§ 3.35 p.m.
§ The Parliamentary Under-Secretary of State, Department of Social Security (Lord Henley)
My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.
§ Moved, That the House do now resolve itself into Committee.—(Lord Henley.)
§ On Question, Motion agreed to.
§ House in Committee accordingly.
§ [The CHAIRMAN OF COMMITTEES in the Chair.]
§ Clause 1 [Introduction of disability living allowance:]:
Lord Henderson of Brompton moved Amendment No. 1:
Page 1, line 12, at end insert ("a community care supplement").
The noble Lord said: I shall speak also to manuscript Amendment No. 22A and Amendment No. 23. I apologise for the manuscript amendment which is necessary to understand Amendment No. 23 which refers back to it and which was inadvertently omitted. The manuscript amendment reads:
, to any one of which may be added a community care supplement payable out of the National Insurance Fund".
The purpose of the amendment is to continue the independent living fund by statute in place of the Government's proposal to abolish it by 1993 and thereafter instead to rely upon local authorities. The amendments are concerned solely with severely disabled people who wish to avoid institutionalisation. I use that monstrous 20-letter word to describe the distaste which we all feel for putting back into institutions, or into institutions for the first time, people who would otherwise live viable lives in the community. It relates to about 7,000 badly disabled people only.
§ I should like to give as an example not those who are in the House today who are badly disabled—it is a significant indicator of the importance of the amendment that they are here—but our late, and beloved, friend Lady Lane-Fox, who wryly described herself as exhibit number one. She was content in her lifetime to be so described and I am sure that she would be happy if I were to so describe her today. Had that valuable person, Felicity Lane-Fox, been institutionalised what a cruel waste of a vital spark it would have been. She animated our debates and did so much for her disabled fellow people. If the Committee remembers her, it will understand what we have in mind.
§ The purpose of the amendment was originally the subject of an amendment tabled in the House in 1986 and moved into the Bill by a considerable majority. It was not accepted in the House of Commons, and a substitute amendment was put in its place.
§ Subsequently, in 1988 I believe, this fund was set up. It is generally agreed by those interested in the 1986 amendment and by all the disability organisations that Mr. Nicholas Scott did a marvellous job in priming the fund, obtaining Treasury approval for it. The fund has since worked extremely well; starting as quite a small fund of about £5 million and now flourishing at about £65 million. It is devoted to making viable the lives of disabled people as severely disabled as Lady Lane-Fox.
§ The fund is remarkable because it is largely administered by disabled people in conjunction with the Ministry. DIG—the Disablement Income Group—and its Scottish equivalent are closely associated with the disbursement of the moneys of the fund. It is tailored to fit the needs of 7,000 people and there is an average disbursement of £70 or £80 a week. The minimum can be as low as a few pounds and increase to as much as £400 per week. I doubt whether we could get a more intimate association between those who distribute the fund and those who are the beneficiaries than we have with the present organisers of the independent living fund.
§ Against that background, one needs to consider the Government's proposal to disband the fund in 1993 and instead to hand over the distribution of the money to local authorities. Very few people in this Chamber would have sufficient confidence in the local authorities to be able to handle the money as intimately as the present administrators of the fund. 1498 Indeed, it may well be that the money allocated to local authorities for this purpose could get lost in the wash and never reach the 7,000 people. I do not wish to tar local authorities across the board with that brush because I am absolutely convinced that a number would carry it out conscientiously and well, but I am not at all convinced that the majority of local authorities would have anything like the sensitivity to administer the fund as it is now administered. That is its history.
§ I find it difficult to understand why the Government propose to get rid of their creature—their brainchild dreamed up by Mr. Nicholas Scott—and disperse its activities across the board to local authorities. Of course, it would be tidier and fit in with the rest of the Government's proposals. But I do not believe that it is just a Treasury objection. If the Government mean what they say, they will spend just as much money after 1993 on the 7,000 severely disabled people as they do now. It cannot be a matter of greater expenditure. Thus, I am puzzled as to the real reasons and I wait to hear them from the noble Lord, Lord Henley.
Most people in this Chamber need few words more from me to persuade them of the merits of the amendment, but I conclude by quoting the words of Mr. Nicholas Scott, the Minister for Social Security and Disabled People when he spoke on Report in the House of Commons on 7th February:
I take a personal interest, and some satisfaction in the way in which the [independent living fund] has developed and expanded … not least because it has identified a real need in the community and gives disabled people the chance to exercise control over the provision made for them. It ensures that they are not simply told that somebody can come at a particular time of day that suits the timetable of the social security department".
That is the nub.
Instead, choice can be exercised about the nature and extent of the care that they are given".—[Official Report, Commons, 7/2/91; col. 440.]
The Minister responsible for disabled people himself puts the case for the amendments in a nutshell. I beg to move.
§ 3.45 p.m.
I am delighted to support the amendment so ably moved by the noble Lord, Lord Henderson of Brompton. Amendment No. 1 is a paving amendment for Amendment No. 23. Members of the Committee will have noticed from the names on them that these are all-party amendments, on which I believe there is all-party agreement. The noble Lord has put the case admirably and I have no wish to prolong the discussion on a matter on which I believe we have already won the argument.
To go back over the history to which the noble Lord referred, many of us were absolutely delighted when the independent living fund came into existence. We heard its announcement and I well remember attending a meeting of the All-Party Disablement Group, at which the noble Lord, Lord Henderson, was present, as was Lady Lane-Fox. We all listened, fascinated and immensely encouraged, when we heard 1499 from those who would be responsible for the fund—Mr. Peter Large and others—on precisely what it would do.
We knew that the fund was there for five years; and at the time five years seemed a long time. Some of us thought that perhaps we might not still be here after five years and unhappily Lady Lane-Fox is not. However, at least we knew that many of the people dependent on the fund would still be here and their needs would have to be provided for. The noble Lord quoted from the remarks of the Minister responsible, Mr. Nicholas Scott, and perhaps I may do the same. On 11th December, Mr. Scott said:After 1993, the generality of [independent living fund] cases should go to local authorities".As the noble Lord rightly said, were I one of the people dependent on the fund I would not have found that statement immensely reassuring, irrespective of the locality or the nature of the local authority in which I resided. It was not very reassuring. Mr. Scott continued:There will obviously be a need for some interim arrangement to deal with the existing load of the independent living fund … There will have to be some transitional provision and there may be some provision for new cases".—[Official Report, Commons, Standing Committee E, 11/12/90; col. 63.]That is what we are trying to do and what the Minister seemed to want to do. When pressed later at Report stage on 7th February, he continued:we wish to look most closely at the proposed arrangements that will come into effect in 1993, the timetable for transfer of cases and any transitional arrangements necessary".—[Official Report, Commons, 7/2/91; col. 441.]Transitional arrangements are bound to be necessary. We must make absolutely sure in this House that they are in place. Later, in a Written Answer, Mr. Scott said in reply to Mr. Allen:Our plans for the future of the independent living fund are still under consideration following the decision to phase the implementation of community care".—[Official Report, Commons, 11/2/91; col. 370.]They arc still under consideration now, as the result of an all-party amendment ably moved by the noble Lord, Lord Henderson. I hope that the Committee will support the amendment.
§ Lord Carter
I was pleased to add my name to the amendment because it deals with a crucially important aspect of the provision of financial help for severely disabled people. The history of the fund is well known so there is no need to repeat it. It fills a real gap in the social security provisions for disabled people and is an excellent example of flexible and ring-fenced community care.
As previous speakers have said, there is considerable concern about the possibility of responsibilities which are now borne by the fund being shifted to local authorities in 1993. I ask the Committee to reflect on the practicalities. Both major parties are considering new structures for local government. There will be a replacement for the poll tax and rumours continue about the possibility of shifting responsibility for community care to health authorities in order to reduce the cost of local government finance. Does anyone really expect that, with this raft of policies to be implemented by local authorities, they will be able 1500 to take on the present responsibilities of the independent living fund? We know that community care funding for local authorities is now inadequate. What will happen to the funds if they are not ring-fenced? I believe that they will disappear into other areas of local authority expenditure. As has been said, they will literally go down holes in the road.
We should also remember that even now local authorities have not fully carried out all their duties and powers under Section 2 of the Chronically Sick and Disabled Persons Act 1970. They are even having to cut back on the parts of that Act that they have fulfilled in the light of the financial restrictions imposed by the poll tax. I ask again how we can be sure that local authorities will be willing and able to provide the essential domiciliary help which some people with disabilities need.
The Disablement Income Group has provided us with a number of examples of the inadequacy of local authority provision, with the temptation to move severely disabled people into residential care. The whole thrust of government policy is intended to avoid that situation. It has been said that in the whole country only six local authorities anywhere near provide the level of support and assistance which is now provided by the independent living fund. The ninth report of the Social Services Select Committee of another place entitled Community Care: Social Security for Disabled People states:We further believe that the Government should consider the establishment of the independent living fund as a statutory body".The Government bear a heavy responsibility in this area. As the noble Lord, Lord Henderson, has said, the Government are to be congratulated on the setting up of the fund. It would be a tragedy if the work of the fund were effectively to disappear in 1993. This amendment gives the Committee the chance to protect the functions and the funding of the ILF. Unlike a number of amendments that were moved from this side of the Chamber on the social security legislation, this amendment will cost the Government not a penny more than they otherwise would have spent. The Government are already spending £62 million on the ILF. We are not asking the Government to spend any more, but we are attempting to protect that funding and, above all, to protect the 7,000 people who are benefiting from the operation of the fund at the moment.
§ Lord Swinfen
I am delighted that the amendment is also tabled in my name in support of the noble Lord, Lord Henderson. I am a firm believer in the independent living fund and the way in which it helps severely physically disabled people. The fund is an aspect of government funding that helps the Government's policy of moving severely disabled people out of long-stay wards in hospitals to allow other people to use those wards.
The organisation for which I work trains severely physically disabled people to live independently. I know of one individual who has now moved on with the help of the fund. She requires help nearly the whole time. If she were not helped by the fund, she 1501 would be in institutional care. What is more, that would mean that her husband would have to live with her in the institution because he is also disabled. He does not need as much help as his wife, but he is not able to help her.
Some years ago before the fund was even thought of, a disabled person was living in the Midlands who was paralysed from the neck down. He was determined not to go into institutional care. He was fortunate in that he had sufficient funds of his own to enable him to stay out of institutional care and to order his own life. The independent living fund helps severely physically disabled people to obtain the independence that the rest of us take for granted. We can pick up a book whenever we want. However, a number of disabled people cannot do so. If they need or wish to read an article, a magazine or a book, is it right that they should have to wait for someone to come along from the local authority at his convenience to do it for them? That person may tell the disabled person that he only has time to read a couple of paragraphs, rather than a whole chapter, on that occasion as he has other things to do. It is much better that local authorities should be able to fund someone to come along when disabled people need attention and to provide help in the way the disabled people wish.
Baroness Darcy (de Knayth)
I wish to express my wholehearted support for these amendments. I had a horrible feeling that I was watching a repeat performance of what happened from the end of the proceedings of the Social Security Act 1986 to the gestation and birth of the ILF when I heard the comments of the Minister responsible for the disabled on the subject of transitional funding and other matters. I should add that the birth of the ILF was almost an induced birth as it was an eleventh hour attempt to sort things out. The noble Lord, Lord Winstanley, said at that time that five years seemed a long period. Perhaps 1993 still seems some time away. However, time is particularly short for disabled people who are trying to plan to come out into the community. That process can easily take two years and I have heard of someone who took four years to plan her entrance into the community. This situation is worrying for such people as they cannot plan ahead. It is also extremely worrying for those who are living in the community now as their future is uncertain.
Why get rid of something that is working well? Does the Minister agree with the comments that my noble friend Lord Henderson made as regards how well the Minister responsible for social services considers the ILF is working? What is the Minister's response to the report of the Social Services Select Committee which the noble Lord, Lord Carter, has already mentioned? Is the Minister aware that all the disability organisations are wholly opposed to the transfer of the ILF to local authorities?
I totally support the amendments on the grounds that they will meet the general feeling that the fund should be put on a statutory basis; that we should put an end to uncertainty for disabled people; and that we 1502 should continue to help severely disabled people to have control of their own lives, in the ways the noble Lord, Lord Swinfen, mentioned.
§ Lord Skelmersdale
I believe I occasioned some surprise by being in my seat—or at least, having rocketed round the Chamber recently in one of my seats—on Second Reading but not speaking although my name was mentioned. My name was sometimes taken in vain, and, just occasionally, in praise when noble Lords referred to my previous utterances during the four years that I was responsible for various social security matters in the Chamber. I did not speak on Second Reading for a concrete reason. I was a Minister in the Department of Social Security when the principles of this Bill were being discussed. Therefore I did not feel it was right for me to speak on Second Reading. Second Reading after all should be concerned with the principles of a Bill.
I listened to most of the proceedings on Second Reading and I have read them very carefully. It is interesting to note the extent to which speakers tend to produce shopping lists on Second Reading and continue that practice throughout the course of a Bill. That was my experience in replying to many amendments in the past. Now that we have got beyond the stage of principles, I have absolutely no hesitation in chipping in. My remarks are based partly on my own memories of the various experiences that I have been through, and partly on the experiences themselves.
I do not know how many Members of the Committee were present in the Chamber the other day when the noble Lord, Lord Peston, made an interesting remark. He said words to the effect that government money equals government interference. The whole history of social security is an example of that. The detailed rules and regulations with which the Government surround the real needs of claimants for various social security benefits are legion.
We are discussing whether the independent living fund should be a statutory body, or whether its benefits should be statutory benefits. I believe it would be folly to take such a step although I fully accept—I have always done so —that severely disabled people have exceptional needs which have to be catered for. I take the point that the noble Baroness, Lady Darcy (de Knayth), made. It would be equally mistaken to pass the functions of the fund to the social services departments of local authorities. I believe it is generally agreed—after a slightly rocky start—that the independent living fund is an extremely good thing, to misquote 1066, And All That. When you have a good thing going for you, you do not change it. You leave it severely alone. That is what I recommend the Government do on this occasion.
§ 4 p.m.
§ Lord Walton of Detchant
I should like to give very warm support to the amendment proposed by the noble Lord, Lord Henderson. I must at once declare an interest. I am chairman of the Muscular Dystrophy Group of Great Britain and Northern Ireland. I have just come from a meeting of the national council of 1503 that body, which I chaired, at which I learned that in the course of 1990 459 people who are severely disabled by different forms of neuro-muscular disease were given grants from the Joseph Patrick Memorial Trust—a branch of the organisation—to enable them to maintain their life in the community. Those grants were towards the cost of equipment, modifications to their homes and other items which under law should have been provided either by the health authority or the total authority. Their grants from that trust eventually totalled some £310,000 last year because neither the local authorities nor the health authorities in the areas where they lived felt able, from the funds available to them, to support their needs to enable them to continue to live in the community.
The independent living fund has made an enormous contribution to the care and welfare of disabled people in our community. It has enabled many of those who would otherwise inevitably have been committed to institutional care to live happy and fruitful lives in the community. In my view it is crucial that that provision should continue.
The fund has made outstanding contributions to the care of many individuals. At a time when the Government are quite rightly promoting care in the community that type of flexible support for severely disabled people who have high care costs should and must remain. If the Government transfer the funding to local authorities, as is proposed in the Bill, I regret to say that, in the present rocky and parlous state of local authority finances, I share the anxieties expressed by many other Members of the Committee that that money may well disappear into the maw of local government finance and may not be used to help those most in need. I therefore support the amendment most warmly.
§ Lord Henley
The amendment provides me with the opportunity, which I readily take, to put on record the great pride which the Government attach to the achievements of the independent living fund. In particular, as many Members of the Committee mentioned, my right honourable friend the Minister for Social Security and Disabled People has taken a close personal interest in the founding of the fund and in its development and expansion over the past three years. I should like to thank those noble Lords who praised my right honourable friend for setting up the fund and getting it going.
I should also like to repeat some of the history of the fund. The Committee will recall that the fund was originally set up in 1988 with a budget of £5 million to provide help to those people who previously received a weekly additional requirement for domestic assistance in their supplementary benefit. Since 1988 the scope of the fund has been progressively widened to provide help with the costs of personal care. That widening, of scope has been a major factor in the growth of the fund. Now the fund helps over 7,000 people within a budget for 1990–91 of some £32 million, with another large increase agreed for next year.
Many Members of the Committee may already know that the trustees of the fund have announced 1504 that they have lifted the previous upper age limit for eligibility for help from the fund. That means that from 1st March this year help can be awarded to people over the age of 74. I am sure that everyone will welcome that further substantial improvement in the fund.
I agree with the noble Baroness, Lady Darcy (de Knayth), that the fund has been a success. We accept that, and my right honourable friend the Minister of State has accepted that. It has been a success not least because it has addressed a real need in the community in giving disabled people the opportunity to exercise control over their lives rather than having to submit to choices made on their behalf by experts. It allows individuals largely to choose the nature and extent of the care that they need in order to remain in their homes, following an in-depth discussion of their needs with trained social workers.
That move towards greater choice on the part of disabled people underlies all this Government's recent and proposed reforms in benefits for disabled people, including the two new benefits proposed in the Bill (which we shall discuss later) and the new administration and adjudication arrangements. However, for disabled people to make real choices in their lives they need information and advice about the options which are open to them and the costs and benefits of those choices. That information can come only from an individual assessment of the disabled person and his or her needs by a trained and experienced professional.
It is my understanding of the amendment that if there were no independent living fund, there would have to be a regulated scheme. All of those who have spoken in support of the amendment would agree that it is not a regulated scheme that is wanted. The amendment seeks a concession from the Government that the independent living fund will be retained. I recognise that. I also recognise that the amendment expresses the concern of many in this Chamber about the ability of local authorities to pick up cases from the independent living fund when the community care arrangements come into effect in 1993.
I can assure the Committee that we understand those anxieties and take very seriously the points that have been made today about the future position of people who are currently supported by the fund. I can only repeat the promise made by my right honourable friend the Minister of State that we shall be looking very carefully at the arrangements for the transfer of cases and at any transitional arrangements which may be necessary. The Government will want to be satisfied that the new arrangements meet the concerns that have been expressed. We shall want to make decisions as quickly as possible, in discussion with all those involved, to allay the fears which I know are felt by many people who receive help from the fund. The Committee can be assured that the Government's record on the independent living fund is our assurance that we shall wish to be satisfied about the practical effects of the arrangements.
Simply continuing the independent living fund at the same time as bringing in community care would 1505 not necessarily be the right way forward. We do not believe that the flexibility that will be available in the community care arrangements when they come into effect needs to be replicated in the independent living fund. Under our community care plans the 1993 arrangements rely on local authorities designing their own care packages for everyone in the community rather than looking to the ILF. It would be quite wrong to separate out that relatively small group of disabled people from the people being catered for by the local authorities.
We shall of course discuss with local authorities the transfer and funding arrangements. We shall want to satisfy ourselves that those arrangements safeguard that very vulnerable group of people. Although I understand the desire of some Members of the Committee to take the opportunity to amend the Bill today, we are still nowhere near the end of the fund's third year; we are barely beyond half way. I understand the desire to take the decisions now but, with all respect, it is not sensible for the Government to take those decisions when so much of the detail of the community care arrangements remain to be worked out.
With those assurances I hope that the noble Lord will feel able to withdraw his amendment.
§ Lord Carter
Before the noble Lord sits down, he will be aware that one of the proposals put forward by his own party for the reform of local government is the abolition of the county councils, which are presently responsible for social services departments and presumably for the devolution of those responsibilities to the district councils. Is there not a possibility that the responsibilities now borne by the ILF could fall between the two tiers if one was abolished?
§ Lord Henley
I am not aware at the moment that it is the Government's policy that the county councils should be abolished. No doubt that is something that one party or another might look at on another occasion. However, whatever happens, there will still be social services departments just as there are social services departments in districts in the old metropolitan counties.
Before the noble Lord, Lord Henderson, replies, perhaps I may point out that the noble Lord did not adequately answer the point made somewhat briefly by his noble friend Lord Skelmersdale. The essence of what he said seemed to be that if something is working well it should be left alone; why mess about with it? The noble Lord gave us an assurance that the greatest possible care would be taken when making new arrangements, but he also said that the present arrangements were perfectly all right. So why do we need any new arrangements? Let us stick to the old ones.
§ Lord Henley
The ILF is working well. Noble Lords will remember that last year we debated at great length the National Health Service and Community Care Bill. The second part of that Bill will bring in community care in 1993. The introduction of community care changes the position on ILF. ILF 1506 would replicate the proposals under community care. For that reason we have to consider our position. We must ensure that there will be adequate transitional arrangements for those supported by the ILF when community care is included in 1993.
§ Lord Henderson of Brompton
I thank the noble Lord for his reply. He will realise that every speech other than his own was in favour of the amendment. There was all-party support for it; and not merely all party support, since the amendment had the support of the noble Lord, Lord Skelmersdale, who for many years represented the noble Lord's department.
§ Lord Skelmersdale
Perhaps I may correct the noble Lord. That certainly was not the tenor of my remarks. I think that it is a great mistake to put this matter on a statutory basis under government control. I thought I made it clear that it was a great mistake when I quoted the noble Lord, Lord Peston, in a previous debate when he said that government money equals government interference. Equally, I accept that I do not like local authority control for rather different reasons. What I requested, as the noble Lord, Lord Winstanley, just picked up, was that it should be left severely alone.
§ Lord Henderson of Brompton
That is what we are aiming to do; that is the whole purpose of the amendment. I am extremely grateful to the noble Lord for reinforcing that point of view and, once again, I thank him for it. There is nothing more for me to say except that I believe that the Committee is absolutely at one in requesting the Government to save Mr. Nick Scott's baby. That is all. We do not want it to die an unnatural death in 1993 at the hands of the local authorities. I commend the amendment to the Committee.
§ Baroness Phillips
On a point of order, may we have the lights put on? The Government may wish to save on light and heat in your Lordships' House but this is a very important debate and is there any reason to turn the lights down?
§ 4.13 p.m.
§ On Question, Whether the said amendment (No. 1) shall be agreed to?
§ Their Lordships divided: Contents, 125; Not-Contents, 103.1508
|Division No. 1|
|Acton, L.||Callaghan of Cardiff, L.|
|Addington, L.||Campbell of Eskan, L.|
|Adrian, L.||Carmichael of Kelvingrove, L.|
|Ailesbury, M.||Carter, L.|
|Airedale, L.||Clanwilliam, E.|
|Allen of Abbeydale, L.||Cledwyn of Penrhos, L.|
|Annan, L.||Cocks of Hartcliffe, L.|
|Ardwick, L.||Craigavon, V.|
|Attlee, E.||Cross, V.|
|Auckland, L.||Cullen of Ashbourne, L.|
|Aylestone, L.||Darcy (de Knayth), B.|
|Birk, B.||David, B.|
|Blackstone, B.||Dean of Beswick, L.|
|Bonham-Carter, L.||Derwent, L.|
|Bottomley, L.||Donaldson of Kingsbridge, L.|
|Brightman, L.||Dormand of Easington, L.|
|Broadbridge, L.||Ennals, L.|
|Bruce of Donington, L.||Ezra, L.|
|Falkender, B.||Lovell-Davis, L.|
|Fisher of Rednal, B.||McIntosh of Haringey, L.|
|Gallacher, L.||Mackie of Benshie, L.|
|Galpern, L.||McNair, L.|
|Gladwyn, L.||Masham of Ilton, B.|
|Glenarthur, L.||Mayhew, L.|
|Graham of Edmonton, L.||Milner of Leeds, L.|
|Gregson, L.||Mishcon, L.|
|Grimond, L.||Morris of Castle Morris, L.|
|Hacking, L.||Moyne, L.|
|Hailsham of Saint Marylebone, L.||Nicol, B.|
|Hampden, V.||Oram, L.|
|Hampton, L.||Peston, L.|
|Hanworth, V.||Phillips, B.|
|Hatch of Lusby, L.||Porritt, L.|
|Hayter, L.||Richard, L.|
|Henderson of Brompton, L. [Teller.]||Rippon of Hexham, L.|
|Holderness, L.||Russell, E.|
|Hollis of Heigham, B. [Teller.]||Sainsbury, L.|
|Holme of Cheltenham, L.||Saltoun of Abernethy, Ly.|
|Hooson, L.||Seear, B.|
|Houghton of Sowerby, L.||Serota, B.|
|Howe, E.||Stallard, L.|
|Hughes, L.||Stedman, B.|
|Hunt, L.||Stoddart of Swindon, L.|
|Hutchinson of Lullington, L.||Strabolgi, L.|
|Hylton, L.||Swinfen, L.|
|Hylton-Foster, B.||Taylor of Blackburn, L.|
|Ilchester, E.||Terrington, L.|
|Ingleby, V.||Tordoff, L.|
|Jacques, L.||Turner of Camden, B.|
|Jay, L.||Underhill, L.|
|Jenkins of Hillhead, L.||Varley, L.|
|Jenkins of Putney, L.||Wallace of Coslany, L.|
|John-Mackie, L.||Walpole, L.|
|Kagan, L.||Walton of Detchant, L.|
|Kearton, L.||Wharton, B.|
|Kilmarnock, L.||White, B.|
|Kinloss, Ly.||Williams of Elvel, L.|
|Lawrence, L.||Willis, L.|
|Listowel, E.||Wilson of Rievaulx, L.|
|Llewelyn-Davies of Hastoe, B.||Winstanley, L.|
|Lockwood, B.||Winterbottom, L.|
|Aldington, L.||Eccles of Moulton, B.|
|Alexander of Tunis, E.||Elliot of Harwood, B.|
|Allenby of Megiddo, V.||Elton, L.|
|Alport, L.||Erne, E.|
|Astor, V.||Ferrers, E.|
|Bauer, L.||Flather, B.|
|Belhaven and Stenton, L.||Fortescue, E.|
|Beloff, L.||Fraser of Kilmorack, L.|
|Birdwood, L.||Geddes, L.|
|Blatch, B.||Gisborough, L.|
|Boardman, L.||Grimthorpe, L.|
|Boyd-Carpenter, L.||Haslam, L.|
|Brabazon of Tara, L.||Henley, L.|
|Brigstocke, B.||Hertford, M.|
|Brougham and Vaux, L.||Hesketh, L.|
|Buckinghamshire, E.||Hood, V.|
|Butterworth, L.||Hooper, B.|
|Caldecote, V.||Joseph, L.|
|Campbell of Alloway, L.||Killearn, L.|
|Carnegy of Lour, B.||Kinnaird, L.|
|Cavendish of Furness, L.||Knollys, V.|
|Clitheroe, L.||Lauderdale, E.|
|Cockfield, L.||Long, V.|
|Colnbrook, L.||Lyell, L.|
|Constantine of Stanmore, L.||Mackay of Clashfern, L.|
|Cottesloe, L.||Macleod of Borve, B.|
|Cox, B.||Mancroft, L.|
|Craigmyle, L.||Massereene and Ferrard, V.|
|Davidson, V. [Teller.]||Merrivale, L.|
|Denham, L. [Teller.]||Mersey, V.|
|Donegall, M.||Monteagle of Brandon, L.|
|Downshire, M.||Mountevans, L.|
|Mowbray and Stourton, L.||Selkirk, E.|
|Murton of Lindisfarne, L.||Selsdon, L.|
|Nelson, E.||Shrewsbury, E.|
|Newall, L.||Skelmersdale, L.|
|Norfolk, D.||Stockton, E.|
|Norrie, L.||Stodart of Leaston, L.|
|Nugent of Guildford, L.||Strange, B.|
|Oppenheim-Barnes, B.||Strathcona and Mount Royal, L.|
|Oxfuird, V.||Strathmore and Kinghorne, E.|
|Pender, L.||Swinton, E.|
|Platt of Writtle, B.||Teviot, L.|
|Plummer of St. Marylebone, L.||Thomas of Gwydir, L.|
|Pym, L.||Thomas of Swynnerton, L.|
|Quinton, L.||Trumpington, B.|
|Reay, L.||Ullswater, V.|
|Renwick, L.||Waddington, L.|
|Rodney, L.||Wade of Chorlton, L.|
|Romney, E.||Westbury, L.|
|Selborne, E.||Wolfson, L.|
§ Resolved in the affirmative, and amendment agreed to accordingly.
§ 4.21 p.m.
Lord Allen of Abbeydale moved Amendment No. 1A:
Page 1, line 13, after ("mobility") insert ("(physical and mental disablement)").
§ The noble Lord said: In moving the amendment I should like to speak also to Amendment No. 27.
§ As the Bill stands only those suffering from physical disability are entitled to the higher rate of the mobility component of a disability living allowance whereas those suffering from physical or mental disability may, under certain criteria, become eligible for the lower rate. The purpose of the amendment is to bring the two provisions into line. The reasons why it is being proposed constitute a further instalment in a long-running campaign which I hope is nearing its end, seeking the full rate of mobility allowance for a comparatively small number of persons estimated at 8,000 or 9,000 with severe mental handicap and particularly severe behavioural problems.
I shall not burden the Committee with an account of the further exchanges and the various arithmetical calculations in which the Government have engaged over the past year or two. I shall rest on what the Minister said on Second Reading, and what was said in another place. In the Official Report at col. 904 on 26th February, the noble Lord, Lord Henley, said:
If we can isolate the 8,000 or 9,000 people in the group whom MENCAP is convinced are markedly more disabled than the others who will, as I mentioned in opening the debate, come into the lower rate, then we will happily do so".
At col. 905, he said:
If we could isolate the group identified by MENCAP—I stress that we must find a way of doing that—then we would be happy to do so".
I repeat the Minister's words:
I stress that we must find a way of doing that".
In the Official Report of another place on 7th February at col. 474 Mr. Nicholas Scott said:
I am on record as giving an undertaking to do my best to find a way of defining those 8,000 or 9,000 people … I am genuinely unhappy that it has not been possible so far to define such a test. The issue will not go away".
Indeed, it will not.
§ It is clear that the test for the lower rate of mobility allowance as set out in the proposed Section 37ZC(1) (b) falls far short of meeting the requirements of this group, which needs physical control, not just guidance and supervision, for most of the time when out of doors. As an example, the mother of one boy says, "He's a danger to himself and everyone else when out of doors unless in a car. He has no road sense whatsoever. He simply cannot be taken on to public transport". Both the mother and the father have to restrain him physically if he takes it into his head to dart across the road; and even two people may not be enough. I could give example after example, but I think that that suffices.
§ When at an earlier stage the Government changed their mind and decided to grant mobility allowance to the deaf-blind, they did so by regulation. However, the regulation-making power was then limited to the physically disabled. The higher rate is repeated in the proposed Section 37ZC(3) of the Bill but there is no known physical cause of the mental handicap of the group about whom I speak. If the amendments were accepted, the provisions too could be dealt with by regulation.
§ The test of severe mental handicap should not be too difficult to define. After all, there is a test of severe mental impairment laid down for exemption from the poll tax. While I do not deny that the wording about severe behavioural problems would not be easy if the gates were not to be opened too wide—although we would be quite willing to help—the drafting could perhaps be done at greater length in a regulation than would be appropriate in a statute. That indeed happened with regard to the deaf-blind. Since we are all agreed on the objective—and I cannot interpret the pronouncements of the Minister as meaning anything else—I cannot believe that it is beyond the wit of man to devise the words. Without the amendments the Government cannot even try. I beg to move.
§ Lord Carter
I am very pleased to support the amendment. As the noble Lord said, there is a long history of trying to enshrine in legislation the mobility allowance availability for severely mentally handicapped people. This Chamber accepted an amendment to that effect in 1989 which was overturned by the Government in another place.
There is no need to repeat the saga of the varying numbers produced by the Department of Social Security with regard to those who would benefit. First, it was 140,000, then 50,000. It then became 200,000 before decreasing to 50,000 again. There is confusion in understanding mental illness and mental handicap. At a late stage of the proceedings there was the mysterious case of the OPCS data tapes. Perhaps I may be allowed a wildly mixed metaphor. They appeared over the horizon like the US cavalry coming to the rescue, and ended up like the Sherlock Holmes' dog which did not bark.
Those of us who have supported the extension of the benefit to the severely mentally handicapped have never changed our view that the number would be less than 10,000. The figure is probably 8,000 to 9,000 1510 people. The figure appears at last to have been accepted by the Government. They say, not unfairly, that definition is the problem. The purpose of the amendment is to give the Government the chance through regulation to solve that problem. I am sure the Minister knows that we are all anxious to help in that task.
The amendment gives the Government a chance to find the right definition. However, if the Minister accepts the amendment will he consider that there is a firm commitment to find the definition through regulation and thereby help such people? I do not doubt the Minister's good intentions but we should not wish to find that the department had accepted the amendment with the understanding that it would enshrine the definition in regulation only to find that this was impossible.
The cost is low; it is less than £8 million. Such people will receive the new lower rate of mobility allowance; so the difference will be the increase in the rate. It is worth an additional £19.10p per week—that is almost £1,000 per year—to 8,000 or 9,000 people.
In recent times the Government have tried hard to deal with the problem. I hope that at last the Minister will accept the amendment so that we can protect these severely handicapped people.
§ 4.30 p.m.
I support the amendment. It is not necessary to prolong the discussion. On many occasions the noble Lord, Lord Allen of Abbeydale, has addressed the Chamber on the subject most movingly. He has given detailed examples of the people in this group about whom he is anxious.
We then get into the numbers game and ask how many such people there are. The nub of the problem is that we are discriminating against the mentally handicapped and the mentally ill. We constantly deny that, but in practice we do so, partly because their disability, profound though it may be, is not as visible as some physical disabilities.
I am informed by the Spastics Society that four years ago Mr. John Major, then the Minister responsible, approved the extension of the mobility allowance equivalent to the higher rate of mobility component to this group of people. That was subject to confirmation by a DHSS survey of the small number of people likely to benefit. Four years is plenty of time in which to ascertain the number of people concerned and I am sure that the Government know it. If it is that given by the noble Lord, Lord Allen, surely now is the time for them to agree to deal with the problem.
§ Lord Glenarthur
I too have a great deal of sympathy with the amendment. For about two years I was responsible for mental health and mental handicap. During that time I gained a certain knowledge of the subject and developed a good deal of sympathy for the people in this plight. Visiting a number of them and seeing the way in which they live left a deep impression on me.
The Government appear to have accepted the principle of the amendment but are stuck with the 1511 difficulty of finding a definition. Reference was made to the Office of Population Censuses and Surveys. I also had responsibility for that department and know that a finer body of people one could not find. I too cannot believe that it is beyond the wit of man nor beyond that of anyone in the OPCS to devise a system of defining more precisely where these people lie in society and how many there are.
We run the risk of missing a real, proper and sensible opportunity to make such an amendment. It is unlikely to present itself again for some time. For that reason I urge my noble friend to take firmly on board what has been said. One is providing a great stimulus to such people in giving them access to the outside world, whether by boat, vehicle or whatever. It helps them in their extremely difficult lives and it provides their carers with the opportunity to develop their limited abilities beyond the state that might otherwise be possible. I hope that the Government will be bold and go further than they have previously found possible. In doing so they will acknowledge their understanding of the plight of so many of these people.
§ Lord Renton
I must first declare a potential family financial interest. I have a severely disabled daughter with a mental age of two years and a natural age of 35. She is unable to walk unless held up and is unable to feed, dress and undress herself. She is completely dependent. Clause 1, which one must welcome as far as it goes, consists of six pages of complicated legislation. The proposition for helping them is relatively simple: I had hoped that it might be done more simply. However, the six pages of the clause are not the end of the story because the provisions will not come in to effect until at least three sets of regulations have been made.
For both personal and broader reasons I earnestly hope that the Government will show sympathy for the clear case that has been made, not for the first time, by the noble Lord, Lord Allen.
§ Lord Skelmersdale
I understand that if an acceptable definition of these particularly unfortunate people existed the amendment would be unexceptionable. The difficulty is finding a method of reaching a definition I believe that the Government are in broad agreement with MENCAP that there are between 8,000 and 9,000 such people. Naturally the Government wish to help them but do not wish to spread the net any wider.
The problem is that under the Bill the application for these benefits is based on self-assessment by the individual, by the carer or by a combination of both. That must make it more difficult to find a definition of these people whom we all agree need to be helped. I do not know a way out of the conundrum. I understand that acceptance of the amendment would put pressure on the Government to find such a definition.
After hearing what was said by my right honourable friend the Minister for Disabled People and my noble friend on the Front Bench I wonder whether any other pressure is needed. The Government have expressed a genuine desire to help 1512 these disadvantaged people. In the circumstances is it necessary to press the amendment at this stage? I should prefer to give the Government a little more time—say, until Report —to reach a sensible solution. They have already accepted existence of the problem and wish to deal with it. I should rather take that course than push them at this stage.
§ Lord Allen of Abbeydale
Perhaps I may rub in the fact that on previous occasions we have tried to amend the statute to include this provision. I accept that our efforts have not done the trick. We are now proposing that that should be done by regulations in which there can be a wider spread; and it is perhaps more practicable to find a satisfactory definition which can be interpreted by those who must operate the scheme in the field. If we miss this opportunity, we should be driven to try to achieve our aim by statute which so far we have failed to do.
§ Lord Auckland
I live in Surrey where there are seven large mental hospitals. It is very rare that parliamentary draftsmen can be accused of drafting concise legislation. The usual accusation is that amendments and Bills are far too long. This clause is extremely vague and I believe that the amendment is right to spell out quite specifically "physical and mental disablement".
In the clause there is no specification as to who is covered. Those who have had experience of hospitals for the mentally handicapped—as I have—would surely agree that the least any government can do is to include the words of the amendment in the Bill.
§ Lord Carter
In response to the point made by the noble Lord, Lord Skelmersdale, we need Amendment No. 27 to insert the words "or mental" in order to bring that into regulations. I believe that is so. Perhaps the Minister will confirm that.
§ 4.45 p.m.
§ Lord Henley
Clearly I should like to reiterate the points made by my noble friends Lord Glenarthur and Lord Skelmersdale. We have taken that on board and have accepted that if the group of some 8,000 or 9,000 people spoken of by MENCAP can be defined then we should be prepared to come forward with an amendment to cover them.
However, as I said on Second Reading, there is a problem as regards definition. The problem has moved on somewhat since our debates of last year and the year before, as the noble Lord, Lord Allen, will remember. We are now debating the matter in a different and better context. One reason for introducing the new lower rate mobility component in DLA is that the OPCS evidence has pointed to substantial numbers of people with relatively low incomes who have mobility problems which are not severe enough to get them into mobility allowance but who nevertheless entail extra costs. I know we may differ about the extent of these extra costs, and about the coverage that the existing benefits give, but I think it is fair to say that the principle of having a disability benefit which gives better recognition of the fact that there are degrees of disability has been generally welcomed.
1513 This amendment really raises the question of whether, within that sizeable population—150,000 or so—who will certainly now be eligible for the lower rate, we can identify a much smaller group whose mobility needs and costs are so great as to justify giving them the higher rate—currently mobility allowance. I stress the phrase "we can identify" because I think in all fairness Members of the Committee should recognise that that, understandably, has to be the focus of the Government's attention.
It is not that we sit in our ivory towers disbelieving what MENCAP and the Spastics Society tell us about the numbers whom they have in mind. The problem is, and always has been, how to distinguish the group they have in mind from the much larger numbers of people, whom we all acknowledge exist, who have mental disabilities, whether mental illness or mental handicap, severe enough for them to require guidance or supervision for most of the time.
The bulk of the people whom we expect to qualify for the lower rate are people who suffer from mental disabilities. As my right honourable friend the Minister pointed out in another place, really very sizeable numbers of these people have what are, by anyone's standards, distressingly severe behavioural problems. For example, 50,000 adults were identified by OPCS as getting "so upset that they hit other people or themselves" and 25,000 children were "aggressive, violent-tempered or destructive and scream or shout most of the time every day". These figures may surprise the Committee; they somewhat surprised us when we looked at this when devising the DLA. But I must say I cannot see why the OPCS research should have come up with significant over-estimates of the numbers of people with behavioural problems of this severity.
Once one reaches these sorts of levels of behavioural problems, I hope the Committee will acknowledge that there are genuine difficulties in splitting off the much smaller group of people which MENCAP and others believe to be their target group. I recognise of course that they, and as I understand it, Members of the Committee are solely referring to those who are mentally handicapped and are not seeking to incorporate the sizeable numbers of mentally ill people whose problems can at least be less permanent.
Even so, we have to be clear on this. Very many people with mental handicaps who appear in the 75,000-strong groups I cited earlier—adults who injure themselves, and violent and aggressive children—are people who must be outside the group which MENCAP wants us to identify. The Committee will, I think, understand that to find a definition which excludes people in these situations is no easy matter.
The noble Lord, Lord Allen, quite rightly cited the example in the community charge provisions of severe mental impairment. However, I believe that the noble Lord has inadvertently made the point which I seek to make. About 100,000 people qualify for exemption 1514 from the community charge on those grounds. Clearly, that is far broader than the group which MENCAP wishes us to identify.
We have never said that it cannot be done. Our intuitive belief is that organisations like MENCAP and the Spastics Society will have the deepest knowledge of the needs of these people and will be best able to help us in trying to draw distinctions within the broader groups. But I have to say that we do not believe that previous amendments that have been tabled referring to the need for "physical control" have met the purpose.
I appreciate and welcome the fact that noble Lords opposite are recognising our genuine difficulties here and are therefore not at this stage trying to pin us down to a specific form of words on the face of the Bill. But in all honesty I do not think that this is an amendment we can or should accept. For one thing, I do not believe it actually works. As we understand the problem, it is not necessarily the case that a person with this degree of mental handicap is in fact unable or virtually unable to walk. So, if we amend the legislation in the way suggested we would not pick up the group which could walk but those who needed really very severe restraint or control in order to do so.
I do not believe that it would be responsible to accept the amendment, to say nothing of the costs which the noble Lord, Lord Carter, raised. He seemed to believe that that cost would be very small. We estimate that the cost could be substantially in excess of £100 million. We do not believe that it would be responsible to accept such an amendment.
§ Lord Carter
My estimate was based on figure of 8,000 to 9,000 people. The difference between the higher and lower rates is about £20 per week. Therefore, if my estimate is accepted, the cost would be under £8 million.
§ Lord Henley
As my right honourable friend and others have said, and I repeat, we accept the principle but there is a problem of definition. That is why it would not be responsible to accept an amendment which might cost far more. It would not be responsible to accept an amendment unless and until we feel we have found a satisfactory form of words to isolate the right group. I am happy to reiterate the commitment given by my right honourable friend the Minister in another place that if we can isolate the group to which Members of the Committee have referred, then we shall do so. I freely admit that we are unhappy because we have not yet managed to do that. However, I ask the Committee to trust me because the department has expanded considerable effort in trying to do that, and will continue to do so.
My noble friend Lord Skelmersdale pointed out that there are two weeks until we deal with the Report stage. Following the announcement by my noble friend the Chief Whip, we shall have an extra week's holiday at Easter and therefore I believe that Third Reading will be that much later after Easter. That will allow more time if Members of the Committee wish to meet either my right honourable friend or myself to see whether a solution can be found. However, I do 1515 not believe that that would necessarily be the right way forward at this time. I have given an assurance that if we can isolate that 8,000 to 9,000 we shall do so. However, this amendment would not be the right way forward. I hope that the noble Lord will accept what I have said and feel able to withdraw his amendment on this occasion.
§ Lord Allen of Abbeydale
I am rather at a loss to understand what is being proposed. We have gone back to all these figures of 100,000 and so forth. I thought the Government had agreed that we were talking about a group of 8,000 to 9,000. Is the Minister now suggesting that we postpone a decision? Is he saying that when we have found the solution it is to be done by regulation, as was done for the deaf and the blind? If so, this would require an amendment somewhat along the lines that we are suggesting. Alternatively, is the noble Lord suggesting that something might be put on the face of the Bill? I just do not know.
§ Lord Henley
The noble Lord is quite right that we could not do it merely by regulation without an amendment. Something would need to be on the face of the Bill. That is why I was trying to stress that this Bill is not being rushed through in any way. My understanding is that there are something like two weeks before Report stage and, because of the length of the Easter Recess, there will have to be at least another two or three weeks after that before Third Reading. It is of course important to get some agreement on this. The noble Lord and I accept that we are trying to isolate the same group, but I do not think that it would be right to take a decision on this today. I have given the noble Lord an assurance that there is still time to talk and that we hope to come forward with an amendment, if it is possible to do so, at a later stage.
§ Lord Allen of Abbeydale
Perhaps the Minister could answer my question. Is he talking about doing this by regulation in the end or is he talking about putting something on the face of the Bill?
§ Lord Henley
I have answered that particular point. I said that it could not be done simply by regulation unless we put something in the Bill. Thereafter, having agreed on that, this is something which I imagine could be on the face of the Bill or be done by regulation; but certainly something has to go into the Bill. I have accepted that point whatever happens.
§ Lord Renton
Perhaps my noble friend would clarify one matter, because it is the prevailing matter in this discussion. He has said that if a suitable formula could be found which would cover only the 8,000 of 9,000, the Government would be happy to have that written into the Bill. Is he expecting other people to work out that formula so that he can either accept it or, with the aid of his officials, knock it down; or will he, with all the expertise at his disposal, work out the formula and then assure us that all will be well?
§ Lord Henley
I said that over the months we had made considerable efforts in the department to try to come forward with a formula and I have apologized 1516 for the fact that we have failed to do so. That is why I invited others to come forward with their expertise and suggestions. I appreciate that my noble friend praises the expertise in the department, but we have not been able to resolve this. We shall continue to try, but we shall also listen to the advice of noble Lords and to those organisations for which they speak.
I cannot promise that the Government will come forward with an amendment but I have given an assurance that if we can isolate that group of 8,000 to 9,000, we shall meet that commitment. However, we must make sure—we have a responsibility to do this—that the group is properly identified. We are dealing with very large sums of taxpayers' money and I do not think it right that an amendment should be accepted which does not properly identify the group which is then allowed to expand and go out of control.
§ Lord Hailsham of Saint Marylebone
I have been trying to follow this Bill but I am not sure that I have quite reached the point where I understand it fully. I was present on an earlier occasion some months ago when this matter came up for decision by your Lordships and there was a discussion. I understood then that there was a disparity between what was proposed in what is now the amendment put forward by the noble Lord, Lord Allen of Abbeydale, and the Government as to the numbers of people involved in the question. The disparity at that stage was very great indeed. I could quite understand that one did not know at that stage whether one was talking about £100 million or £10 million, and at that time I was entirely on the side of the Government. But we have moved on from there. If I have got this rather complicated drafting right, there are two components to be considered in the first two sections: one is the care and the other is the mobility.
Both of them at one stage or another in the definitions on page 2 of the Bill contain a mental factor, which is on the face of the Bill. I understand, though I may be wrong, that when we look at the subsequent pages we realise that nothing much can be done until regulations are passed by the Secretary of State. If that is a correct view, I can quite see why my noble friend wants to postpone a decision at this Committee stage, when it is still open to discuss the matter on Report. However, I should have thought it was not beyond the wit of man to insert on the face of the Bill a phrase which would enable the last stage—namely, the regulatory stage—to be the effective trigger in respect of the concession.
I thought that was the only point which the noble Lord, Lord Allen of Abbeydale, was trying to make in moving the amendment. I may have misunderstood, but I should have thought that this was capable of agreement. I am not ever wholly familiar with the Companion to the Standing Orders and with what is precluded on Report after discussion at Committee, but I should have thought it was possible for both parties to come to an arrangement whereby there need not be a Division at this stage and that the matter could be proceeded with on Report, as my noble friend suggests. If I am wrong, of course I shall be the first to concede it.
§ Lord Allen of Abbeydale
Perhaps I could try again. Under the Bill there are two rates of mobility allowance: one of £10 a week and one of £29.10, if I have got the figure right. Our argument is that some 8,000 people who suffer from the most appalling behavioural difficulties should get the higher rate instead of the lower rate. That cannot be done unless the relevant clause is amended so as to enable people who suffer from mental disablement as well as those who suffer from physical disablement to get the higher rate. There is a provision that the lower rate is available to those who suffer from physical or mental disablement. There is no provision that those who suffer from mental disablement can qualify for the higher rate. The Bill says that circumstances may be prescribed by the Secretary of State in which a person can be taken to satisfy either of those conditions. The sole purpose of the amendment I have moved, and which has had a good deal of support, is to enable the Secretary of State to prescribe circumstances applying to these 8,000 people.
The noble Lord, Lord Henley, said, if I heard him aright, that it can be done. My feeling is that it is a terrible thing for this Committee to say that 8,000 people who are suffering from the most appalling behavioural problems, with all that that involves for their families, and with severe mental handicap, should be precluded from getting the higher rate simply because we cannot find the words. I suggest that if it is done by regulation, as can be done if this amendment is accepted, you can spell it out and have quite a long definition and be quite sure that you are limiting it to the 8,000 and not opening the doors any wider. That is the simple issue we have been discussing.
§ 5 p.m.
§ Lord Henley
I think I should come in. We are close to agreement but not close to agreement on this amendment as being the way forward. I have accepted that the Government could not make the necessary regulations without an amendment and that we need an amendment. What I am trying to say is two things. First, it would be wrong to bring in this amendment until we are sure that we can get the regulations right. I have given my commitment that we accept the figure of 8,000 or 9,000, but we must isolate it. No responsible government could bring forward an amendment that is going to produce a figure much greater than that.
The second point is that this amendment does not do the trick. Only the mentally disabled people who are unable, or virtually unable, to walk would qualify. As we understand it, it may mean that MENCAP's target group can walk but that they cannot reach any sort of destination, and the amendment does not achieve the purpose that the noble Lord is setting out. If we could talk further between now and Report stage, because I have given the commitment that we have accepted a figure of 8,000 or 9,000, I am sure we can come forward with something, but we must come forward with an amendment that will closely identify the proper target group and not go wider than that.
I have listened most carefully, but perhaps I am a bit slow in following the noble Lord's arguments, although I am doing my best. Bearing in mind that we appear to agree on the objective and that we share the common aim to do this, and bearing in mind that the noble Lord has said that everything would depend in the end on the precise nature of the regulations—and regulations will have to be framed—can he tell me in simple terms what damage it would do if we passed this amendment?
§ Lord Henley
My understanding in simple terms is that this amendment would not allow us to make the regulations that the noble Lord is seeking. What I say is that we must come forward with a different amendment, and before we come forward with a different amendment we must be sure that we can identify the appropriate group.
§ Lord Allen of Abbeydale
I am sorry to prolong this, but can the noble Lord help us a bit more about what might be the appropriate sort of amendment? Is he still talking about doing this on the face of the Bill, or is he following the precedent of the blind and deaf? I still do not understand this.
§ Lord Henley
We would be quite prepared to do it by means of regulations. If the noble Lord would find it more convenient to discuss it on the Floor of the House during the course of the Bill, he might prefer to come forward with an amendment at Report stage to put it on the face of the Bill.
Baroness Darcy (de Knayth)
Before my noble friend decides what to do, may I ask a question because I, along with a great many other people, are confused by this? Was the noble Lord saying about two interventions back that the phrase "virtually unable to walk" was the sticking point?
§ Lord Henley
I would have to take further advice on this, but my understanding is that that is a problem at the moment with the way that this amendment has been drafted and the effect it would have on any regulations laid as a result of the amendment.
§ Lord Allen of Abbeydale
I think that is a view that we might wish to challenge, but I do not think there is much point in continuing the argument. I am quite prepared to withdraw the amendment and leave it for further consideration at Report. But I would like to put on record that, as I understand it, the Government now accept that what we are talking about is some 8,000 people; that there has been rather wild talk about cost to public funds, but the sums we are talking about are something less than £8 million; and that the Government would look sympathetically on an amendment enabling this to be done by regulation provided the powers are made clearly enough and provided there is some idea of what would be put in the regulation. Is that an accurate understanding?
§ Lord Henley
I can accept what the noble Lord has said. We have accepted a figure of 8,000 or 9,000. The problem is one of definition. If we can define that, as I and others have said, we would be quite prepared to accept an amendment.
§ Baroness Seear
It may be rather improper for me to come in at this stage as I was not here at the 1519 beginning of the debate on this clause. However, as I understand it, what we need is something on the face of the Bill which authorises the regulation, and that has to be in a form which makes an appropriate regulation possible. Am I right in that? I think I am.
If that is so, may I ask the noble Lord why new Section 37ZC(1) (b) is not adequate? Subsection (1) (a) refers to not being able to walk. Subsection (1) (b) refers toable to walk but is so severely disabled physically or mentally that to take advantage of the faculty out of doors he requires guidance or supervision".Is that not enough to provide the basis for the regulation?
§ Lord Allen of Abbeydale
I do not know whether it is for me to answer that, but I touched on this in my opening speech. The test set out in paragraph (b) falls far short of what meets the requirements of these people with particular behavioural difficulties. They require much more than guidance and supervision from another person for most of the time. They have to be physically restrained and might have to be controlled by two people when they are out of doors because no one knows what they are going to do.
If one rested on paragraph (b) as it stood the doors would be opened much too wide. We are as anxious as the Government to limit this strictly so that it defines as clearly as possible the perhaps 8,000 candidates, if I can me that word, that we have been talking about. In the light of the discussion, I think that we are not going to get much further today, and I shall ask leave to withdraw the amendment but we shall certainly be coming back at a later stage.
Amendment, by leave, withdrawn.
Lord Carter moved Amendment No. 2:
Page 1, line 13, at end insert ("and a laundry component,").
§ The noble Lord said: In moving Amendment No. 2 I shall also speak to Amendments Nos. 3 to 9, 11 and then 13 to 19.
§ Lord Henley
I told the noble Lord that I would intervene at this stage to make the point that I accept that we shall be speaking to all of these amendments as one group because they are all linked, but any decision by the Committee on each amendment would obviously have to be taken separately. A decision on one particular amendment would not necessarily bind the Committee in any way on any of the later amendments. I hope the noble Lord will accept that.
§ Lord Carter
I am grateful to the noble Lord. I should be extremely surprised if he said anything else in the circumstances of this rather large group of amendments. The best way to deal with it, as a number of noble Lords have their names to different amendments concerning the different components of extra cost, would be if I were to say a few words on the general argument about extra costs in toto, as it were, then speak briefly to the two amendments regarding laundry and heating to which I have attached my name, leaving other noble Lords then to deal with the amendments with the particular extra cost components with which they are concerned.
1520 We made a point at Second Reading that there is a need for a disability living allowance. In our view the DLA only covers the care and mobility costs. There are many other disability-related costs that we feel are not covered, and that is the reason for the successive amendments under the various extra cost components dealing with laundry, heating, communication, domestic help, diet and the rest.
It seems that the Government's attitude to this, as revealed in the other place, relies on the OPCS data regarding costs. I quote from a letter from the department to Mrs. Brown of the Norfolk Association for the Disabled—I have her permission to do so—which says:You make the point that the DLA does not include specific allowances for the extra costs of, for example, clothing, diet and heating. The overwhelming evidence from the OPCS surveys was that need for help with attendance or mobility often accompanied other disabilities. In that way, the care and the mobility components in DLA are well targeted on the more severely disabled people".In effect the Government are saying that there is a need for help with attendance and mobility costs, so help will probably be needed with other disability costs. Therefore, help will be given with attendance and mobility costs. That is the logic of the Government's argument. It seems to me that that argument is completely circular. It is either a syllogism, tautology or perhaps both. I cannot see the logic of the Government's position: because there are people who need help with the costs of mobility and care and who also have other disabilities which are not caught by the Bill, helping them with care and mobility helps them with the other costs of disability. After all, the qualifying criteria are for the needs of care and mobility. How can the DLA be expected to cover these other extra costs?
The OPCS revealed that 87 per cent. of people with disabilities living in private households are not receiving a mobility allowance or an attendance allowance. One-third of the people in categories 8, 9 and 10 of the OPCS survey involving the most severely disabled did not receive a mobility or attendance allowance. I know that the Government rely on the OPCS figures. I am sure that the Minister will refer to them when he replies. Expenditure of £6.10p per week is the average extra expenditure for a disabled person. We feel that that provision is faulty in its methodology. The Social Security Advisory Committee made a report in 1988 which states:The UK system recognises … some of the extra costs of disability through payment of attendance allowance for care needs and mobility allowance for mobility needs. However there are many needs which go unmet".The Family Expenditure Survey (Disability, Household Income and Expenditure) found that,fuel and services (especially domestic service) are important areas of extra spending for disabled people".Other areas in order of magnitude include expenditure on housing costs, food, durables, bedding, gadgets, aids, appliances and the telephone. Disabled people are also poor people. We have evidence that the average income of disabled people is much less than the average for the community as a whole. The OPCS asked people who were poor how much they spent. We feel the question should have been how much extra 1521 cost would have been incurred if there was sufficient help to meet the extra cost of disability in order to allow the disabled person to live a decent life.
The family expenditure survey said that the,actual spending by disabled people is considerably lower than for other households because of their low incomes. Disabled people face extra costs, but on average, differences in spending are relatively small".That is a situation which was picked up by the OPCS. If people who are poor are asked how much they actually spend on the extra cost of disability, the question arises that if the money is not available, it cannot be spent. The survey should have tried to discover what would be the extra cost of disability if the disabled were to be given a decent life.
I am sure that the Minister is familiar with the survey conducted by the Disabled Income Group (DIG) which revealed just how much extra cost severely disabled people incur. That survey provides valuable information. The OPCS survey covered a whole range of disabilities and then the figure was averaged out over the whole range. DIG dealt only with the most severely disabled. The DIG method was concerned with people who were more aware of the cost of their disability. If I ask noble Lords how much extra they spent on heating during the recent cold spell, I am sure that every one would have difficulty in replying without further research. That is almost what the OPCS survey discovered in the time for each interview, instead of looking at the documents and having the time to find out how much extra expenditure was required.
The average income of the DIG sample was much higher, at £182 per week in 1989 compared with £82 per week in the OPCS survey in 1985. As I said, what one does not have one cannot spend. When the Minister replies can he say what the Government's attitude is in this area of extra cost? Is the difficulty the cost of meeting these amendments, the complexity in attempting to define and deal with the extra costs, or both?
This morning I received a communication from the National Consumer Council which states:Our reasons for supporting all these amendments are essentially the same. They are, that failure to recognise the special needs of disabled people would lead to their being denied access to goods and services on an equal footing with other consumers. We are not asking for preferential treatment but for recognition of particular needs in order to uphold the principle of equity to which my Council attaches great importance".Those were the general points about the extra cost as a whole. I shall be extremely brief because I know that the noble Baroness, Lady Darcy (de Knayth), will speak about laundry and other noble Lords will speak about heating. I wish to say a few words about those two extra costs in order to save me having to intervene later in the debate. We know that laundry is a particular problem for certain disabilities, for example, incontinence, dribbling, vomiting, the spilling of things and falling over, with effects on clothes and so on. There is also the problem of perspiration and the effect on clothing, bed clothes and upholstery.
1522 I have already said that by definition the care components help with the cost of care but not the extra cost of such things as laundry. I have received valuable information from both the Spastics Society and MENCAP. There is one example from the Spastics Society, from the mother of Danny. She says:Danny's always had a problem with feeding and being sick. Constantly—his clothes being washed all the time. My clothes being washed all the time, because he's sick on them. His bedclothes being washed all the time. The sheets —you go through sheets like no-one's business because they're always in and out of the washing machine".There is also evidence from MENCAP. It points out that the health service's research unit at the University of Kent made a study of families with children with a mental handicap. It found that 50 per cent. of families said that there was more expense than normal on laundry. I wish to refer to one example among many regarding a family which has mental handicap in it:Although we use 'modern day incontinence items', we still use far more water than a normal family would use. Daily washing of clothes and often daily washing of bedlinen due to incontinence, is necessary, as is almost constant bottom and hands washing. Hygiene has to become a way of life, therefore extra washing of towels, flannels, toilet and bathroom equipment is very necessary".Those of us who have experience in our own families of dealing with severely handicapped people can recognise the strength of that quotation.
I turn equally briefly to the subject of heating. The need for the amendment that deals with heating was underlined by the Minister, Mr. Nicholas Scott, in Standing Committee E on 6th December 1990 in the other place. He said:People who have mobility needs will of course often need assistance with costs such as heating, because their immobility will make them more subject to fluctuations in temperature".The mentally handicapped are perhaps less mobile and spend much more time indoors either sitting or lying down. They feel the cold more. The house has to be kept much warmer. Many of us are familiar with that situation. There is a fear of extra heating bills in the families that have these problems. It can result in considerable discomfort for the disabled because the family is frightened to turn up the heating in order to make the disabled person comfortable. We have heard about the likely increases in electricity charges. They will present a problem.
We have had experience of payments for the elderly and the disabled because of the recent severe weather. For many of the disabled that is a need all the year round. I ask the Minister to say where the disabled and their carers are supposed to find the money for these extra costs. I have referred to only two examples. I am sure that other noble Lords will give further examples of other extra costs included in this group. If the Government reject these amendments, will the Minister say whether the rejection is on the grounds that they would cost too much, their complexity, or both? I beg to move.
§ 5.15 p.m.
Baroness Darcy (de Knayth)
As I added my name to the amendment concerning the laundry component perhaps I may speak next. I wholeheartedly support this group of amendments which are essential if we are 1523 to move towards a realistic disablement costs allowance. The noble Lord has given a splendidly broad picture of the general argument. I shall certainly not add to it. I shall home in directly on Amendment No. 2. I was particularly keen to add my name to the amendment concerning the laundry component. As a paraplegic I know very well that the extra laundry engendered by incontinence is not something that can be skimped without the risk of pressure sore or skin problems.
As the noble Lord, Lord Carter, said, people with cerebral palsy also have particular problems. He enumerated the various reasons for needing extra laundry. It can mean washing or dry cleaning not only of the disabled person's clothes but the clothes of the carers, bed clothes, chair covers, carpets and so on. It also means buying, maintaining and frequently replacing laundry equipment. If one cannot wash and dry clothes quickly and efficiently extra costs arise through having to have a double or triple supply of sheets, towels and clothes. It is a real and unavoidable extra cost. The same applies to each of these components, but payment would only be made to the person who had the specific need. That is why I support the amendments.
§ Lord Henderson of Brompton
Before the Minister replies, I have my name down to one or two amendments on the cost of clothing—a slightly different issue from laundry but interrelated. If one is always laundering one's clothes they will wear out much quicker than if one is not doing so.
I should like to say a few words relating to a 1984 survey I by Judith Buckle about which the Government may or may not know. The survey was entitled Mental Handicap Costs More. I shall talk only about the mentally handicapped and their families. I shall be very brief on the subject of clothing but I can say without fear of being contradicted that more clothes are needed when a person feels cold. Often, coldness is a feature of disability, and a very important one. Shoes wear out more quickly with extra wear and tear. Some shoes cost more in the first place because they have to be specially made to fit. We have heard also about people with severe mental handicaps who tear their clothes. One cannot put anything on them because they tear their clothes straight off. Therefore more clothes have to be bought or the clothes that have been torn off have to be mended. It is a number of such factors which add up to a very considerable extra cost per year. Clothes wear out more quickly and more sets of clothes are needed because of incontinence and messiness.
Judith Buckle discovered that threequarters of the sample families in her survey required extra clothes. When the study was made in 1984 it was found that £80 a year was the cost of the expenditure on extra clothes. On the assumption that prices have risen 50 per cent. since 1984, the figure would now be £120. I instance the figures to show that it is certainly not a negligible sum of money, especially to those who are on income support. I would add my own penny's worth to the many pounds' worth adduced by the noble Lord, Lord Carter, and the noble Baroness, Lady Darcy (de Knayth).
§ Lord Swinfen
In this group of amendments there are two in my name which deal with the problems of communication. I am thinking not only of people who are deaf, deaf-blind, and blind but of those with dyslexia, a rather hidden form of disability which people tend to ignore, thinking that the individual is daft, when very often he is incredibly intelligent.
Deaf people often have to buy special equipment to overcome their lack of hearing. For example, they need specially adapted telephones, where messages can be typed and not spoken. They need door bells and smoke alarms that flash lights. I could continue at length but time is moving on. They often incur additional travel costs in order to be able to communicate directly with people. They cannot use an ordinary telephone and the person at the other end may not have the kind of telephone that communicates with their telephone. On occasions they need an interpreter to translate between sign language and English.
The deaf-blind are doubly impaired. When conducting important business they may need to take with them a companion to interpret. The blind face considerable difficulties in communicating with other people. One of the hidden disabilities is dyslexia. The dyslexic individual very often cannot complete the forms necessary to obtain the benefits to which he has a right. I have recently been told about a dyslexic individual who went to the Department of Social Security office and said that he could not fill in the form because he could not write. He was told in a very loud voice, "If you cannot write you need to fill in this other form or get someone to fill it in for you". That was not only thoroughly unhelpful but rather demeaning at the same time. In general I support this whole group of amendments.
§ 5.30 p.m.
§ Lord Kilmarnock
I am not sure whether we are supposed to be speaking in strict batting order on this group of amendments. However, as they have been grouped, I shall speak principally to Amendments Nos.7 and 19 which stand in my name and in the names of the noble Lords, Lord Banks and Lord Carter.
At Second Reading the noble Lord, Lord Henley, reiterated the Government's intention to resist any idea of a reversion to the complexities, as he described them, of the previous system. He also said:Care and mobility needs represent the common denominator between the most frequently occurring and the most expensive of the disability related costs which people incur".He then added rather mysteriously:the more expensive disabilities were the least common"—[Official Report, 26/2/91; col. 904.]I believe that those words came from the report to which reference has been made.
That statement leaves out of account a whole raft of costs which are also expensive. They are not and cannot be covered in blanket fashion by either the care or the mobility component or a combination of both. By definition they are awarded for those purposes and they will be largely absorbed by those purposes. They 1525 are not presumably intended as jam to be spread more thinly over a larger loaf. Nor is it correct to say that the most expensive disabilities are the least common when, on the Government's own admission, in a Written Answer to Mr. Alf Morris on 28th February, Mr. Scott said:We anticipate that around 240,000 people will be eligible for the new lower rate of the care component of the disability living allowance and that around 60,000 of these will be people who need a special diet".—[Official Report, Commons, 28/2/91; col. 610.]It is to stretch language to suggest that the requirement of 60,000 people for a special diet which is expensive as I shall show is an uncommon disability.
At Second Reading I gave some figures for the costs of a high protein high calorie diet which is required by 80 per cent. of HIV or AIDS patients when they reach what doctors call Category 4, which is the transition point from HIV positive to what is sometimes called full-blown AIDS. The life expectancy from that point is currently in the region of 10 to 20 months. Therefore, such people will not initially be covered by the new arrangements for the terminally ill, as Mr. Scott seemed to suppose, erroneously, on Report in another place.
As regards the costs involved, I do not like to repeat myself but some aspects need to be repeated. In 1991 a joint initiative by the Terrence Higgins Trust and the Bloomsbury Health Authority found that the mean weekly cost of a standardised high protein high calorie diet in London amounted to £42. That figure is very much in line with the costing by the Royal Victoria Infirmary in Newcastle upon Tyne of a diet suitable for someone with AIDS who is living alone—namely, £32.75 at 1988 prices. In that year, 1988, the self-help organisation, Front Liners, produced a figure of £34.20. It will be seen that all those estimates converge on a figure of around £40 at current prices.
At this stage of the proceedings I should like to instance a concrete case reported by the Citizens Advice Bureaux about a man suffering from AIDS. He was 43 years of age and had spent three months in hospital. He was only eligible for £36.70 income support and he did not, at the time, qualify for disability premium or attendance allowance. After discharge from hospital he was housed temporarily in a local authority homeless persons unit. A community care grant met only half of his essential needs for furniture and household equipment when he moved into permanent accommodation. He had no warm clothing and had to rely upon charitable donations. The fact that he suffered from diarrhoea and incontinence meant that he had to meet the additional cost of the washing of bedding and clothing to which reference has already been made. A high calorie and high protein diet was recommended but, together with the other costs we have mentioned, it was impossible for him to afford it. Indeed, he spent much of his time in bed trying to keep warm and frequently had no meal at all during the day.
That is a matter to which I hope the Government will address themselves, and I hope that the noble Lord will do so in his reply. What happens to such people when they can no longer cope? Clearly they will 1526 eventually go back into hospital. But surely it is an extremely inefficient use of hospital resources for a person who could live in the community with a little more help to block a hospital bed. Such a situation makes it less likely than ever that the Government will achieve their aim of reducing the number of people on the waiting lists. They have been remarkably unsuccessful in that respect.
Since the separation of the Department of Health and Social Security, which was no doubt desirable, a frontier has inevitably been traced between the two departments. One hopes that it will not be a closed frontier. If the noble and delightful Baroness, who is the Minister's opposite number in the other side of that divide, were present in the Chamber she would no doubt confirm the fact that waiting lists are a prime target of government policy. If the Department of Social Security will not address itself more urgently to the meaningful enablement of independent living her department's aims are doomed to disappointment. Such matters cannot be resolved if the left hand of the Government does not know what the right hand is doing. Those two hands must come together.
I spoke about AIDS sufferers because I have special knowledge of their plight. However, in terms of numbers, those people suffering from diabetes, liver or kidney disease and malabsorption syndrome are much more numerous. Indeed, we have heard the Government's own estimate of 60,000 sufferers who require special diets. Some of those diets are quite different from those required by HIV or AIDS sufferers; nevertheless, they are expensive. The Diabetics' Association calculates a figure in the region of £30 to £40 for a healthy diet. Moreover, some liver conditions require a very expensive low sodium diet which means that everything has to be fresh and nothing tinned can be eaten other than fruit. Kidney sufferers also require a restricted sodium low protein and low fat diet with similarly expensive implications.
The general picture for all special diets of whatever variety is that they do not come cheap—£30 to £40 a week is the average range. This afternoon I telephoned the dieticians in three London hospitals; namely, St. Thomas's Hospital, the Royal Free Hospital and the Bloomsbury community care team in the National Temperance Hospital. They all agree that it is crucial that the dietary needs of patients in the community should be supported financially. For many people their diet is an absolutely vital part of the treatment.
Finally, if the noble Lord accepts the figures I have put forward—I believe that he must do so in general orders of magnitude because in my speech on Second Reading I demolished the figures upon which the Government had been working—and refuses to go back to the old system (I believe that he may do so) then he is obliged to tell us how he supposes that independent living can be maintained for those concerned in the sort of cases which I have mentioned. Perhaps he will tell the Committee that the independent living fund, of which mention was made earlier and which, as I understand it, is at present restricted to those receiving the higher rate of attendance allowance, can be widened and adapted to take account of the miscellaneous claims which are the 1527 subject of these amendments. However, at some point he must bring forward a solution, otherwise we shall find it difficult to accept that the Government are seriously committed to the policy of independent living for disabled people.
§ Lord Skelmersdale
I am rather sorry that there is no former Secretary of State for Social Security, or of the DHNS as it was in the old days, present in the Committee. It has always been my belief, in the development of social security policy, that one must have cognisance, first, of the desirability of future actions, secondly, of the practical issues and, thirdly, of the expense involved. Moreover, since the 1986 Act, the Government have added to those considerations the complexity argument. The noble Lord, Lord Carter, and I have had many arguments in the past about complexity.
I believe that the 1986 Act was actually based upon the premise of KISS. I think that I should explain that concept now as it appears that I have confused the noble Baroness opposite. KISS stands for "keep it simple, stupid". I should stress at once that I am not addressing any Members of the Committee in that way, or any of those involved in the excellent organisations which represent the needs and objectives of disabled people.
Many of the subjects covered by the amendments before us were additions to supplementary benefit under an earlier regime. It has been a long-term aim of noble Lords opposite, and of the disability organisations, to get them returned in one form or another. There is no doubt that, judged against the criterion of desirability, many people would have need of certain of these extra benefits. They are desirable.
I was moderately encouraged by the remarks made by the noble Lord, Lord Carter, on Second reading. At the beginning of his speech he said:I believe that it is correct that there will now be no fewer than 11 possible combinations of benefit under the DLA".—[Official Report, 26/2/91; col. 887.]Later—I accept that it is the middle of a sentence but I hope that it is not out of context—he continued that,no fewer than 11 combinations of allowances … included in one overall benefit represents a positive merry-go-round of benefits".— [Col. 888.]I took some comfort from those remarks, as no doubt did my noble friend on the Front Bench. I assumed that he had become an afficionado of the KISS principle.
§ Lord Carter
If the noble Lord reads on he will note that in his reply the Minister explained—though it was a bit of a tease—that the system will be similar in effect to that involving the one claim form, and so on. I accept that fact.
§ Lord Skelmersdale
In my view, that simplicity of operation must be carried forward into the rest of the social security system. There is no doubt in my mind that DLA is as simple as it is possible to make it. As I understand it, not only will it be simple but it will also be based, as we explored previously, on the basis of self-assessment. Moreover, it will benefit about 300,000 people, as my noble friend said on an earlier 1528 occasion, who currently receive no extra help with the cost of their disability. They will gain to the tune of £10 per week.
However desirable all these benefits are—I accept that they are—we have a basic complication. I say that because people will be assessing themselves as regards the need for these various additions. Clearly, any responsible organisation administering social security benefits will have to carry out a check from time to time in respect of such people on an on-the-spot basis. A complex, multi-component benefit would not be in the least compatible with self-assessment. It would inevitably require difficult subjective medical judgments about severity levels. How is the disability level measured? How do the local DSS office and the board measure it? How do we check up on it?
My noble friend has said on numerous occasions that personal care and mobility are two of the most expensive costs disabled people can incur and that it is therefore sensible to target help on those needs. The way to deal with those particular and peculiar needs is through the independent living fund mentioned by the noble Lord, Lord Kilmarnock. I have already said that the matter should not be dealt with by the local authorities or a statutory agency run by a government organisation. It should be left severely alone. I am not trying to repeat the arguments we heard when discussing the first amendment but I believe that it would be far too difficult for a realistic and fair assessment to be made in each of the cases no matter how desirable they are, to say nothing of the cumulative expense which I cannot go into. I am sure that my noble friend on the Front Bench will do so.
§ Baroness Hollis of Heigham
I shall speak to Amendments Nos. 6 and 18. Amendment No: 18 relates to water. The extra costs, as we are all aware, and the lower income of the disabled intersect with their greater needs. As previous speakers have made clear, the disabled face extra costs because they have to spend more on the ordinary items of living such as housing. Other additional costs relate exclusively to disability; for example, medication, diet, as the noble Lord, Lord Kilmarnock, said, and medical aids. A third cluster of costs flow from the disability because people have to pay others to do what they would normally be able to do themselves. That includes cleaning, taxis and some of the communication items already referred to.
The amendment that I seek to persuade the Committee to accept differs from those three categories. It relates to water. Water bills were a relatively insignificant addition to rates. In the past they were often brigaded for council tenants with their rates and rent. After 1974, when water was removed from the local authorities, costs began to rise. In the 1980s, pressure from the environmental lobby and Europe rightly led to investment to improve water quality and better sewage treatment facilities.
As a result, water rates have been rising nationally by between 15 per cent. and 25 per cent. a year. Given that two-thirds of disabled adults live in households in which there are no earners—the household is 1529 dependent solely upon benefits—how well provided for are those on benefit, especially the disabled, in meeting rising water rates?
When supplementary benefit became income support, £1.65 was earmarked for water. That sum has now been absorbed into the basic benefit. Basic benefit will of course be uprated by the rate of inflation. There are three problems associated with that. The first is that even when, in 1988, that £1.65 was identified, it was an average snapshot. Many disabled were immediate losers because they were already paying water rates of between £3 and £4 a week. Secondly, the benefit has been uprated in line with inflation but, as the Committee will be aware, the inflation index excludes housing costs with which water rates are joined. Therefore, higher water rate costs—we are all aware of what they are —are not looped back into the assessment for inflation by which income support is uprated and in which the water element is embodied.
While water rates rise faster than inflation, there is no protection or addition for people receiving income support. That means that whereas water rates are now on average about 6 per cent. of income support, in a few years the NCC expects them to represent 13 per cent. In other words, water rates now are already double the 20 per cent. poll tax average levy and they will soon be three or four times that levy. One couple in their seventies in my area were without water for 18 months because they were disconnected for being unable to meet their bills, according to the local CAB.
Water is not a discretionary item. It is, as I have said, an increasingly onerous top slice off income support and disability benefit. Not only was the original snapshot an average which produced at least as many losers as gainers, with water costs rising faster than inflation there is no way for those costs to be looped back into the index by which income support and benefits are upgraded.
There is a third threat on the horizon—metering. It may or may not be rational to meter—a move which adds to the already high fixed costs of water and which can have only marginal effects on the discretionary costs of usage. We are already the second lowest per capita users of water in Europe. In more ways than one, we are the dirty people of Europe. To discourage consumption, especially for the disabled, when it reduces personal hygiene, is not wise. If consumption falls, the heavy fixed charges remain. Therefore, an increasing proportion of the costs and user charges will rise even faster than we already predict.
As the NCC's response to the OFWAT consultation paper made clear last month, the heaviest users of water are large families, the disabled and those with dirty jobs. Metering will fall heaviest upon those least able to afford it. As previous speakers have made clear, over 1 million disabled people have the heavy costs associated with incontinence—bed linen, clothes and twice daily baths. Others need a heavy water supply because of their use of kidney dialysis machines. Others have skin diseases and need baths two or three times a day. Still others suffer what we now call challenging behaviour and physically messy 1530 lifestyles. Metering involves not just heavy installation costs; it also involves higher standing charges. It will have a regressive effect on consumption patterns.
I urge the Minister to give an assurance that in the event of pilot schemes such as that in the Isle of Wight being extended across the country—it is expected that 96 per cent. of the country will be metered by 2000—the Government will fully protect the disabled from additional costs.
Water rates are high. They are growing higher. Existing disability benefits are being top sliced by water bills at the expense of heating, clothes and diet. Recognising that, Peter Barclay, chairman of the Social Security Advisory Committee, wrote to the Secretary of State in October 1990 calling for income support rates to rise,by an amount greater than would otherwise be the case to recognise the increasing burden caused by the exceptional rise in water chargeson the grounds that water was so basic and the increases so exceptional.
OFWAT, the water regulatory body, recognises the severity of the problem but insists that not a matter for the water companies but for government. Appropriate government agencies should support necessitous customers. If the companies will not, the Government must. The right answer is to add water charges, where appropriate, to rents so that they are eligible for 100 per cent. housing benefit, or, if an applicant is not an income support claimant, to add them to the poll tax, or whatever replaces it, and then for them to be eligible for rebates along with the taper.
To meet ever increasing water rates—perhaps I may respond to the criteria for additional components set out by the noble Lord, Lord Skelmersdale—in that way is not complicated. It is not onerous, it does not engender problems of self-assessment and it seems to me that it pinpoints the needs that must be met. I hope that the Committee will be able to support the amendment.
§ Baroness Seear
Amendments Nos. 7 and 17 put the case for a component of domestic help. It seems to me self-evident that whatever else is necessary for the disabled person, it is essential to keep the house clean. Speaking as someone who is remarkably bad at doing so, I feel it is obvious that to have the floor and bath cleaned and the washing up done properly, especially if one is housebound as many disabled people are, is of the highest importance. I could do without a certain amount of care as defined in the Bill, provided the house was reasonably tidied up.
Amendments Nos. 7 and 17 propose a specific item for domestic help so that disabled people are able to pay for it if they cannot get the home help component that is difficult to obtain because there are not enough people. This is a down-to-earth addition which is of the greatest importance and I rate it highly. I hope that the Government will take it on board. I support the amendment.
§ Lord Henley
It may be necessary for me to speak for a short while in answering the debate. The noble Lord, Lord Carter, asked whether we wished to reject the amendment because of its cost or complexity. I make three points. First, cost is obviously a factor that 1531 the Government must take into account. However, one should look at our record over the past 10 years. Our expenditure on the long-term sick and disabled has doubled in real terms to £10 billion a year. In addition, the Bill will bring in approximately a further £300 million and we can be very proud of our record as we have gradually built on our success over the years. Cost must be a factor that we take into account when Members of the Committee seek to extend the Bill in one way or another.
Complexity is the second point and we are obviously keen to minimise the complexity of DLA. As the Committee knows, we have been criticised on a number of occasions for the many combinations of rates and components of DLA. The noble Lord, Lord Carter, made this point at Second Reading. He said that it was a mere tease, but one of his honourable or right honourable friends in another place took it quite seriously.
The more complex the structure, the more difficult self-assessment will become, as my noble friend Lord Skelmersdale quite rightly pointed out. However, in the end our main point is that the amendments are unnecessary because the care and mobility components will target help on the most severely disabled people, whatever their precise needs.
There is an important area of principle between us here. The Government's intention in introducing the disability living allowance and the intentions of noble Lords in introducing their amendments are not dissimilar, but there are significant differences between the routes which we have chosen to achieve our respective ends. I am sure that all sides of the Committee would like to create a wide-reaching disability benefit which would cater for all the many possible kinds of additional expenditure which people with varying disabilities can face.
However, I wish to look briefly at just how the kind of scheme which these amendments propose would be put into practice and then compare this with the benefit which we are developing. Our benefit has been criticised because of the alleged complexity of its structure. The noble Lord teased me about this. I hope that I shall have an opportunity later in the debate to reassure the Committee that from the point of view of the claimant DLA will be a simple two-component benefit. This pales into insignificance if we consider the complexities of the scheme devised by the amendments. Were we to accept the various amendments put forward to widen the scope of the new benefit, as I understand it, there would be an extra cost benefit consisting of 10 possible components with literally hundreds —it would take a mathematician to work it out, which I am not—of possible combinations of benefit which people with disabilities could receive. Such a system would make it absolutely impossible for potential beneficiaries ever to work out what they might or might not be entitled to, or even to understand which component or combination of components of DLA they were receiving.
The groups of amendments which have been put forward recreate pretty faithfully the old supplementary benefit system with all the complexities that it 1532 engendered, as my noble friend Lord Skelmersdale quite rightly pointed out. However, the experience of the past has shown us that the old supplementary benefit additional requirements were not a successful way of getting cash into the hands of people with disabilities.
In order to administer the kind of benefit which the amendments propose, the claim form would be so long and complicated as to discourage all but the most determined possible beneficiary. That is something one ought to stress. Whatever other criticisms have been made of the Bill, the assessment and adjudication procedures have generally been welcomed. The Committee should bear in mind that, even with the assessment procedures proposed, probably a fairly long document will be required. If we went down the route proposed by the amendments the chances of anyone managing to provide the Department of Social Security with enough information at the first, second or even third attempt to enable adjudication officers successfully to decide upon that person's entitlement to each of the 10 different components of DLA would be slim.
I also find it difficult to imagine just how this new multi-component benefit could be adjudicated and what the conditions of entitlement would be. Just how would the extra costs incurred by people with disabilities in such widely disparate areas as laundry and diet be measured? There would, of course, have to be some kind of objective measure of comparison with the amount spent on these items by people without disabilities. Attempting to develop a benefit along these lines would do nothing to simplify the process of claiming benefit for people with disabilities. It would make it very difficult for these people to obtain the benefit to which they are entitled.
Perhaps I may touch on one or two areas of the individual amendments dealing with different components. The noble Baroness, Lady Hollis, raised the problem of water. I obviously cannot give her the commitment she requested. However, I ask her to look at our record. It is not true that income support for disabled people has been up-rated slowly by inflation or inflation less housing costs. One significant component of The Way Ahead package, of which this Bill is the culmination, was the increase in 1990 of more than double the rate of inflation for disability premiums within income related benefits. That takes account of the complaints made by the noble Baroness that the disabled were left out of the increases in income support.
Turning to the laundry component, were we to accept that there was a need for it we would again have to deal with the practical problems such as how we could measure the extent to which the costs incurred by people with disabilities were in excess of the expenditure incurred by people without disabilities. We should have to decide whether such extra costs were solely incurred as a result of the disability.
We should need to develop some kind of objective standard against which to measure the extra expenditure incurred by the people whom we are trying to help. This is where the old system with the 1533 supplementary benefit fell down. We should also have to subject people to the much more complicated procedures for adjudication and claims.
I turn to clothing and the survey by Judith Buckle, mentioned by the noble Lord, Lord Henderson, Mental Handicap Costs More. No one would wish to deny that mentally handicapped people may incur extra expenditure on clothing. Again it is a question of whether a special clothing component—that attempts to isolate, first, the specific costs incurred and, secondly, the groups who should qualify for help—is the right way to proceed. The Government again believe that the extra complexity that such a provision would involve is not the right approach. I could say the same thing about heating. Added complexity would be introduced in comparing normal costs for heating with the extra costs for heating incurred by certain groups of disabled people.
I now turn to diets. We would like to be able to extend help to everyone who required a special diet. However, the important point here is that the Bill is concerned with disability. Many people who follow special diets are not disabled in any commonly accepted sense. Their diets do not, for example, prevent them from working. Many of those whose dietary disorder is linked to some other disability that, for example, prevents them from working, will qualify for one or other of the components of DLA, and the rate will depend on their disability.
§ 6 p.m.
§ Lord Kilmarnock
Does the Minister agree that the Bill focuses almost entirely on care and mobility, and therefore its purpose is to help with the care of disabled people and to improve their mobility? One cannot spread the resources over all the other requirements. I gave the noble Lord some figures of up to £30 or £40 a week per person just to cover diet.
§ Lord Henley
I do not accept those remarks. We see the care and mobility needs as the simple gateway into benefits. I have been trying to stress the advantages of creating a simple way into benefits. We have never said that all the money available for attendance allowance and mobility allowance—the precursors of DLA—must be spent on care or mobility needs. The OPCS reports show that, if one wishes to direct resources to the most severely disabled people who incur heavy extra costs, the entitlement criteria for attendance allowance and mobility allowance provide an effective way of channelling those resources. That is the point we are making, and that is the general point of DLA. We would therefore resist including any extra components as they would add much greater complexity to the system that we have developed. We believe that the two-component system is the most sensible way forward and that it represents the best solution to the problem which besets all social security systems, which is how to construct a benefit which meets individual needs without making it so complicated that it is impossible for people to claim and it is impossible to administer.
1534 The OPCS (Office of Population, Censuses and Surveys) reports have provided us with an unprecedented volume of information about the circumstances of the kinds of people whom we are trying to help. Their findings have been supported by a follow-up study using the Family Expenditure Survey. The OPCS reports clearly showed that the existing extra costs benefits are well targeted on those members of the population who are most severely disabled.
In addition, the surveys made clear that personal care and locomotion are in fact two of the most expensive of the extra costs which people with disabilities can incur, and that they, (along with hearing difficulties which carry low associated extra costs), are actually the most frequently occurring of the 13 categories of disability that OPCS considered. We therefore believe it is right to concentrate the help we are giving to people who incur extra costs as a result of their disability, on these two areas which represent the common denominator between the most frequent and the most costly of the possible costs of disability.
Of course we would accept that various disability organisations have conducted their own surveys. I believe the noble Lord, Lord Carter, mentioned the survey carried out by the Disablement Income Group. However, that survey considered only some 80 or 90 severely disabled people. That cannot compare, as a basis for framing a general benefit, with the evidence that has been accumulated from the OPCS surveys, which considered some 10,000 different disabled people.
As I have said, we accept that various disability organisations have conducted their own surveys which indicated that some people incur higher disability-related costs than the OPCS reports would suggest. But it is important to remember that attendance allowance and mobility allowance were substantially in excess of the average costs incurred by even those in the highest OPCS severity category.
We would not deny that some people do incur higher costs. But a non means-tested benefit for getting on for 2 million people with disabilities cannot hope to cater for every individual nuance of need, and we have concentrated our attention upon those areas where help could be directed most easily and effectively.
The OPCS surveys demonstrated that there was an identifiable gap in the coverage which the existing extra costs benefits are providing for people with disabilities. A group of disabled people some way below the highest severity category appeared to be relatively disadvantaged in income terms. Part of their income disadvantage was that a much lower proportion of this group were in receipt of either of the extra costs benefits. Despite the substantial take-up increases since 1985, there were clearly some people at the middle severity levels who were never going to qualify for help under the current system. Those at the greatest income disadvantage tended to be people who were disabled earlier in life and who did not have other sources of income, or had not had the opportunity to 1535 build up financial resources. People in the lowest severity categories tended to have other sources of income, such as earnings, while those disabled later in life might well have built up savings or be entitled to some kind of pension. The surveys indicated that the incomes of disabled pensioners did not differ greatly from those of non-disabled pensioners. However, there was a much greater disparity between the incomes of disabled and non-disabled people under pension age. The introduction of DLA is intended to help this group of people whom the OPCS surveys identified as caught in the middle. They were too disabled to work but not likely to qualify for the existing extra costs benefits.
We have built these new lower rates of DLA on to the proven foundation of benefits based on care and mobility, because, as the evidence I outlined earlier shows, they are a successful way of delivering benefit to people who incur extra costs because of a disability. We are seeking to simplify the benefit system to ensure that the method of claiming the new benefit is easier both for claimants to understand and for the department to administer. We want to be certain that as many as possible of those who may actually be entitled to help with the extra costs of disability will be brought into benefit. The real test of a benefit system is not how good it sounds but how successful it is at getting cash to the people who need it.
Above all, we want to distinguish between the cause of a person's disability—the fact that he suffers from the impairment of particular faculties—and the effects of that disability. He may for example require extra heating or extra laundry because of that impairment.
We expect that the new lower rates of DLA will bring nearly 300,000 people into benefit. This has to be seen in its proper context. Since 1979, the number of recipients of attendance allowance has tripled from 265,000 to 795,000, while the number of recipients of mobility allowance has grown sixfold from 95,000 to 615,000. I am sure the Committee would agree that this is a substantial achievement. By 1993–94 we shall see 1.9 million people receiving either DLA or attendance allowance and expenditure will be over £5 billion more in real terms than in 1979. This is perhaps a tribute to the extent to which people increasingly understand the current benefits and how they work. That gives us an excellent basis on which to build.
After that rather lengthy explanation of why we believe our two-component system is the best provision, I hope noble Lords will not feel it necessary to press for the various extra components covering laundry, heating or other matters.
Baroness Darcy (de Knayth)
Speaking as a recipient of the mobility allowance but not of the attendance allowance, before the noble Lord, Lord Carter, decides what to do about the amendment perhaps I may briefly explain the difficulty that I have with the constant emphasis on complexity, particularly in relation to self-assessment. That was a point which the Minister mentioned and which the noble Lord, Lord Skelmersdale, raised originally.
Surely it is fairly simple to determine that one has a certain level of heating costs and therefore one needs 1536 the heating component; or one has a certain level of special diet costs and therefore one needs the diet component. That must be simpler than saying, "I have heating costs and diet costs which are more than my care costs but luckily the latter are sufficient to qualify me for the care component. I shall receive that although it will not cover my care, heating and diet costs". It may be complicated but at least it is better than the person who may have significant heating and diet costs but no care and mobility costs receiving neither component. Will the Minister confirm that if one has no care or mobility needs one will receive no help?
§ Lord Henley
The noble Baroness is quite correct. That is why we have extended both the care and mobility categories so as to include a greater number of people. We believe that by that means we shall include virtually all of the people in the most severe categories as well as a great many others in the middle categories who were perceived as suffering income disadvantage.
I do not accept that the way in which the noble Baroness wishes to go forward will make life simpler. It would add enormous complexity. Colleagues of the noble Lord, Lord Carter, accused us of bringing in a complicated system because the two components would produce 11 variations. They cannot now argue that to increase the number of combinations would make it simpler.
§ Lord Carter
The noble Baroness, Lady Darcy (de Knayth), has put her finger on the problem. The Minister said that the way in which recipients spend the DLA benefit is not restricted to care and mobility. However, the qualifying criteria are restricted entirely to care and mobility. The noble Baroness is entirely correct to say that if one does not meet those criteria one will not receive the money.
§ Lord Henley
I also pointed out that we have extended both mobility and care provisions and it will therefore be easier for people to receive the allowances. That will extend to most of the people to whom the noble Baroness referred.
§ Lord Carter
That argument could obviously continue for a long time and I do not propose to extend it. On the measurement of extra costs, there are many examples of allowances of one kind or another which are uprated annually and have to be calculated. The attempt to measure might be a broad-brush approach but it would certainly help those who receive the money.
There is no doubt that extra costs exist under various headings. There has been evidence from noble Lords on all sides of the Chamber to support that. I am not entirely clear whether the Government are saying that the costs do not exist or that they exist and the Government cannot afford to meet the requirements, or even that they exist and are met by the DLA. The argument was rather muddled. The noble Lord, Lord Skelmersdale, said that it was desirable to assist with those costs but it was too complex, too expensive, or both.
1537 On the subject of complexity, most Members of the Committee will have had experience of dealing with personal and corporate taxation systems. We never hear about the complexity of successive Finance Acts when they result in tax cuts.
The Government are clearly not prepared to accept the argument. I would respect their case more if they said that we were right, those extra costs exist but it would be too expensive to meet them, instead of pretending that the DLA meets the costs that we have described.
I shall withdraw the amendment that I moved, but we shall wish to return to the whole matter of extra costs at Report. Perhaps the group of amendments may be more tightly drafted, but we shall have to come back to the point. We have not been able to convince the Government this afternoon but there is a problem concerning the extra costs and I believe that it is the duty of the Government to deal with it. I beg leave to withdraw the amendment.
§ Amendment, by leave, withdrawn.
§ [Amendments Nos. 3 to 9 not moved.]
§ 6.15 p.m.
Lord Carter moved Amendment No. 10:
Page 1, line 18, leave out from ("life") to end of line 20.
§ The noble Lord said: The amendment deals with the different fixed periods for claiming disability living allowance. As the Bill is presently drafted a person may be awarded either component for a fixed period or for life. However, if the award of a disability living allowance consists of both components he may not be awarded the components for different fixed periods.
§ During the Committee stage of the Bill in another place the Minister said that if the components were awarded for different fixed periods the alignment must be for the shorter period. This is a probing amendment to establish whether we have understood the matter correctly because there is a great deal of anxiety about it. As we understand it, the effect of the Bill as it stands is that if someone has care needs that are expected to last for a period of two years and mobility needs likely to last for at least four years he would be awarded the two components for two years only. Thus, despite qualifying for a four-year award for the mobility component, the claimant would be compelled to submit a fresh application and go through the whole procedure again after two years even though he had already established that he was entitled to the mobility component for four years. Will the Minister say whether that is a correct understanding of the Bill?
§ The amendment would enable each component to be awarded for different fixed periods. Thus, the duration of awards for different components would reflect the length of time that the claimant was expected to meet the qualifying conditions for the fixed component rather than being adapted for the purposes of administrative convenience, about which we heard a good deal in connection with the previous group of amendments.1538
§ It is not clear what would happen if a claimant was awarded one component for a fixed period and was subsequently awarded the other component for a shorter fixed period. Would the previous award have to be shortened so as to align it with the subsequent award? The Minister will understand the point that I am making.
I was given an example by the Multiple Sclerosis Society, which has pointed out that the Bill as drafted could cause particular problems for individuals with multiple sclerosis. MS is a fluctuating and unpredictable condition, characterised by relapses and remissions. At any point in time the care and mobility needs of the sufferer are not necessarily equal. The effects of MS are such that many individuals have severely impaired mobility permanently but their personal care needs may vary in their periods of relapse or remission. The duration and severity of the relapse cannot be predicted. MS is also considered to be exacerbated by stress. The MS Society says:
We are deeply concerned that as the legislation currently stands, the individual may have to undergo repeated medical examinations to re-establish entitlement. This will cause further stress, to an already debilitating condition".
§ Another area of concern arising from this part of the Bill relates to the connection between the mobility award and the Motability scheme. Motability allows people to lease a car for three-year periods in return for which they surrender their mobility allowance. At present people who are awarded attendance allowance for two years and mobility allowance for three years or more can make use of the Motability scheme because the two allowances are entirely separate and are paid for different periods. Under the Bill's proposals the mobility component would be awarded only for two years in line with the care component. We are concerned that people in that situation would not be able to use their mobility component for that purpose. The Minister in another place said that the Government would discuss the problem with Motability to try to find a way round it. We are entitled to ask the Government how they propose to deal with that situation, which is potentially very serious for those who use the Motability scheme.
§ It has been pointed out by MENCAP that the attendance component and the mobility component are designed to cater for different needs and they should be needs led. In other words, if you need a care component for two or three years and a mobility allowance for longer, perhaps for life, there should be some way of adapting the system to allow for that. I should be interested to hear from the Minister whether the reason for adopting the same fixed periods is one of administrative convenience or simplicity or whether there is something further behind it. I beg to move.
§ Lord Henley
I can assure the noble Lord that there is no sinister motive behind what we are doing. Perhaps I may briefly explain. The noble Lord's understanding is broadly correct. A person with care and mobility needs, unless one of the awards is for life, will find the other award shortened to bring it into line. Let me give noble Lords the rationale. A person with care and mobility needs will have to complete 1539 only one claim form and, at most, have one medical examination in order for his entitlement to both components of DLA to be considered.
I appreciate that the noble Lord's amendment is a probing amendment but its effect would be to cut across the advantages which unification will bring. In providing for components to be awarded for different periods, the amendment would increase the number of times when entitlement would need to be reconsidered. It is conceivable that a person could be awarded the mobility component for, say, four years and the care component for five years. That would mean that that person's case would be reviewed twice in the space of a year. On both occasions the claimant would be asked to provide evidence in support of continuing entitlement. Despite our intention to reduce considerably the reliance on medical examinations, we could not rule out the possibility of his being required to have a medical examination on both occasions.
We do not believe that that is in the claimant's best interests; nor is it good administrative practice. We feel that it would be much better to align the award periods, either at the outset or when the second component is awarded. Where the disabled person continues to meet the qualifying conditions the award would be renewed for a further period.
The major exception to this approach—I touched on this point at the beginning is where one of the components is awarded for life, which, incidentally, is the position in which the great majority of beneficiaries receiving both components will find themselves. Here there are not the same considerations about repeated assessments of the claimant's circumstances. A life award should mean precisely that. Unless the claimant's condition changes, either for better or worse, there should be no need to review entitlement. The Bill recognises that fact and provides that an award of one component can be made to a person for life irrespective of the period of award of the other component.
The noble Lord rightly mentioned the Motability scheme. He pointed out the concerns that have been expressed in another place, which the Government recognise. We recognise the implications that the introduction of DLA might have for the scheme. My right honourable friend in another place said that he would be discussing the practical arrangements for the new benefit with representatives of Motability. I can now report that discussions have taken place and that an administrative solution has been identified which should ensure that no one misses out on the opportunity to enter into the Motability scheme simply because his award of the mobility component has been aligned with that of the shorter care component. The fine details of the arrangements have still to be sorted out. I cannot go into them at this moment. However, I am confident that they should be resolved well in advance of the introduction of the new benefit. I hope that that will satisfy the disquiet expressed by the noble Lord.
I return to the general advantages of simplification. I hope that the advantages, as I have set them out, of 1540 unifying the two components of the claim will be accepted by the noble Lord and that he will therefore be prepared to withdraw his amendment.
§ Lord Carter
I certainly intend to withdraw the amendment but before doing so perhaps the noble Lord will confirm that my understanding is correct. When I moved the amendment it seemed to me that there was a real problem for the person who has a care component for, say, four years and then receives a mobility component for two years. Presumably he has to drop two years off the first allocation of the care component. That is how I understand the position. Incidentally, the Motability situation reveals the problem extremely well. If the Government have been able to find an administrative solution—at the moment it sounds rather mysterious and I understand that the Minister cannot explain it in detail—why cannot they use the same administrative solution for the other problems which I mentioned?
§ Lord Henley
The noble Lord is quite correct. Someone who has the mobility award then gets the attendance for a shorter period which brings it down. Thereafter, when the two years are up, he will have to reapply. But he would have to reapply for his attendance allowance at that stage anyway. That would be the time to bring them into line. That would create a much simpler way of doing things and is better than telling him that there is no need to bother about the mobility component this year and he should come back in two years' time. I think that we could reduce the number of times that he would have to claim and reduce the potential number of times that he would have to see the doctor and so on.
§ Lord Carter
I am grateful to the noble Lord. I shall read with care what he said. In the meantime I beg leave to withdraw the amendment.
§ Amendment, by leave, withdrawn.
§ [Amendment No. 11 not moved]
Lord Swinfen moved Amendment No. 12:
Page 2, line 2, leave out from ("he") to end of line 3 and insert ("is resident and present in Great Britain at the time of claim and at the time of payment except in such circumstances as shall be prescribed.").
§ The noble Lord said: At Second Reading I mentioned the difficulties that some people have with severe disablement allowance. As the regulations are currently drafted, quite rightly in order to avoid people flooding into this country to take advantage of our welfare state, those who have not been in the country for more than 10 out of the past 20 years are denied severe disablement allowance. Unfortunately, that catches the families of some Crown servants and in particular those of members of the Army in the armoured regiments. Following either husband or father, they may be out of the country supporting that Crown servant for more than 10 out of the past 20 years.
§ This measure affects only a handful of people. I wonder whether my noble friend will be able to take advantage of today's proceedings to give an undertaking that the Government will change those regulations so that families of Crown servants will be 1541 covered. If he is able to do so, can he tell me when the Government will do it? I am afraid that vague promises never get one anywhere.
§ The purpose of the amendment is not only to put forward that point but to make certain that a similar situation does not arise with disability living allowance. I wonder whether my noble friend, when he comes to reply, can also give an undertaking that the regulations will be so drafted as to take care of the families of the Crown servants whom we send abroad on our behalf. I beg to move.
§ Earl Russell
I should like to support the amendment. I am delighted that the noble Lord, Lord Swinfen, has brought back this issue. He has spoken on it before and made a compelling case. He has again made a compelling case. People who serve the Crown often at great inconvenience and with great effort should not be penalised for so doing.
§ 6.30 p.m.
§ Lord Henderson of Brompton
I add my support for the amendment. Clearly one of the great disadvantages of serving the Crown overseas is that one might be caught by such a provision. I am sure that the noble Lord will relieve the Committee by stating that he will remedy the position straight away.
Will he inform us whether or not such provision goes against our social security regulations and the European Community regulations relating to nationals? If he cannot answer now perhaps he will reply by letter.
§ Lord Carter
I am pleased to have my name on the amendment. It is a matter that the noble Lord, Lord Swinfen, has brought to the House on a number of occasions. It is time that he received a satisfactory answer.
§ Lord Henley
I thought that I always gave satisfactory answers. Obviously that is not felt to be the case. I shall respond to the noble Lord, Lord Henderson, by letter, if he will permit me. Since some of the concerns expressed go somewhat wide of the amendment, perhaps I may speak to the amendment and then deal with points raised by my noble friend Lord Swinfen.
The Government intend that the residence and presence rules for disability living allowance should be the same as those which apply currently for attendance allowance and invalid care allowance. Those are that the claimant is ordinarily resident in Great Britain and has been present here for 26 weeks out of the past 12 months. This in fact improves the position for people claiming the mobility component of DLA because currently mobility allowance requires presence in 52 weeks out of the last 18 months. That easement I think shows that the Government are not intent on placing unduly harsh requirements on the payment of benefit to people who have been out of the country. Indeed, I suggest that a requirement of 26 weeks presence in the last 12 months is very reasonable. I should also emphasise that this requirement is deemed to be satisfied in certain cases, including the case where the absence from Great 1542 Britain is because the claimant is a member of the family of a serving member of Her Majesty's armed forces.
I realise that while the terms of the noble Lord's amendment relate to the disability living allowance, he has a particular concern with regard to severe disablement allowance and the residence and presence test. The noble Lord accepted that that concern goes slightly beyond the scope of the Bill. Nevertheless, with the permission of the Committee I should say a little on severe disablement allowance.
As my noble friend said, to qualify for severe disablement allowance, a claimant must be present in Great Britain and have been resident here for 10 out of the past 20 years. We recognise that this rule presents difficulties for the families of serving members of the forces. Such people may be unable to qualify for the allowance simply because they belong to the family of someone who is required to be abroad in the service of his country. I should perhaps point out that in practice this rules out only a very small number of people since the effect of a commissioner's recent decision has been to enable members of the forces to be treated as being resident in this country if they are continuing to maintain or purchase a home here.
This 10 in 20 year residence test for severe disablement allowance is a stricter one than applies for other non-contributory benefits for disabled people. We have been re-examining the test and are looking very carefully at the issues involved.
I have to admit that our deliberations are not yet complete on the general issue. But on the specific question of forces families I am pleased to say that I can today announce a change to meet the concern expressed by my noble friend. As noble Lords on all sides of the Committee will acknowledge, recent events in the Gulf must remind us that members of Her Majesty's armed forces have frequently to be overseas, and often in situations of great danger, in the service of this country. We think it only right that the structure of the social security benefits system should recognise their special position. Consequently, we propose to amend the residence condition as it applies to the severe disablement allowance, to allow periods spent abroad by serving members of Her Majesty's armed forces and their families to be treated as residence in Great Britain for the purposes of qualifying for SDA. My noble friend asked when the regulations will be made. The necessary regulations will be made at the first suitable opportunity later in the year.
I hope that with that one piece of good news my noble friend will feel able to withdraw his amendment.
§ Lord Swinfen
I thank my noble friend for what he describes as a piece of good news. It is extremely welcome. Perhaps I may suggest that he considers the question of Crown servants generally. There will still be a number of civil servants serving this country in the EC. If he takes account only of the armed forces one or two individuals will be involved as opposed to between five and 10, which is the current situation.
§ Lord Henley
I said that we are considering the general issue but our deliberations are not yet complete. That is why I wished in the meantime to announce the concession for the families of our armed forces.
§ Lord Swinfen
I am glad to hear that after some months of badgering my noble friend is gradually being moved. With those thanks, I beg leave to withdraw the amendment.
§ Amendment, by leave, withdrawn.
§ [Amendments Nos. 13 to 19 not moved.]
Lord Carter moved Amendment No. 20:
Page 2, line 10 leave out from ("with") to end of line 14 and insert ("either his bodily functions or functions of daily living or both combined attention from another person for a prolonged period of the day; or").
§ The noble Lord said: The care component of the DLA simply reproduces the current attendance allowance rules and adds on an extra set of criteria for the new lower rate of payment. With the permission of the Committee, I speak also to Amendments Nos. 21 and 22.
§ Lord Henley
Perhaps I may confirm that the noble Lord is moving Amendment No. 20 and speaking to Amendments Nos. 21 and 22.
§ Lord Carter
I apologise. Yes. I should have stated that at the start. The aims of the amendments are to widen the attendance criteria to include what we describe as "functions of daily living", to amend the pattern of care required to obtain the allowance, and to amend the night time supervision test introduced in 1988. We know that just under 900,000 people claim attendance allowance. It is a small proportion of the 6.5 million disabled who are recognised by the OPCS. Roughly two-thirds of the claimants for attendance allowance are over pensionable age.
The legislation for attendance allowance, and its implementation, has caused some problems. Last year the greatest load of cases before the social security commissioners consisted of attendance allowance appeals. There were almost 1,000 cases, most of which were successful for the claimant. Nearly three-quarters—69 per cent.—of claimants who challenge an unfavourable decision are successful on review. Does the Minister feel that this high percentage of turnover of decisions on appeal and review is acceptable for any benefit?
I refer to attendance in connection with bodily functions required frequently throughout the day, or for prolonged or repeated periods at night. The trigger for claiming attendance allowance for most people comes when they feel unable to look after themselves independently or safely, or when they feel in danger in some way. Preparing food, personal hygiene and cleanliness are all basic activities which most non-disabled people take for granted. Yet one would be refused an attendance allowance if one claimed on the basis of those criteria alone regardless of how crucial they were to one's life.
In this group of amendments we approach the extra cost argument from a different angle. Only a small proportion of the 6.5 million disabled population 1544 receive the attendance allowance. One is entitled to ask: Why should a person who needs a special diet prepared, or assistance with laundering because of incontinence, be excluded through a narrow interpretation of the words?
If the amendment is accepted it will allow consideration of essential needs which arise as a result of disablement to be counted for all three rates of payment. The inclusion of the phrase "functions of daily living" will allow disabled people to claim on the basis of needing assistance when preparing or observing a special diet, for needs with laundering, for cleanliness, and for getting out and about, and so on. Those are normal daily needs and functions which are limited through disability. The intention of the wider form of words is to clarify what has been achieved effectively by case law in the appeals to which I have referred, and slightly to extend the law beyond the strictly intimate bodily functions.
According to a recent survey conducted by the Royal National Institute for the Blind, 91 per cent. of all blind and partially sighted people had difficulties with at least one of their daily living tasks. We know that only a small proportion of the blind qualify for attendance or mobility allowance.
The amendments deal with another problem of attendance allowance which the new DLA has failed to tackle: the excessive emphasis that is placed on a pattern of care requirements. The attendance allowance was designed to help disabled people who had extensive and personal needs. As the rule stands the criteria rely much too heavily on the pattern of those care needs. We propose that the day time attention condition for the middle and higher rates of DLA would be satisfied where a person meets a lighter time and pattern of care needs tests. That is far more equitable than forcing people on to the £10 rate who may have substantial needs which may occur at the wrong time of day.
Our third aim is to reinstate the night-time supervision test which was used until March 1988. It will therefore remove the watching-over test which was installed by the 1988 Act. While "attention" has always been taken to mean actual physical assistance, "supervision" is seen as being more hands off; that is, having someone available in case of need in order to prevent a substantial danger arising. If as we suspect no one is qualified under the current night-time and watching-over test it should be abolished and replaced with a simpler, fairer and continual supervision test. It would be better to remove the night-time and supervision test rather than operate a test which is so tight that nobody can satisfy it in practice.
In tabling the amendments we believe that there is a need for easing the current rules for attendance allowance rather than a mere perpetuation of their deficiencies through the care component of the DLA for people under 65 and the continuation of the attendance allowance for claimants over 65. Amending the care criteria now would be more reasonable and would also lend the criteria more easily to self-assessment.
1545 MIND has pointed out that the existing criteria for attendance allowance remain unchanged as a basis for receiving the middle and higher rates of the care component of DLA. But this formula, which concentrates on a physical need or danger, often fails people whose disability arises from mental health problems. When the mental health service users successfully claim attendance allowance it is on the grounds of need for supervision. Diet, medication, finances and support are areas where supervision may be needed to avoid harm to the person. However, there are situations in which a person can be very disabled and have substantial care needs but where neither bodily functions nor substantial danger are an issue.
The Minister will understand that in tabling the amendments we are trying to improve the present situation. I beg to move.
§ 6.45 p.m.
§ Lord Henley
The amendments concern the qualifying conditions for the care component of the disability living allowance. I freely admit that the conditions for the middle and higher rates are exactly the same as the existing conditions for the attendance allowance. As regards the care and mobility components of DLA our deliberate aim was to target extra resources for people with less severe disabilities who do not currently qualify for help. We also wished to ensure that the people who do not receive help under the current schemes continue to be eligible for the extra resources on the basis of the same qualifying conditions under DLA.
Having heard the noble Lord's reasons for tabling Amendments Nos. 20 and 21, I wonder whether in our basic intentions we are as far apart as he might think. His fundamental point is that people's care needs may be broader than simply the need for attention in connection with bodily functions. That is a fair point and one that we had in mind when inventing the conditions for the new lower rate of the care component.
The OPCS identified two particular groups of people who have care needs but are not currently receiving attendance allowance. These were people whose needs in connection with bodily functions were more limited and predictable than those of current attendance allowance beneficiaries and people who had no needs directly related to their bodily functions but who nevertheless had considerable difficulty in dealing with the kind of mundane tasks of everyday life that pose little or no problem for the non-disabled population.
We have tried to pick up both these groups with the qualifying conditions for the lower rate. I am sure that the noble Lord would want us to go further and extend the middle rate of DLA care to people whose care needs were not related to bodily functions. I have to say that that is not the direction that either our experience of attendance allowance or the evidence of the OPCS reports would justify.
1546 We would all accept that disabled people's care needs range from the acute to the markedly less substantial. What we are inventing with DLA is a benefit that gives far greater recognition to this gradation of need. I do not think there is serious doubt that people whose needs relate to their bodily functions should command the greatest help from the benefit system.
We are concerned to bring into benefit people whose needs go broader than that. Our intention in drawing up the criteria for the lower rates, particularly in the area to which the noble Lord refers as "the functions of daily living", has been to find a single test which is amenable to self-assessment, which is a crucial feature of the new benefit. That is the reason for the appearance in the legislation of what might to Members of the Committee look like the odd formula of "He cannot prepare a main cooked daily meal for himself if he has the ingredients".
§ Lord Henley
The criterion is intended to be a subjective test. The mere fact that the noble Lord claims to be unable to fulfil it would not entitle him to the benefit.
§ Lord Carter
The Notes on Clauses state that it is an "abstract concept". I do not know what the abstract concept is in a cooked main meal.
§ Lord Henley
I am beginning to look forward to a more concrete concept of a cooked meal.
We looked at the OPCS evidence about the daily tasks which those disabled people who did not need attention in connection with their bodily functions nevertheless found difficulty in performing. We then created a deliberately difficult abstract test which on the basis of that evidence will be well beyond the capacity of the group we want to target. It will be an abstract test. No one will put to the test the cooking abilities of the claimant, of the noble Lord, Lord Carter, or of the noble Baroness, Lady Hollis. However, perhaps one day they might allow me to do so. No one will be ruled out of benefit merely because they do not in practice ever want to cook themselves a main daily meal. Let us be clear that the more difficult the test, the more people will be unable to perform the task and thus more people will receive benefit.
In essence, my argument would be that on the lower rate we have found a different and I think a better way of achieving what I believe the noble Lord wants. As the system beds down we shall look very closely at whether our abstract test is meeting these objectives. On that basis I hope that the noble Lord will not press his amendments.
Amendment No. 22 seeks to reverse the steps taken in the Social Security Act 1988 to put on a clear and coherent footing the night-time criteria for people who require care from another person in order to avoid substantial danger to themselves or to others. I hope to persuade Members of the Committee that it would not be sensible to do that. When the 1988 Act was passed my noble friend emphasised that the reason for 1547 changing the law was in no way to tighten up the conditions for entitlement to benefit; rather the Government's aim was to restore the law to what was generally believed to be the case before the decision of the Court of Appeal in the case of Mrs. Dorothy Moran.
A fundamental aim of the attendance allowance has always been to recognise the extra costs and disruption of normal family life that arise from the attendance needs of severely disabled people. At night, when the normal state of the members of any household is that of sleep and quiet, such disruption can be caused because the disabled person requires frequent attention with his bodily functions or because his condition requires that someone else is awake and watching over in order to avoid the disabled person putting himself or other people at risk of substantial danger. In that situation, as Members of the Committee have recognised, there is a clear need which should be met. On that basis, many hundreds of thousands of people have qualified for attendance allowance since 1971. As I said before, since that time numbers have increased considerably.
However, the Court of Appeal held that in some circumstances continual supervision might be exercised even by someone who is asleep, albeit ready to wake up if and when a danger occurs. Such danger need not be common provided that it is not,so remote a possibility that it can reasonably be disregarded".Therefore, we were getting very close to the position where the household routine need scarcely be disturbed at all for benefits to be payable. We were getting away from the whole idea of need.
The night-time criteria introduced in 1988, which are being carried forward into disability living allowance, provide a clear and unequivocal test which identifies exactly the people for whom the benefit was always intended. There is no evidence that those criteria have been applied any differently from the way in which the original criteria were applied until the time of that judgment. I believe that Amendment No. 22 would be a retrograde step and unnecessary. Therefore, I hope that the noble Lord will withdraw his amendment.
§ Lord Carter
I propose to withdraw the amendment. As the moving of the amendment and the reply by the Minister indicate, this is a complicated area. However I do not believe that the Minister answered my question as to how many people qualify under the night-time supervision test. If, as we believe, it is a very small number, then perhaps it may be sensible to replace it. If the Minister does not have that information now, perhaps he will write to me. We believe that the continual supervision test would make more sense.
I shall read what the Minister said on this complicated matter. In the meantime, I beg leave to withdraw the amendment.
§ Amendment, by leave, withdrawn.
§ [Amendments Nos. 21 and 22 not moved.]1548
Lord Henderson of Brompton moved Amendment No. 22A:
Page 3, line 6, at end insert (", to any one of which may be added a community care supplement payable out of the National Insurance Fund.")
§ On Question, amendment agreed to.
Lord Henderson of Brompton moved Amendment No. 23:
Page 3, line 36, at end insert:
§ On Question, amendment agreed to.
Baroness Hollis of Heigham moved Amendment No. 24:
Page 4, line 12, after ("person") insert (", except a child under the age of 16 who is accompanied or frequently visited by a parent or guardian who provides prolonged or repeated supervision or attention with bodily functions while in hospital for medical treatment",).
§ The noble Baroness said: This is a modest amendment and I shall not take up a great deal of the Committee's time. It refers to children in hospital. The amendment seeks to rectify what is currently perceived as an injustice which will be carried forward into the DLA.
§ At present, parents of severely disabled children receive attendance allowance which is withdrawn if the child goes to hospital and remains there for more than 28 days. One understands why that rule may make sense when an adult goes into hospital, even if it takes faint regard of the costs of hospital visiting for the family. It may make sense also when a child is in for respite long-stay care and, therefore, where the hospital is shouldering the entire nursing and caring burden.
However, this amendment deals with a much smaller group; namely, those children who are in hospital for long-stay medical treatment—for example, for cerebral palsy—which may require elaborate surgery and where they continue to receive care and nursing from their parents within the hospital ward. Such care reduces the load on the staff and the trauma on the child. As one senior paediatrician, Dr. Judith Kingston, pointed out in a radio interview:
It does seem unfair that parents should lose attendance allowance when their children are in hospital for a long time. We rely on parents looking after their children when they are in hospital, the mums contribute significantly to the nursing care of the child and there's a lot of expense —extra expense—involved when the child is in hospital".
The extra expense referred to is not merely travelling costs but the extra costs for the family at home when one parent is almost full-time at the hospital.
§ If the Committee were to accept the amendment, it would aid a small group of families which are already under considerable strain. At very modest expense this Bill could take the opportunity to remedy and not carry forward what is currently perceived as an injustice as regards the attendance allowance. I beg to move.
Baroness Darcy (de Knayth)
I support the amendment. I hope very much that the Minister will accept it or an amendment which achieves the same objective.
§ Earl Russell
I also support the amendment. It is very modest. It does not create an entitlement to new money but merely refrains from taking away from people money to which they have previously been entitled. Therefore, the effect of the amendment will be to ease considerably an administrative burden. The allowance is given when a child is out of hospital. It is taken away when the child is in hospital and returned when the child comes out of hospital. Therefore, it is necessary to go through two administrative processes and the saving of administrative costs which this amendment would involve may be an extra reason for the Government looking upon it with favour.
§ Lord Swinfen
I have some sympathy with the amendment, but only some sympathy. I appreciate that where disability living allowance is used to pay for extra staff to help to look after a child, it would be quite wrong to dismiss the staff while that child is in hospital. It would perhaps be impossible to find staff when the child came out. Therefore, that on-going expense needs to be paid and there will be other expenses which still need to be paid.
However, in moving the amendment the noble Baroness said that the parents of a child in hospital saved the National Health Service a certain amount of expense by helping to look after the child. Is it not the case that where that child would be looked after in hospital, so would an able-bodied child be looked after in hospital by that able-bodied child's parents?
I recall my own children being in hospital years ago. My wife helped on the ward. She had a possible advantage because she was already a state registered nurse. However, many other parents were looking after their children and they received no allowance for doing so. They may well have had to give up work and lose income in order to look after their child in hospital. Therefore, it is very much half a dozen of one and six of another.
§ Lord Skelmersdale
I agree with my noble friend. I have some sympathy for the amendment for the same reasons that he has given. However, the amendment worries me slightly because if a parent receives an 1550 attendance allowance for a child, by definition the parent is responsible for the child and the state accepts that the parent has that responsibility. The moment the child becomes hospitalised then somebody else is responsible for the child; namely, the nurses, doctors and other professionals involved. Therefore, I do not believe that this is the right way forward on this occasion.
§ 7 p.m.
§ Lord Henley
The children whom the noble Baroness has in mind in particular are those for whom the parents or guardians continue to provide substantial care on a regular basis while the child is in hospital. I recognise well the anxiety of the noble Baroness for that group of children. However, the amendment raises serious questions of principle and administration.
I shall deal first with the principle. From the outset 20 years ago, attendance allowance was designed to help meet the cost of care and attention in the home. That must be its primary purpose. I believe there has been consistent bipartisan acceptance of that principle.
We have recognised that the financial commitments associated with a severe disability do not cease immediately on the person going into hospital. That is why, in 1983, we changed the rules to allow attendance allowance to continue to be paid for the first four weeks in hospital. Also payment is restored when the disabled child returns home and, provided a minimum of 29 days is spent at home, attendance allowance continues in payment if the claimant is obliged to spend another stint in hospital.
So we have gone to some lengths to be flexible. I recognise that the noble Baroness is trying to be precise in the exemption she is seeking from the general rule, but I think I should briefly restate that I would not favour any general relaxation of the rules on payment of AA/DLA to people staying in hospital for protracted periods. They are, after all, in the vast bulk of cases, receiving most of their care from the hospital staff and many or all of the expenses which are incurred in giving this type of care are being borne by the hospital. It would, I think, be wrong for attendance allowance to continue in the generality of cases, giving double provision for the same needs from the benefit system and the NHS.
To turn briefly to the administrative difficulties, the first is that pinpointing the group which concerns the noble Baroness without going far broader, as I suspect my noble kinsman Lord Russell wished to do—is genuinely difficult. I think we would want to assure ourselves, for example, that parents' presence and care was requested by the hospital—that is, that the hospital nurses were not in practice doing all the caring for which DLA is paid. But if we did seek that assurance from the paediatricians—and I take the noble Baroness's word that most paediatricians would be only too happy to supply the information to us—we should for this group be applying a very different test from that we are using for DLA in all other circumstances. The DLA criteria make no reference to whether the help is in practice given, simply to whether 1551 it is required. For this group, we should be asking for evidence of the parents' actual contribution to the caring.
I must say that I am wary of inventing new tests for our adjudication officers to have to apply even if—and perhaps especially if—they apply only to very small numbers. And I do wonder, if we did try to circumvent the many problems we see with this amendment, whether we should simply be creating new anomalies in the system. For example, what about the situation of children over the age of 16 or of mentally handicapped adults needing constant attention—and perhaps also getting it from a relative when in hospital? There are real dangers in trying to fine-tune a social security system so much to cover very worthwhile contingencies that you end up with a system that is inoperable and incomprehensible.
In the light of the flexibility that I have mentioned we brought it in some time ago in relation to the payment for the first four weeks and also the restoration of payment when the child goes home provided a minimum of 29 days is involved. I hope that the noble Baroness will feel able to withdraw her amendment.
Lady Hollis of Heigham
I thank the Minister for his reply but I have to say that I am not persuaded by it. The situation, when we are dealing with a small group of children such as are referred to in the amendment, has three characteristics. First, they are children; secondly, they enter hospital already disabled; and, thirdly, they are sick. Given that, they are likely—certainly all the evidence from the paediatricians suggests this—to have needs over and above those of an able-bodied child or indeed an adult. That need is normally met by the parent, usually the mother. It is very clear from the evidence we have had that the nursing and caring need, because of the triple effect of being a child, being disabled and being sick, is great and that the nursing staff count on the very active contribution made by the parent. As a result, the paediatricians themselves would welcome the allowance.
Therefore it is not only a matter of fairness to the mother —it is usually the mother—who is continuing the nursing care in hospital but of house and attendance allowance of either £25 or £35, compared to the average cost of an NHS bed which may well be £200 plus. In addition the family at home, left without the care offered usually by the parent, including cooking, cleaning, laundry and so on, because that parent is almost full-time in hospital, is itself incurring costs over and beyond those originally faced. The extra responsibilities involved in giving nursing care and so on in the hospital, the extra costs facing the family without that parent at home, and the costs of medication and of visiting that the parent incurs, would, it seems to me, justify targeting this sum at those parents.
Secondly, the Minister made much of the point about opening the floodgates to care. I find it very odd that he objects to fine-tuning, unless of course he manages to call it "targeting", whereupon he is in favour of it. I would suggest that what he regards as fine-tuning in this case is a matter of targeting those 1552 children who are already disabled and require extensive parental nursing in hospital: a group which the paediatricians say can be easily identified. If I may reinforce the point made by the noble Earl, Lord Russell, what we are talking about here is allowing an existing benefit to continue—not asking for new money—because the core of the activity which attracts that benefit, which is nursing care and attendance for the child, continues whether the child is in hospital or at home. On that basis, I would hope that perhaps the noble Lord might find himself able to redefine fine-tuning as targeting and come back to this matter at Report stage. In the meantime I would ask your Lordships' permission to withdraw the amendment.
Amendment, by leave, withdrawn.
My Lords, I beg to move that the House be resumed and, in moving that, perhaps I may suggest that the Committee stage should begin again at five minutes past eight.
Moved accordingly, and, on Question, Motion agreed to.