§ 8.40 p.m.
§ Baroness Masham of Ilton
My Lords, I beg to move that the Bill be now read a second time.
It is a privilege that the honourable Mr. Thomas Clarke, who sponsored this Bill in another place and 1222 who so ably negotiated its procedure through another place, saw fit to entrust it to me to take it through your Lordships' House. As a fellow member with Mr. Clarke of the All-Party Disablement Committee I can say that your Lordships will know how much support this Bill has had from all members of the committee and from all political parties. The Bill has many supporters from all over the country, and if Care in the Community is going to be meaningful it is legislation such as this which will help successful settlement and integration of many disabled people. Many of the provisions of this Bill are already being undertaken—and even more than is in the Bill. Regional health authorities, in conjunction with social services departments and voluntary agencies, like my own regional health authority in Yorkshire, are making great progress.
The Disabled Persons (Services, Consultation and Representation) Bill comes to your Lordships' House in the tradition of other Private Members' Bills before it, most notably the Chronically Sick and Disabled Persons Bill 1970 introduced in another place by the right honourable Mr. Alfred Morris—on which I made my maiden speech, as did my noble friend Lady Darcy (de Knayth)—and the Disabled Persons Bill 1981 introduced in another place by the right honourable Mr. Dafydd Wigley, and which I was pleased to take through its stages in your Lordships' House. Both Bills were improved in your Lordships' House because there never seems to be enough time for full discussion at all stages for Private Members' Bills in another place. I hope that with this Bill your Lordships will be able to make the improvements necessary without changing its agreed clauses. Should any changes be made which were not in the agreement in another place, the Bill could be lost.
The Bill comes to your Lordships' House with a list of distinguished sponsors and all-party support in another place. There has been no division on any aspect of the Bill and I hope that we can proceed with the same level of agreement in your Lordships' House. As I have said, the Bill has very wide backing outside Parliament too, not just from the voluntary associations which one would expect to be behind such a measure but also from the local authority associations, from professional bodies and—perhaps most important—from organisations of disabled people. The Bill recognises that disabled people are no longer passive recipients of service. They are no longer clients with needs. They are seeking the right to be involved in decisions about services that are to be provided for them, and in decisions about planning and developing of those services. The Bill is founded on those principles.
In assessments under Clause 2, disabled people have a formal opportunity to say what their needs for services are and a right to make further representations to a local authority if those needs are not met. Under Clause 7, where a person with special knowledge of needs of disabled people is co-opted to any council, committee or body that co-option shall only be made after consultation with organisations of disabled people. In the same vein, the Bill also makes provision for those disabled people who feel unable to speak out for themselves. Clause 1 gives them the right to appoint a representative to accompany them or speak 1223 for them in relation to services provided by social service departments.
To clarify any doubts, it may be useful to emphasise that the Bill applies to all disabled people to whom Section 29 of the National Assistance Act 1948 and subsequent amendments apply; namely, persons who are blind, deaf or dumb and other persons who are substantially and permanently handicapped by illness, injury or congenital deformity or who are suffering from a mental disorder within the meaning of the Mental Health Act.
Before I deal with the provisions of the Bill clause by clause, I should like to draw your Lordships' attention to a further key principle of the Bill. This is embodied in Clauses 3 and 4 where there is provision for an automatic assessment of need: for young people before they leave special education, and for people who have been in long-stay mental handicap or psychiatric hospitals before they are discharged. The assessments involve social services before crises occur. It is a small starting step in a move from crisis management to crisis prevention. At this traumatic point in people's lives, and at this point where there is a transfer of responsibility of care between agencies, the assessments will ensure a smooth transition and proper planning.
The Bill does not ensure that services will be provided unless there are existing statutory duties as, for example, under the Chronically Sick and Disabled Persons Act 1970. But it ensures for people that at key points in their lives their needs will be recognised.
Clause 1 is the newest legislative ground that the Bill covers. It gives disabled people the right to appoint representatives to accompany them or to speak on their behalf in relation to services provided by social services departments. It also allows this right to be extended to health authorities and other local authority services by the Secretary of State. Nothing in the Bill forces a disabled person to appoint a representative. This is the paramount principle: it is up to the disabled person whether or not they have a representative and it is up to the disabled person who their representative shall be.
There are of course people who, because of their disability, will be unable to appoint a representative themselves. These are arguably the people who most need someone independent of service providers to look after their interests. In subsection (7) of the clause the Secretary of State can make special arrangements to meet this need. Detailed discussions are already taking place between the DHSS, local authority associations and voluntary organisations as to how this may best be done. When the clause is fully implemented—in other words, when there is the right to appoint a representative in relation to health services and other local authority services—it will achieve what was envisaged in the original Bill. I hope that the Government will consult and proceed with this as quickly as possible. I ask the noble Baroness the Minister to give a firm indication of when they intend to initiate and conclude the consultation.
For many disabled people the quality of their housing and a modest level of nursing care are the most important factors in being able to continue to 1224 live in the community. In both those areas a disabled person cannot at present appoint a representative. At a time when many services, in particular for people with mental illness, are being provided in the community by both social services and health authorities it makes no sense to retain this rigid distinction between the two. In considering legislation, we are constructing a framework for the future and not codifying increasingly obsolete administrative divisions.
Clause 2 lays down a formal procedure for assessment when the local authority determines the needs of a disabled person for statutory services under welfare enactments. These are defined in Clause 12 as Part III of the National Assistance Act 1948, Section 2 of the Chronically Sick and Disabled Persons Act 1970, Schedule 8 to the National Health Service Act 1977, and, in Scotland, Section 27 of the National Health Service (Scotland) Act 1947, the Social Work (Scotland) Act 1968 and the Mental Health (Scotland) Act 1984.
The clause is extremely welcome. It standardises what can be highly variable assessment practices from authority to authority. However, more than that, it lays out clearly in statute the right of the disabled person to be involved in the assessments being made for services to meet his needs. It recognises that the decisions are usually taken for, and not with, disabled people and that disabled people have views as well as needs.
It is also an important logical step forward. Many of us—and certainly the noble Baroness, Lady Trumpington—will know of people who have assistance from their local social services department, but who find the services provided to be less than fully appropriate. Taking note, as this clause obliges local authorities to do, of what a disabled person says he needs will lead to the provision of more appropriate services.
Subsection (1) gives a disabled person or his representative a formal opportunity to make representations as to his needs for any services when the social services department is undertaking an assessment. Where representations have been made, and the local authority has decided which services will be provided, a disabled person or his representative can request, under subsections (2) and (3), a written statement from the local authority. The statement will (a) specify the services that the authority proposes to provide; and (b) give an explanation of the proposals.
As the clause is currently drafted, a disabled person or his representative can request a written statement from the local authority only when he has previously made representations on what are his needs for services. Also, as the clause is currently drafted, a disabled person or his representative will have a right to make further representations only where the local authority does not propose to provide any services to meet a need identified by a disabled person. They cannot, therefore, make further representations if their needs are partially provided for or inappropriately provided for. However, I understand that it is not the Government's intention to restrict the rights of disabled people on those latter two points, and that it is simply a matter of drafting. I look forward to 1225 amendments in Committee which will clarify these points.
I turn to Clause 3. I am delighted that the Government accepted the clause in this form in another place. It was drawn up after considerable consultation with officials of the Association of County Councils and the Association of Metropolitan Authorities and it has their full support. It is an important advance in the notion of shared care by local education authorities and social services departments of young disabled people with special educational needs. The clause ensures that before a young person leaves school at 16 years of age, or full-time further education at 19 years of age, the social services department will undertake an assessment of need for any statutory services under the welfare enactments.
Some technical amendments will have to be made on the timing, but at the start of the young person's final year at school or further education college the local education authority must inform the social services department of the likely leaving date. The social services department will then be obliged to complete an assessment of needs at least three months before the leaving date. I expect technical amendments in Committee to deal with these two points. The first will be to ensure that young people leaving full-time further education at 19 (when technically they may no longer be children) are covered by the provisions of the clause. Secondly, to ensure that the same provisions apply to young people in Scotland an equivalent Scottish clause must be drafted.
Clause 4 is perhaps the most complex clause in the Bill and it is probably easiest to begin with the position which is now being agreed between the sponsors of the Bill, the local authority associations—the Association of Metropolitan Authorities and the Association of County Councils—and the National Association of Health Authorities (NAHA) and which was implicit in the speech of the health Minister at Report stage in another place. The principles reflect long-standing Government policy and existing best practice. The first principle is that no one should leave a hospital for the mentally handicapped or a psychiatric hospital after lengthy in-patient treatment without a full assessment of his or her needs and a proper plan involving all relevant services. Secondly, it is agreed that the hospital should initiate the assessment process, but that the social services of the area where the person is to live must be involved. Those two aspects are specified in the clause as it stands. However, the Minister, Mr. Barney Hayhoe, was worried that the duty on the social services to co-operate in the assessment was not strong enough. Discussions are continuing and I am sure that all noble Lords will agree to improving the Bill by laying such a duty on local authorities—a duty which the local authority associations want.
The third point is the extent of the assessment. As it stands, the Bill refers only to welfare services. However, if the hospital is involved in the assessment, it would obviously be sensible—indeed, I should have thought automatic—to consider what health services were needed. I hope, therefore, that it will also be possible to reflect that in the wording of the Bill.
1226 The Bill refers only to people who have been in hospital for a continuous period of six months and only to those with a mental disorder. I know that there are many who are worried about the "revolving door syndrome" and would wish to see these statutory assessments extended to people returning to hospital regularly but never there for a full six months. There are problems over defining that group in legislation. However, I see no reason why once the system is in operation other patients could not be included on a voluntary basis.
There has also been pressure to include people with any disability, but we are forging new legislative ground here and to include everyone who had been in hospital for six months would vastly increase the number of hospitals involved and also the proportion of people for whom special assistance was not needed. I accept that the last argument is not overwhelming, but I believe it is right in this Bill to concentrate on the two groups where the need is greatest and the failure of existing community care policies most apparent.
There are a great number of technical details to be tidied up, and I am sure that the noble Baroness will refer to these in her speech, but I commend the principle and purposes of this clause most warmly to your Lordships.
Everyone acknowledges the immense debt that the country owes to the millions of people, mostly women, who devote their lives to caring for elderly and disabled friends and relatives, yet because the debt is so large it remains unpaid. Where there is a carer the social services often feel that they are excused from their responsibilities, especially where the carer is a married woman and can be "expected" to be at home anyway. And we all know that this has been the attitude of successive governments to the payment of the invalidity care allowance—an attitude soon to be formally declared unlawful by the European Court, we hope.
What is needed is a genuine partnership between informal carers, government and the social services. If, as a country, we are to meet the challenge of the increasing elderly population in a manner we would all wish, it seems extraordinary to me that in 1986 carers are practically ignored in legislation. This Bill is a small opportunity to mark the essential contribution of carers and provide a basis on which I hope governments will build in the future.
I must acknowledge that the Bill is weaker than I would have wished. In essence it only enshrines not best practice but universal current practice, which is why there have been no bleats about resources from local authorities. When a local authority is assessing the needs of a disabled person and that person is receiving a substantial amount of regular care, the authority must "have regard to the ability" of the carer "to continue to provide such care on a regular basis". As your Lordships know, the phrase "have regard to" is about the weakest formulation, which is often used. Nevertheless, while I am sorry that the Government have not agreed to a rather more positive approach, I am certain that this clause will prove a bridgehead, and that we shall return to this subject on many future occasions in later legislation.
1227 Clause 6 extends the scope of the information that a local authority social services department is required to provide to any disabled person who receives any of their services. Many local authorities provide excellent booklets on local services, and I hope that this clause will encourage all councils to do the same. The list of what may be included is endless, but would obviously include all the activities of voluntary organisations, transport schemes, leisure opportunities, and I hope also education and employment opportunities. Basic information on benefits should be included as well as all the personal services provided by the council and the National Health Service. Naturally it must be up to the council to decide how to provide the information. One guide may be sufficient for a London borough whereas several may be needed in a large rural county.
Clause 7 builds on those sections of the Chronically Sick and Disabled Persons Act 1970 which require certain bodies to consider the appointment or co-option of disabled people on committees. I shall not list all the bodies here but they include local council committees and various advisory bodies. Indeed, your Lordships' House has been instrumental in extending the list in the Transport Act and the Telecommunications Act, and no doubt will do the same in the Gas Bill.
No one can doubt the value that has arisen from these appointments. There is nothing like first-hand experience when decisions are being taken. Yet there are some organisations of disabled people who feel that some appointments are of "safe" disabled people who may know little of other disabilities and do not always have close links with representative bodies. This clause would ensure that nominations were invited from organisations of disabled people, and I am sure that this will improve even further the flow of information and guidance between disabled people and decision makers.
Clause 8 obviously links very closely with Clause 4, since it requires the Secretary of State to provide detailed information on people receiving treatment for mental handicap or mental illness, and produce an annual report on the development of community services for them. Although the community care policy is nearly 30 years old, if one dates it from the 1959 Act or from the right honourable Mr. Enoch Powell's "water tower" speech, we seem to be trapped in an eternal experimental stage. I hope that these reports will do much to evaluate experiments and move our community care programme from the experimental into the developmental stage.
Clause 9 simply puts beyond doubt that the Chronically Sick and Disabled Persons Act 1970 applies in Scotland to people who are mentally ill or mentally handicapped. There has never been any doubt of its extent in England and Wales, but apparently there have been doubts north of the Border, which I am happy to be able to resolve in this Bill. Clause 10 is another clause added at the request of the Scottish Office. It includes a number of minor improvements to the law relating to disabled young people, which I am sure that the House will welcome.
Clause 11 was included in the original Bill as a marker for substantial improvements in the joint 1228 planning mechanism in Scotland which a number of groups there wish to see, in particular the Care in the Community Scottish Working Group. Unfortunately, agreement with the Scottish Office was reached only at the last minute, when Mr. John Mackay announced that he would ensure that a suitable extension to this clause, or a separate new clause, was brought forward in your Lordships' House. He also said that he wished to extend this clause to elderly people—something to which I am sure no one will object, but which requires an amendment to the Long Title. I know that one or two noble Lords wish specifically to address this issue and we shall obviously have a full debate in Committee when we have the Government's amendments before us. Clauses 12 and 13 are purely technical, but I should like to say a brief word on Clause 14.
First, the Bill leaves the dates of implementation totally to the Secretary of State, Clearly he must consult a number of organisations, but I hope the noble Baroness the Minister will during her speech be able to give us some idea of the dates on which the clause will be brought into force. It is my regret that the Northern Ireland Office has shown resistance to extending the Bill to Northern Ireland. It took eight years before the noble Lord, Lord Fitt, managed to persuade it to accept the Chronically Sick and Disabled Persons Act 1970. but happily the Disabled Persons Act 1981 was extended by order soon after Royal Assent. Clearly the different structure in Northern Ireland would mean adaptations to the Bill. But I certainly feel that Clauses 1 and 2 are needed as much in Northern Ireland as in England, Wales and Scotland.
Finally, in commending the Bill to your Lordships, I should repeat what I believe is the key to this Bill—that is, partnership—an equal partnership between disabled people and public bodies based on information and full participation in decision making. It is only through such a partnership that we can meet the challenge of the next century.
Many of your Lordships have a great fountain of knowledge on these matters—far more than I; and I am delighted that so many noble Lords and Baronesses are to speak on this Second Reading. The noble Lord. Lord Stallard, has been a great supporter of this Bill from the start. I am also so pleased that the noble Baroness, Lady Elliot of Harwood, is giving her support. She has been a trojan supporter over the years of the needs of disabled people. I am grateful to all noble Lords who are here to take an interest in what is a very important Bill. I hope your Lordships will give the Bill a Second Reading. I beg to move.
§ Moved, That the Bill be now read a second time.—(Baroness Masham of Ilton.)
§ 9.12 p.m.
§ Baroness Elliot of Harwood
My Lords, I am sure that all your Lordships wish me to congratulate the noble Baroness, Lady Masham, on the brilliant way in which she has presented the Bill to all of us. It is absolutely excellent and has my full support. Any contribution that I can make will be short but enthusiastic.
1229 Your Lordships have already had a long debate this afternoon on the vital importance of doing everything to prevent disability. This Bill suggests many vital ways in which people with disabilities can become fully integrated into the community (so far as their disabilities allow) both in England and in Scotland. I speak tonight as having had all my experience of this in Scotland.
There is no doubt that a great change has come over the general public about disabled people. They now understand and want to be certain that the disabled have just the same opportunities as those who are not disabled, although there are difficulties that they cannot always be able to accept. It is there for the taking, so to speak. People are not segregated, put into special places and then almost forgotten by the community. That has gone, thank goodness! We all care desperately that the community shall show responsibility and care for the disabled.
The Bill has put forward many suggestions which, if agreed, will help enormously to bring disabled people into the ordinary community. First, there must be cooperation among all the services, whether national or local, voluntary or state. There must be co-operation between medical and hospital care and the community care through the social service departments of local authorities, through the health authorities and also through voluntary organisations. I was chairman for something like 15 years of a social work committee in a county area. I know that it is not always easy to get that kind of co-operation. Yet if we are going to get effective help for disabled people, co-operation is absolutely the keynote. One of the things about cooperation is to know when people in hospital are discharged to live in the community. It was often difficult to find out because there was not that cooperation between the social services in the area and the hospital and the health people. Then it was difficult for us to know what aftercare was needed. Sometimes it failed and this was disastrous because the person generally had to go back into hospital. Co-operation as recommended in this Bill would stop all that. If community services were not available, the person could appeal to local authorities in order to get some satisfaction for himself or herself.
I think that possibly this is more so in Scotland than in England but too many people with mental disabilities can be kept in institutions when, if there were real community care, they could live in their own homes and be cared for in day centres of different kinds. In the area in which I live, in the Borders, I managed about 15 years ago to start a day centre for handicapped people of all kinds. There was great opposition, I may say, from the locality because they said that it was going to cost too much money. Actually, compared to what it would cost today, it cost very little.
It has been an enormous success. From all over the county, buses run to this centre at Hawick (which is where it is) every day and it has made all the difference to the handicapped people. This could be repeated very easily in many areas. I dare say that it has been. But I happen to know about this one because I was responsible for starting it. During all those years that I was chairman of the committee my great desire was to keep people in their homes but, during the daytime enable them to go to the centre—in the case of the 1230 disabled, this centre; and in the case of old people, an old people's centre—which meant that they could live at home, be with their families; but in the daytime they were elsewhere and were looked after in the community. This was an enormous success.
One of the things which pleases me very much about this Bill is that it recommends that kind of treatment. I think that that is something which would make a tremendous difference to handicapped people and also to the community. In Scotland, again if I may say so, it is essential for the Secretary of State to know and to be able to intervene if, in the efforts to get co-operation from all these many different interests, there are disagreements. Of course, there will be disagreements. We all know that. It happens always in any community. At times, you have to be quite certain that someone has the authority to bring the people together and to see that the work is carried out.
In Scotland I think that it should be the Secretary of State, and I hope very much that this will be organised through the Bill. All this is covered in Part III of the Bill. I hope that this will be implemented. Part III is the Scottish section of the Bill. There is much more that I could say but it is late and there are a number of speakers. We are going to discuss in the Committee stages other suggestions, some of which the noble Baroness, Lady Masham, has already suggested.
I hope that the Government will give time for the passage of this Bill, that we shall be able to discuss it, and that before too long this Bill will be on the statute book. It will be a great step forward in the whole organisation of the community, bringing in the disabled people just like any other of us in getting all the opportunities that we all share because we are fortunate enough not to be handicapped. I strongly support the Bill.
§ 9.18 p.m.
§ Lord Stallard
My Lords, I, too, should like to congratulate the noble Baroness on agreeing to sponsor this Bill through your Lordships' House and on the very full and comprehensive outline that she has given us of the provisions of the Bill. I should like to join her, too, in congratulating all those responsible both in government and in opposition for the passage of the Bill through another place—not an easy feat. The sponsor in another place, Mr. Tom Clarke, and his advisers, Mr. Peter Mitchell and Mr. John Healey, together with members and officers of the all-party Disablement Group aided by voluntary organisations, many of them—organisations like the Spastics Society, MENCAP, RADAR, the Forum on Disability in Glasgow and many others—all played a part in achieving what to me, at any rate, is a real and quite unique Bill and in getting it through the other place. I hope that we shall be able to assist in the process of aiding it on to the statute book.
The noble Baroness has outlined the Bill, as I have said, and her reservations. I agree with almost everything that she said in that respect, so I can be mercifully brief and concentrate on one or two points that are of particular interest to me. As I read it, the main purpose of the Bill is to improve the services received by disabled people, not necessarily by the direct provision of more resources but by ensuring that 1231 existing resources are exploited to the full. The Bill aims to achieve this by giving disabled people a far greater say in the assessment of their needs and of what is provided for them.
In my view, Clauses 1 and 7 probably represent the biggest advance in this connection. I have been connected with disabled people and their organisations for something over 35 years now, and while I, and many others like me—for instance, quite a number of your Lordships have much more experience than I have in this field—have tried our best, over and over again, to understand and articulate the needs of disabled and handicapped people, we could never hope fully to understand the multifarious problems that they and their families face day in and day out.
I know only too well what frustrations this has caused among disabled people, even when they felt they were trying to get something to which they were entitled but which seemed to be just beyond their grasp. There was something missing; there was a power or a duty that was not there; or they did not have enough personal access to the kind of bodies and committees that they felt could really help them. So I was made aware many years ago of the need for something more; something with the weight of statute law behind it; something like this Bill, which has come along in the nick of time.
Many of my disabled friends have said that they are sick and tired of being done unto; of waiting outside in the corridor while their case was argued, albeit with the best will in the world, by people like me. Now, under this Bill, they have to be consulted about all issues affecting them, either personally or by their own representative. This, I consider, is the major breakthrough in affairs affecting handicapped and disabled people since the 1944 Act. It certainly takes them a great step forward, and if for no other reason I think I would be keen to support the Bill almost as it stands—and I emphasise the word "almost". But certainly that step in itself is, to me, a tremendous achievement. Of course, as the noble Baroness said, there is room for improvement, and perhaps in Committee we shall be able to improve the Bill. But the basic framework is there in those two clauses that I have mentioned, and I welcome them.
The noble Baroness mentioned Clauses 3 and 4, and I certainly look to the new procedures of assessment for those needing special education and long-stay mental handicap hospitals to help two forgotten groups of people. First, there are the young disabled school-leavers, and noble Lords and Baronesses will remember the short debate that we had only a few weeks ago, when we discussed the problems affecting young school-leavers when they leave special education schools. Secondly, there are the people being discharged from institutional care into the community. The statement mentioned in the Bill would form a vital part of a planned programme of individual care. During that short debate I gave some examples that I had received from the Spastics Society, and if I had time I could give many more similar examples where Clauses 3 and 4 will be of immense value.
1232 I should like to ask the noble Baroness who is to reply for the Government whether she is yet in a position to tell us what technical changes there will be. It always worries me when I hear about technical changes. Does that mean dropping out a clause or putting in a new paragraph? How technical are these changes to be, and what technical changes might be made at Committee stage? Has the noble Baroness any inkling of what they may be?
I want also to mention Clause 5 and the question of carers, which the noble Baroness mentioned as being one of the other vital issues dealt with in the Bill. We all know from previous debates on social services about the invaluable service that is rendered by carers. We shall certainly hear more about this issue as the recent judgment in the European Court, which was mentioned by the noble Baroness, proceeds in discussion and becomes finalised.
I imagine that other noble Lords will have received, as I did, some literature from the Alzheimer's Disease Society. I can do no better than to quote the Society's views in its letter to me because they so coincide with my own. I hope that other noble Lords may be prepared to consider these views between now and Committee stage. I quote:The Alzheimer's Disease Society aims to support the estimated three to four million people suffering from Alzheimer's disease and other forms of dementia and their carers. The carers, numbering at least another three to four million, have to operate on a 24-hour-a-day basis broken only by intermittent bouts of sleep. Most carers wish to carry on caring for as long as they are able. There comes a point, however, where the strain of so doing becomes unbearable and help is sought from the statutory services. But even with domiciliary and day and respite care support available the time comes for many where residential care for the sufferer is the only means of averting a breakdown for the carer, and for this reason we consider that the original Clause 5 of the Disabled Persons Bill, which placed an obligation on local authorities to carry out an assessment of a carer's ability to go on caring when requested to do so by the carer, is the very least that can be asked if carers are to hope to secure access to services when they need them".I fully concur with the views expressed by the society. It would obviously like the original clause restored. I shall come back to that in a moment.
Before I finish I want to mention briefly two other points that troubled me as I tried to keep in touch with the proceedings in the other place. Noble Lords will probably agree with me that the changes were fairly rapid—a little too rapid for us perhaps to keep up with all the time—and changes occurred right up to the last minute. Before the publication of the Bill and its arrival here there were changes. I understand that changes are still taking place, and so it has been a little difficult to keep up all the time with what has been happening.
I should like to express some qualms about some of the things I have read. I shall mention only two. First, the Minister of Health said on 11th April, at col. 543 of Hansard:The Bill has to go to another place. If the other place and those responsible for the Bill there have the same skill, moderation, realism, patience and consideration which the honourable Gentleman has shown I see no reason why the Bill should not become law and receive Royal Assent".I can of course agree that the sponsor of the Bill in another place has all of those qualities, but I think we should resent the fact that the Minister seems to be putting some kind of condition on how we discuss it. 1233 Is he saying that we do not have those qualities, or is he saying that if we dare to change it—this is the most important point—if we dare to amend it in a way that he considers not to be in line with those criteria, he will reintroduce the delaying procedures that threatened the Bill at some other stage? Is he saying, as the noble Baroness said in her opening remarks, that if amendments are carried here, the Bill may not get through the other place?
That is what he seems to be saying. It sounds funny at first, but there is a serious implication behind those words. I hope that in her reply the noble Baroness will be able to reassure me that that is not what he meant, that he recognises the revising role of this Chamber, and that we do not need such restrictions put on us. I have certainly accepted that most Members of your Lordships' House are here because they have the very qualities that the Minister mentioned, and they have them to a far greater degree than is perhaps thought to exist in the other place. I should like some assurance that that is not what he is saying and that we can carry on in our normal way to revise, if we think fit, any piece of legislation that comes from the other place.
The other point that I want to raise was again mentioned by the noble Baronesss in her opening speech. In the same issue of Hansard to which I referred earlier, the Minister stated also:As I have explained, the Government will make commencement orders to bring into effect those of the Bill's provisions which have significant resource implications when the necessary resources are available".—[col. 542.]I shall quote also, with the leave of the House, a letter from the Prime Minister to a Member of another place, in which that point was underlined. The Prime Minister wrote:The Bill represents an important development of existing provisions for disabled people and as such it has significant cost implications. The Government have made it clear that if the Bill is enacted it would not be possible to make commencement orders to bring into effect the provisions of the Bill which have significant financial implications until such time as the necessary funds could be made available".Again, there seems to be a hint that the Government might consider a provision as having serious financial implications when this House or the country generally may not consider it to have such implications. As I have already said, I take the view that there are no direct resource implications in the Bill. What we are doing is trying to make fuller use of existing provisions.
I know that great reservations were attached by government spokesmen to the resource implications of the Bill when it was passing through another place. I have maintained throughout that any increase in demand for services as a result of better assessment of need as outlined in the Bill would be a demand to meet needs that already exist. By replacing crisis management, as it has been called, the Bill will help services to become cost-effective and care-effective. Whatever expenditure is incurred—and I hope noble Lords will agree—such expenditure is surely an investment in the lives of disabled people.
I hope that the Government will ensure that the modest resources needed to implement the Bill are made available, and that measures are introduced without unreasonable delay. I hope that we can agree to specify some dates for the enactment of certain 1234 clauses during our discussions on Clause 14. If we can do that, and can consider some of the further points that I and other speakers have mentioned, we shall have a Bill that will make an important difference to the lives of many thousands of disabled and handicapped people and their families.
§ 9.32 p.m.
§ Lord Banks
My Lords, I welcome this Bill most warmly on behalf of my noble friends. I thank the noble Baroness, Lady Masham, for the very clear and comprehensive explanation of the Bill that she gave the House. I also pay tribute to Mr. Tom Clarke, who piloted the Bill through another place and who was successful there in reconciling different views. Before I say more, I apologise for the fact that I may have to leave the House before the end of this debate because I have to catch a train. I am particularly sorry about that because it will be the first time that I have left early a debate in which I have been speaking.
The Bill is concerned, as we have heard, with services provided to a large extent by local authorities to and for disabled people. The Bill is designed, as the noble Lord, Lord Stallard, said, to ensure that existing resources are used to the best advantage. But it must also involve some additional resources.
When the Bill is on the statute book it will not stand alone. It builds on other Acts affecting the disabled; for example, the Chronically Sick and Disabled Persons Act 1970 and the Education Act 1981. The Bill deals with representation. We have heard that the disabled person is to have the right to appoint a representative to represent him in connection with social services. That representative is to have the right to all the same information as is available to the disabled person. However, a local authority has the power to withhold that information where it is considered that it would be harmful for the disabled person to disclose it. I understand that it is intended to use that power only in extreme cases. However, if one has a power of that kind there is always the danger that it could be used less discriminatingly eventually, and that must be guarded against.
The Bill deals with assessment procedure, and disabled persons or their representatives can compel reconsideration by the local authority where no services are offered. However, there is no appeal against the nature of the provisions where services are offered, and it might be appropriate to consider such a right in Committee.
The Bill deals with consultation, and I welcome the fact that where persons are appointed to bodies and to committees to represent disabled people they will be appointed after consultation with organisations associated with and representing the disabled.
The Bill deals with crisis prevention. The object is to prevent a crisis arising in the care of a disabled person by anticipating in advance and providing in advance. In that context, as we have heard, it deals with those leaving special education and people leaving hospital. The noble Baroness, Lady Masham, pointed out that this latter procedure is restricted to those who have suffered mental disorder or handicap. I wonder whether these procedures should not be extended to all who leave hospital with a new physical impairment.
1235 Where disabled people are living at home and receiving care from another person the local authority must have regard to the ability of that other person to continue to provide care on a regular basis. As I understand it, this is intended to discover, among other things—I repeat, among other things—what the carer needs to enable the disabled person to continue living at home. Perhaps that should be made clearer in the Bill and the carer given the right to ask for an assessment of the disabled person's needs.
The noble Lord, Lord Stallard, pointed out the importance of carers, and I think we would all agree with that. Incidentally, I am sure that we would feel, too, that as soon as possible it is desirable to have a decent income for carers, including married women, though I realise that that is beyond the scope of this Bill.
I have one question affecting what the noble Baroness said about Scotland. The question is really for the noble Baroness, Lady Trumpington. Is it the intention of the Government to table an amendment in Committee to make joint planning in Scotland a statutory requirement, as it is in England? When the Bill was considered in another place the Government supported the principles but at Second Reading expressed reservations. There was then discussion in Committee and then consultation between the sponsors of the Bill, the Government, the local authorities and the voluntary organisations connected with the disabled. As a consequence, amendments appeared on Report with general agreement. I imagine that this House will not wish to try to upset that basic agreement, while seeking, nevertheless, to improve on it here and there.
The Government's reservations were, of course, about resources and it is no good laying extra duties on local authorities if the resources to carry them out are not provided. It might be assumed, in view of the agreement reached in another place, that the Government are satisfied about the provision of resources required by the Bill. However, I note that the health Minister, Mr. Barney Hayhoe, said in another place on 11th April, reported in col. 542 of Hansard, that,the Government will make commencement orders to bring into effect those of the Bill's provisions which have significant resource implications when the necessary resources are available".That last phrase has a familiar and ominous ring about it. Which of the Bill's provisions are regarded as having "significant resource implications" and how long are they likely to be delayed?
This is not a major piece of legislation and in many respects it does not go as far as its sponsors would have liked: but it is a useful and important addition to the existing legislation dealing with disabled people, and as such it is to be welcomed.
§ 9.40 p.m.
§ The Lord Bishop of Gloucester
My Lords, I should like to give a general welcome to this Bill and I believe that others who might have spoken from this quarter of the House would certainly want to do likewise and indeed to add our tribute to the untiring work of the noble Baroness, Lady Masham, and to express the 1236 hope that perhaps the passage of this Bill will be a crown to her efforts.
What I want to say now is perhaps mainly, though not exclusively, applicable to mental rather than physical disability. It seems to me that the existence of disability and handicap, whether mental or physical, has engendered a variety of responses from other members of the community. It is perhaps possible to trace the sequence of those responses in different societies. In our earlier debate today on the prevention of disability worldwide we were reminded that in some societies there is still a great deal of indifference and apathy in the face of disabling diseases or mental handicap—what one might call the wrong kind of acceptance.
Then this attitude tends to give way to a more sensitive yet hopeless and inadequate response, which is mainly one of anxiety and fear. It is a fear which isolates and alienates the sufferer. This response avoids accepting realistically the fact that a proportion of the members of any society are bound to be handicapped or disabled, and it prefers to keep them at arm's length, hidden away in institutions or elsewhere.
Though it is now over 20 years ago, I remember vividly the sense of shock when, as a parish priest, I discovered by accident that the middle-aged widow whom I had regularly visited for months, if not for years, was keeping in the house a mentally handicapped daughter who was probably by then in her twenties or even her thirties. Until that moment neither I nor, I believe, any of her neighbours were even aware of the existence of her daughter, who literally never went out of the house.
We might be rash to assume or assert that such a thing could not happen today. I do not know. I know that in the diocese of Gloucester (and no doubt this happens in other dioceses as well), there is a priest who acts for me as chaplain to the mentally handicapped. Certainly he tells me constantly that there is still far too much fear, anxiety and guilt around when dealing with the handicapped in the community. Thankfully, this attitude in turn has been giving way to a much larger and more general compassion, which has now perhaps become the dominant attitude.
However, this Bill leads us further still, for compassion itself can be distancing and even condescending toward those who are its objects. I believe that there are signs in this Bill that we are moving on beyond simple compassion into a positive appreciation of the contribution that people with disabilities and handicaps make to our common life. They are not just people for whom we should feel compassion; they are members of the community in full right.
The occurrence of mental or physical handicap, particularly when congenital or hereditary, will always constitute, I suppose, not only a social problem but a moral and a theological problem as well. Christian theology can never wholly explain, let alone justify, why such things should be. It can, however, affirm God's power to bring creative good out of tragedy and handicap, disability or disaster—to recognise both the contribution which disabled people make to society through their humanity, gifts and personalities and 1237 also the many ways in which their life and presence within the community nourish goodness in others.
It is in that context that I hope that we may read, for example, the provision in the first clause of the Bill for a disabled person to appoint his own representative to take a more active part in assessing his needs, or the reference in Clause 7 to consultation with "organisations of disabled people"—"of" and not "for" disabled people. In this legislation I believe that we are beginning to come to the truth that disabled people are simply people like the rest of us within the community.
Another good principle seems to me to be embodied in the Bill; namely, as other noble Lords have mentioned, that prevention is always better than cure. I refer particularly to the mandatory assessment of the needs of young disabled people leaving special schools and of those leaving mental hospitals after a prolonged period there. That, together with the suggestion in Clause 5 that the burden shouldered by those who care for the disabled at home needs also to be taken into account, represent a hopeful move into the realm of planning to anticipate problems rather than waiting 1238 for them to erupt and then dealing with them as though they were always a crisis.
If, as I am sure many of us hope, this Bill completes its course through the House without damaging amendments, it will represent another step forward in the general movement towards policies of community care. Generally speaking, the Churches are in support of such policies. Of course, as several noble Lords have already asserted, there must be difficulties and no doubt differences of opinion about resources. But may I offer the thought that resources do not have to be drawn so tightly as almost to be identified exclusively with financial resources? There are already enormous resources within the community through voluntary societies—resources of care, love and voluntary service.
I believe it to be true, and I hope that noble Lords will agree, that church-going Christians, along with many other men and women of good will, are time and time again to be found active in the voluntary organisations that work with and among those who, like all of us, are disabled or handicapped one way or another. I wish the Bill every success.
§ 9.48 p.m.
§ Lord Mottistone
My Lords, I too should like to congratulate the noble Baroness, Lady Masham, for so clearly introducing the Bill. I should also like to congratulate the Bill's sponsors in another place for so painstakingly bringing it so far. I welcome the Bill in principle. The right reverend Prelate the Bishop of Gloucester, who has just spoken, expressed more clearly than I can much of why I do so. It has been a privilege to follow him.
I must remind the House that I am advised by the National Schizophrenia Fellowship. Accordingly, I am particularly interested in how the Bill affects persons who are mentally ill and those who care for them, who are usually the close relatives. I am also concerned with the practical effects that the Bill may have on local authorities. In those connections the Bill seems to have several gaps, and that leads me to a series of questions. I am concerned about the relationship between the authorised representative introduced in Clause 1 and members of the disabled person's family in circumstances where one of the latter has not been appointed in accordance with subsection (8).
For example, does the nearest relative, as defined in the Mental Health Acts, have the right to receive information and see the documents referred to in Clause 1(2), as well as the disabled person and the authorised representative? The nearest relative may well be caring for the disabled person at the time even if the latter, being mentally ill, sometimes resents it. The carer could well be further hampered in a well-nigh impossible task which sadly it too often is, if important information is withheld from him or her. In that general theme, what is the position of the carer with regard to Clause 1(3)?
Moving to Clause 1(7), when the mentally ill person is unable to appoint an authorised representative because of mental incapacity, can the nearest relative appoint himself or herself or, if more suitable, someone else to that position? In connection with those points, the Mental Health Act 1983 provides that any substitution of someone else for the nearest relative has to be authorised by a court. How does that affect the introduction of the authorised representative, because I observe that the Bill has no schedule of repeals or amendment of other legislation? Finally with regard to Clause 1, will my noble friend the Minister explain what she has in mind for the regulations under subsection (6)?
On Clause 2(1), if the local authority does not consider that an occasion has arisen on which it should initiate action as described in the subsection, can the disabled person or his authorised representative or, if different from the latter, the nearest relative call for such action to be initiated?
Clause 4 seems to presume, because in subsection (1)(a) and (b) it calls for consultation between the local authority and other appropriate authority, as defined in subsection (4), that the mentally ill person will go only into authoritative care. What happens when the local authority does not have the facilities to satisfy the assessed needs and the only available care is the person's family? Should they not also be consulted? In 1240 any case, Clause 4 has no obvious conclusion. What is the point in assessing needs if that will not lead to some kind of action?
In regard to Clause 7, the people who have a great deal of special knowledge of the needs of disabled persons are members of their families. May I be reassured that those persons will be considered as appropriate for co-option within the terms of the clause?
Although I have the doubts that I have expressed, I am in sympathy with the Bill's aims, as I said earlier. However, notwithstanding the assurances given by the noble Baroness, Lady Masham, when she introduced the Bill, about discussions with local authority organisations, I fear, unlike the noble Lord, Lord Stallard, but perhaps like the noble Lord, Lord Banks, that the Bill could put on local authorities yet another large burden for which they are unlikely to be granted adequate resources for some time, whichever government are in power. Councillors, for example, may be under embarrassing pressure to provide caring facilities which could not be immediately obtainable, in the event that an assessment says that such caring facilities should be provided for the patient. I shall be grateful, therefore, if my noble friend the Minister can give some idea of how she sees the problem, and what her thoughts are about when the power in Clause 14(2) might be used from a rather different point of view.
I have provided my noble friend the Minister and the noble Baroness with a summary of my questions. I hope that they will be able to give answers to at least some of them. Depending on those answers, I shall have to consider tabling amendments to tidy up the Bill or at any rate perhaps asking questions again, However, I still hope that the House will give the Bill a Second Reading.
§ 9.55 p.m.
Baroness Darcy (de Knayth)
My Lords, I should like to give a warm welcome to the Bill, which gives disabled people more control over their lives and should result in a better assessment of their needs and more co-ordinated services. The noble Baroness, Lady Lane-Fox, has asked me to say that she, too, welcomes the Bill most warmly.
I add my congratulations to my noble friend for a clear and comprehensive introduction of the Bill. I am very pleased that it is she who is its sponsor. Not only has she done a lot to help disabled people, with her first-hand knowledge of problems, but she has always shown that she cares very much about those who are less mobile and less able to speak for themselves than she herself is.
I think that the Bill will be of particular benefit to those severely and multiply handicapped people who could do with some extra help. Therefore, I very much welcome the right to representation provided by Clause 1. However, I echo my noble friend's hope that the Government will be able to introduce substantive amendments to subsection (9) to provide in statute form the extension of the right to representation in connection with health authority services. Surely this is only logical when we are already allowed the same procedure with social services.
1241 I recognise that in another place the Minister for Health felt that there were problems where health authorities are involved, but that he included the power contained in subsection (9) because he believed that those difficulties could be overcome. The Minister said at col. 519 of the Official Report of 11th April that the intention is to find a route to follow. I very much hope that the correct route will be found in the passage of the Bill through this House.
The principle of "a representative across the board" is, predictably, strongly supported by the voluntary organisations. But the professional bodies, such as the Royal College of Nursing, and some regional health authorities—for example, the North West Thames and North Western Regional Health Authorities—also believe that no distinction should be made between the health authority and social services.
Even the National Association of Health Authorities, in its response to the Government's consultation document on the Bill, said that the NAHA,does not support the Government's proposal that the hospital and the family practitioner services shall be excluded from the terms of Clause 1. It considers that special provision in this respect for disabled people would be justified and that any practical problems would be overcome.I am particularly concerned that those in long-stay mental handicap hospitals will not otherwise have the right to representation. Many people with cerebral palsy are in such hospitals, and they have communication problems. The director of the Spastics Society has commented:We believe that these 'forgotten people' must not be denied the rights extended to those who are already in the community.These are some of the people who are perhaps most in need of help. I hope that the noble Baroness the Minister will be able to ensure that the "forgotten people" are recognised, remembered and given those rights before the Bill leaves this House.
Clause 2 is most welcome in that it gives disabled people much more say in decisions affecting their lives. The British Deaf Association, whose members will probably be the largest single group affected by the provisions for the interpreting and communication services in the Bill in subsection (6), however, has some worries over this subsection. As the subsection stands, the local authority, not the disabled person, determines, first, whether assistance in communication is required; secondly, what services will be provided to facilitate communication; and thirdly, the person who will fill the role of interpreter or facilitator.
This is inconsistent with the rest of the clause and the rest of the Bill, which recognise, first, that services are likely to be more appropriate if the disabled consumer is involved in deciding what the services should be; and, secondly, that disabled people have a right to be involved in decisions about services to be provided for them. It is therefore really only a question of shifting the emphasis on to the disabled person to decide whether assistance in communication is required, what form this assistance will take, and who will do it. I hope very much that the Minister may be able to offer hope of changing the emphasis of this subsection and will bring it into line with the whole 1242 philosophy of the clause and the Bill—the responsibility of the disabled person to make decisions.
I welcome warmly Clauses 3 and 4, dealing with the assessment of people leaving special education and those discharged from hospital, which ensures that the necessary help will be continued at a time of life which, as my noble friend said, can be very difficult. I recognise and appreciate how helpful the Government have been in respect of these clauses.
Along with most noble Lords who have spoken, I wish briefly to mention carers. As my noble friend has said, Clause 5 is a start in that it recognises carers. I appreciate that I am venturing into a sensitive area. I shall leave my noble friend Lord Allen of Abbeydale to deal with the matter further as he has perhaps a more delicate step. I shall leave it to my noble friend to ask the question already touched upon by the noble Lord, Lord Banks. I await the answer eagerly.
I should, however, like to add a few words of appreciation for carers, many of them elderly and sometimes stretched almost to breaking point and physically exhausted by caring for a severely physically handicapped person or emotionally drained by caring for someone with, for example, Alzheimer's disease, or some other form of dementia. If the carer cracks up, that means two people out of the community and in hospital.
Once again, I warmly welcome the Bill. I appreciate what the Government achieved on Report in another place. I hope that the Government will be able to make one or two further improvements in this House. I wish the Bill a safe, smooth and speedy passage.
§ 10.2 p.m.
§ Lord Swinfen
My Lords, like the noble Baroness, Lady Darcy (de Knayth), I welcome the Bill and wish it a speedy passage. I wish also to speak about Clause 5, as she did, and to follow the noble Lord, Lord Banks, who mentioned that the Bill was an exercise in crisis prevention. Many people who look after disabled people at home do not realise what a great financial service they are performing for the community. Some of them who look after people with huntington's chorea may not have simply one disabled person in the family to look after; they may have several. The may even themselves be in the early stages of the same disease, knowing that they themselves, shortly, in perhaps a matter of years, will be in the same position as those they are looking after. That must be terrible strain and very depressing.
Should those people who are disabled be given up by their families, they would have to be taken into care. At the moment, the allowances paid by the Government are £180 a week for a disabled person in care. By my reckoning, that is £9,360 a year, not forgetting that a number of instances—not in all—the local authority will provide additional topping up over and above that figure. These sums that I am talking about are minimum sums. Thinking for the moment purely of the financial aspects and the benefit to the community, do not those carers themselves need some form of care?
1243 Even if one bounces a rubber ball up and down forever it reaches its own breaking point. Carers are not rubber balls; they are flesh and blood like the rest of us. There may be other strains within their family, apart from the disabled person. There are other members of the family who demand their attention and time. Perhaps they are looking after a disabled husband or child while at the same time, 30 miles away, they have a parent gradually getter older who needs more and more attention as well. Even without the additional strains, looking after one disabled person, where one is never getting a full night's sleep, brings one to the verge of breaking point. If that is allowed to happen—as another noble Lord said, I am afraid I do not remember who it was—one would end up with two people in care: the disabled person and the carer.
Respite care is surely the answer. While the family who are looking after the disabled person go and have a holiday and recover so that they can look after that person for another period of time the disabled person goes into an institution and is looked after for, say, a fortnight. If that is done at the very least, say, a fortnight a year, costing what the Government claim that it costs to look after a disabled person—£180 a week—that is £360 for a fortnight. If one takes that away from the cost that the carer is already saving the community—a minimum of £9,360—that only reduces the saving to £9,000. I have here a letter from one of the Welsh county councils seeking from the organisation for the disabled for which I work funds to take a man suffering from huntington's chorea into a home for a fortnight. The charges in that home are only £85 a week and so the savings may well be more than £9,000.
I think that it is a very short-sighted view on the part of the Treasury—not the noble Baroness's ministry, because I know she would like to do more. I recognise that the noble Baroness is aware of many of the problems. But surely she should take it upon herself to persuade the other Ministers in her ministry to hammer on the Treasury door, to get inside, and to knock some heads together, because the saving to the community would be very considerable. If we do not care for the carers and make certain that that is provided for under Clause 5—I do not think that it is as the Bill is written at the moment; I feel that it needs amending in this respect—we are not doing the right job.
Another point upon which I need elucidation is Clause 6. As I understand the clause, the information to be given to disabled people and their representatives is only on the services available within the local authority's area. But not all local authorities provide all services; some of the services are very specialised. I should have thought that it was essential to have the means to find out and provide information on specialised services anywhere in the country to disabled people and their representatives.
With those remarks I wish this Bill a speedy passage.
§ 10.9 p.m.
§ Lord Allen of Abbeydale
My Lords, at this stage of the evening I shall be very brief, particularly as most of 1244 the points that I was thinking of raising have already been extremely well covered in the speeches made so far. I want to thank the noble Baroness, Lady Masham, for introducing this important Bill and explaining it so clearly.
I am glad—and I speak especially as chairman of MENCAP—that Parliament is able to have this opportunity to take a really effective step forward to improve the quality of life of some of the most disadvantaged members of the community. I look upon the Bill as a further significant step in seeing that resources for the disabled are used to the best advantage and that disabled people are themselves given a say in the improvement of services available to them. I recall that the International Year of Disabled in 1981 had the aim of, "full participation and equality". Five years later this Bill represents an important move to that end.
It would be wrong not to express appreciation of the Government's attitude to the Bill. Some of us trembled for its progress in another place, and although the Bill as it emerged and is before us today falls short of perfection, it is certainly a good deal better than at one stage I, for one, had feared. For a Private Member's Bill it is a very substantive document, and I am lost in admiration of Mr. Tom Clarke's skill in piloting it through another place.
I am conscious of the shortage of parliamentary time and of the pressure on the legislative programme. I realise that in practice—in full deference to what the noble Lord, Lord Stallard, said a little earlier—there is only limited room for manoeuvre in changing the Bill without putting the whole enterprise in jeopardy. But I hope that the Government who, as has been explained, were still brooding about a number of issues when the Bill left another place, will themselves seek to strengthen and improve it during its passage through this House. We shall be only too glad to help and encourage them in so worthy a purpose.
Mention has already been made in the opening speech of the noble Baroness, and in other speeches, of a number of points of comparative detail which will require to be looked at in Committee. I should like to add my own few words to the points which the noble Lord, Lord Swinfen, has just been making about the provisions in Clause 5 relating to carers. I have been looking at the Answer given by the noble Baroness the Minister to a Written Question about extending invalid care allowance to all married women in the light of the proceedings going on before the European Court in Luxembourg, I am referring to col. 815 of the Official Report for 8th May. The Answer seems to me to be somewhat Delphic. That is not an adjective that one would normally apply to pronouncements of the noble Baroness. However, it makes a point of referring to the valuable work which the carers do. It is valuable indeed, as has been well illustrated by the noble Lord, Lord Swinfen, and others who spoke earlier.
This group, many of them elderly women with very few resources of their own, make possibly the greatest contribution of all in looking after the disabled in the community; and, as has been said, in so doing they save the Treasury a great deal of money. The cost of state and local authority provision would run into billions of pounds if they all gave up overnight. I hope 1245 therefore that further thought will lead the Government to add to this clause for two reasons: first, to make more specific the purpose of seeing what help the carer needs to enable the disabled person to continue to live in the community; but secondly to enable the carer to ask for an assessment of the needs of a disabled person.
This is a Private Member's Bill but I shall listen with care to whatever the Minister may volunteer about implementation, and particularly the possible timetable for bringing the various provisions into force. I know that this is an issue of the greatest possible interest to all of us this evening. Although, as I understand it, the original hope was that the main objects would be achieved by using existing resources more efficiently, as the noble Lord, Lord Stallard, explained, I go along with those who believe that there can be no blinking the fact that additional resources will have to be found by central and local government if the provisions of the Bill, either in its present form or, as we hope, extended and improved, are to be brought into effect and produce worthwhile results.
I take comfort from the fact that the Government have declared time and again their compassion and deep feeling for disabled people and their families. I feel that they can hardly fail to seize this opportunity to translate those feelings into practical reality and to demonstrate, as I think must now be one of their main objectives, that they are indeed a caring and compassionate Administration.
§ 10.17 p.m.
§ Lord Ennals
My Lords, one of the most encouraging factors about this debate has been the unanimous support from all parts of the House for this Bill. I certainly want to add my thanks to the noble Baroness, Lady Masham, for her presentation of it, and for what is going to be quite a difficult task in piloting this Bill through your Lordships' House. I should also like to give my praise to Mr. Tom Clarke, the Member of Parliament who introduced it in another place; to those voluntary organisations who helped and advised him; and also to the Minister of Health, Mr. Barney Hayhoe. It was important that they managed to put together a package, and if any of us try really seriously to destroy that package, the Bill may suffer as a consequence.
I do not take the view expressed by the noble Lord, Lord Banks, that this is not, if I have his words right, a major piece of legislation. Rather do I go along with the noble Lord, Lord Allen, and the right reverend Prelate the Bishop of Gloucester that this is an extremely important piece of legislation. It may not mark the same watershed in services for people with disabilities as the Chronically Sick and Disabled Persons Act 1970. I was deeply involved with that Bill but I recognise what its weaknesses were.
It gave disabled people rights but did not do enough to ensure that they were able to obtain those rights. This Bill builds on the experience of the 1970 Act and recognises that in the intervening years disabled people have ceased to be just recipients of services and are demanding their full rights as citizens, as was said by 1246 the noble Baroness, Lady Elliot—full say not only in the provision of those services but in all aspects of the life of the community. They are not now tucked away. They are part of us, and they demand the same rights as we accord to ourselves, and as we should accord to them.
Clause 1 gives disabled people the right to appoint their representatives, and that is a tremendous step forward. I agree with the noble Lord, Lord Mottistone, that there seem to be gaps in this that we shall have to deal with in Committee. Perhaps the noble Baroness will make some points which will show the way to tackle those problems. As the clause stands, representatives will only operate in relation to the social services.
The Secretary of State can extend that to the health service and to other local authority services. I certainly hope he will. I think it is absolutely essential that the same opportunities for representation are available in the health service as are available in local authorities. I hope he will not drag his feet about this. The clause builds on the successful work of the Advocacy Alliance, whose main field of operation has been long-stay hospitals. I think that they take some of the same points of view as those presented by the noble Lord, Lord Mottistone. The key issue in the health and social services is the movement from hospital to community care. To allow representation in one section and not in the other would be absolutely absurd. I am glad that this is the view of most of the health bodies which have responded to the DHSS consultation paper.
There will be difficulties in implementing this clause in relation to people who are incapable of appointing a representative. I know that this is an issue which has been discussed only today at a seminar organised by MIND. I wish I had been able to be there as chairman of MIND to see what conclusions they reached, but we will have details of their conclusions and this may help us in Committee. We shall have full and constructive debates on this. I shall not go further at this stage.
Clause 2 gives disabled people explicit rights to put their views to the social services when their needs are being assessed, to have a written statement on decisions and to ask for a review if they are not happy. As the noble Baroness, Lady Masham, said, as drafted the clause restricts these rights in a rather illogical way so that, for example, a person can appeal against non-provision of a service but not under-provision of the same type of service. I understand that the DHSS and local authorities have agreed to widen the clause and we look forward very much to what will come either from the Minister tonight or through amendments at Committee stage.
The clause still, however, does not go as far as I should have liked. I should have liked to see some breach in the compartmentalisation which disabled people have to face; I have in mind, for example, some of the most intractable problems surrounding the question of adapting or rehousing with responsibilities split between district and county councils. As it stands, the written statement encompasses only social service functions. Quite clearly there are problems that go way beyond the health and social services.
1247 This is an issue which arises again on Clause 4, when housing for discharged patients must clearly be on top of the agenda. We cannot have people discharged from long-stay hospitals without proper, good, decent accommodation into which to move, with the sort of community support they will need.
Clause 3 is the first of two clauses which seek to move from what we might call crisis management to crisis prevention. It requires a social service assessment before disabled children leave full-time education. Here again there are still a few details to be sorted out, but I understand that agreement has been reached with all the parties concerned and I look forward to the appropriate amendments coming forward at Committee stage.
Clause 4 seeks to achieve the same result for people who have been treated for mental handicap or mental illness in hospital for at least six months. It is in my view an absolutely key clause of the Bill, since it obliges authorities actually to implement policies to which governments have been paying lip service for years. The clause has been through a number of transformations. Originally it was similar to Clause 3 involving notification by the hospital of the date of discharge and the subsequent social services assessment.
On Report in another place, the Government submitted a new clause which would have changed this solely to notification without any duty on the social services to do anything, a procedure described by the AMA as almost a waste of paper. Mr. Clarke, after agreeing with the local authority associations, proposed an alternative, which is what we see in the Bill now. The hospital managers are required to undertake an assessment in conjunction with the social services. I think that that is a very fair phrase and it means that it will have to be done in conjunction with the social services. The clause was accepted by the Minister, whose main criticism was that the drafting did not place a sufficient duty on the social services to co-operate in the assessment. I think that that was right.
Perhaps I may quote from two paragraphs from Mr. Barney Hayoe in col. 497. He said:It is right that social services should contribute to assessments, but hospital authorities with current responsibility for the patient should normally be in the lead.That was a good statement. Then he said in col. 499:It fails to make clear what the extent and duty would be of hospital managers when a local authority failed to participate in the arrangements for an assessment. What will happen if the local authority's social services department is unco-operative? That is not clear in the present formulation. Clearly, hospital authorities have no power to direct local authorities to participate in the assessment of needs".Quite clearly, this question of the relationship between the health authorities and the social services authorities is going to be central to our discussions in Committee. I must say that I am waiting with great interest to learn from the speech of the noble Baroness, Lady Trumpington, what precise amendments the Government will be suggesting to the Committee. I do not mean that she is going to suggest the precise amendments now, but she may give us some inkling of what will happen.
1248 I think that there should be a general agreement not only in this House but among local and health authorities that current best practice is a multidisciplinary assessment involving both health and social services and possibly other bodies as well—voluntary organisations too. Obviously we want legislation which will require authorities to provide the best possible care for patients but we do not want to tie their hands to a precise formula. Possibly the solution would be to lay separate duties on each authority, health and social service, to assess for their own services but to co-operate with each other when they do so.
Clause 5, the carers' clause, I shall not say much about. It has been touched upon by the noble Earl, Lord Swinton, by the noble Lord, Lord Allen, by the noble Baroness, Lady Darcy (de Knayth), and also by the noble Lords, Lord Mottistone and Lord Stallard. All of them have expressed concern about the carers' clause. My concern goes along with all they have said and I shall not repeat what has been said. It is a problem. We know that we are not going to be able to put into this Bill something with massive resources but I must say that one sometimes feels sad as one hears constant tributes to the noble—and I agree noble—work which is carried out by the carers; but it is accompanied by an almost total lack of action. We have to see in some other way that there really is action in this field.
I should like to record my regret that the clause which would have increased the influence of disabled people when local authorities were drawing up structure plans seems to have disappeared altogether. Given the procedures in the other place, it was inevitable that non-DHSS clauses would receive a rather wooden response from Ministers. It may be that in Committee here we may hear directly from the noble Lord, Lord Elton, to explain the rather negative briefs which I felt that his department had provided in the field that concerned him.
In col. 536 on this notable and historic day, Mr. Tony Newton, the Minister for Social Security, said:If it transpires that the attention of planning authorities needs to be directed more closely to the needs of disabled people, that could be done in the form of guidance from the Department of the Environment. I understand that my colleagues there are considering whether such guidance might be helpful.In my experience, where disabled people have been involved at an early stage great benefits have accrued not only to them but to many other members of the public. I suggest that authoritative guidance, perhaps formulated in conjunction with the Access Committee for England, would be of immense value. I hope that the noble Baroness may be able to up-date the House on the progress her colleagues have made on this issue since 11th April.
I also hope—and this is the last point I want to make—following on from the point made by the noble Lord, Lord Allen, that the noble Baroness may say something about timing, because we do not want to see this House following on from another place, passing the Bill and then waiting for years for something to happen. I see no reason why Clause 5 and Parts II to IV cannot come into force immediately, Clauses 2 and 3 and most of Clause 1 next April and the rest of the Bill the following year. That is the sort of timetable that I should like to set.
1249 The only complicated matters are setting up procedures for authorising representatives for people who are legally incompetent and preparing the ground for joint assessments of people coming out of hospital. As requested by the noble Baroness, Lady Masham, I hope that the noble Baroness the Minister can give some fairly precise indication of the Government's thinking on timing, though I appreciate that discussions with the authorities will be continuing during the process of this Bill through your Lordships' House.
I want to give the Bill every possible support and to assure those on all sides of the House that these Benches will seek very positively to see that what I think is a very important initiative, and this agreement which was hammered out in another place, are carried through into reality and into practice, ensuring that so many disabled people are able, by joint planning and with their own consultation and their own representatives, to be settled effectively and properly as full citizens in the community.
§ 10.32 p.m.
§ Baroness Trumpington
My Lords, perhaps I may first add my congratulations to those that others have offered to the noble Baroness, Lady Masham, on so eloquently bringing this Bill before us today. This Bill certainly represents a very important development of the legislative structure within which services are provided for disabled people and we are indeed grateful to her.
The Government have made it clear throughout that we endorsed the principles that the Bill seeks to enshrine. But we were concerned that in the form that it was originally introduced in another place it would have imposed inflexible, impracticable and bureaucratic burdens on local authorities. The Government consulted widely on proposals for amending the Bill to produce more workable measures, and substantial amendments were subsequently tabled. After a certain amount of what I can best describe as constructive give and take between the Government and the Bill's sponsors, the Bill in its present form emerged from another place. I think we have now got what is basically a most worthwhile Bill, although, in our view, as I shall outline briefly in a moment, some bits of it still need a bit of further refining and tidying up.
The noble Baroness, Lady Masham, referred in her opening speech to the most important changes envisaged, as discussed between the DHSS and those advising the Bill's sponsors. May I assure the noble Baroness and the noble Lord, Lord Stallard, that we have no intention of any radical rewriting. I should like to make one other brief introductory comment. I should like to say that I particularly enjoyed listening to the speech of my noble friend Lady Elliot of Harwood. Her foresight and her own hard work have resulted in so much help being offered to so many people in Scotland.
Before I talk briefly about some of the individual provisions of the Bill, I should like to touch on the subject of costs. The Bill represents a substantial 1250 development of services for disabled people. As such, it has been clear from the outset that it would have substantial resource implications for local authorities. The additional costs would reflect not only the new administrative procedures which the Bill would require local authorities to undertake, but there would also be the cost of meeting the need for additional services which those new procedures—specifically for assessment and for representation of disabled people—would bring to light. It is this latter element which would be the most significant element. I am sorry that the noble Lord, Lord Allen, thought that my reply was Delphic. I am afraid that I cannot even claim to be a Vestal Virgin; therefore I have nothing to add.
What the cost of the Bill would be cannot at this stage be stated at all exactly. We asked the local authority associations to estimate the costs of the Bill if it were amended on the basis of the proposals set out in the consultation paper issued by the Government in February. The answer they came up with was a minimum of £100 million in a full year, though it is clear that it would take at least a year or two after implementation for the costs to build up to that level. We now need to take into account the fact that the Bill in its present form does not in some respects reflect the proposals in the Government's consultation paper. It seems likely—and I must make it clear that we are still discussing this with the local authority associations and others—that Clause 4 at any rate (on the assessment of the needs of people discharged from long-stay psychiatric hospitals) could be significantly more expensive in its present form than if the amendment originally proposed by the Government had been adopted.
The upshot of all this is that, as Government Ministers have made quite clear in another place, it will not be possible, if the Bill reaches the statute book, to make commencement orders bringing into effect those parts of the Bill that have significant resource implications until such time as the necessary resources can be made available. But do not despair, my Lords: what I have said does not mean that parts of the Bill could not be implemented reasonably quickly after the Bill is enacted. I should hope it would be possible to implement those parts of the Bill which do not carry significant resource implications not too many months after Royal Assent. I should hope, for example, that Clause 3 (disabled school leavers), Clause 5 (carers), Clause 6 (information), Clause 7 (co-option of disabled people to committees etc.) and Clause 8 (reports to Parliament) could be implemented on that sort of timescale.
However, I must say in reply to the noble Lord, Lord Banks—and I understand his absence—that Clause 1 (on representatives) where in any case there will be regulations that will need to be the subject of further consultation before they are made, Clause 2 (on assessment) and possibly Clause 4 (people discharged from long-stay psychiatric hospitals) will have to await the availability of the necessary resources. I hope this also answers a specific point raised by my noble friend Lord Mottistone.
I should like to make some comments from the Government's point of view on some of the more important provisions of the Bill. I first of all turn to Clause 1, on representation of disabled people. This is 1251 a very important step forward. For the first time disabled people are given the right to appoint people to represent them in connection with the provision of services by local authority social services departments. As some of your Lordships may be aware, the department has been funding a pilot scheme for the provision of advocates for disabled people, run by the Advocacy Alliance. I hope it will be possible to build upon the experience of that scheme in developing statutory arrangements under this clause of the Bill.
I now turn to Clause 2, on assessment of need. This again represents an important development. For the first time disabled people are to be given, as of right, the opportunity to make representations about their need for social services as they perceive them to be and, arguably more importantly, to receive a written explanation outlining the services to be provided and make further representations if they are unhappy with the outcome. The clause also requires local authorities to provide interpretation services to disabled people or their representatives who are unable to communicate normally because of disability. Following discussions with the Bill's sponsors we have it in mind to bring forward some relatively minor improvements to the clause, to improve the way it works. I am confident that those measures will command the support of the House.
My noble friend Lord Mottistone asked whether a disabled person or someone acting for him could call for the local authority to consider the needs of a disabled person if the local authority had shown unwillingness to do so off its own bat. The clause does not make specific provision for that, but the question of whether clarification of the local authority's duties in that respect is requested is one that we are looking at anyway at the request of the Bill's sponsors. If we conclude that it is necessary or appropriate to do so, we shall bring forward an amendment at a later stage.
The noble Baroness, Lady Darcy (de Knayth) asked, in regard to Clause 2(6), whether more weight could be given to the disabled person's views in deciding whether interpretation of services is needed. We shall certainly consider that point. On the face of it a local authority must take the final decision as to what is needed in the way of interpretation of services to enable it to discharge its functions. I certainly take the point that the views of the disabled person should be given weight.
The noble Lord, Lord Ennals, asked for an assurance that the right will be extended to allow rights of representation against under-provision as well as non-provision, and I can give such an assurance.
Clause 3 deals with young disabled people leaving education. It puts a duty on the local authority to assess the young person's needs for social services at what is generally recognised to be a particularly significant milestone in his or her life. The provisions of the clause go beyond the proposals in the Government's consultative paper issued in February. However, having considered the views of the local authority associations and others, we now accept that the clause in its present form is an improvement on our original proposals. Again, we shall be bringing forward some minor tidying up arrangements which I do not expect the House will find in any way controversial.
1252 I anticipate, however, that we shall need to give careful consideration in Committee to Clause 4, on long-stay patients discharged from psychiatric hospitals. That again goes beyond the Government's proposed amendment to the original Bill, which envisaged only a requirement on hospital managers to notify the social services department in the area to which the patient was likely to be discharged. We now have a provision requiring the hospital managers to "make arrangements" for the needs of the patient for social services to be assessed before he or she is discharged. The overall intention here is one which we wholeheartedly support.
On the other hand, the clause as it stands does not seem to be at all clear as to what would be the precise responsibilities in the assessment process of the hospital managers and the social services department (or, in some cases, departments) concerned. In reply to the noble Lord, Lord Stallard, I am unwilling to go into that rather complicated area in any more detail, as we are still studying the implications of the clause—including, as I said earlier, the resource implications—in consultation with the Bill's sponsors and others. But, as I said, we shall certainly need to spend some time on this clause in Committee.
My noble friend Lord Mottistone asked whether the disabled person's family would be involved in the assessment process. I agree that as a matter of good practice that would indeed be highly desirable. I am not convinced however that it would be practicable to make it a statutory requirement. I have a feeling that it would not be desirable to cover matters of professional practice of this sort in legislation. However, I shall study most carefully what my noble friend said.
My noble friend also wondered what was the point of assessing needs if this would not lead to some kind of action. I believe that in practice an assessment would lead to action in virtually every case if unmet needs were disclosed. The identification of those needs would necessarily act as a trigger for the exercise of the authority's existing powers (and, indeed, in some cases duties) under the relevant legislation.
Clause 5 puts a duty on local authorities to take carers' abilities into account when considering whether services need to be provided for a disabled person. This provision has rightly attracted a lot of attention and was the subject of much discussion in another place. On that occasion my honourable friend the Minister for the disabled, in proposing the government new clause which has now been incorporated in the Bill, undertook that the Government would consider carefully whether further amendments needed to be brought forward in this House to clarify the purpose of this clause. We have indeed given further consideration to this point, and have had further discussions with the Bill's sponsors. We remain unpersuaded that further amendments are necessary or desirable, but we will of course carefully consider the points which have been put forward today.
The noble Baroness, Lady Darcy (de Knayth) spoke most movingly about the role of carers, as did other noble Lords. My noble friend Lord Swinfen asked about the implications of Clause 5 for respite care—providing care for the disabled person while 1253 carers have a well-earned rest. Local authorities can, and of course already do, provide such care under existing legislation and the Bill would not impose any new powers or duties in this respect. What the Bill does is require the local authority to have regard to the ability of the carer to continue to provide regular care when it looks at the disabled person's need for services.
Clauses 1 to 5 represent the meat of this Bill. The remainder of the Bill contains a number of useful minor improvements in provisions for disabled people which the Government generally welcome. The only clause to which at present we are minded to suggest substantive amendments is Clause 11, on co-operation in planning in Scotland. My honourable friend the Parliamentary Under-Secretary of State for Scotland undertook in another place that an amendment would be introduced to meet the concerns of the Bill's sponsors by giving statutory powers to the Secretary of State to prescribe for joint planning committees and their activities for use if the present administrative arrangements should prove to be unsatisfactory after a fair trial.
The noble Lord, Lord Banks, asked about joint planning in Scotland and whether it would be put on a statutory basis as it is in England. The Parliamentary Under-Secretary of State's undertaking was to introduce a reserve power in support of the administrative arrangements. The precise formulation of that power is still under consideration by Scottish Ministers. He also undertook to seek an amendment to the Bill's Long Title to enable services for elderly people to be covered in this context. We also intend to introduce a clause that would apply the principles of Clause 3 of the Bill concerning children with special educational needs to the particular circumstances that apply in Scotland.
My noble friend Lord Swinfen asked whether local authorities should not have the duty to get specialised information from whatever source, not just information in their possession. We considered this point at an earlier stage but decided that it would put an unreasonable and unenforceable burden on local authorities. I agree that they ought to provide this sort of information, but it would be wrong to put them under a statutory obligation to do so.
My noble friend Lord Mottistone raised a point on Clause 7 which deals with the appointment to various committees and other bodies of people with special knowledge of the needs of disabled persons. I can assure him that the clause will in no way preclude relatives of disabled people being appointed to such bodies. What it will do is ensure that before such appointments are made there shall, in appropriate cases, be consultation with organisations directly representing disabled people themselves.
The right reverend Prelate the Bishop of Gloucester mentioned the use of the word "of" in Clause 7. Personally I could not agree with him more, but I am no parliamentary draftsman.
I should like to conclude my remarks by once again congratulating the noble Baroness, Lady Masham, on sponsoring this important Bill and by expressing the hope that the House will agree that it should be given a Second Reading. I wish the Bill an easy and speedy passage through this House. I am quite sure that, 1254 subject to minor amendments on the lines which I have suggested, this Bill is potentially a very important milestone on the road toward better services for disabled people, which is a goal that we all share.
§ 10.50 p.m.
§ Baroness Masham of Ilton
My Lords, the lights are dim, the hour is late and there is another important debate to follow. I shall be very brief.
We have had a very full and constructive debate and I am most grateful to all the noble Lords and Baronesses who have taken part. Though the Bill is a modest measure in terms of direct resource implications, it represents a change of direction in society's approach to people with disabilities, the significance of which will be demonstrated in the coming years. I should like to congratulate all the speakers who have made such valuable and knowledgeable points.
I am particularly grateful to the noble Baroness, Lady Trumpington, the Minister, for her very helpful and constructive speech on behalf of the Government. I think it right to put on record the immense help that the sponsors of this Bill have had from the Government and their officials not only in the Department of Health and Social Security but also in the Department of Education and the Scottish Office. I should also like to pay tribute to the Association of Metropolitan Authorities, the Association of County Councils and the National Association of Health Authorities for their invaluable and essential contributions in forging a Bill on which there is now universal agreement and which we can therefore be confident will be implemented with enthusiasm by local and health authorities throughout the country.
I should like to give a special word of thanks to Mr. Peter Mitchell of the Royal Association for Disability and Rehabilitation and to Mr. John Healey of MIND who have worked extremely hard and have been most helpful. Much work goes on behind the scenes with a Bill such as this. I hope that noble Lords will forgive me if at this late hour I do not comment on all the detailed points that have been made in the debate. The Chief Whip would be furious, I know. However, I can assure your Lordships that they will all be carefully considered and can be debated further in Committee.
The noble Lord, Lord Mottistone, expressed some of the concerns put to him by the National Schizophrenia Fellowship. Although the Bill is primarily concerned with giving a greater say to disabled people themselves, the position of those who care for them in the community is very much a concern of the sponsors. In relation to Clause 1, the Minister for Health in another place said that the position of the family would be considered in the regulations, and I am sure that the fellowship will be invited by the department to give its views at that stage.
The only other clause on which I wish to comment is Clause 4. I hope that we can achieve a satisfactory outcome at the Committee stage. It is most important. I also hope, as the noble Lord, Lord Swinfen, suggested, that the noble Baroness will hammer hard 1255 at the Treasury's coffers. She understands the problems; she is, I feel, one of us who care. I hope that your Lordships will now give the Bill a Second Reading.
On Question, Bill read a second time, and committed to a Committee of the Whole House.