was entirely due to the new treatment which had been prescribed by this expert on autism.

So I should like to say that there is a chance for all autistic children if they arc found and diagnosed at any early stage, are given the proper education and taken to the right places. I would urge on the Government that education authorities should take this question of the training of teachers for autistic children very seriously. It is a specialised subject. There ought to be one teacher for every child. That is almost impossible, but I do not think that units should be of more than five children to a teacher, otherwise the children will not get any benefit.

5.58 p.m.

LORD NAPIER AND ETTRICK

My Lords, I wish to intervene only briefly in your Lordships' debate this afternoon. May I first add to those of other noble Lords who have already spoken my congratulations to my noble friend Lord Cullen of Ashbourne on his maiden speech. The fact that he has not addressed your Lordships for I think 39 years is I believe your Lordships' loss.

The whole problem of the disabled has never before received so much emphasis as to-day, both in this country and abroad. Valuable as it is in making mandatory so much of what enlightened local authorities have done for the disabled under permissive powers in the past, the Act is in my opinion devoid of an end product. It does not of itself promote and ensure the means of restoration of a disabled person to a viable place in the economic life of the nation, which is the object of rehabilitation, as I see it.

The philosophy of the British Council for the Rehabilitation of the Disabled, with which I am associated, contains, among others, two phrases which I believe are worthy of attention and which, in the context of to-day, have particular relevance to us in relation to both medicine and employment. They are, first, that in medicine there is a duty to preserve and improve physical function and to appraise capacity for work. In other words, medicine is faced with the task of restoring function. Secondly, placed in the statement as " worthy of attention " is in Government there is a duty to retrain lost industrial faculty or to train an alternative faculty. In a democracy, the State expresses this philosophy through the Government it elects, so it is right that we should impose upon Governments such a duty, especially when the ruling Party claims to care. However, this does not mean that the rest of society can evade action. It must not merely delegate responsibility but participate in it by ensuring that by its own efforts executive responsibility is carried out and leads to achievements. This means that industry, commerce, the trade unions and professional associations have a share in absorbing in gainful employment all those who have been restored by the combined skills of medicine, Government and society. The problem of the disabled in society will, I believe, always he with us, and it is surely for us to sharpen our skills and abilities in order to recognise at any given moment where the most acute problem lies.

One of the greatest problems to be faced is in relation to motivation, if I may use an Americanism; and here one has to decide sooner or later how delicate a balance there is between incentive and disincentive. One must recognise the basic right of those who want to, to enjoy to the maximum the privileges of a worthwhile place in society. Once motivation is right, an investment in rehabili- tation can be justified. There are two notable problems to be faced. The first concerns the way in which disability affects the efficiency of the physical mechanism, which is a problem for medicine. The second problem is the impact of environmental factors upon that efficiency. And always remember, my Lords, that the longer the delay the less likely is the affected person to get better. Some recent figures from the Department of Social Security show that over 900,000 people were on benefit, and of these over 500,000 have been on benefit for over six months.

The practical definition of rehabilitation might be " the restoration of capacity for normal work or normal wage-earning". When a disabling condition arises, medicine has the problem of discovering how far the efficiency of the mechanism has been impaired, and then of devising the means of restoration to as near normal as possible. Ultimate success, in other words rehabilitation, may be affected one way or another by the impact of subsequent environmental factors. Medicine may find its own success marred by factors in the patient's life, such as social prejudice, poverty, bad housing, lack of opportunity in the economic set-up, even in employment. We should be concerned with the enhancement of residual ability: we should be committed to the prevention of superimposed disability. We must work at the task of providing substitutes for lost function. We must devise complete reorganisation. What is achieved by the patient in social activity is the justification of rehabilitation. An important part of this, namely, vocational training or retraining, is generally accepted; but the employment of the retrained is a problem which is often conditioned by such things as the state of the labour market, the nature and availability of transport and, by no means least, architectural design. These two latter are fit subjects for even more intense study in the engineering fields than they are now receiving.

I ask you to remember this, my Lords: there is no really sound reason, other than prejudice, why an adequately assessed and treated re-abled worker should not be an asset to an expanding country's economy. Perhaps one of the most delightful success stories of fulfilment in this respect is one that was told by Senator Humphrey, a former Vice-President of the United States. A young woman, severely disabled, had gone through all the phases of rehabilitation. She got her first job and, while still on a comparatively low wage rate, was thrilled to see on her wage slip a small deduction for income tax. At last she was no longer an encumbrance upon society. She was actually a contributor; and her excitement knew no bounds. With increasing skill and efficiency, her pay packet grew larger and by the end of the year she was a leader in a campaign for the abolition of " this intolerable burden of income tax ". Who would say that her rehabilitation was incomplete? Surely she was no longer disabled. In another place last week, Mr. Jack Ashley said, among other things, that the number of disabled people who are unemployed is five times the national average, and it is of paramount importance that the 50 per cent. of British employers who are failing to employ their quota of disabled persons should fulfil their obligations. I agree with that sentiment, but surely it is unenforceable. I shall be interested to see whether my noble friend Lord Sandford comments upon this point when he comes to wind up.

I should like to support wholeheartedly all that the noble Lord, Lord Wells-Pestell, said about the Government circular. He has put his finger on a critical spot. When one is dealing with a problem of some 2 million permanently and substantially handicapped people, as we have to-day in this country, I do not believe that the loose wording of the Government circular of August 17, 1970, in which they stated. inter alia, regarding Section 1 of the Act: It is not a requirement of the section that authorities should attempt 100 per cent. identification and registration of the handicapped is nearly positive enough. Some local authorities are first-class, but others are not. I well remember moving an Amendment during the Committee stage in your Lordships' House to make further education mandatory rather than permissive. so far as local authorities were concerned. The noble Baroness, Lady Phillips, who was then replying for the Government, begged me not to press the Amendment on the grounds that we might lose the Bill altogether because of the time factor. I agreed, because it was better to have some Act rather than no Act at all; but herein lie some of its limitations.

I should like to ask my noble friend. Lord Sandford, when he comes to wind up for Her Majesty's Government, whether he will take some urgent action to improve upon the monstrous three-wheeler vehicle. I believe these vehicles to be thoroughly dangerous and unsatisfactory. I drove one once and found it a most unpleasant experience. What is required is a suitable four-wheeled vehicle, at no greater cost than the three-wheeler. I wonder why there is reluctance to make progress on the matter? Is there an official fear that there might suddenly be an increased demand? I have read what my right honourable friend, the Secretary of State for Social Services, said in reply to the debate in another place last week. He said that the whole issue of vehicles for the disabled was under study by the Government. My Lords, when can we expect a decision? I hope that " under. discussion " is not the same as the description of Royal Commissions once used by the noble and learned Lord, Lord Gardiner, when he described them as the classical method used by people who did not want any real reform.

I would put forward one suggestion for consideration. What about some easement by way of tax relief for those who are disabled and who must have special equipment in order to effectively pursue their chosen careers? If my noble friend, when he comes to reply, has to tell me that there is no money, my answer will be, using some words of Emerson, Can anybody remember when times were not bad and money scarce?

6.8 p.m.

BARONESS HYLTON-FOSTER

My Lords, I should like to thank the noble Viscount, Lord Ingleby, for giving us the opportunity to have this debate to-day. I was very pleased that he mentioned the importance of social life for the disabled, because in this connection I should like to raise paragraphs (c) and (f) of Section 2(1), covering holidays and outings. Such things make all the difference to the home-bound. Those who are able to get into cars can be driven about to all kinds of exciting places by kind volunteers, but there is a problem where special transport has to be provided for seriously handicapped people. This type of transport is extremely expensive and it is often necessary to make a wide tour, first of all to pick up all the disabled people living in scattered districts. For example, in London, if one could gather a load of these people—and they enjoy being together—they could be taken to Kew, to Richmond Park, to Windsor and sometimes perhaps to the sea. Some of the severely handicapped might also be taken for a trip on the Thames. They might even, for a bit of fun, be taken down the King's Road to see the sights. At this moment, and all this week, there are quite a number of disabled people who are being pushed around in their wheelchairs at the Chelsea Flower Show. The Act refers to arrangements for the provision of lectures, games, outings et cetera, but it does not say who pays.

Let me now say a word or two about holidays. Noble Lords who saw the Red Cross film in the Grand Committee Room, of which I had the honour to be one of the sponsors, will have seen the handicapped children being looked after by young members; they will have seen them joining in the games and races, and even in the novelty of peeling potatoes, something which they have never done and which is fun when doing it with other people. As well as that, they joined in the swimming, and of course the exciting pony rides. All this was fun, and it was enjoyed by the helpers as well as by the handicapped. This brings a wonderful atmosphere into their very dull lives. In London we are very lucky because grants are available from the London Boroughs Youth Committee for holidays for the handicapped; and the young people helping with these holidays can get a grant from the Inner London Education Authority towards their training—they of course, already having had elementary training. This is not so in other parts of the country, and the expense of holidays of this sort becomes a real problem.

The types of case that we like to include on these holidays include cerebral palsy, spinal bifidus, spastics, autistic children and others, because we believe that the mixing together of these dis- abilities is a good thing and cheers them all up. But, of course, they have to be supervised, not only by the young people who come to look after them and help them to enjoy a week or a fortnight, but also by specially trained people, like trained nurses, caterers, physiotherapists, welfare officers and others, according to the disability. These holidays are very worth while. But for adults it is a much more difficult problem, and much more expensive, because they come under welfare and not under education. The welfare grants are very limited, and therefore much more difficult to get, and there are many more handicapped than there is money available to provide for them. These holidays are important not only for the children and the adults, but also because they help parents and relatives, or those who are caring for the handicapped, to have a holiday or perhaps just a rest.

The real problem, as has been.said, is that although grants are available, the way in which local authorities use them differs in many parts of the country, as it does in the London boroughs. I am not at the moment talking about the disabled people living in hospitals, hostels or homes; I am concerned with the homebound, who are not always known to the local authority, and who rely on the different voluntary societies for any holiday or outing. The official view, no doubt governed by finance, is that one short holiday is all that can be managed. But we in the Red Cross find that immense pleasure and benefit can be given by regular outings. If grants towards the cost of transport, and particularly for hiring special vehicles, could be gone into, this would be a very real help. Also, if the word " provision " could be made compulsive instead of permissive, a great deal more could be done by the voluntary societies.

Noble Lords know the generosity of the disabled fellow sufferers, and our " mobile Bench " (Lord Aberdare's brilliant term) is a great example of this. I would ask the noble Lord, Lord Sandford, when he replies, not to let them down. I would ask him please to tell me whether it was intended that the cost of transport was to be included in the arrangements for the provision of outings and the facilitating of holidays in paragraphs (c) and (f) of Section 2.

6.16 p.m.

LORD JANNER

My Lords, I should like to add my thanks to the noble Viscount, Lord Ingleby, for having brought the treatment of the chronically sick and disabled once again to the attention of this House. I am of the opinion that the Act which was passed is a substantial and important one, and if properly put into effect it will assist considerably in solving the problem that we are facing. I think one should pay tribute to the Member of Parliament, Mr. Alfred Morris, for having introduced a Bill on this subject, and having piloted that Bill into a place among the Statutes of our country. In a long Parliamentary experience, I have rarely, if ever, come across so refreshing an experience as witnessing this inspired effort, one which was met by such warm support from every Party in Parliament and throughout the country as a whole. I think, too, one ought to say here, as was said in another place, that Mr. Morris is to be congratulated on the great honour which has been bestowed upon him as the first recipient of the Harding Award for services to the disabled.

Living as we do in a world and time of stress and strain, we are apt to overlook the needs of our fellow citizens who are afflicted by physical or mental incapacities, unless, as in the case in some families, there is one or more than one member of the family who suffer such infirmity. That there are hundreds of thousands throughout the country of those who have no relatives to look after them, whose relatives ignore their existence, is well known to the various public and private bodies concerned with their problems. The magnificent work that is done by the voluntary organisations in this field, and by some authorities, must be acknowledged, but the indifference to the plight of these human beings is so widespread that the nation as a whole had to be jerked into a sense of its responsibility, in my view, by such a measure as the Chronically Sick and Disabled Persons Act.

It is now clear that millions of afflicted persons have been denied elementary necessities during the whole of their lives, which could have made living more tolerable for them and even reasonably happy. It is high time that the Government—whichever Government it may be —should fully implement the provisions of the Act, so as to relieve the anxieties and sufferings of those to whom it relates, and to do so to the fullest extent possible. The recent publications of the Social Security Division of the Office of Census and Surveys shows the strong need and urgency of remedial measures, but such action, to be as fully effective as possible, must in my view depend upon two factors in particular. It must be known what persons are in need of help, and those persons must be fully informed as to where they can obtain that help and what kind of help it is the duty of the authorities to provide.

The provisions of Section 1 of the Act are not to come into force until October. I heard the noble Lord, Lord Aberdare, refer to this matter, but I ask: Why was there delay? Surely, every person to whom Section 29 of the National Assistance Act 1948 applies depends upon information being ascertained in accordance with Section 1 of the Chronically Sick and Disabled Persons Act. Otherwise, how can the local authorities know —I emphasise this—this need for making available in their area, services provided under arrangements made with the authority under Section 29 of the National Assistance Act "? Or how can the authority ensure that every person shall be informed of any other services that are relevant to his needs?

What is causing grave concern to the general public is the fact that a year after the passing of the Act many local authorities have not yet even begun to implement Section 1 which makes it mandatory to search for and register the disabled. One such instance has been brought to my attention where a local voluntary body, recognising the fact that the reorganisation of social services was imposing a great strain upon the Department, volunteered to do this job for the local authority—I am not sure whether it is not the same case as that referred to earlier by a noble Lord on the other side of the House. They volunteered to do this job for the local authority. The local authority said that this was not acceptable, as the voluntary body do not have suitably qualified workers and the work done by the voluntary body would have to be checked in any event and no time would be saved at all. The Disablement Income Group who, among others, took exception to this decision, pointed out, quite rightly, as is my opinion, that it does not require an expert to seek out a housebound cripple or a paralysed person living in his own home without adequate support.

The Minister, Sir Keith Joseph, quite rightly said in another place that increased co-operation between statutory and voluntary bodies would be necessary to tackle problems of the chronic disabled. Is it not now time for the Government to take the initiative and to convene a conference of representatives of the relevant agencies to iron out difficulties such as the one I have just mentioned? I believe that the calling of a conference of that kind would be very useful in getting the assistance of the voluntary bodies—they are excellent bodies themselves—to implement the Act, and perhaps it would bring a considerable amount of information to the attention of the Government themselves and their representatives which hitherto they have not obtained.

A further example of how the Act is not being implemented comes to my mind. One of the less affluent boroughs was approached by a voluntary organisation on behalf of a housebound woman and a telephone was requested. The answer was that the authority in question did not have sufficient funds to pay for the installation of a telephone and the application was rejected. The end result was that the voluntary organisation felt obliged to pay for the installation itself. Such instances quite rightly incur the anger of voluntary organisations. They feel that it is their job to supplement the statutory obligations of local authorities, not to replace them. The two examples I have given illustrate the ambivalent feelings of local authorities towards voluntary organisations. On the one hand, they will reject the offer of social work help from " non-experts; " on the other hand, they will unstintingly use their resources rather than implement what is, after all, an Act of Parliament.

Unfortunately, certain parts of the Act give local authorities the power to be discretionary in the evaluation of need. The Act has many phrases such as: So far as it is in the circumstances both practicable and reasonable… et cetera. May I suggest that it is here that the Minister should acknowledge and accept that it is his Department's responsibility to ensure that local authorities do not default on the spirit of the Act; and, if possible, he should set up the means to check that they are complying to the satisfaction of the general public, and apply pressure where necessary.

The example I quoted regarding a less affluent borough being approached for a telephone gives rise to another matter of supreme importance; namely, the question of disparity of resources between the poor and the rich local authorities. Those boroughs which have taken up the challenge embodied in the Act must be duly commended. But is it not far easier for a wealthier borough to do so than a local authority with a high population of unemployed and disabled? It is high time for the Minister to take a hard look at this aspect and to make available the necessary resources in order to remove the unequal state of affairs which now obtains. Where a borough is obviously struggling to find a means to help its ailing community, should it not have access to funds from the central Government? The question of whether there is a disparity in various areas can be referred to by pointing out that, while the academic authorities agree that the incidence of severe disablement is evenly spread across our country, there can be no doubt that the incidence is particularly severe in some localities. In South Wales there are some mining communities where over 50 per cent. of the men over 50 years of age are severely damaged; and in the other coalfields—in Yorkshire, Durham, and parts of Scotland—the incidence is of a high nature, too.

Many of the points that I had intended to deal with have already been dealt with, and dealt with very effectively, by speakers who have addressed your Lordships before me. Noble Lords have expressed themselves in a manner beyond my capabilities, but I should like to mention one or two other points. I am wondering whether it has ever been taken into consideration, or whether the Government are taking into consideration, that changes take place in the possibilities of training such people as the blind, for example, who require assistance. In Leicester the Royal Institute for the Blind state that the blind have for a considerable period been making basketwork. This basketwork is now no longer being used to anything like the extent it was before. For example, prison baskets are now made in synthetics; and other uses of this product are falling very far from the position they held before as, for example, by the Post Office. Fresh machinery is required by an institution of that description for box making and later corrugated boxes, and it is not within their capability to provide the necessary funds for this purpose. I would suggest that this is a point which might be taken into consideration when examining the situation of the disabled, with a view to assistance being given.

I do not want to detain the House any longer. As I said before, I think all the points have been made admirably by previous speakers but the numbers which have now been revealed—3 million people coming within the category of those with whose cases we are dealing at the present time—have to be carefully regarded as a matter of extreme importance, and I hope that the Government will give maximum help and will insist upon local authorities doing their job as they should do it under the Act.

6.30 p.m.

BARONESS ELLIOT OF HARWOOD

My Lords, we have had a most interesting debate this afternoon and many re— markable contributions have been made. We are much indebted to the noble Viscount, Lord Ingleby, for allowing us to spend a Wednesday afternoon discussing so very important a subject. I was most interested in what the Minister had to say, and I was delighted to hear that more money is being made available for the help which is so urgently needed, and which has been described so eloquently by other noble Lords.

The Minister made one reference that I should like to pick up before I come to the few things I want to say on the subject of this Motion. He referred to someone who would have been here to-day and would have spoken in this debate, and who has done more than anyone in my generation to organise voluntary services in a variety of different spheres of our national life—I mean, of course, the noble Baroness, Lady Swanborough, better known to us all as Stella Reading. It was a terrible shock to hear of her sudden death, as I did on Saturday morning when I was at home, listening to the wireless. She and I worked together for many years in the days before the war, when evacuation was being planned. We lived side by side in the same street in London, and it was a tremendous shock to realise that someone who had done so much voluntary work for the community and who was so deeply interested in all forms of voluntary work would not be with us to-day. I want to pay my tribute to her for all she has done; and I am sure that in saying that I am only voicing what many other noble Lords in this House feel about her sudden death.

My Lords, my contribution to-day is really to stand almost in a white sheet, because I am perhaps the only speaker in this debate who is actually a member of a local authority. I am a county councillor, here standing in your Lordships' House. Only yesterday afternoon I flew from Newcastle down to London in time to take my share of the interminable discussions on the Industrial Relations Bill, and I came straight from a county council meeting. All that has been said about local authorities is absolutely true, but I should like to make one point. Many local authorities are most anxious to do what they can to implement the Act, but there are quite a number of difficulties in their way. I am one of the people who want to see Section 1 to the Act, which calls for a register of handicapped people, put into effect. I am the chairman of the social work committee on my county council. I have a perfectly excellent director of social work and a team of excellent social workers. I think I shall be able to get a register of all the disabled and handicapped people in the county which I represent, but the task is very difficult.

If I may say so, I was immensely glad to hear from the noble Baroness, Lady Summerskill, all that she said about co-operation with the local doctors and the medical officer of health. It seems to me that it is difficult to get a register voluntarily. It is also very difficult to get the doctors to give one, from their roll of patients, all the necessary information about disabled people. It may be that that information will come in time; and perhaps people will realise that this is not an attempt to pry into their private affairs but a genuine attempt to try to find out the extent of the problem in any given area. The area that I represent is tiny, and it should not be at all difficult for me to get all the information I want. But when we think of the cities, and the large areas in London, there is obviously a great problem. Yet I am sure that it is essential to get it all done, and I would endorse what the noble Baroness, Lady Summerskill, said about trying to use a variety of approaches not only through the doctors (because it seems to be difficult to get the co-operation of the doctors) but also through the services ancillary to medicine, as she described them. and all local authorities have those services.

I agree with the noble Lord, Lord Janner, that one could use many of the voluntary organisations which are expert in many of these subjects, although they may not have what are called professional social workers. However, they have people who are accustomed to working with and knowing about disabled people, and such workers can be used. But I would suggest to the Government that it is tremendously important that we should insist upon getting this register, because otherwise we have no idea what the total picture is in any given area; and until we get that it is extremely difficult to take any extensive action. Local authorities must be urged, and members of local authorities must be told, that this is a real priority in their lives. Again speaking as a member of a local authority I know that there are innumerable subjects which tumble on to one's desk and about which one has to know. It is difficult to decide on priorities. But it seems to me that this is one of the real priorities, and one could turn an eye away from some of the other subjects which one is looking after, because this is the first opportunity we have ever had to try to deal with this subject, and the responsibility is being laid on local authorities.

The noble Lord, Lord Wells-Pestell, mentioned the great importance of getting local authorities to look at this responsibility. Of course they have not done a great deal so far. Most local authorities, and particularly the staff, are enormously overworked. But the work is now being done in Scotland, where operation of the Act has been going on for about two years and is working very well. But it is only just beginning in England, so that makes it more difficult for the authorities there. But I still think that every effort should be made by the central department to impress upon the local government that this is a number one priority.

During this debate, several noble Lords have mentioned various items of importance under this Act, and I should like to mention just one or two. I would first thank the noble Lady, Lady Ruthven of Freeland, and the noble Countess, Lady Loudoun, very much for what they said about the importance of educating autistic children. Your Lordships will know that I have a very close association with the National Society for Autistic Children, and only recently I had the opportunity of discussing this subject with the Minister of Education on a deputation. The Minister was most sympathetic and understanding, and very anxious to help in every possible way to bring the training of teachers for autistic children into the other important aspects of the training of teachers. Also my plea to her, which is one that has been echoed by many noble Lords, is that there should be included among the special teaching arrangements in any given local education authority, the teaching of autistic children. It should not be done by a voluntary society. It is impossible; it is far too big a subject. It should be done in the same way as the teaching of the deaf, or the blind, or the spastics, as part of the education authority's responsibility. I hope very much that the Government will encourage all local education authorities to make a point of including among the specialist teaching that of the teaching of autistic children.

The noble Baroness, Lady Hylton-Foster, raised another very important point which we must not leave out—it is in the Act, and it is again something that can be laid at the door of the local authorities—and that is the question of holidays and of facilities for doing things other than just earning a living. No one feels more anxious than I do that disabled people should be put into the position of being as independent as possible, to be able to earn their living and be taught whatever trade or work they can do. But there are other things in life. There is the joy we get from going to see beautiful things, picture galleries, listening to music, attending courses in subjects in which we are interested. These should come into the picture as well as the question of the disabled being rehabilitated and earning their living. It is vital that they should also have the joy of doing something not technical, something that helps the spirit and the morale. I hope that the local authorities—because they now have mandatory powers—will help with things other than just the technical matter of rehabilitation and earning a living. The noble Baroness, Lady Summerskill, referred to youth clubs, spread throughout the country for the physically handicapped and able-bodied young people working together—what are known as the Phab Clubs. These have been an immense success. They are running courses of a week or a fortnight on interesting subjects for young people, the handicapped and able-bodied together. I am very keen that the local authorities should back that as well.

There is one further point in which I am particularly interested. Shortly, due to the generosity of the Carnegie United Kingdom Trust, we shall be able to build a purpose-built college of further education which disabled people will he able to go to for a week or a fortnight, not for technical training but for just the sort of things of which the noble Baroness, Lady Hylton-Foster, spoke, to do with the study of art or music or other subjects than people want. This enterprise, which is only beginning, will, I hope, make a great contribution to help disabled people. It will be built by voluntary funds and it will be among the Selly Oak Colleges in Birmingham. Once it is built it will be somewhere the local authorities can send people to, where they will find that extra bit of happiness and interest. They will be enabled to meet other people, non-handicapped people as well, since it will be in the middle of an area where there are a number of colleges of further education not for handicapped people at all, and quite near the university. Indeed, we hope to get help from the university extra-mural teachers.

I mention these things because they are all part of the good which arises out of this remarkable Act of Parliament. It requires a tremendous amount of energy, drive and imagination, and for all the members of the local authorities to take an interest in it. It is something which will revolutionise the lives of the people about whom we are speaking. There are three million of them. I do not believe half the country knows how many there are. Every day we hear on the wireless of tragic cases, of serious motor accidents and so on, and these people are being added to the list every day. Yet we cannot get the local authorities or anyone else to take a real interest in it. Perhaps to-day in this House and in another place our words will be listened to and we shall recruit from among the voluntary enthusiasts as well as local authorities people who will help to make this a living Act, not just a dead Act written on a piece of paper. I feel sure we shall have done something well worth while if out of this debate comes action of this kind.

6.47 p.m.

THE EARL OF LONGFORD

My Lords, I join, as I am sure does everyone in the tributes paid by the noble Baroness, Lady Elliot, to Lady Reading. Certainly, as she says, there has been no one in our time, man or woman, Peer or commoner, who has done as much for the voluntary services as Stella Reading. Many of the large things are well known. I suppose, perhaps, in these collective days no individual will ever be able to build a big social service, as she, with many friends, but in a sense on her own, built the W.V.S. There are many smaller things which cannot in some cases be revealed even yet; she helped people in circumstances that might be embarrassing if they were known. But at any rate there was nobody more effective, or for that matter more kindly. If one really wanted help for somebody in an extremely sticky position Stella Reading was the one person who provided the effective help, and she did so often. I feel sure that if she were asked now—and no doubt she is enjoying this debate elsewhere—she would say that if there is one person left to us here who is likely before the close to do more for the voluntary services than anyone else, that would be the noble Baroness, Lady Elliot, who is far too modest to recognise that fact; but I am sure that is how it would have struck Lady Reading.

The noble Baroness said that so far as she was aware she was the only member of a local authority speaking in this debate, and I have no doubt, as she said that, that as she always speaks the truth it is true; I have no reason to think it is not. Perhaps it is just as well that I am no longer a member, as I was once proud to be, of the Oxford City Council, because, so far as I can make out, their record is deplorable, and if I were still a member I should not have the temerity to face the House at all. I do not know why things have gone to the dogs since my time in Oxford, but so it seems.

The House is waiting to hear important speeches from the noble Baroness who is to follow me, the noble Baroness, Lady Phillips, and the Minister. I rise to speak more by way of token than in order to take up any time or say anything very important. I am afraid that, through engagements that simply could not be put off, I was unable to hear the first speeches, including the fine speech, as I know it was and heard it was, of the noble Viscount, Lord Ingleby, and speeches, also very successful, from the noble Lord, Lord Crawshaw, and the noble Baroness, Lady Darcy (de Knayth) and others. I was particularly sorry to miss the maiden speech, which everyone says was so good, of the noble Lord, Lord Cullen, who understands this problem so well at first hand. But yet it might be argued in the circumstances that this is an occasion when I would have done well to keep silent; I miss a good opportunity, as they say in French, to hold my tongue.

Nevertheless, it would have seemed a little discourteous to the House, in view of the fact that I had the great honour of technically carrying this Bill through this House last year, and it would have shown some lack of respect for the noble Lord— he is not a noble Lord yet—Mr. Alf. Morris, who deserves whatever honours this world has to offer. It might have shown some slight lack of respect for him, because we all regard his achievement as perhaps the greatest single legislative achievement of a private Member that any of us can remember. It has been well brought out, even while I have been here—by the noble Lord, Lord Janner, for example—that we now realise that the situation is even more urgent than we thought it was last year. It was partially uncovered last year by Mr. Alf. Morris and many others, but now that the facts are beginning to emerge and they probably have not all come out yet —the situation is more grave. We now realise that the Bill was still more overdue than we thought at the time. Therefore, I make no apology for saying these very few words.

Some of your Lordships may, or may not, have heard that I have been involved in a struggle against a moral evil. It may be said, on the face of it, that here we are struggling against a physical evil and not, in that sense, combating something that is morally detestable. That is certainly true if we think of the disabled themselves and their affliction. But if we are thinking of ourselves, of the community as a whole, then certainly our failure to do anything effective to help the disabled in the past is a moral delinquency of the first order. So we can fairly describe it as a moral evil if we do not do far better in the future than we have ever done in the past. If one asks why have we done so relatively little, why has it taken us so much effort and so much time to discover the facts and the poignancy and the possibilities of help—because many people have told us to-day, Lady Ruthven among others, of things that are being done to improve the lot of those who are disabled—I offer this thought. Perhaps it is because we ourselves refuse to admit what has been occasionally brought out in the speeches —and I remember the noble Lord, Lord Platt, speaking in the debates last year—that we are all disabled. We tend to think of ourselves as, so to speak, the able-bodied, and of some other branch of humanity as the disabled. There are ways in which they are more disabled than we are, but it is as well to think of ourselves as all disabled in one sense or another. Therefore, the only thought that I leave with the House to-day is that we shall buckle to and do much better in the future if we approach the problem of the disabled in a spirit of humility.

It is true of everyone in this country and in other countries that we are all mutually dependent. Nobody can just stand on his own feet and say, " I do not need anybody's help." We all need help from somebody, and most of us need help from a great many people. So do not let us fail to identify ourselves with the disabled. It is sometimes possible in social work to identify oneself, but sometimes it is not wise to do so. When one tries to do youth work it is not always wise to identify oneself with the young, or one might break one's Achilles tendon or strain one's heart. There may be a danger in over-identification with the young. In the case of delinquents, it is a good rule to remember that we are all sinners, and when we try to help the disabled let us remember that we are all disabled. That, I think, is the beginning of wisdom.

6.54 p.m..

BARONESS MASHAM OF ILTON

My Lords, as noble Lords will know, this Motion was first in the name of the noble Lord, Lord Crawshaw, so I should like to thank him first. I thank the Cross-Bench Peers for agreeing that this day be given for investigating the progress of the Chronically Sick and Disabled Persons Act. I also thank my noble friend Lord Ingleby for giving us this opportunity. There is no rush to-night, there is no dissolution of Parliament hanging over our heads and, as I am speaking in this position, it has been suggested that I make a few remarks on what noble Lords have said to-day. But, first, I should like to say what I myself have prepared.

This debate has been pending for some time in this House, but when I heard recently that the Chronically Sick and Disabled Persons Act was also to be discussed in another place I was extremely pleased, as great importance is being attached to that Act which involves facilities for millions of people. It entails not only the disabled themselves, but their families and helpers who will benefit or suffer from good or inadequate facilities. Now that the Government's survey on handicapped and impaired people in Great Britain has been completed, and the number of problems has been found to be even greater than was anticipated, I hope that this country will really get down to providing facilities which will enable the disabled to live more contented and congenial lives.

I am sure that Members of another place will have had many letters from disabled constituents and their relatives. I have had several hundred, with all sorts of inquiries, and I have four filing cabinets bulging. Often the telephone rings, and there is usually a distraught mother who has tried all the departments she can to solve her problems, and I am her last resort. It is for that reason that I welcome Section 1 of the Act, and I hope that when it comes into effect everyone who needs welfare services will be made aware of them. I hope that if local authorities cannot provide their own facilities they will make use of centres in other parts of the country. I get most frustrated trying to find information regarding after-care services; this seems to be a great weakness. In some areas ancillary services do not seem to exist.

The field of the disabled is so wide and so varied, and the problems are so many, that it seems unlikely that local authorities and Government will be able to solve them without the help of the voluntary societies. It is for this reason that I should like to see a directory for the disabled. This could be like a telephone directory, with different coloured pages and headings, with all the facilities and places of treatment and equipment available to the disabled. With advertisements, such a directory could most likely pay its way. It should be made available in Post Offices, welfare departments and in all places dealing with the disabled. The Roman Catholic Church has a comprehensive directory giving all sorts of valuable information about its facilities. If the Department of Health and Social Security could follow the example of the Catholic Church, I am sure that many people would benefit.

I also feel that hospitals could do more in the way of equipping patients with information before discharge. Many patients are sent to units specialising in different fields of treatment. If they were discharged with a small booklet giving information relating to their special needs, it could. save a great deal of worry. Once outside the protective walls of a hospital, with its trained staff to give support, a badly disabled person once at home can feel utterly isolated and neglected and it is very easy to forget what to do when something goes wrong. The Marie Curie Memorial Foundation has an excellent little booklet called Advice to Patients following Mastectomy.I hope that when community health care comes into effect in 1974, there will be more of a link between hospital and home for patients who are to remain with a disability.

Some voluntary organisations have made a start at making known the aids which are available for the disabled. As noble Lords have already said, there is now an aids centre in Kensington, which I have visited, run by the Disabled Living Foundation. This is an excellent place, but it is not easy for disabled people or their families to visit London from the North, as travelling has become so expensive. As my noble friend Lady Darcy has said, the Spastics Society has launched a mobile aid centre which will travel from place to place. This has access for the disabled, and disabled people should be able to make themselves aware of new aids which may help them to a more independent life. When local authorities make the registers of disabled people, I hope this will be done diplomatically and by skilled people. I feel it is important that people's privacy is not invaded unnecessarily. But the needs of the disabled should be thoroughly assessed, so that resources are correctly allocated and help is readily available when needed.

It is dangerous to build people up too much if there is no hope of giving them what they want. They will become warped, and feel neglected and let down. Loneliness can be a real killer; and this should be unnecessary, as there are many voluntary groups willing to help. But it is a real problem. Only last week I had several telephone calls. One was from a disabled lady who said she was about to " go up the wall " as she had nothing to do. She wanted to be involved in something useful. Another lady tele— phoned me saying she had a group of people who had a riding school ponies, instructor and helpers—but how were they to get the disabled riders? I hope that when the registers are made local authorities will be able to help put people needing help and people wanting to help in touch with each other. Some local authorities are finding practical difficulty in deciding who is chronically sick and disabled. It is quite obvious that some- one who has completely broken his neck is " permanently and substantially handicapped ", but somebody with a chest or heart condition may be permanently but not substantially handicapped. A person with a progressive disease may not be substantially handicapped at the time, but will obviously become so. The victim of a stroke may be substantially handicapped at some time, but cease to be so in the future. It is because of these changing conditions that I hope local authorities will act with flexibility when dealing with the disabled. Rigid rules do not work when dealing with human beings or human problems: they only restrict and tie down.

My Lords. having spoken with some of the new directors of social services. I have been greatly encouraged by the outlook. One tells me that he wants his staff to address the people they are corresponding with by name rather than " Sir " or " Madam ", and he hopes that, in turn, he will be known by his name. This personal approach seems to be a good start. to set his new department off to the spirit, " We will help if we can ", rather than the old attitude of " not getting involved " and treating the disabled as cases and not people. To provide many of the facilities in Clause 2 I should think will be impossible unless full cooperation between the voluntary and statutory bodies takes place. In some areas, to provide a home help service is difficult, as there is a lack of home helps: but I know of one local authority which has refused to increase this service and has in fact cut down on home helps. Perhaps after to-day something will be done about this. To make the Act really work, there needs to be more social workers who have the specialised knowledge and skill necessary to help physically handicapped persons. There is a crying need for more occupational therapists. Because of the difficulty of getting occupational therapists, we are now at less than half the proper quota, with about one occupational therapist per half million of the population. I I hope the new social service departments will be able to develop this service over the years.

The Library Association run a housebound service. In some areas this is operating and disabled people have an excellent service, but in other areas it does not exist. I was sorry to find last year that very badly disabled people who spent most of the day in bed, living in residential care such as a Cheshire Home, had to pay a full television licence each. A few of the more severely disabled had been given a television set to have in their own room. They had a terrible surprise when they found that they had to pay the full licence, even though the Home already paid for the communal set. Each room in my London hotel has its own television set, but I am sure the hotel does not pay for about 200 television licences. I did not receive a helpful reply from the Minister of Posts and Telecommunications; and I am reminded of these cases every time I stay in my hotel.

My Lords, the telephone section has caused more controversy than any other. Some authorities have made a start. I know, for example, that Sheffield have installed their first 15 telephones and intend to continue taking the cases by priority. But some other local authorities seem to have done nothing, and have adopted a most stubborn and limiting outlook. One particular authority in the North refused to supply a telephone to two very severely disabled people living alone, one virtually immobile, even though their doctor had stated that in their case a telephone would be a safety link which was reasonable and justifiable, and could prove lifesaving. I feel that if local authorities were to send in a report to the Government on what progress they had made during the year this might keep the less progressive ones up to the mark. Anyway, hope that the Government intend in some way to ask for this information.

Since the passing of the Act, new buildings have been built, and it was the mayor of one town who remembered about access for the disabled at a place open to the public. It will be necessary for all members of the community to remember Section 4. Unless one is a disabled person not able to climb steps, it is so easy, accidentally, to forget. In some towns, new shopping precincts are being built. These are usually excellent shopping places for wheelchair users, having everything at hand. But new construction subways, with steps at intervals, are being built, preventing access. What can be done about this? Perhaps the noble Lord, Lord Sandford, will give us some suggestions.

This year I have visited several fine town halls, three being those at Manchester, Sheffield and Leeds. When I sit looking up at the many palatial steps, and at the solid majestic buildings which will still be there long after all of us arc dead, I feel despondent. The only hope is to adapt. I think the four of us here to-day in wheelchairs all feel grateful for the example that your Lordships' House and the other place have set. The disabled persons' lavatory must have been the first to be established after the passing of this Act. When I visited Lord Dalkeith yesterday in hospital, I was able to tell him that he could use the disabled persons' lavatory. This now is a very progressive place, used by both sexes. He was very pleased, as he had not realised this.

When I went to Waterloo Station the other day I wanted to go to the lavatory. The first one I went to had several steps, so I set off in search of another, asking a porter on the way. I asked him if he knew of a lavatory with access for a wheelchair. He did not know, he said, as he had never visited the " Ladies' "! When I arrived at the second " Ladies' ", at the other end of the station, I was delighted to find an excellent lavatory—in fact, the first one I have been to at a station where I have been able to shut the door. This adventure made me wonder if stations know of Section 7 of the Act, " Signs at buildings ". When driving down the M.1, I found an excellent " Ladies" with a ramped entrance, but before reaching this it was necessary to jump up a large step on to an island, making what would have been accessible inaccessible. It is these small points which should not be overlooked.

The importance of providing suitable housing for the disabled was brought home to me a few days ago when I received a letter about a young, physically disabled man paralysed through an accident. He is now being treated in a psychiatric ward, having made several attempts on his own life. I have been told that his problems related to housing and employment. These cases of tragedy could be avoided if there were better provisions, but employment has hardly been touched upon in this Act. With the larger numbers of disabled needing employment, if not for the financial benefits for their self-respect, this subject needs full investigation.

It has been proved, and I think all your Lordships will agree, that it is better for disabled people to remain in their own houses whenever possible. In the Social Survey, Part 2, it was found that many disabled people live in inadequate housing and without even indoor lavatories. The Multiple Sclerosis Housing Association has a scheme which is new. It helps to provide for multiple sclerosis patients welfare housing of such a kind that sufferers will be able to maintain their independence for the longest possible time. Particular emphasis is being placed on retaining the family unit and by the provision of the necessary welfare and nursing services, giving the opportunity to fit married partners to continue in or begin employment, instead of being dependent upon the State. This pilot scheme does not fit into the existing pattern of welfare housing or sheltered housing schemes. To succeed, this scheme will require the cooperation of both the Department of the Environment and the Ministry of Health. I should like to ask the noble Lord, Lord Sandford, whether this will be possible.

In Section 8, " Access to and facilities at universities or school buildings ", I should be grateful for a fuller answer to my question which I asked during the debate on handicapped children. Sometimes the Department of Education and Science are prepared to allow certain items of abnormal expenditure—for example, those due to site conditions—over and above the cost limit. If it is desired to incorporate in a project certain special provisions for handicapped people it is most likely that it will be possible to meet the cost within the normal prescribed cost limits. I asked whether the Department of Education and Science would be prepared to allow the cost of the facilities for handicapped people over and above the normal cost limits? The answer I received was that the Secretary of State had given sympathetic consideration to certain proposals from local education authorities, but it is not entirely clear whether the answer related to existing buildings or to new buildings. Will it be possible for local education authorities to have larger minor building programme allocations which will make it easier to carry out such work as they consider necessary to help disabled people?

Section 17 gives me a great deal of concern, but perhaps it is too early to expect any progress so far. I am still hearing of cases of young patients being sent to geriatric wards. Some areas have no accommodation at all for young disabled people. Are the Government going to press local authorities to provide suitable places for young people? Local authorities do a great deal to equip the disabled people in their own homes, in the way of providing hoists and aids, but very often they do not do this when these people are in residential voluntary homes. Yet the disabled people, of course, still need lifting and helping with daily living. Some local authorities depend almost entirely on these voluntary places. Many of these homes are struggling to make ends meet. I should like to know what the West Riding of Yorkshire would do if all the ordinary residential homes for the handicapped closed down. In borstal to-day there is a high percentage of boys who are from families with disabled parents. The battle has been too great. the circumstances too difficult. Many of these children are lucky if they go to school with a cup of tea for their breakfast. By stopping free milk for children aged from 7 to 11 years, the Government, I believe, are actually encouraging the development of more disabling disabilities, such as bone deficiency, deficiency of vitamins and dental troubles. So I very much hope this unpopular decision will be reconsidered. Then there are some borderline cases, such as sufferers from post-encephalitis, who do not seem to fit in anywhere. Will it be possible for local authorities to supply more residential care for such people?

Section 20 caused great disappointment to some users of invalid carriages. There was great rejoicing when the severely disabled users of these carriages thought they had been granted a little more freedom. This was short-lived when brown envelopes arrived, the contents of which told them that the Ministry electric chairs were for indoor use only. I think the circular could have been less harsh, perhaps giving them a little hope and encouraging them to buy, or to get given by a voluntary society, another wheelchair. Section 21 gives the first glimmer of hope to the badly disabled passenger. He has at last been recognised and will soon be able to display a badge on his car. He may have spent all his life savings on this car, as this is the only way to independence. Of all the Amendments that did not get into the Bill I felt most sorry about the one relating to disabled mothers, as also did the noble Baroness, Lady Darcy. Both of us have young children. We feel that to separate children from their mothers is one of the cruellest things one can do. I hope the day will come when families with disabled members will be encouraged to unite.

I was very pleased to hear the noble Viscount, Lord Ingleby, say that employment should be encouraged for disabled people. I feel that if the S.E.T. tax were removed in the case of the disabled this might encourage firms to take more disabled people. Certainly in the North, people are business men, and if disabled persons are to be laid off they will do this.

The noble Lord, Lord Aberdare, I know, has been working very hard. I have had personal proof of this, and I know that he is far from complacent. I feel that the care of the disabled is in good hands. He says that local authorities will not spend their own money, but I feel that the Government should act as a big brother in some cases and give expert advice when it is needed, because they have the better facilities for getting this advice. The chief cause of disabilities, he said, was arthritis and I was delighted to hear that more money is to be given to research. I myself am connected with the West Riding Medical Research, and I hope that they will benefit from this decision. I was delighted to hear the noble Lord, Lord Cullen of Ashbourne, make his excellent maiden speech on this subject. We felt that we now had a man with a true understanding of the problems of the disabled when he said that we want to live in dignity.

The noble Lord, Lord Wells-Pestell, brought up the problem of the local authorities. We feel that he has stressed the need for the progress report, and I shall await with interest the reply of the noble Lord, Lord Sandford, on what he is able to do. The noble Baroness, Lady Darcy (de Knayth), brought up the subject of the means test. I think that this is the first time that this has been mentioned. For example, there could be a husband and wife, the wife being disabled, the husband a school teacher. It is very hard if, because of his wife's disability, he cannot live to the standard of his own profession. This might well encourage the break-up of the marriage. When the right reverend Prelate the Bishop of Rochester spoke, we felt it very important that right reverend Prelates should take part in debates of this kind. I am delighted to hear that the Church is going to encourage the voluntary and statutory bodies to work together.

I thought that the noble Lord, Lord Crawshaw, made a splendid speech. The hospital services are very much in the news and I know only too well the need for more nurses. A great deal of energy seems to be needed to find a way to put nursing at the top of the professions, to make it so attractive that people will want to take it up. The noble Lord, Lord Amulree, stressed the need for domiciliary physiotherapy. I should like to add to this by saying how important we feel domiciliary physiotherapy to be and how especially useful to the high lesion tetraplegics who will be put at risk if they go in the winter to hospital physiotherapy departments where they might be in contact with infectious diseases such as influenza. Also, this service would help the elderly disabled who may have arthritic or rheumatic disorders and for whom travelling long distances in an ambulance can be too painful or too vigorous. To keep these people going in their own homes would help relieve the overcrowding of our under-staffed hospitals. I am sure that this will be economically beneficial as well as a happier solution all round.

The noble Lord, Lord Harding, said that we were only touching the fringe of the problem. He stressed the need for research, of prevention being better than cure; for, as he said, often there is no cure. Perhaps there is hope that one day there will be a way of joining the spinal cord, and when that happens three of us here will leap out of our chairs. The noble Baroness, Lady Summerskill, is an excellent person and one experienced in campaigning for the disabled. On behalf of the disabled I should like to thank her for her support. I was pleased to hear the noble Countess, Lady Loudoun, who brought up the point of the mentally ill. We all know that they need even more tender and loving care than the physically disabled. The noble Lord, Lord Platt, again spoke on research. There could be no better person to remind the Government about the need for a Report on this subject.

The noble Baroness, Lady Ruthven, spoke on the progress that autistic children make when they have the correct facilities. The noble Lord, Lord Napier and Ettrick, stressed the need for rehabilitation. I could not agree more that it should be the right of every disabled person to have rehabilitation to develop to the full their potentialities. The noble Baroness, Lady Hylton-Foster, spoke of the need to widen the interests of the disabled and of the need of holidays. All of us are better for holidays. I am delighted to support what the noble Lord, Lord Janner, said about Alfred Morris, who has become a great friend of all disabled people because of his sincerity. The noble Baroness, Lady Elliot, stressed the need to know who the disabled are. Nobody can say that this point has not now been made plain to the Government. We were pleased that the noble Earl, Lord Longford gave his support and also paid tributes in which I am sure we all join.

7.25 p.m.

BARONESS PHILLIPS

My Lords, one consolation about coming at the end of a debate of 19 speakers, all excellent, is that it will not be necessary for me to labour the points but rather to underline some of those which have been made so ably by various speakers throughout the debate. I should like to pay tribute immediately to the late Lady Swanborough. I was delighted that the noble Lord, Lord Aberdare, mentioned her, as did subsequent speakers. She was a remarkable person, a warm-hearted woman and one we shall always remember. It is not necessary for an individual to have a large monument to her memory if she has been a practical and loving person throughout her life.

My Lords, I remember the excitement when we had the " charter for the chronically sick and disabled " introduced into this House last year by our " Mobile Bench ". I am delighted to see them here again, all in action. I think that " action " is the word. They have certainly all come in again with the practical suggestions and informative speeches by which we have now come to recognise them so well. I should like also to pay tribute to the splendid maiden speech of the noble Lord, Lord Cullen of Ashbourne. He immediately touched the right chord for all when he said that what we want is that the sick and disabled should live in dignity. He said that we all seek that all human beings should live in dignity; and I think that this is the note which this debate has struck to-day.

When my noble friend Lady Serota, speaking for the Government at that time, spoke about the Bill, she said that it was a valuable pointer for forms of action that ought to be produced in the future. This is the point from which we start. That Bill, now this Act, is a form of action. It has 29 sections; it affects no fewer than ten Departments of State and, as the social survey has shown and as many noble Lords have said, the size of the problem is vast—even vaster than was recognised at that time. But until Section 1 is fully implemented—and we must never forget this—two-thirds of Britain's handicapped may be denied the benefit of the provisions of the Act. Until Section 1 is implemented the rest of the Act will not come to fruition. Several noble Lords have emphasised this fact to-day.

They have also mentioned the necessity for co-operation between the voluntary and the statutory social services. As one who has devoted the greater part of her life to the voluntary services, I should like to remind the House that the Council of Social Services have always sought full co-operation with all the voluntary and statutory services. This Act has been the mainspring for many of the activities that have been carried out. I would repeat something that was said in the original debate by a certain noble Lord. He spoke not from the Bench he now occupies—and this is the intriguing part of this debate that takes place a year after the original debate. He spoke of a particular circular which gave comprehensive guidance to the local authorities on the discharge of their duties to the disabled under the legislation to which he was referring. He said: 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."—[OFFICIAL REPORT, 9/4/70, col. 248.] He then gave various reasons (which I shall not repeat now) why this should be done. The speaker was the noble Lord, Lord Sandford. I am sure that we are going to get this circular as he is now in a position to do all the things that he urged the Government to do when he was in Opposition.

My Lords, a great deal of thought has been given to Section 2, the provisions in which a re of course not mandatory. I draw the attention of your Lordships to what happens when individual matters are left to local authority services, to quote the noble Lord, Lord Aberdare. At the risk of boring your Lordships, I use as an example a question concerning blind children. There are blind children in the care of the Cardiff local authority, which is not, I should have thought, a poor authority; it is not one perhaps about which my noble friend Lord Janner was pleading. The authority has not paid travelling expenses for those blind children taken to a residential school rather against Ole wishes of the parents.

The reply given to me on this subject by the Secretary of State for Wales highlights, 1 think, what a local authority will not do if something is not mandatory. On the question of travelling expenses, the Secretary of State said: Local education authorities do have discretionary power to assist, not only with the expenses of the children travelling home for week-ends but also to assist parents, where travelling or other expenses are high, with the cost of visiting the school as often as the interests of the child may require. In assessing the need for assistance in such cases, however, authorities usually take into account the fact that the parents are relieved of a greater part of the expense of maintaining the child while at a residential school. My Lords, the parents do not want to be relieved of a greater part of the expense of maintaining their children. They are not receiving any help with the travelling expenses. I cite this as an example of what a local authority will not do unless the powers given to it by the central Government are of a mandatory character,

Several references have been made to the provision of telephones. This again is an example where the mandatory character of the provisions of the Act would have been much more satisfactory. Local councils are laying down regulations about telephones which are so ridiculous that a disabled person, unless he or she is a chronic house-bound invalid, with no relatives and practically no money, cannot get a telephone. This is not the way it was envisaged that the Act would work. Other authorities are insisting that such disabled persons must have no relatives in the town or other friends nearby who can answer the telephone. If these provisions are made difficult, and are hedged around with enough rules, no one will take advantage of them.

The noble Lord, Lord Crawshaw made the point, as have other noble Lords—and it is one we must reiterate—that to keep people in their own homes must always be our first priority. There is no true saving of public money, to put it at its lowest, in failing to provide adequate local services for the severely disabled. If local authorities think that there is such a saving, they confuse apparent cost with net cost. The more people can be encouraged to live in their own homes as normally as possible, the less cost will fall on public funds.

I also wish to refer to the question of access to public transport. I believe that one noble Lord has already referred to this matter, but it is so important that it is worth mentioning again. When we were debating this subject last year my noble friend Lord Hughes agreed to issue a circular on access to public transport. He said he would make a statement about the circular on the needs of the disabled with reference to access to public transport which the Government intended to issue to operators and manufacturers of equipment. I understand that the noble Lord, Lord Crawshaw, and the noble Viscount, Lord Ingleby, actually withdrew an Amendment on the understanding that this matter would be dealt with. I ask the noble Lord who is to reply to this debate; have there in fact been further discussions, and has the circular been issued?

I should have liked to feel that there was no further need for the activities of the Disablement Income Group, but unfortunately we still find that disablement is synonymous with povetry, and there is still need for the work of this Group. I was delighted when the Minister reminded us about the attendance allowance and the invalidity allowance, but even allowing for these, there are still many disabled housewives whose cases have not yet been dealt with.

My Lords, the noble Baroness, Lady Darcy (de Knayth), and other noble Lords referred to the question of mobility. I mention this point again because I recently had a case which I drew to the attention of the noble Lord, Lord Aberdare, concerning these wretched three-wheeled vehicles. A very articulate and well-educated lady kept a diary about her activities with such a vehicle. It contained some hair-raising statements. I only wish that time permitted me to read from the diary. When questions were asked of the noble Lord, Lord Aberdare, he gave a very sympathetic reply. He said, I am sorry to hear of Miss Page's unfortunate experience with a three-wheeler. I can assure you that it is not typical. I am sorry to say that I am afraid it is typical.

By the same post I received another letter from another articulate lady relating the experience she has had with a three-wheeled invalid vehicle. Is it possible that I have found the only two disabled people in the country who have had difficulty with three-wheeled vehicles? Both these ladies have experienced difficulty in getting repairs done to their machines. I ask the Minister to look at this question again. The lady in the second case told me that on one occasion she had to wait at least two months for a new battery. Because of the nature of these machines, the number of people who will service and repair them is small, and as a result disabled people suffer all kinds of complications which no one should be required to suffer.

My Lords, we have had a very full debate. There are a great many other points that I should have liked to raise, but they were raised most ably by the opener of this debate and by various noble Lords who have spoken from a depth of experience of knowledge. The 1970 Act still remains to me an exciting charter for the disabled. I conclude with the words of Mr. Alfred Morris, spoken when he presented his paper to the Royal Society of Medicine on the occasion of the Harding Award. He said—and this is what it is all about: We seek a society where there is a genuine respect for the handicapped, where understanding is unostentatious and sincere; where if years cannot be added to the lives of the very sick, at least life can be added to their years, where needs come before means and where no man has cause to feel ill at ease because of his disability. I wish more power to our " Mobile Bench ". I hope they will again bring to our notice the working of the Act and see that it really becomes a working Act.

7.38 p.m.

THE PARLIAMENTARY UNDERSECRETARY OF STATE, DEPARTMENT OF THE ENVIRONMENT (LORD SANDFORD)

My Lords, I can see that I have to avoid two errors—either of being so thorough in trying to reply to this debate that I become tedious to the whole House, or so brief as to be discourteous to our 21 speakers. May I assure them all that we have taken notes of what they have said and that either my noble friend Lord Aberdare or I will reply later if I do not reply to them now.

I have it in mind to go briskly through the sections of the Act and to comment on the progress that has been made, and answer some of the points which have been made on each section. But before doing so, I should refer to one or two points put to me which do not relate to any specific section of the Act. One was put by the noble Viscount, Lord Ingleby. with reference to the Department of Employment's survey of employment services for the disabled. That work will. we expect, be completed by the end of the year. The noble Viscount also raised the question of sloping kerbs. The further investigations which have been made into this matter indicate that there are disadvantages, as well as advantages, to the extent that it is not possible to give general guidance upon them; but local authorities are perfectly free to adopt this proposal in particular cases where it seems to them appropriate. The matter rests like that.

I was asked by a number of speakers to dwell at some length on Section 1, and I will do so; but I shall not tackle every other section in the Act. The Department of Health and Social Security are at present consulting the local authority associations about this section. It is intended to give authorities guidance about implementing subsection (1) when it comes into operation on October 1. It has not finally been decided precisely what form the advice should take, but it will be designed to enable authorities to obtain, in the first instance, a reasonably good estimate of the number of handicapped people in their area so that they may plan services to meet their needs. Probably the 'simplest method of arriving at this is to carry out a sample survey. This will not enable local authorities to identify and register more than a fraction of those qualifying for service, but it will give them a target figure to aim at. Advice to local authorities will cover the various methods of drawing representative samples and recommend the most useful one; discuss whether a postal sift is necessary; examine the problem of non-response and give advice about how to deal with it; identify and classify the handicapped and attempt to define groups not 'adequately covered by the survey carried out by the Office of Population Censuses and Surveys. It will suggest methods of establishing primary needs and suggest interview schedules, instructions for administration and coding instructions, and give advice about methods of estimating from sample to total population.

The views of those who say that only a complete registration of the handicapped will achieve the objects of Section 1 are, of course, fully understood; and they have been well deployed during the debate. However, the survey suggests that among the very large number of impaired people there are many who do not want to be registered. As many as 70 per cent. of those who had no previous knowledge of the register said that they did not want to be registered. Bearing in mind that there is no compulsion to register, it is agreed that the ultimate object should be the comprehensive identification of those in need. But the cost and effort of seeking this immediately would he likely to result in too great a diversion of money and personnel, so tha. the whole point of the task would be nullified. Also, total identification is not a once-for-all exercise, and would need to be constantly up-dated. While I accept that a few local authorities may well feel justified in embarking straightaway on 100 per cent. identification, properly organised sample surveys are an essential first stage in carrying out the duty under subsection (1) and would be the right first step in most areas.

My Lords, I was glad about what was said by the right reverend Prelate the Bishop of Rochester regarding the way in which this whole exercise presents an excellent challenge for co-operation between statutory and voluntary bodies. In this connection I would mention again the booklet on services for the handicapped. It is in course of preparation by the D.H.S.S., who are now considering how it may best he directed to those in need. It is designed to complement local publicity material provided by the authority itself, so that disabled people are continuously made aware of what is available. As was pointed out by the noble Lord, Lord Platt, and the noble Baroness, Lady Masham of Ilion, this is one of the matters on which advice will be given to local authorities. It is the subject of current discussion with the local associations and further research is going on into ways and means of getting information of this kind to the handicapped who need to have it.

I turn now to Section 2. I was particularly grateful to the noble Baroness, Lady Darcy (de Knayth) for all she had to say about this. The noble Lady spoke so briskly that I must confess I did not get it all down myself; but it is all in Hansard, I trust, and we shall be able to read it there with great profit. The subsection on home helps is an illustration of a service which is now—contrary to what I think the noble Lord, Lord Wells-Pestell. thought—made a mandatory service by the bringing into force of Section 13 of the Health Services and Public Health Act 1968. There is now a duty on local authorities to provide this service. The noble Baroness, Lady Summerskill, asked about wages for home helps. Those are determined by the Joint Standing Committee for local authority manual workers, so it is not a matter which is within the discretion of the Secretary of State.

LORD WELLS-PESTELL

My Lords. may I ask the noble Lord one question? Is he saying that only parts of Section 2 are mandatory, and not the whole?

LORD SANDFORD

My Lords, I think the noble Lord said that there was nothing in Section 2 that was mandatory; this particular part is.

LORD WELLS-PESTELL

No, my Lords, I asked whether it was; I thank the noble Lord.

LORD SANDFORD

My Lords, the survey has shown that when it comes to wireless and television there is very little unmet need; 94 per cent. of the handicapped have radio, and 89 per cent. have television. There are, of course, some who cannot use either radio or television because they are deaf or blind. The noble Baroness, Lady Hylton-Foster, asked me about holidays for the handicapped. The D.H.S.S. Social Science Research Unit has carried out a special study of local authority schemes, and the Department expects to issue a circular later this year which, I feel confident, will answer all the other questions which the noble Baroness asked about that.

There has been a lot of concern about telephones. The fact of the matter is that if this provision were made mandatory and telephones were provided for all those who needed them, it would cost some £12½ million. Given £12½. million to spend across this whole field, I do not believe that any noble Lord would feel that it would be right to spend it all on telephones. The problem—and it is one that local authorities have to face—is how to make the best use of all the resources that are now available to them. I do not think that at this stage one can do better than proceed with the register, and then we can see the needs more clearly. There will, of course, be handicapped for whom it would be appropriate to provide telephones.

My Lords, I turn now to Section 4, which relates to premises. In answer to a question which I believe was put by the noble Viscount, Lord Ingleby, I think it would be true to say that attention is now drawn to this section with every planning permision given for a relevant building that is to say, a building to which the public have access. Regarding Government buildings—this point was raised by the noble Lord, Lord Crawshaw—a circular drawing attention to the provisions of the Act and referring to the available design guides was issued to all the Department of the Environment's design staff in December, 1970. In new Crown buildings for instance, courts— which are visited by the public, the Department makes suitable provision where it is practicable and reasonable to do so, for disabled people to enter and leave the building. Care is taken to ensure ease of movement inside; lift controls are positioned so that they may be reached from a wheelchair, and so on. Again in answer to the noble Lord, Lord Craw-show, a circular to public transport operators is now being prepared. It is proposed that this should draw attention to the special needs of disabled travellers, and to suggestions made by the associations for the disabled. The Department intend shortly to discuss the form of this circular with representatives of the chronic sick and disabled.

The noble Baroness, Lady Masham of Mon, asked me about schools and the cost of making them accessible to the disabled. The cost of building this accessibility into new buildings is negligible if thought is given at the design stage. So far as alterations to buildings go, if and when any applications are received for extra allocations for minor works, they will be considered on their merits. Lady Masham also asked about the separation of the younger from older patients in hospital. As my noble friend said, the Secretary of State has made available an additional £3 million over the four years beginning April 1, 1971, specifically for the provision of special units for the younger chronic sick. Of itself, this is expected to make a significant contribution to the problem. The noble Lord, Lord Amulree, also was interested in this aspect. If I may, I will write to him about the other points concerned with rehabilitation which he raised. On the question of existing residential accommodation other than hospitals, the noble Baroness, Lady Masham of Mon, would like to know that as part of the necessary measures to fill some of the gaps left, a census of residences, staff and buildings providing residential accommodation for the elderly and the mentally and physically handicapped was undertaken last year, and the results of that are still being processed.

I turn briefly to Section 20. Here I think it is known that the Ministry of Transport and Industries in my Department made regulations to give effect to the provisions of Section 20 on September 26 and 28, 1970. All the representatives of the disabled have been generous in their tributes to the Department for the speed with which the regulations were made and for the consultations which preceded them. The question of the provision of vehicles for the disabled, including all-weather wheelchairs designed to operate indoors and to be taken out of doors, is still being reviewed by the Department of Health and Social Security. On the question of badges, two sets of regulations are necessary. Consultations are almost complete and regulations should he made in a few weeks' time. A circular is also needed to explain the scheme in detail, and that will be issued to local authorities when the regulations are ready.

We are grateful to the noble Lord, Lord Harding of Petherton, for what he said on Section 22 of the Act. I think he was the only noble Lord to speak of this subject. My noble friend Lord Aberdare will have what he said very much in mind when he comes to prepare the first report called for under this section, and I think that he would like me to thank the noble Lord for helping him well on his way towards the writing of that report. On Section 24, the Department of Health and Social Security are consulting widely among bodies and individuals working in this field of hearing research, which is very complex, and a report will be presented to the Medical Research Council, as required under the section, when consultations are complete. The noble Baroness, Lady Phillips, asked me about Section 25, which deals with the education of the deaf-blind. A circular asking local authorities to review the provision for deaf-blind available in their areas and to supply details of the special provision made his been sent out. Most authorities have replied but not all.

Several noble Lords spoke on Section 26 on autistic children and we are par- ticularly grateful to the noble Countess, Lady Loudoun, for her contribution. The Department of Education and Science intend shortly to issue a circular of guidance to local education authorities on special education for autistic children, which will deal both with educational methods and staffing and will give advice on placement of school leavers. Information will be required on numbers and present arrangements for autistic children. Further information will soon be available, probably in 1972, as the result of a comparative study by Dr. Michael Rutter, of three units in the London area which employ distinctive approaches to the education of autistic children. The Secretary of State received a deputation from the National Autistic Society, who presented a memorandum on the further provisions they thought necessary for autistic children. The meeting provided a useful opportunity for the exchange of ideas, and Ministers will be giving further consideration to some of the specific points raised.

I am sorry that this speech is so long, but I think that I am near the end of the Act. On Section 27, colleges of education are giving increasing emphasis to the teaching of reading, and most primary and infant school teachers are aware of the need for early detection of reading handicaps. The noble Countess, Lady Loudoun, asked me about schizophrenia of middle age. The Department of Health and Social Security has in preparation a memorandum giving advice to hospital authorities, revising and bringing up to date existing advice on hospital services for the mentally ill, including guidance on linking hospital services with the community services of local authorities and with general practitioners. Departmental policy has been to encourage the provision of psychiatric units in general hospitals, and the continuation of this process, together with the planned development of community supporting services by local authority social service departments, should give the mentally ill persons of all ages a fully comprehensive service.

At the beginning of this debate the noble Viscount, Lord Ingleby, thought that there would be some fall-out. I do not think that sufficient recognition has been given during the debate to what a flood of financial benefits is already falling. There is some £30 million per annum invalidity allowance and attendance allowance; and £1 a week, in round terms, for old age pensioners from next September. Looking at the hospital services, there is £3 million for special provisions for the young chronic sick, a point which the noble Lord, Lord Platt, and many others mentioned. There is a considerable increase in hospital services for the mentally handicapped, the mentally ill and the elderly, including many of the disabled. There is £90 million capital and £105 million revenue expenditure annually, and, on top of that, the local authorities have capital loan sanctions which will enable them to provide upwards of 150 new centres of various kinds. They have a 12 per cent. increase this year and a 12 par cent. increase in addition to that next year in rate support grant, and on ton of that an extra £11 million over two years to improve local authority health and social services, including the cost of services provided under Section 2 of this Act.

Far from the central Government not giving a lead. there has been an absolute cascade of circulars and advice. There are circulars on housing needs of the disabled, on the design of Government buildings, to health and welfare authorities on the provision of services under Section 2, to local education authorities about teaching deaf, blind, autistic and dyslexic children. We are not stopping there. There is a circular, with attendant regulations, coming out on badges for the disabled; circulars on teaching autistic children; to public transport operators on holidays for the handicapped, and a circular on home helps. There is the first report under Section 22 of the Act and, in addition, another circular on the operation of Section 1; and there is this survey as well. We are not, immediately on top of all that, going to add a lot of circulars for local authorities to have to deal with.

I was glad that the noble Baroness, Lady Masham of Ilton, reminded us that in place of the separate and splintered local authority social services we had a year ago, we now have a freshly reorganised set of integrated social service departments in all the local authorities, which have just come under their new directors. The next step, starting in earnest when Section 1 of this Act comes into force this October, is for every local authority—and here I agree with the noble Lord, Lord Wells-Pestell —to take action to make its own assessment of the needs of the handicapped that have to be met in its own area, to form its own judgment of how best to progress and advance, to apply the fruits of this very valuable and useful service to its own area, to deploy its new staff, to make the most of the increased cash benefits which have been made available and to involve the ever-ready voluntary efforts which were so properly brought to our attention by the noble Lord, Lord Cullen, in his admirable maiden speech. Local authorities have to do all this to meet the needs in their own areas to the best effect. Those in local government whose duty it is now to give effect to this Act will be most grateful to the noble Viscount, Lord Ingleby, for the opportunity this debate has given them to bring this wide and diffuse problem into sharper focus and to help us all to see more clearly what the next steps should be.

BARONESS SUMMERSKILL

My Lords, may I ask just one question, which is rather important? Could the noble Lord see to it that this important information reaches the doctors of this country, either direct from his Department or perhaps sent out by local authorities—because the doctors are in touch with the patients.

LORD SANDFORD

Yes, my Lords. I will certainly see that that is done where appropriate.

VISCOUNT INGLEBY

My Lords, I should like to thank all who have taken part in this debate. The fact that there are still so many people here shows the interest in it. There has been a fund of goodwill towards disabled people shown from all sides of the House, but it is clear that we have a lot of homework to do to ensure that this Act is implemented in the way that Parliament wants. We shall have another opportunity to come back to it when the Secretary of State issues his annual report on research and development, which I understand will be later this year. We will keep the pressure up. I beg leave to withdraw my Motion.

Motion for Papers, by leave, withdrawn.