HL Deb 21 May 1980 vol 409 cc919-55

3.5 p.m.

Baroness FISHER of REDNAL rose to call attention to the present lack of facilities and the prospects for the multi- handicapped blind; and to move for Papers. The noble Baroness said: My Lords, to make your Lordships more aware of the existence of this group, I will try to describe what I mean by multiple- handicapped blind and the frustrations and difficulties that this category of persons suffers. I am not going to talk about the blind handicapped as that description applies to those persons who suffer blindness through injury or accident; neither am I going to talk about blind handicapped in relation to old age. What I am going to talk about is the handicapped child who grows into a handicapped teenager and ultimately into a blind handicapped adult.

We must recognise that a child who is born blind handicapped is left with very few resources by which he can grow, develop and lead his life. The courage of the individual child and the hope and despair of the parents are something of which any civilised country must take serious consideration. The advances that have taken place in modern medicine and medical science over the last 20 years have resulted in the survival of children with handicaps— blind, physically disabled and with all kinds of serious problems. These children prior to the advent of medical science, would have died before the age of two or three and in the main their length of life would have been, at the maximum, 14 or 15 years. Advances in methods of preservation of life have left us with the problems of training and managing this group of multiple-handi- capped children with whom few people have had any experience at all in the past.

While, in your Lordships' House in the past there have been debates on blind persons, and there have been debates on the mentally handicapped, the category of children and young people that I am talking about today is the direct result of modern medical science. They are not what used to be called the straightforward blind persons who suffered blindness as the only affliction. The number of children and young persons involved is very difficult to come by, but my research shows that there are approximately 25, 000 people of this description in the country. I want to emphasise— because sometimes I think the Department are not aware of this— that this is a category where the visual impairment is equal to any other handicap that the child or young person has.

I repeat that this is a recent problem because the advance in medical science that I spoke about of 20 years ago meant that babies in this category were born and started to grow up, and the problem is now getting to serious proportions because no facilities are available for them. If we start with those 25, 000 (and this number is only an estimate, for it is difficult to get accurate figures) we recognise that in the hospitals for the mentally handicapped in this country there are very large numbers of these particular young people who, more often than not, are placed there because nobody knows what to do with them. Social services departments are at their wits' end to find places for this category of child. As in many other cases, we find that the mental hospitals of this country become a receiving depot for all those kinds of problems which nobody else seems to be able to solve.

Inside the mental hospitals we find that, included among the blind handicapped, there will be— very unfortunately for this category of persons— some for whom there is little or nothing that we can do; their handicaps, mental and physical (with their blindness) are so serious that all we can ask for is that dedicated care be given to them. Then there are those others that are in the mental hospitals for whom a limited amount might be done. When I say "limited" I recognise quite clearly that there are mental handicaps with the blindness. That limited amount of training that can be done, along with the care and attention that is given in the hospitals, could result in training these very severely handicapped children to do their own toileting and to feed themselves. It may sound a very simple thing to do, but if one visits mental hospitals and sees this kind of child, one sees that there are great problems.

In the main, those children will live all their lives in the hospitals. But if we can give this initial training of the elementary social wellbeing that they need, feeding themselves and looking after their own toilet arrangements, then in the long run— if we want to be mercenary about it— when they grow into adults the care that will have to be spent on them will be less because there will be less need for the elementary duties of looking after them in their personal affairs.

Then we move on to those for whom further education— and I use the word "education" in a very liberal sense, I am not talking in a vocational or academic sense— of a social and practical nature would be of great help. I have said that numbers are very difficult to ascertain. I could not possibly give the numbers in the respective groupings that I have enumerated. What I can say to noble Lords this afternoon is that there are only approximately 200 special places in the whole of England outside of mental hospitals for the individuals concerned.

At Leatherhead, which is known throughout the length and breadth of the country as the largest residential home for blind handicapped persons, there is a serious problem. The maximum number that it can house— people aged from 20 until they die— is 150. During the three years 1977 to 1979 there were 70 referrals from local authorities up and down the country. Only 19 could be admitted. During the first few months of 1980 there have been referrals at the rate of two a month. They cannot stretch the walls any further; there are not the facilities. It is a deplorable situation in a civilised country like ours.

I want to emphasise that blind people need special help to learn basic and self-care skills when they are faced with other disabilities, which include deafness, physical or mental handicaps. Their problem can be ameliorated by training techniques and staff skills which are presently available in in-service training courses. Here I should like to mention Dr. Simon of Lea Castle Hospital at Bromsgrove. He has been doing pioneering work in in-service training for staff in mental hospitals. There is also the Southern and Western Regional Association of the Blind. They, too, are in a position to develop a programme of staff training if further financial aid can be provided.

May I draw to the attention of the Minister the fact that the impetus for training is coming from the nurses and the professional staff in the hospitals concerned who want to do a better job of caring than they are doing at the moment, but who are under the greatest difficulties because they do not know how to tackle the blindness problem along with the mental handicap. It is from that source, from the nursing and professional staffs, that the push is coming for in- service training.

Over the past three or four months I have been putting to the Minister Questions for Written Answer about the blind handicapped. I must say to the Minister that I found those Answers very evasive and non-commital. I am not blaming the Minister for that. I would accept that he is a very kind man. Only last week, when I was talking to him about this debate, he told me of his own personal involvement in a charity regarding talking books. The department itself has little or no knowledge, little or no statistics, on this grave difficulty of the blind multiple handicapped.

May I quote from the comments that were made at a seminar which was organised by the Southern and Western Regional Association of the Blind last July at Jesus College. One of those speaking at the seminar was a principal at the Department of Health and Social Security at the Elephant and Castle district. I read from what he says: I am the only principal in the Elephant for services for visually handicapped people; and I have other responsibilities as well, … and they take up much more than half my time … I have two full-time members of staff. One is slightly less than half-time on visual impairment. The other deals always with other matters. My full- time assistant on blind matters is a trainee administrator, and I get a fresh one each year ".

Is it any wonder that the Minister, when he comes to answer questions, is in the gravest difficulties? The department itself seems not to take the problem of visual impairment as seriously as they might do. I say to the noble Lord the Minister that if any cuts have to come into the particular department of the DHSS to do with blind impairment, I hope he will resist them, otherwise we shall get a quarter of a principal, and a quarter of a half-time woman and perhaps a third of a trainee administrator, which is not good enough.

I shall not talk about the blind-deaf because I see that the noble Lord, Lord Maybray-King, has his name down to speak. As a patron of the Rubella Association, I fee! sure that he will cover the points regarding the blind-deaf. I see on the list of speakers the name of the noble Lady, Lady Kinloss. I know that she has an interest in the Wilberforce Home which is for the blind physically handicapped. I will not say anything about that, except that the noble Lord, Lord Milverton, wrote to me and said he had hoped to be here to join in the debate but that he was unable to do so. He drew my attention to what the Dutch are doing in the field of small hospital units for this category of persons. I want to emphasise the smallness of the units in hospitals because many parents are disturbed when their children have to go into what they call the big old-fashioned mental hospitals, with all the connotations from the past that they have. The parents are obviously protective about their children, and obviously the children take to the smaller annexe much more easily.

May I now refer to the blind mentally handicapped in the community generally, living at home. They often have no back-up services at all from local authorities, hospitals or anybody. Parents try the best they can to cope with very serious problems. These handicapped people cover a wide variety of intellectual ability, and many of them find themselves in adult training centres. Unfortunately, the adult training centre service does not yet cover the whole community. However, I do hope that local authorities will also take up the training facilities which are necessary when the blind go into the normal sighted situations that are found in the adult training centres. I want to emphasise the point about training, be- cause it is so easy for a sighted person to visualise a problem and it is much more difficult for handicapped blind persons to assess quickly what is demanded of them.

Turning to the last group that I emphasise, these are boys and girls who have hand the benefit of the education system at various schools throughout the country: Condover Hall is the most famous of them all. They find themselves at school- leaving age going through a vocational training test. This normally takes place at the Queen Alexandra College in Birmingham or Hethersett in Surrey. Unfortunately, not all the children who take the vocational test satisfy that test and therefore we must ask: what happens to this group? The Vernon Group specified in its report the need for a special type of centre for this particular group. They did not specify what kind— it would not be vocational or academic— and a centre of that nature has been set up in Liverpool for 12 young women. It is being run by the Catholic Institute for the Blind at Christopher Grange. That is a start but it is being run chiefly by a voluntary organisation. I understand that the Queen Alexandra College in Birmingham are particularly concerned to try to help this group of people. Unfortunately, residential places cannot be provided and with no hostel no training can be given to them. They need a period of further education— and I emphasise again not academic or vocational— for self-help, self-care and training. In other words, they need further education following the education they have received up to school-leaving level. If we can provide further education for the more able people in the community, I think it is incumbent upon us to provide further education for the less able people in the community. Many of these people may be able to live at home, but for those who are not able to live at home perhaps the most ambitious part of the project would be the provision of sheltered housing so that people in this particular group would be able to learn how to cope with day-today living and looking after themselves, although they will not be gainfully employed.

I am aware that the Birmingham Royal Institution for the Blind have recently extended their day care facilities for the blind multiple-handicapped, and already at the Elizabeth Gunn Centre at Harborne in Birmingham, a new hostel has been provided and is now ready to accept people. This hostel has been provided through the good offices of a housing association, working with the governors of the Birmingham Royal Institution for the Blind. I do not want to boast about what Birmingham does— though, being a "Brummie" myself, I am proud of the place, and rightly so— -but the activities of Birmingham are perhaps best known to me through being a citizen of that great city. I believe that Birmingham is the only city and the only region in the country where specialised care has been developed for the multiple-handicapped blind, and it has all taken place at Harborne under the Birmingham Royal Institution for the Blind. It is the enthusiasm of the staff there and the encouragement and support they get from their governors, who have dedication, tenancity and lots of spare time and who work so hard at their job as governors, that makes the whole thing tick.

I should like to ask the Minister— I do not ask him to give any details today— whether there is any possibility that he could advise voluntary bodies on how to try to get money for hostel accommodation and for sheltered housing accommodation so that we can plan for the future. It is important that if people are not to spend their days in mental hospitals when their parents have died, there should be somewhere they can go. Perhaps the long-term solution will be sheltered housing. Can the Minister say whether there is any possibliity of the EEC Social Fund perhaps being able to help in this respect?

Drawing now to a conclusion, there is a fundamental need— I say this to the Minister quite seriously— to develop an administrative strategy which ensures that those who are blind and handicapped and who require special training are identified and guaranteed access to the appropriate training. We know that under the National Assistance Act 1949 it is incumbent upon local authorities to compile and maintain classified registers of persons. I do not think that the DHSS really puts any pressure at all on local authorities to do that. I suggest that, with the best will in the world, if you do not count your numbers, you do not know your problems and you do not have to do anything about them. That might sound very cynical, but it is normally the reason for not taking numbers.

Therefore I would say that registration is a major issue in this connection; it means that a child who is suspected of suffering from blindness and other physical or mental handicap is known to some authority, and it is known what is happening to that child. In that connection I would ask the Minister whether he can give us any information regarding the progress of improvements to form BD8. I know there have been problems about that. I wonder whether he can also tell us anything about the issue of the new NVH— the form for notification of a visually handicapped child. Is it available for distribution and is it being used?

May I say that I believe it is important that Government support is asked for to recognise the problems, to give financial support for special training facilities, to extend further social education facilities to set up assessment units and staff training inside hospitals, for local authorities to provide residential and care facilities and for the provision of future sheltered housing. I do not deny that that is a formidable list; but this is a handicap and we are starting from scratch where there are no real facilities in the country— a follow-on procedure from the time the child is born until the child reaches manhood.

I do not mind where the money comes from— whether from the DHSS or the DES— as long as it is forthcoming. Moreover, I think it is justifiable to expect that, even in times of financial stringency, it should come from somewhere, for it is the price we all must pay to help those who are less fortunate in the community. The amount required is a pittance compared with that which we in this country spend on armaments and weapons of war. I would advocate that perhaps we should spend more on letting these people enjoy themselves and less on destroying things.

Those are my final words, and I thank your Lordships for listening so intently to what I have had to say. The children, the teenagers, the young people and their parents— and noble Lords will know families of this description— are daily facing difficulties, frustrations and disappointments. They lose the hope and the courage which are daily necessities for them. What I am asking noble Lords, and the Minister in particular, today is that the Government and local authorities, working alongside the voluntary bodies, recognise that courage by increasing financial aid and giving greater facilities. I thank your Lordships again for listening. My Lords, I beg to move for Papers.

3.31 p.m.


My Lords, I am happy to say a few words in this debate, as patron of the National Association for Deaf Blind and Rubella Handicapped. I will explain that in a moment. First, I should like to thank the noble Baroness, Lady Fisher, for initiating this debate and for making such a moving, thoughtful, eloquent speech on a very grave topic indeed. I thank her, too, for opening our centre in Market Deeping some weeks ago. The noble Baroness devotes much of her life to helping the less fortunate, and I wish her well in all that she is doing in this field.

The association that I have mentioned was founded, as are so many of the societies which help the handicapped, by parents of handicapped children; in this case, children who are both deaf and blind. They are born deaf and blind, because their mothers had rubella or German measles during their pregnancies. This little association has grown steadily over the past few years, always hampered by lack of finance in doing what it dreamed of doing.

Then, last year, fortunately, a miracle happened. There was a "Magpie" appeal on Thames TV and 45, 000 people sent in gifts which totalled nearly £ 250, 000 for this voluntary body. As a result, it has been able to set up two training centres, one in Ealing and one, which the noble Baroness opened, in Market Deeping. There children will be cared for by dedicated experts who try to improve a child's ability to receive communication, despite the grave handicap of not seeing and not hearing.

The goal is a great one; the achievement will be very difficult. I pay warm tribute to those devoted teachers up and down the country, inside our association and in many hospitals, who dedicate themselves to this formidable task, and I hope that, when voluntary centres like ours have been set up, local authorities will assist in their maintenance.

The pattern of progress of societies for the handicapped is always the same. First, devoted parents and friends get together, share their problems, seek to raise funds, find ways of helping each other and arrange conferences to be addressed by experts and then, when they are sufficiently well-established the State steps in and the State and the voluntary body co-operate. That is the history of almost every voluntary charity in this country, and it is certainly true of this association. I pay tribute to the Department of Health and Social Security for its co-operation and help in tackling this problem, as I do to doctors, parents and friends for their devoted voluntary work, year by year, in this field.

Vaccination of the nation's mothers can reduce the incidence of rubella and is, perhaps, the key to eliminating this handicap for all time for all our children. Both the association and the Ministry publicise to parents the need for the immunisation of expectant mothers, and even of all female children, as the long- term answer. But the immediate problem is that of helping the afflicted child to cope with life, to get in touch— and it is especially "touch"— with those around them and to open little windows on an otherwise darkened life.

It is estimated that some 400 rubella deformed babies are born in the United Kingdom in a non-epidemic year— there was an epidemic in 1978 when the number was greater— and that is some measure of this problem. Both the association and the Government are stepping up vaccination campaigns. I am informed that some 70 per cent. of schoolgirls between the ages of 11 and 14, have been immunised. Many doctors and health centres are playing an active part in the campaign, and the General Medical Services Committee is negotiating with the department for the payment of doctors for screening tests, with the ultimate aim of getting every fertile woman vaccinated.

Let me give your Lordships two sad examples from the number that I know through reports by parents. First, when Jayne was born she weighed only 3 lb. 7 oz. was blind and had a heart condition. For four months she clung to life with little chance of surviving. But today she weighs 101b. 4 oz. and gurgles happily as her parents play with her. Her mother said: The doctors say that Jayne's heart is like that of an old man and it might give out at any time. Now we pray that as she gets older there will be no sign of brain damage. So every day with us counts as a bonus ". That is because rubella children are in danger of other complications, such as a heart condition or a brain condition, to add to their great problem.

The second example is James, a boy with partial hearing and with only one eye. The other had to be removed because of glaucoma. An artificial eye was made for him. After an anxious three months in hospital, James was back at the centre, looking very handsome with his new eye. His mother said: He is far better without the glaucoma eye. He has stopped crying and banging the right side and is a healthy happy boy ". He is progressing at school, understanding far more and has shown signs of trying to form sounds. A recent visit to the audiologist recorded that, while wearing hearing aids, James had some useful hearing in his right ear. We were never quite certain before; unfortunately, what the brain does with messages received is still unknown. He is now being encouraged by his teachers to verbalise when he requires something, as well as to try to use signs.

To me, one of the notable features of this House is the number of your Lordships who support one or more societies which cater for the handicapped. I can think of hardly anyone more deserving of voluntary and State support than those associations which care for the multiple-handicapped— for those who are blind and mentally ill, or deaf and mentally ill, or those who have a heart condition and are blind and deaf. In all these fields we have achieved a lot in my lifetime. I hope that this debate will be fruitful and will stimulate the Government and public opinion to further interest in those who suffer from multiple handicaps. Especially would I like to see more people taking up the training to which the noble Baroness, Lady Fisher of Rednal, referred, and making their life's work the task of communicating with those who can hardly ever be communicated with.

I end up by paying tribute to the nation's hospitals which are already doing so much. And, as always, I pay tribute to the parents of handicapped children for their love and to handicapped children for their magnificent courage.

3.41 p.m.


My Lords, I am very grateful to the noble Baroness, Lady Fisher of Rednal, for initiating this debate to-day because I believe at this time, with rising inflation and the prospect of worse to come, that it is going to be the less fortunate members of society who will suffer most. There are more than 118, 000 blind persons registered in the United Kingdom, of whom 70 to 75 per cent. are over the age of 65, and it is well known that a large proportion of persons who are blind suffer from other forms of disability.

When one researches the various forms of handicap, the list is quite formidable and alarming, ranging from mental disorders through to blindness and deafness, and physical disabilities. One has to define the meaning of "handicap" to help understand the term. It can be described as follows: The long-term disadvantages which adversely affect the individual's capacity to achieve the personal and economic independence which is normal for his peers ". The problems that the handicapped blind face are many, but two categories are of importance: employment and finance. There are between 20, 000 to 30, 000 blind registered for work, but only 13, 000 of those are in employment, and I would think that the majority of those out of work are suffering further handicaps, apart from being blind. I understand that as yet there has not been a well-conducted comprehensive Government survey into the numbers of people who are in the category of blind, handicapped blind or disabled and blind. I shall be grateful if the Minister is able to shed some light on this matter.

There are provisions laid down to help the blind. There are elementary schools for the blind, which are mainly charities with grants from the Government, and the Royal National Institute for the Blind runs two or three schools for blind children with additional disabilities. I should like to ask the Minister, when he replies, to say whether the cuts in public expenditure will affect the programme for the blind. Will there be any cut-backs in this area, and if so— though I hope there will not be— why?

It is vitally important that each child who is handicapped and blind is treated and trained with the view that he or she will be able to fulfil a satisfying, rewarding and constructive purpose in life. The stronger the emphasis on that aspect, the smaller the financial burden that will be incurred in future years.

Many multi-handicapped blind persons are singly housed, with a staff on call 24 hours a day to care for their needs. This results in enormous expense, costing many thousands per year. Would it not be beneficial to the patient, and to the state, if in these cases two or three patients were housed together? I am told that the cost per patient per year can amount to more than the cost of a heart transplant.

The allowance system is in need of a realistic review. I understand that a blind person in receipt of supplementary benefit will receive a further £ 1.25 per week and, if in employment and paying tax— and I should think that there are few in that category— there is a further allowance of £ 180. When one considers the hardship and extra expense that a blind person has to contend with, does the Minister not agree that these allowances are too low and need increasing? Also, would the Minister outline the benefits and state what future proposals there will be, and what is being done to inform people about their benefits? I know that in some areas the local authority will grant free bus travel, and that if they are travelling by rail and need a guide to accompany them they can travel for the price of one person.

The disabilities of a great number of the multi-handicapped blind are the result of rubella in the mother, but thanks to inoculation the number is now decreasing. The problems they face during adolescence are high, but it is when a child passes adolescence that the real problems, finan- cial and practical, begin. The parents suffer a great emotional and financial burden which is very hard to bear. In many cases, a parent has to give up employment in order to take care of the child. If the parent is unable to fulfil this need, then the burden rests with organisations, both charities and the State. Are there facilities that are granted to such a parent, in the form of financial grants?

I am told that a blind person is not able to qualify for the mobility allowance, partly because of the physical ability to walk. His or her problem with regard to mobility is just as great, and J believe that the mobility allowance should be extended. Also, the organisations and people who are involved in caring for the multi-handicapped blind are very critical of the attendance allowance. I should be very grateful if we could have an assurance and a satisfying answer about this problem.

One cannot praise highly enough the Royal National Institute for the Blind, the National League of the Blind and Disabled, the National Association for the Deaf/Blind and Rubella Handicapped, and people like Dr. Margaret Agerholm, and other associations, including Government departments, who do so much in this field.

3.47 p.m.

Baroness VICKERS

My Lords, may I from these Benches express my thanks to the noble Baroness, Lady Fisher of Rednal, for bringing up this tragic subject and for putting it in such an excellent way. I am also very glad that the noble Lord, Lord Maybray-King, joined in the debate, because lie and I so often spoke on these subjects in the other House. I was also pleased to note that the noble Baroness mentioned the Cambridge conference, because I opened it. I think that it was very successful and did a lot of good in pointing the way to further progress.

There are some extremely intelligent blind-deaf children. Regrettably, they are often considered to be mentally retarded because they get so frustrated and because they have no means of giving expression to their feelings and desires. However, many noble Lords must have read The Life of Helen Keller, the most remarkable story of a woman I was privileged to meet who overcame all these difficulties. She became deaf and blind at the age of 19 months. In her book The Story of My Life, she wrote that one day she found out the use of a key. She locked up her mother in the pantry, where she was obliged to remain for three hours. This woke up her parents to the fact that she should and that she could be taught, so they obtained a governess for her. The first thing that Helen Keller did was to lock up her governess in the cupboard and to hide the key. Her father, Captain Keller, had to get a ladder and the governess had to climb out of the window.

This remarkable governess obtained complete control over Helen Keller over a number of months and years, and I am delighted to say how well she did. She was also trained at the Perkin's Institute and went in for college examinations. On the first day she took Elementary Greek and Advanced Latin, and on the second day she took Geometry, Algebra and Advanced Greek. Then she learned French, German, English Literature and Composition. This was taught to her by spelling it out on her hand, and also by means of braille, and she had a special kind of typewriter. This meant that she could get full enjoyment out of life.

There was another young person called Poh Lim, whom the society for which I worked discovered in Singapore. This girl, the daughter of a Chinese washerwoman, went blind and deaf at the age of eight years. She was a very intelligent person, and she also was able to go to the Perkin's Institute in the United States. In 1962, I had the pleasure of showing her round both Houses of Parliament. She felt everything with her hands, and she really did understand, by putting her fingers here, what I was saying. She herself is now teaching in the school for the deaf, blind and others in Singapore. Also known to some Members of this House is Mr. Kinny who was one of the outstanding people in this organisation.

I understand that there are 2, 086 blind people between the age of 0 and 15; 869 are multi-handicapped; 40 are blind and deaf; 221 are blind and physically handicapped, 315 are blind and mentally handicapped and 289 have two other handicaps. Out of the 152 at Condover Hall, which was mentioned by the noble Baroness, I think about 108 can be educated. This place is run by 90 per cent. official funds, but money for capital projects has to come from voluntary organisations. Sadly, one of the reasons why there are deaf blind is accidents, and by that I mean baby battering. It is very sad to realise that in this day and age and is particularly tragic because these children were born quite normal.

The noble Lord, Lord Maybray-King, has mentioned the question of rubella vaccine. Unlike the whooping-cough vaccine, that is considered to be a very safe vaccine, and I think we should get into contact with all the health visitors. I understand that it is not a good idea to have rubella vaccine at the time of pregnancy; it should be before. A quarter of the people at Condover Hall had rubella and a quarter had injuries at birth and others were battered in some way or other, or fell out of their cots

I understand that next year— 1981— is to be the year of the handicapped, and I also understand that it has been proposed to Geoffrey Lloyd, who is a trustee of Leeds Castle, that a conference of disabled persons should be held there. He has been extremely helpful and is discussing the project with the Government. This suggestion has been welcomed by WHO, UN1CEF, ILO and by the IYDP— which is the International Year of Disabled Persons, and the NGOs. I understand that it is hoped to bring together a small multi-disciplinary group to look at a possible international strategy for the prevention of disablement, as distinct from the prevention of individual disablements.

As the noble Baroness mentioned, there are fewer than 200 specialised places in the whole of the country, and therefore far too many of these people are inactive, in hospitals. Regrettably, too, as was touched on by the noble Earl, Lord Grey, the disability allowance in this country is very low and the supplementary benefit is not adequate. What interests me and I think must be looked into is that there are more handicapped children among the families of unskilled workers than there are among others, and nobody quite seems to know the reason for this.

I should like to mention, also, the Warnock Committee's recommendations. Here 28 persons gave up time and produced a document (Cmnd. 7212) which regrettably has not been debated. I think we should have a full day's debate on the proposals in that document. I also regret that under the recent Local Government Act quite a lot of local authorities are not facing up to looking after the blind, as they did previously. As was mentioned by the noble Baroness, there is a need for up-to-date statistics and also to look into the question of the multi- handicapped young people in the way in which she put it, which I will not repeat because it was so excellently put. There is also a need to co-ordinate the services for the placement of the multi-handicapped blind school-leavers and I want to suggest that it should be run by a national agency and perhaps we could ask the RNIB to undertake that work. I agree with the noble Baroness that not enough trained staff are available; there should be more assessment of children in hospitals and also more sheltered homes.

I should like to express my sincere thanks to the people who do this work, because day in and day out they are dealing with some of the most difficult problems in connection with these young people, and also of course with adults. I am on the EEC committee which deals with this and I should like to find out whether we could get something from the Social Fund for training purposes. I think we might put that forward at one of our meetings. Therefore, I should like to thank the noble Baroness very much for raising this matter today and wish her success in the future for improving the status of life of these people.

3.55 p.m.


My Lords, the noble Baroness, Lady Fisher of Rednal, in initiating this debate has deservedly highlighted a comparatively small number of people in our society who nevertheless are individuals who merit our help in every posisble way. In the case of the mentally handicapped blind who have been in special schools, there are few places which they can go to when they leave school, other than mental hospitals, where really many of them ought not to be at all. This needs sorting out because it is unfair both on the hospital and on the hapless individuals.

A further problem is that the nurses, through no fault of their own, are not necessarily trained in dealing with blind patients. The British Institute of Mental Handicap, helped to some extent by regional associations for the blind, offer short introductory courses on blindness to hospital staff. As the noble Baroness, Lady Fisher, has said, some in-service training is already available at Lea College, Bromsgrove. Perhaps some nurses could volunteer to train and could be released on a part-time basis, just like day release schemes elsewhere. I realise that this involves expenditure, but surely it could be met from existing resources.

In York, near where I live, is the Wilber- force home for the multi-handicapped blind. It is the only institution of its kind in the country. I visited it specially last Saturday at the invitation of the chairman. Originally it was the Yorkshire School for the Blind, then it became the Workshops for the Blind, and some 10 or 12 years ago the local authority took over their work. A Government department was asked how the Wilberforce Trust could help the blind and it was suggested that they should help those blind people who were also physically handicapped and for whom no other separate specialised provision existed. It is in this way that it is unique.

It can accommodate 28 now, but one vacancy is kept, if possible, against emergencies. The fees for each patient are paid by the local authority from which the resident comes. It is a wonderfully happy place and nothing that I could say would be praise high enough for the staff of the home. It is run as a happy family. Of the present 25 residents, 20 receive the mobility allowance. It is not clear to me why the other five do not receive it. They appear to be able to walk, sometimes with difficulty and not very far, and they are certainly not capable of getting on a bus. Two of them were assessed at the Condover Hall School and turned down for the mobility allowance; two were assessed when they were already at the Wilberforce Home and they also were turned down, and I am not clear about the fifth.

One of the five is a spastic who, if he has a turn of spasticity on the pavement, may have to be held by a nurse or whoever is accompanying him for as long as 10 minutes before he is mobile again. Perhaps one might say that when he appeared before the medical board he appeared to be a blind person who seemed to be otherwise normal, who could walk across the room, and not until later did he have his bad turn, which of course was not seen by the doctors. It seems to me, as it does to the superintendent, that this situation leads to some distress because it is discriminatory. These five simply have pocket money of £ 4.65 a week, which all the residents get. Out of this they pay for clothing, toothpaste and other necessities, and they have their own tuck shop. They are all quite happy with this.

However, as I have already said, 20 of the residents also have the mobility allowance, so whenever there is an outing to be paid for such as riding for the disabled— which they all greatly enjoy— these five are sometimes overheard saying, "Can I afford it this week?" They go by taxi, three at a time, which costs £ 7.20 for the return trip, shared between the three. For those who have no mobility allowance this is where the distress comes in, because for one or perhaps two out of the three, £ 2.40 is a lot of money when one only has £ 4.65 pocket money a week. There is also the question of taxis for a visit to the dentist, which has to be paid for out of their pocket money.

Is there no way in which these five can be brought again before a medical board and sympathetically re-assessed? And perhaps for future assessment there could be some form of appeal if they are turned down the first time.

4 p.m.


My Lords, if we ever needed evidence that these short debates which we have from time to time in your Lordships' House are justified, I think the short debate we are engaged upon this afternoon more than justifies them, and I am grateful to my noble friend Lady Fisher for introducing this debate. I think the fact that it has to be kept within a defined period makes each of us think very carefully about what we are going to say; we say the important things and we cut out (shall I say?) the supporting material.

I am glad to have an opportunity of participating in this debate from the Opposition Front Bench because I have had some experience of what we are discussing this afternoon. When I was a Minister in the Department of Health and Social Security I had the good fortune of spending a fair amount of time visiting hospitals and institutions, and my wife and I did in fact go to Lea Castle Hospital, which is one— I say, one— of the many progressive hospitals that we have in this country. I have always accepted that saints do walk this earth; I have always accepted that fact. I do not think one meets them only when one leaves this earth. It is in this field where I think they are to be found. I gladly pay tribute to Dr. Simon, who in my view is one of them, and to a good many of the members of the staff there who are looking after multi-handicapped people. It may well be that some of your Lordships have not had the experience— because it is an experience— of seeing a multi- handicapped child lying on a very comfortable mattress and being told that if you never went near that child again it would never move. When you try to make contact there is not a chance of making any contact. My wife spoke in the face of some of them and got no response at all. They are completely out of touch. They are looked after for 168 hours a week, 52 weeks a year, year in and year out.

They are not all as bad as that. This is one of the important things about this debate, because it does remind us that there are three groups. There are those so severely handicapped, mentally and physically, that we have got to face the fact that nothing can be done for them. That means that somebody has got to do everything for them, and they do tend to live quite an appreciable number of years. Then there are those for whom only care and attention is possible. They know and respond— how they know, I do not know— to care and attention, and you can see that they obviously like it by the sounds that some of them try to make and the expression that others have on their faces. But this is as much as can be done. But there is the small group that are able to benefit from some form of education, of a social and practical kind, and society, my Lords, owes it to that child, who never asked to be born but who is alive and who can benefit from some form of education of a social and practical kind. It is the responsibility of society to provide it.

My noble friend Lady Fisher said that there are only some 200 special places available. We need three, four and five times this number of places, if only to relieve the parent or parents for a week or two, or three or four weeks. Many of us, I certainly, have no conception of what it means to have to look after a multi-handicapped child day and night, month after month and year after year. I am surprised that ordinary people can stand up to it, but they do stand up to it. They have a sense of vocation, but they do stand up to it, and I think they need to be helped from time to time to escape— and I make no apology for using the word escape— from that kind of responsibility. If for no other reason, we ought to be able to provide these additional places.

I have not discussed it with my noble friend the Minister, but were I in his place I should have to be honest and say, "Well, it is all a question of money". The only difference between us on this side of the House and the Government— I see the noble Lord, Lord Thorneycroft knows what I am going to say— is that we do not agree with the way in which the Government are saving money, and the regions in which they are applying cuts. But this is not the time to discuss these matters; this is not a political occassion. All I want to say is that there is never going to be enough money, not next year, or the year after, to do all that I believe the majority of people in your Lordships' House and in the country as a whole would want to do for the benefit of the community as a whole.

So what are we going to do about it? Well, we have enjoyed in this country for a good many years— more so in this country, I believe, than in any other country in the civilised world— a vast and comprehensive network of voluntary social organisations which is the envy of the world. I think it may well be that we have got to look at what they are doing. What I want to say to the Minister is this: I am not asking a question, but I should like to leave this with the Minister in the hope that perhaps his right honourable friend could do something about it. Has not the time come when it might be possible to reconsider the allocation of monies ' that we give to some voluntary organisa- tions. I shall be misunderstood, having said that, but I do remember a very substantial sum of money being given to a national voluntary organisation that went immediately into the reserve. It is a very big national organisation. It is true it has a right to say, "We must have a reserve, so that we can see the way clear for the next 18 months or two years". This is a perfectly proper thing, but I am wondering how many have more money on reserve than they need for (shall I say?) the next two or three years.

I am wondering whether it would not be possible to undertake some kind of organisation of grants so that we could make more money available to those organisations which have obviously not only a concern for but a good deal of experience in, areas in which some sort of development is necessary. We are talking about the multi-handicapped blind. I am sure that there are many organisations that can come forward and say, "Well, there are other organisations that could do with more money". That is perfectly true and it may well be that we must have a system of priorities, and this is an extremely difficult area in which to start having priorities. However, I am wondering whether, with some sort of reorganisation, it might be possible to make more money available.

I think that today we are talking about the situation in an area which is of supreme importance to the community and to those who are looking after these people. I wish to finish by saying merely what I have already said in one respect— namely, that we ought to be providing more places in this area if for no other purpose than to enable parents to leave their child for a few weeks while they refresh themselves for the next period ahead. I am sure that we shall receive a sympathetic reply from the noble Lord, the Minister, but I hope that it can be translated in some way into something concrete being done, because I believe that the amount of money that needs to be released for this particular purpose is infinitesimal compared with what the department— which is very generous— gives every year to voluntary organisations.


My Lords, before my noble friend sits down, can he put forward a figure with regard to this matter? I entirely agree that it is very small, but I think that if one could put a figure on it— whatever it may be— it would be helpful to all of us who are prepared to support the point of view which my noble friend Lady Fisher of Rednal and my noble friend on the Front Bench have put forward.


My Lords, I think that it would be wrong for me to hazard a guess, because I have not thought in terms of capital expenditure— that, of course, as my noble friend knows, takes the money. But, if there were a few hundred more places, I think that they could be provided with a comparitively small sum, but I would hesitate to specify it. If my noble friend presses me and asks what I mean by "a comparatively small sum", I should have thought that if something in the region of perhaps £ 200, 000 was made available almost immediately, it would be helpful to start by providing alternatives so that parents who are looking after children in this condition could at least get some relief.

4.13 p.m.


My Lords, I should like to begin by agreeing entirely with the noble Lord, Lord Wells- Pestell, that this has been an extremely interesting debate, with most moving and illuminating speeches. I certainly trust that the noble Baroness, Lady Fisher of Rednal, will feel that it was well worth having the debate. I personally am very grateful to her for having raised the matter because it is of great importance and concern to so many of us. It is a subject on which the noble Baroness is particularly well-informed as chairman of the Committee on the Multi-Handicapped Blind, and it is an indication of the noble Baroness's high standing among organisations of and for disabled people that she was invited to open the new hostel at Market Deeping which is to be run by the National Association for the Deaf/ Blind and Rubella Handicapped, to which the noble Lord, Lord Maybray-King, referred.

I can assure the noble Baroness that the Government are well aware of and have every sympathy for the problems faced by multiple-handicapped blind people. No Government can afford to be complacent when confronted with the needs of people with such problems. The par- ticular disadvantages of blindness have long been recognised in the special provision in the social security system, the personal social services and the special employment services offered through the Manpower Services Commission; but, clearly, those blind people who suffer additional handicaps have special needs and present special problems.

What has emerged this afternoon is that even if the Government had unlimited funds— and the noble Lord, Lord Wells- Pestell, made it quite clear that we never do have unlimited funds for these purposes— to spend on services for this comparatively small but tragically disabled group, no one easy solution would at a stroke improve their quality of life. The multi- handicapped blind are not a readily identifiable, easily labelled homogeneous group. They suffer a common visual disability (although even in that respect the degree of visual impairment itself will range from poor sight to total blindness), but their other disabilities vary considerably. For example, some people may have mobility problems, may be suffering from crippling diseases, perhaps being confined to wheelchairs; others are deaf, sometimes without any speech. Some are mentally handicapped or mentally ill. A number, thankfully small, have a combination of mental, physical and sensory disabilities. Even within these broad groups, needs vary from individual to individual.

The noble Baroness pointed to what she saw as a lack of knowledge on the Government's part about the numbers of multi- handicapped blind. In fact, the noble Baroness did not much like the Written Answers which I gave to the Questions that she sent to me. I hope that she will not find the answer this afternoon equally unacceptable. I accept that there is a lack of knowledge, but that is inevitable. One source of figures is registration with local authorities but that is, and must remain, voluntary. We cannot compel people to register if they do not wish to do so. Thus, while there are some 105, 000 blind people registered with local authorities in England, almost 24, 000 of these notified to us as having additional handicaps, it is generally accepted that this is an understatement.

The overall aim of services for all disabled people must be to encourage and help them to live in the community as independently as their disabilities allow. Local authorities and voluntary organisations do a great deal to assist in this by the provision of social work support, home helps and personal aids— which have such an important part to play in helping people to live as normally as possible. For disabled people, the ability to live at home is so often dependent on the physical and emotional strength of the person caring for them. There are no simple solutions to the problems that can confront those caring for a disabled relative. But a fully co-ordinated approach by social services departments, health authorities, housing departments and voluntary organisations is crucial when the needs of individual disabled people are being considered, and can go a long way towards relieving the stress experienced by many of those who look after handicapped relatives.

In many instances a little practical help from the right people at the right time is all that is required. The Crossroads Care Attendant Scheme Trust realised this some years ago when their first scheme was set up in Rugby in 1974. Their conviction that seemingly insoluble problems can be relieved by a regular injection of practical help with an all-important personal touch have led to the development of 20 schemes in England today with many more in the pipeline. Crossroads schemes are a relatively low-cost way of providing a caring service to disabled people and their families. With as little as £ 10, 000 a year a scheme helping 25 to 30 families can be set up— £ 10, 00 well spent to keep 25 to 30 people out of homes or hospitals.

The care attendants are trained to undertake the role of a relative and to act as a prop by taking over the duties of the carer at a time when help is most needed— early in the morning, late at night or, in some instances, all night. And they aim to copy as far as possible the routine and pattern of caring which is normally given by the relative they temporarily replace. In recognition of the value of this scheme the department gives a grant towards the administrative costs of the trust, which provides a superb example of an effective partnership between the voluntary and statutory sectors.

In many cases, even with practical help from local authorities and voluntary organisations, a person's needs are best met in residential accommodation. In the case of multi-handicapped blind people it has often been suggested that specialist residential centres should be provided, perhaps on a regional basis. However, because of the range of disabilities involved, this is not necessarily the best way forward. The multi-handicapped blind person in residential care, be it provided by the NHS, a local authority or a voluntary organisation, should be placed in accommodation most suited to whichever of his disabilities needs particular care and attention. To the individual, blindness might not be the major disability.

I am sure that your Lordships will be interested to learn of two innovatory developments in providing specialised residential accommodation for one group of the multi-handicapped blind— the deaf/ blind— whose dual handicap poses special problems of caring, particularly because of the difficulty in communication. The first, Manor House Hostel in Market Deeping, is a specially adapted house which will become the home of 12 young adults. The emphasis there is on independence, and as well as the main house, there are flatlets within the grounds which will provide a unique opportunity for young people to develop confidence in caring for themselves. There is also a workshop and a gymnasium to supplement the teaching essential to the social development of these youngsters.

Manor House Hostel represents the fulfilment of a number of years hard work and epitomises what can be achieved by co-operation between voluntary organisations themselves, and the voluntary and statutory sectors. The Deaf/ Blind Helpers League purchased the property and the Association for the Deaf/Blind and Rubella Handicapped raised much of the money required to convert it for use as a hostel. Considerable help was received from the viewers of the television programme, "Magpie", about which the noble Lord, Lord Maybray-King, told us earlier, which in itself helped to focus attention on the special needs of rubella handicapped children. Help was also received from the Mental Health Foundation. The Government provided some £ 40, 000 and in addition both the DHSS and the local social services department have given professional advice when called upon. Already three young people have moved in and are benefiting from living at the hostel.

Another important project, into which residents should move early next year, is the complex of the Royal National Institute for the Deaf at Poolemead which, with substantial help from the Government, will offer eight places to deaf/blind young adults. Here again, much emphasis will be placed on independence, the residents living in specially adapted bed-sitting room accommodation. The opening of Market Deeping and Poolemead will enable us to learn more about the different methods of care required to meet the individual needs of these young people. It is too early yet to assess demand for the places they will offer, but the Government hope that local authorities will bear in mind the availability of such placements if suitable facilities are not readily available locally.

I should like to turn to the special problems faced by those multi-handicapped blind people whose disabilities include a degree of mental handicap. A substantial number of children handicapped in this way are cared for by their families, and others are in hospitals or homes for mentally-handicapped people; the local authority registers undoubtedly underestimate the size of this group and we do not know how many people fall into this category. It is clear that people so handicapped have special needs: but let me stress again that they do not constitute a homogeneous group. Each individual is differently affected. Comprehensive and regular assessment, as recommended in the 1971 White Paper, Better Services for the Mentally Handicapped, is needed to find out each individual's particular needs and the help he could be given.

I come now to the quality of care provided for multi-handicapped blind residents in mental handicap hospitals. The National Development Group for the Mentally Handicapped published in 1978 a report on these hospitals entitled, Helping Mentally Handicapped People in Hospital. This contained valuable advice on the environment and training of multi-handicapped blind residents, and on how specialist advice, including the provision of training manuals, could help staff to care for their special needs. This report has been widely disseminated to staff working in mental handicap hospitals and units. Two chapters of the report, which include the section on visually- handicapped residents, have been reprinted in a more easy-to-handle booklet which many hospitals have found very helpful in trying to improve the quality of care they provide.

The major burden of caring for mentally-handicapped people in hospital is laid upon the nurse. The syllabus of training for nurses working with mentally-handicapped people is wide- ranging, and it would be unrealistic to expect basic nurse training to cover in depth the particular problems of the multiple-handicapped blind. It is obviously desirable, however, for staff who are working with these people to have some training in their special needs. The British Institute of Mental Handicap, in conjunction with the Southern and Western Regional Association for the Blind, recently organised a four-day workshop on the needs of the visually and mentally- handicapped, and is prepared to visit hospitals on request and conduct two-day workshops on the same theme. The aim of these workshops is to give an understanding of some of the difficulties faced by this group of handicapped people, to offer suggestions for techniques of management and appropriate training activities, to consider staffing requirements, and discuss the suitability of alternative placements.

The National Mobility Centre for the Blind mounts courses for staff working with blind people and some nurses working in mental handicap hospitals have attended these courses. Although the organisations concerned must be congratulated for their initiative in arranging these workshops and courses, I could not for one moment pretend that what they are doing meets the total need. I hope that the professional organisations responsible for post-basic training will recognise the lack of training in this area, but there is a shortage of people who are expert in this field and can pass on their skills to others.

Some health authorities have set up special units for the mentally-handicapped blind— these include the Mary Sheridan Unit at Borocourt and the deaf/blind unit at Lea Castle. At the latter, the DHSS is funding an important three-year research project aimed at assessing current levels of competence and functioning of multiple-disabled blind and deaf/blind adults and adolescents, and from that evaluating the effectiveness and development of training programmes. The results will be incorporated into a handbook for the guidance of families and of hostel, hospital and training centre staff. An extension of this project, which could include compiling information on the numbers of visually-handicapped people at centres for the mentally-handicapped and on the staff who work with them, is currently being considered.

To many disabled people, of course, independence means not relying on state benefits, but being employed. The Government, through the Manpower Services Commission and with the help of the Royal National Institute for the Blind, are actively seeking to improve the employment opportunities of multi- handicapped blind people, although the numbers seeking employment in open industry remain relatively few. There are a variety of special schemes and facilities to help severely disabled people obtain employment.

The schemes, administered by the Manpower Services Commission, include the provision of aids to employment where special tools or pieces of equipment needed by disabled people are loaned to them. These include aids for multi-handicapped blind people; for example, a closed circuit television has just been ordered for a thalidomide girl with an additional sight defect, to enable her to make the best use of her residual vision. Also an optacon (a sophisticated tactile reading machine) has been loaned for assessment to a girl who is blind and suffers with severe arthritis. Much has been done to emphasise to employers the abilities of disabled people— -this was the thrust of the excellent "Fit for Work" campaign, and I am sure that the Manpower Services Commission's continuing efforts will benefit all disabled groups but in particular more severely disabled people.

Crossroads schemes and innovations like the Market Deeping hostel are really only the tip of the iceberg when talking of the contribution of the voluntary sector in the disablement field. The Government are determined to continue to support and encourage the growth of an effective and vigorous voluntary sector. The DHSS has already announced that the total of grants it makes will be maintained in real terms this year— something over £ 7 million— a fair proportion of which is paid to organisations of and for disabled people and which, in terms of the services provided and the innovatory developments it helps, represents money very well spent. In that connection I shall certainly speak to my right honourable friend as to whether we could, as the noble Lord, Lord Wells-Pestell, suggested, have another look into that matter.

I was asked a number of questions, which I shall do my best to reply to. The noble Baroness asked about financial help for voluntary organisations who wish to establish special hostels or further education centres. I shall certainly investigate whether the EEC Social Fund can help, and write to her, although I understand that the fund is mainly concerned with open employment. However, my noble friend Lady Vickers probably knows the answer to that question, and I shall confer with her also.

The Government have helped on an exceptional basis with two hostels at Market Deeping and at Poolemead. While the Government are always prepared to consider assistance to voluntary bodies I must, in fairness, warn that resources available for such developments are strictly limited and demand considerably outstrips supply. The noble Baroness also referred to adult training centres and mentioned the lack of provision of these centres. I accept that we do not yet have sufficient of these, but nearly all local authorities who are responsible for this provision have at least one ATC, although the number of places varies widely up and down the country.

The noble Baroness asked about progress on the revision of Form BD8 and the introduction of the new Form NVH for children. Here I regret to say that the work that the department has been doing on the introduction of these forms has regrettably had to be suspended for the time being. I shall write to the noble Baroness on this point when I know more about it. At this moment I do not.

The noble Earl, Lord Grey, spoke about cuts in local authority spending. I should like to point out that expenditure on social services has virtually doubled since 1971. The Government are budgeting for an increase of about 2 per cent. a year for the years 1981/82 and 1982/83. As we have hitherto frequently said, the Government have urged authorities in making reductions to protect the services for the most vulnerable, including the severely disabled, and how they meet their spending targets must be for them. We hope that they will find areas for economy other than in the services for the disabled. We believe that the necessary reductions can be made by further pruning of administrative costs, by adopting more efficient and cost-effective methods of providing services, and by making greater use of the voluntary sector and the resources of the community itself.

The noble Earl also raised the question of a blindness allowance. Organisations of, and for, the blind have long campaigned for a special blindness allowance to reflect the additional costs, like transport, incurred as a direct result of blindness. The Government have made clear that, while there is a strong case for such an allowance, the money is simply not available for the introduction of any new benefits. In any event, Ministers are presently opposed to the introduction of any further benefits for special groups of disabled people as these complicate the system, raise problems of demarcation, and lead to pressure from other groups for similar treatment. The long-term aim is to move to some form of general disablement benefit which would simplify the present system.

The noble Earl and the noble Lady, Lady Kinloss, mentioned mobility allowance. Mobility allowance is payable to people who are unable, or virtually unable, to walk because of physical disablement. Thus, blindness of itself does not qualify one for mobility allowance. I regret to say that there are no plans at present to extend the current qualifying conditions. My noble friend Lady Vickers highlighted the importance of education if multi-handicapped blind children are to realise their full potential.

In education too it is essential to look at the special needs of the individual child. This was, of course, the central recom- mendation of the Warnock Report to which my noble friend referred, and the Government have announced their intention to introduce legislation to provide a statutory framework essentially on the lines recommended in the report. I can assure your Lordships' House that the legislation will safeguard the interests of children with complex special educational needs, such as have many of the children we have talked about today. If there are any other questions to which I have not properly replied, if I may, I will write to noble Lords.

I am sure that today's debate will be of great value in drawing the needs of the multi-handicapped blind to the attention of an even wider audience, and the constructive contributions we have heard will be very useful in helping to formulate policies at national and local level to ensure that the multi-handicapped blind are given the opportunity to realise their full potential. Much of what has been said today has concentrated understandably on the disabilities of the multi- handicapped blind. These people need our sympathy and our help, but let us not paint too gloomy a picture. Many multi-handicapped people live fairly independent lives— at home, in sheltered housing or hostels, in residential care— and they deserve our fullest admiration for the way in which they have overcome or minimised their difficulties.

Baroness VICKERS

My Lords, before the noble Lord sits down, may I ask him whether he will be kind enough to further the point— I do not want him to do it now because I think we have had long enough on this debate— about plans for the Year of the Disabled, because it is in 1981 and it is very important? Perhaps he will write to me about that.


Yes, my Lords, I will.

4.40 p.m.


My Lords, I thank the Minister for his reply and I shall read his observations in Hansard. I also thank noble Lords who have taken part in the debate. The noble Lord, Lord Maybray-King, made an important point when speaking about vaccination. Rubella and the disabilites of the deaf blind can be overcome so long as the vaccination programme maintains its impetus. I wish to reiterate that cuts are being made which have no need to be made, and the vaccination programme falls into that category. If we can overcome Rubella and keep up the impetus of the vaccination programme, much will be achieved, and it should be outside the cuts that any Government may consider.

I thank the noble Earl, Lord Gray, for pointing out that there are difficulties among different categories. What worries me more— indeed, the Minister himself made this point— is that nobody seems to want to categorise people when one is talking generally about them, but when it comes to individual cases and the question of paying somebody some money, how easy it is then for the DHSS to categorise and say that this or that person does not fit this or that little bill, or does not come within this or that category. On the other hand, when we ask for places for people they say, "We want to know exactly what you are so that you can be put into this or that slot". It is rather a contradiction in terms and I thank the noble Earl for drawing attention to this problem.

As we know, the noble Baroness, Lady Vickers, has concerned herself for many years with the less fortunate in the community. She made an extremely valid point when she said we need a national agency of some description, be it Government sponsored or through the RNIB, for the placement of school-leavers. That is vital, because at present the real problem is that of how to place these children, where to put them and what is to happen to them.

It is not simply parents who are asking this question; directors of social services are writing in querying these matters. For example, the Southern and Western Regional Association for the Blind receives many such queries, and I quote briefly from a letter from a director of social services: I would be most grateful if you could let me know of any establishments known to you which might consider Stephen as a resident ". Let us remember that directors of social services are some of the most competent people we have dealing with this sort of handicap, yet they do not know what to do with the people who are drawn to their attention. Local authorities cannot do anything to be helpful if the provision is not there, and the directors of social services do not know what to do. Indeed, the same applies to parents, and I quote this extract from a recent letter we have received: I am worried about my son. He has had an accident … the Royal National Institute for the Blind cannot offer mc any help. Can you please tell me"— the word "please" is underlined— who I can get in touch with? More often than not we cannot give more information as to whom such an inquirer should contact, because there are no people to get in touch with, and that is the problem. The noble Baroness, Lady Vickers, therefore made a very valid point when she said there needs to be a central co-ordinating organisation which would be able to make this information available. It would then be shown clearly to the department that the facilities are not available. At present this responsibility is pushed on to many people's shoulders, all of whom arc trying to do something, but to no avail.

The noble Lady, Lady Kinloss. brought out clearly the effects on the blind physically handicapped. Certainly Wilberforce is a small home compared with others, but it is a home, and that is the point she emphasised. If we can get more organisations like Wilberforce, small groupings, we shall have real homes for these people, and that is what their parents are asking for. The worry of the parents of these people can be summarised in this way: "I will try to cope while I can, but I shall not live forever. What will happen then?" Wilberforce and homes of that description provide a lovely homely atmosphere, and that is what we are aiming at, and I thank the noble Lady for bringing out that point so vividly.

I always find the contribution of my noble friend Lord Wells-Pestell extremely moving on subjects of this kind, and this afternoon was no exception, particularly when he gave an insight into what goes on at Lea Castle in Bromsgrove. I thought his remarks moved noble Lords in all parts of the House as he brought clearly to mind the difficulties and frustrations that are encountered. My noble friend's contribution showed how easy it is for certain phrases to slip off the tongue, and I feel that the Minister was himself guilty of that to-day. It is so easy to say, "Parents should take note of the resources of the community." In many cases that does not mean anything because there are no resources in the community. It is a lovely sounding phrase, yet we have directors of social services and the RNIB saying, "Sorry, we cannot help". Too often parents are told, "Draw on the resources of the community". It is such hypocrisy to use phrases of that sort.

As my noble friend Lord Wells-Pestell pointed out, parents will draw on their own resources and on those of relations and even next-door neighbours, but the point is reached when they ask, "Please, could we have a break, just a little rest? We have a problem and nobody else wants to know about it". They get fed up with talk about an extra £ 1 they might get from some department because they can prove something else is wrong with their child. Eventually, all that becomes of no consequence— they are left on their own— and they say, "Please, give us a rest". My noble friend's comments showed what a matter of grave importance this is for parents who are told, "Look after the children yourselves because we cannot do anything to help you."

When it comes to considering the financial implications, with which my noble friend dealt, perhaps because I am a woman I prefer to over-estimate costs. I am one of those who likes to double-up on what something really costs so that one makes a profit, as it were, in the long run. Possibly that is a feminine trait. If you tell your husband something will cost £ 50 and it turns out to cost £ 25, you are £ 25 better off. The figure which my noble friend gave was not over- generous. I would have said that we could accept a lesser amount for a start, especially on extra training facilities, but the capital investment we would be making for hostels is a different proposition. We could start with the figure that my noble friend Lord Wells-Pestell mentioned, and then we could come down a little if necessary.

I listened very intently to what the Minister said. I believe that the handicapped, whether they be blind or have some other disability, always come very low in political priorities, and in this respect I do not criticise this Government any more than any others. There is no glamour at all in looking after mentally handicapped blind people. It is a life of dedication as my noble friend Lord Wells-Pestell said; so it can never compete with other news items. It will never hit the headlines in the way that heart surgery or kidney transplants do. It will never be in that class. The only satisfaction here is that which is derived by those who work with this category of handicapped people. They experience a small degree of satisfaction, or a thrill, when they see that a handicapped child can pick up his own spoon and feed himself. That is the thanks they derive. There is nothing glamorous, nor anything to hit the headlines.

I appreciate what the Minister says; there is a conflict regarding definitions in relation to any particular handicap. Some people consider that labelling is dangerous, yet in my view it is the only acceptable way in which to assess the numbers involved, from which we can ascertain what special provision is needed. I could not accept the Minister's words when he said that we have a homogeneous group—


My Lords, I said that we have not a homogeneous group.


I apologise most sincerely to the noble Lord. Perhaps what he said was not so clear because of bad acoustics. All these children are individual and separate. They cannot be defined exactly— I think that this is what the Minister was saying— and that causes a problem. They are all individual and are all different, but some of the differences are only slight; and this must be accepted, as it is accepted in any school where one child may be rather backward while another is a little brighter.

So we accept that there must be a mixing, and one might add a merging; but bearing in mind this merging, we must remember that blindness, as well as deafness, is a serious handicap. There is no means of communication, other perhaps than by bodily signs or touch. If we do do not provide special training, we condemn the blind and deaf more than is necessary. Our plea is that the problems of blindness and deafness, and all the other handicaps, must be tackled with con- centration of effort. There are techniques that can ameliorate and help.

I wish to thank all noble Lords who have spoken this afternoon. I should point out to noble Lords that the noble Baroness, Lady Faithfull, spoke to me earlier. Her work with Dr. Barnado's and the Invalid Children's Association is very well known, and she greatly desired to join in the debate. We all listen with great interest when the noble Baroness speaks on these matters, but unfortunately she had to attend a meeting at Dr. Barnado's this afternoon. I thank your Lordships for your kind attention. My Lords, I beg leave to withdraw my Motion for Papers.

Motion for Papers, by leave, withdrawn.