HL Deb 17 May 1993 vol 545 cc1536-67

3.7 p.m.

The Parliamentary Under-Secretary of State, Department of Social Security (Lord Henley)

My Lords, I beg to move that this Bill be now read a second time.

This is a short Bill. It serves one purpose and one purpose only. It provides authority to my right honourable friend the Secretary of State for Social Security to make grants to the Independent Living Extension Fund, the Independent Living 1993 Fund and Motability. The first two are the successors to the Independent Living Fund—the ILF—which has done a splendid job over the past five years in providing help for the severely disabled and enabling them to live independently in the community. The growth and success of the ILF is a tribute to the hard work and judgment of the trustees and staff of the ILF and I should like to pay tribute to all those involved with it. The work of the fund has paved the way for the community care reforms in demonstrating that disabled people do not have to be passive recipients of care plans devised for them by experts. They can participate in devising and managing their own packages of care.

But that said, the ILF was announced as an interim measure, pending the introduction of the community care arrangements. Those arrangements are now in place but, as I have said, the ILF has been so successful that the Government have chosen to continue support for independent living, adapted to suit the new arrangements.

As I have said, there are two successor funds which were established by trustees in February of this year, with operations starting on 1st April. The extension fund is quite simply what its name implies. It takes on the existing case load from the older ILF and will continue payments and will have the power to increase rates where any individual shows such a need. The other is the 1993 fund. By far the most popular aspect of the ILF was the flexibility and freedom of choice it allowed disabled people. The whole point of community care is that local authorities will respond to their clients' needs and provide such flexibility in the future. The 1993 fund is designed to fit closely with those arrangements, adding an element of cash payment, to ensure that the dignity and independence conferred by the old arrangements are carried forward into the new arrangements.

Both the new funds are now operational, with a full board of trustees. The hand-over from the ILF to the extension fund went smoothly and all clients continued to receive their weekly payments. The new director is also now in post, and we are progressing towards building the necessary bridges that will allow the innovative new partnership between the 1993 fund and local authorities to work smoothly.

With the introduction of the new community care arrangements, the vast majority of disabled people—including the bulk of those who would have looked to the ILF for help in the past—now look to their local authority to arrange their care needs. Local authorities either provide services themselves or contract with other providers to meet the needs of their clients. For the most severely disabled people whose care needs are so great that without additional help they would have to go into residential or nursing care, the 1993 fund will provide an additional option for social workers in planning packages of care with their disabled clients. The first applications have been received by the fund, and those are now being processed.

We expect that each year about 1,500 people aged 16 to 65 will get a cash payment from the new fund as well as help from their local authority. The Bill is part of the Government's overall strategy for disabled people—a series of measures that improve the lives of disabled people. Being able to make choices and decisions about everyday matters, like when to get out of bed in the morning or when to eat lunch, is something that many of us, for now, take for granted.

By continuing to fund the independent living extension and 1993 funds which offer flexibility and independence, more of the most severely disabled people in our society are able to make these important decisions for themselves. That undoubtedly increases the quality of their lives.

Finally, I should like to say a couple of words about Motability. The Motability scheme is an extremely successful joint enterprise of government, voluntary sector and the clearing banks. It serves to increase the quality of life of ever increasing numbers of disabled people and commands all-party support. I feel sure, therefore, that the House will wish to support this provision, which puts Motability funding on a statutory footing to ensure continued financial support in the future. I commend the Bill to your Lordships.

Moved, That the Bill be now read a second time. —(Lord Henley.)

Lord Ennals

My Lords, before the Minister sits down, there are a number of Members on this side of the House who are worried about certain aspects of the legislation and who have been concerned since the funds were established. Will we have an opportunity to table amendments? Will there be a Committee stage? What is the situation in relation to whatever ruling may have been given by the Speaker in another place?

Lord Henley

My Lords, as the noble Lord will be aware, this is a money Bill. The decision about whether it is a money Bill is a matter for the Speaker of another place. It is not something we in this House can challenge. My understanding is—this has been agreed through the usual channels and was moved last week by my noble friend the Leader of the House—that we shall take the Second Reading and all other stages today. I do not therefore imagine that it will be possible for the noble Lord to put down amendments. Bearing in mind that it is a money Bill, it would not be right for this House to send the Bill back amended to the other place, it having been declared by the Speaker to be a money Bill. It is not for us to challenge that decision.

3.14 p.m.

Baroness Hollis of Heigham

My Lords, we thank the Minister for his clear introduction of the Bill. As the Minister said, the Bill funds two successor bodies to the old ILF—an ILF extension fund for existing clients and ILF 1993 for a limited number of new clients. Despite the Bill's bland clauses, the Bill is decidedly controversial. It disposes of considerable sums of public money to the disabled in ways that the disabled and the local authorities regard as retrograde. It is an odd Bill, drafted in a way which means that it evades, as my noble friend Lord Ennals has rightly pointed out, proper parliamentary scrutiny.

Those of us interested in DSS matters always face difficulties over scrutiny because the Benefits Agency is at arm's length. The ILF was set up by the Secretary of State, and the Bill merely grants its successor bodies the funds with which to fulfil their functions. Its terms of reference, including controversial items such as debarring those over 65 from applying to the ILF cannot, as such, be debated properly. It has been laid down in trust deeds, determined by the Secretary of State, and beyond parliamentary scrutiny until Members in another place demanded that the trust deeds be placed in the Library, and then moved amendments accordingly.

The Bill, as drafted by government, means that we in this House cannot even do that. As it is a money Bill we cannot realistically seek a Committee stage in which to press amendments which might have enjoyed your Lordships' support today, even though, as I say, it is a controversial measure with major implications for public policy and the disabled.

We on this side of the House face an arm's length DSS, an inaccessible trust and an unamendable Bill. So I hope that your Lordships will forgive us if I, and other speakers, make somewhat longer Second Reading speeches than we normally would, and go into matters in rather greater detail than we normally would so as to press those issues which ordinarily would have been explored in Committee. All that is the more worrying because of the unfortunate way the transition between the old ILF and the new successor bodies has been handled by government.

The original ILF was set up in June 1988 for five years to replace the special payments to the disabled which were wiped out by the Social Security Act 1988. Clearly, the original ILF had to be reconsidered in the light of the care in the community proposals, and we take no objection to that. But suddenly, and on 24 hours' notice, the Government announced last November that the ILF was to be replaced by two successor funds. When we on this side pressed the Minister at Question Time, he said that the Minister for disabled people would wish to hear the ILF's views about future arrangements. He did not and has not.

The original ILF had unrivalled experience and effectiveness. One might have expected it to have been consulted by government about successor bodies. No such consultation has taken place, despite the Minister's assurances to the contrary. One might have expected that some of the trustees—perhaps half—would have been invited to serve on the successor body, but not one of the Disability Income Group trustees was approached. Not one trustee will provide continuity between funds carrying the same name.

One might have expected that the old ILF would have been involved deeply with hand-over arrangements as 22,000 disabled people were affected. It was not. One might have thought that at the very least the old ILF fund would have been consulted about the timetable. It was not. It read about its fate in the DSS press release.

I cannot speak too highly of the two founding trustees of the successor bodies, but I have to say that I have never seen trustees of such a reputable body treated with so little respect for their skills and so little courtesy for their position. I can only assume that that was not because they did a bad job on behalf of disabled people but because they did a good job—too good a job for the comfort of Ministers and the Treasury alike.

In consequence, the old ILF had to close with 24 hours' notice, leaving a black hole against which disabled people could not claim for four-and-a-half months. Meanwhile, the Benefits Agency was introducing, or more accurately not introducing, a disability living allowance, and doing it so incompetently that it has recently been censured by the Parliamentary Ombudsman. Because applicants to the ILF had to be in receipt of DLA, it meant that many thousands lost their claim to such money because DLA claims had not been processed by the department.

When at Question Time the Minister, the noble Lord, Lord Henley, was pressed on the matter he blamed the trustees for not exercising the discretion which we know they did not have. However, the Minister in another place, Mr. Scott, said on 15th March: It has been said, and technically it is correct, that trustees of charitable funds have discretion. However, I have always recognised that the need for an orderly handover prevented the trustees from being able to exercise their discretion in those circumstances. I want to make plain my regrets and apologies".—[Official Report, Commons, 15/3/93; col. 38.] I am sure that on reflection the Minister will wish to be associated with Mr. Scott's apologies.

The way in which the two successor funds have been set up is unfortunate enough. More worrying still are the new terms of reference—the trust deeds—within which the successor funds will operate. As I said, and as the Minister frankly explained, the ILF extension fund will support existing ILF clients who in the past have approached the fund directly. ILF 1993 will support new clients but only if they have been referred by the local authority as needing more than £200-worth of care.

Who are we talking about? ILF clients are severely disabled people. Most of them suffer multiple disabilities; 45 per cent. are not able to move at all; 50 per cent. are able to move only with difficulty or with help; 45 per cent. have impaired sight. Only 6 per cent. can wash themselves; only 7 per cent. can toilet themselves; only 7 per cent. can go to bed without assistance; and only 4 per cent. can cope with their nightly needs without help. The majority of the young disabled are men. Of the elderly disabled, three-quarters are women. They need care throughout the day because without that they will have to go into residential care.

Astonishingly, only one-quarter of ILF clients were receiving any help from the local authorities. On average that help was limited to two hours per week of home help and one day a week at a day centre. They remained in the community not because of the help which they received from the local authorities but because they were able to tap a network of informal, private and voluntary caring. That in turn was made possible precisely because ILF moneys could reimburse the expenses of informal carers, pay for respite care and pay for additional help when informal carers were themselves in poor health or burnt out.

ILF moneys were useful because, as they were flexible and in cash, they could leverage the rest of the care package. By funding between 20 and 25 hours the ILF could float a further 60 or 70 hours of informal care cheaply for all of us and allow the disabled to do what they wish to do; that is, to remain in the community. The fund was targeted, flexible, in-dividualised, welcome and cheap. Without it the disabled would have had to enter residential care. All the research shows that people enter residential care not because their disabilities have grown more severe but because the informal network of caring has broken down.

That is why we believe the Bill and the two new successor funds have the structure so tragically wrong. The Bill destroys the capacity of disabled people to tap ILF funds to keep their informal care arrangements afloat. As a result, if informal care falters, as it often does, the disabled will become more dependent on formal and more costly local authority care. The local authorities themselves cannot afford to finance that.

I wish to look in particular at three aspects of the new arrangements about which I have notified the Minister and which concern the disability groups. The first is that local authorities must provide the first £200 of package before the client can be referred to the ILF. The second is that that £200 must be in kind and in services but not in cash. The third is that the arrangements are restricted to the under-65s.

First, under the proposed new arrangements in the trust deeds disabled people must receive £200 in services from the local authority before the local authority can refer them to the ILF. Yet we know that the severely disabled may need 24-hour a day intermittent care. But where they receive local authority support—and only one-quarter of them do—it will average only about two hours a week of home help and a day at a day centre, the value of which is about £40 a week. Can and will local authorities top up those services as required under the new arrangements? That is impossible.

Local authorities receive some £536 million for care in the community arrangements. Those are funds transferred largely from the DSS to fund existing residential care arrangements in private homes. Some such arrangements are £200 million short of what local authorities need to meet their existing commitments. In addition, the Government are producing £26 million, which we welcome, specifically to fund the £200 care packages for the severely disabled during the first year. That works out at about £50,000 for every 100,000 people—the average size of a district council.

If the severely disabled are already receiving an average of £40 per week in care from the local authority that £50,000 will buy, in an average district council, care of £200 per week for just seven severely disabled people. If the local authority perfectly prudently decides to stretch its money more thinly to help to keep more people afloat, not one will breach the £200 ceiling which would allow them to tap the ILF. As local authorities are capped they cannot add to their resources themselves. No one can make the sums work.

Research by the director of DIG, Pauline Thompson, asked directors of social services whether they believed they could fund the £200 package, which the Bill requires, within their own resources. Of the 68 who took part in the survey —that is, two-thirds of all the directors of social services—only one was sure that he could fund the package, 25 were fairly confident but 32 doubted that they could or would do so. Forty of the directors—that is two-thirds—admitted that care packages for the disabled would be determined not by the needs of the disabled but be limited by the resources of their departments.

Very few severely disabled people, therefore, will be able to turn to the ILF not because their needs do not exist—their needs are great—but because the gatekeeper, the local authority, will not be able to fund the first £200-worth of services, which make them eligible to pass through that gate.

I turn to the second criticism. I say "pay" for services, but, of course, the local authority is not permitted to pay, which is the second major problem. Local authorities are allowed to provide that £200 care package only in the form of services. They are not allowed to offer cash even when they wish to do so.

Many of the issues were aired around the Private Member's Bill introduced by the noble Lord, Lord McColl, to permit direct payments. Noble Lords from all sides of the House unanimously reminded the Minister of the virtues of cash payments. Cash payments are flexible; services in kind are inevitably inflexible because the client must fit the services rather than the services fitting the client. The clients may wish to go to bed at 11 o'clock, but if the local authority staff are to put them to bed effectively some of them must begin at half past eight in order to finish.

Cash payments are not only more flexible but cheaper. Formal home helpers charge £6.50 per hour, social workers' time costs £30 per hour but self-management—private brokerage which comes with cash payment—is not only more flexible but much less expensive. Cash payments also put the disabled people in control. The most recent Rowntree Report shows that service packages—that is, services in kind—are determined by professionals whose judgments are often at odds with what the disabled people want themselves. Above all—and the Minister spoke movingly of this - it is a matter of dignity and choice. Jenny Morris, herself disabled, said: Having the money to pay for personal assistance is the most important factor in enabling disabled people to assert the kind of choices which non-disabled people take for granted". Another young disabled woman, Jane Campbell, said: Direct payments have turned my life around". She has rediscovered spontaneity: to get up when she wants, to go out when she wants, to stay up late when she wants. That is everything that we take for granted. With cash, the carers work to her.

That principle is widely accepted in the other place. I quote from the debate on the Bill: We all know that by far the most popular aspect of the Independent Living Fund is the flexibility and freedom of choice that cash payments bring. Dignity and independence are as important to disabled people as they are to everyone else in society. Disabled people have come to value the ability to select and employ their own carers". The speaker, of course, was the Minister, Nicholas Scott, speaking on a Bill which for virtually all disabled people takes away that right.

Why is that? In the debate on the Bill sponsored by the noble Lord, Lord McColl, the Minister argued that it is the job of the DSS to provide cash, the job of the local authorities to provide services and there should be no trespassing. That is nonsense. In Scotland trespassing occurs all the time. Indeed, in England local authorities make cash payments to children leaving care, to adults fostering children, adults running sports, the arts, and voluntary organisations. Cash payments are made to a wide variety of organisations and individuals, unless they happen to be disabled. It is only the disabled who are not to be trusted with cash.

The Minister, the noble Baroness, Lady Cumberlege, told us also that costs would escalate. Why should that be so? We seek only to give power to, rather than impose a duty on, local authorities to make cash payments. That power would be exercised by the local authorities only where it offered better value for money. It is already clear that the same resource put into cash rather than services will leverage far more informal care from neighbours and friends. Therefore, it will go further and help more people.

Indeed, without cash payments there is a greatly increased likelihood of a need for residential care. The Shaftesbury and Cheshire homes cost between £400 and £600 per week for the provision of care for the physically handicapped; yet Kingston social services department was keeping eight severely disabled people in the community at a cost of £55,000—a tenth of what it would cost to keep them in residential homes.

The Minister, Mr. Scott, said also that if local authorities can find a way around the law—for example, by paying money to a local trust to pay out to disabled people —he would be delighted. Is it really sensible social policy to encourage local authorities to bend the law rather than expect the Government to amend it? That really will not do.

I turn now to the third major criticism offered by the disability groups; that is, that the new funds are confined to those aged under 65.

Lord Ennals

My Lords, I am grateful to my noble friend for giving way. I wonder whether my noble friend will deal with the top limit of £500. That seems to me to he extremely disturbing. There are many highly qualified doctors and nurses who have an enormous contribution to make who can only make that contribution if they are able to have the assistance which we are talking about here.

The Minister in another place, when dealing with the top limit of £500, said that he did not believe that there is anything offensive in our setting an upper limit beyond which it is not unreasonable that people would need help and decide, sometimes reluctantly, that the time has come for them to go into residential care. Does my noble friend find, as I do, that that is a shocking statement? Is the figure of £500 the price of freedom in this country for severely disabled people who have a great contribution to make to our society?

Baroness Hollis of Heigham

My Lords, my noble friend raises an extremely important point. Indeed, in the other place the discussions became somewhat muddied as the Minister used metaphors about sandwiches. If a disabled person requires £200 worth of care, he gets that as a package from the local authority in the form of services. If he requires up to £500 worth of care, the first £200 comes from the local authority and the next £300 can come from the ILF. But if he requires £501 worth of care, he is not eligible at all to apply to the ILF. All funding must come from the local authority and must be funded entirely in the form of services. Therefore, my noble friend is entirely right. It means that a person in that situation will not have the flexibility to construct the care package which is needed, but very few disabled people will be financed by local authorities in that respect.

Finally, I turn to my last criticism; namely, that those aged over 65 are not eligible to receive money from the ILF. Thirty-seven per cent. of the old ILF clients were aged over 60. We accept that resources are finite but why are the Government privileging those aged under 65?

The argument advanced by the Government throughout is that older people have had the opportunity to share in the country's growing prosperity and to build up pensions and savings. As with so much of the debate, that is simply not true. Only one-third of the retired are disabled but those who are have only 88 per cent. of the income of younger disabled people. Therefore, they are poorer. Only one in six of those disabled have income above income support levels. They are poorer. One should add to that that three-quarters of the elderly disabled are women. They will not have built up pensions in their own right. Indeed, only 28 per cent. of all women leaving work qualify for a state pension in their own right. The rest are dependent on their husband's contributions. They certainly do not have access to private pensions or SERPS in their own right.

The reason that those women are very poor, usually on income support with no savings, is because too often they have been among the army of carers, caring usually for men. That has kept them out of the labour market so that by the time that they need help for themselves they are on very low incomes, with no savings, in poor health and can find by caring for others that they have become socially isolated. When the time comes for them to need care in turn, often they have no informal network on which to draw. Three-quarters of those living alone are women. Therefore, they are more rather than less likely to need to buy formal care.

Because those woman are now refused access to the ILF, what do the Government believe will happen to those older disabled women? Are the Government saying that they will not be cared for, or are they saying that because they are over 65 and because they are women they must be cared for differently, more expensively and in ways in which the women almost certainly do not want? The connections between poverty, gender and disability are there for all to see. By confining ILF funds to those aged under 65, the Government are denying help to those very women who, when younger, kept many other disabled people afloat in their community. That is deeply unjust.

This is a rationing Bill. It requires the first £200 to come from the local authorities in kind, which most social services directors believe is not financially possible. Secondly, it provides payment by services rather than by cash. That will allow local authorities, if they follow Mr. Lemming's advice, to conceal assessed needs and to make obscure the degree to which that is being met. Confining ILF funds to those aged under 65 ensures that those who have least access to informal caring and are, therefore, in greatest need —women—are denied access to the ILF altogether.

It is a rationing device and it is clearly very successful. Whereas the old ILF had 8,500 clients per year, the new ILF expects only 1,500. Whereas the old ILF had nearly 600 inquiries in its first month, the new ILF has had only 12 and, even now, there have been only 56 inquiries. If the money provided by the Bill is sufficient for the successor funds, it will be so precisely because the disabled will have been deterred or debarred from applying for it. In terms of the funds that it provides, the legislation may well be successful. It is a pity about the disabled.

3.40 p.m.

Lord Addington

My Lords, it has been pointed out to me that, under the Companion to the Standing Orders, we are not debarred from amending the Bill. Moreover, if we choose to do so, the House of Commons does not have to consider the amendments. Indeed, there have been cases in the past where this Chamber has actually amended Bills and the other place has accepted such amendments.

Having said that, I now find myself in the position of having to follow the speech of the noble Baroness who examined the subject in such detail that much of what I intended to say is more or less superfluous. However, I should like to support the noble Baroness on several of the points she made. For example, if you provide help to those who are disabled so that they can choose what it is that they need—that is, by giving them cash so that they can purchase their own assistance and support—you will give them far greater freedom. If you give someone freedom you are adding to his status in life and his ability to enjoy a quality of life. The noble Baroness was right to draw our attention to that fact. I should have thought that it was fairly obvious to all concerned that that is the case. If you want to give someone dignity and control over his life by allowing him to organise it himself, invariably the people who are receiving the help will be the best people to tell you how that help should be administered.

I concur totally with the point that we should not have a finite cut-off limit. An article in Social Work Today said that about 1 per cent. of those trying to claim extra funding would go over the 5 per cent. limit. Surely, bringing down an arbitrary line with that sort of heavy terminology is just a little obscuring. For example, if someone needs £501, as the noble Baroness said, that person will be debarred from help. Surely it is better to have a more flexible approach.

There is the other area of debarring those below the age of 65. As the noble Baroness said, a person who has had a disability for quite a long time will have had less chance to build up a pension or savings and thus will be in more need of help. Surely, bringing down artificial barriers—namely, a very rigid level of finance and a very rigid age barrier—will mean that more people are forced into residential care which is invariably more expensive. They will not be able to live in their own homes in dignity and enjoy a far higher standard of living as well as saving the taxpayer money.

3.42 p.m.

Baroness Masham of Ilton

My Lords, on Thursday evening I attended a dinner with American people working in Britain. I was told that a couple of Americans were returning home and wanted to travel on the QE2. The wife was disabled. When the shipping firm was told, the attitude was that she would be a nuisance. I was told that the firm had been most unhelpful. The Americans, who now have antidiscrimination legislation, are understandably furious.

Are we, as a country, trying to push disabled people aside? The Disability (Grants) Bill now before us is causing great concern among organisations of disabled people. I am president of the Spinal Injuries Association. Many of our members are extremely disabled, having broken their necks in accidents which are often not covered by insurance. If you break your neck, you can become totally paralysed from the neck down. You can lose feeling from that area down and you can also lose the usual bodily functions of the bladder and the bowels. A manual evacuation of the bowels has to be performed every two days and the bladder has to be managed throughout the day.

To prevent pressure sores, the person has to be lifted and moved constantly. People without the use of their hands and arms require such things to be done for them. There must be trust in, and compatibility with, the carer. Care is costly. The Spinal Injuries Association runs campaigns on accident prevention. We are very pleased that the Government have put accident prevention as a priority category in The Health of the Nation.

I am attending a conference tomorrow on pressure sore prevention, organised by the Department of Health. Pressure sores are enormously expensive to the quality of life of the individual and to the Department of Health. I am very concerned that. without adequate care in the community, there will be an increase of such preventable conditions as pressure sores.

Will social service departments which assess and give grants to severely disabled people understand such matters? It is no small matter: we are talking about a life and death situation. Unless some amendments are made to the Disability (Grants) Bill, the organisations of disabled people believe that the Government's proposals will be the death knell of the future of independent living. Adequate and appropriate personal assistance provision is fundamental to equality for disabled people. Denial of that is a denial of equal rights.

One of the main reasons for the growth of the Independent Living Fund (ILF) was that social services departments were becoming increasingly unable to cope with the high degree of personal assistance needed by severely disabled people. It has been found that many local authorities are not providing adequate means; they are concerned that they are not meeting the needs because of financial stringency. Moreover, because of that, they may be under-assessing people so that they will not reach the threshold to qualify for the ILF money.

A young man who broke his neck in a rugby accident and lived with his widowed mother founded the Spinal Injuries Association with myself and others. David's mother was becoming very crippled with arthritis. On one occasion, he said to me, "I will never go into residential care". That severely disabled person must have realised how care in the community was moving, for some months after I saw him he was found dead in his lily pond in the garden. Somehow he had managed, without the use of his arms, to get himself there. To this day, no one knows how he did it. But I feel that society let him down. That is why our debate today is so important.

Another young man who had broken his neck was placed in residential care. His parents who lived in the East End of London did not want him home. They would not change to a more suitable flat. I saw the young man when he was being visited by his girl friend in a unit attached to a hospital for elderly people. The young man looked and felt like a caged animal. If that sort of person has to live in residential care, there is no light at the end of the tunnel.

I should like to ask the Minister why there is a requirement under the trust deeds that employment details of employees should be given to the trustees. That seems to be an infringement of privacy and confidentiality and represents unnecessary bureaucracy. It also negates the positive aspect provided by direct cash payments of flexibility and genuine self-control by the disabled person. I hope that the Government will review that requirement.

The Spinal Injuries Association estimates that, for its severely disabled members, the average personal assistance cost is in the region of £300 per week. Therefore, the amount of cash received under the new arrangements will not give them any meaningful control over their personal assistance arrangements. The Association of Metropolitan Authorities, the Association of County Councils and the Association of Directors of Social Services have said that that will lead to, muddled personal assistance provision for severely disabled people". All those bodies support the case for direct payments.

There has been so much change, especially as regards severely disabled people. Some might say it is change for the sake of change. The Government seem to be restless. They are always changing benefits and making the vulnerable feel more vulnerable. Many people are sorry to see the end of the Independent Living Fund, as it was. Its replacement is but a pale ghost of the original. Such experienced, admirable people as Peter Large, who has done so much for disabled people through the Disablement Income Group, are worried about the changes. It is severely disabled people who know the real importance of the Government getting a Bill like this right.

Many people are concerned that the House of Lords will not discuss the matter fully enough. Disabled people must contact their Members of Parliament about financial matters. This issue is probably more appropriate for another place rather than your Lordships' House as it is a financial matter. I hope that the Minister will explain the Government's position so that we in this House are not thought to be complacent. We consider this to be a very important matter.

3.51 p.m.

Lord Campbell of Croy

My Lords, I thank my noble friend Lord Henley for his introduction of the Bill which contains the Government's arrangements to replace the former Independent Living Fund and, we hope, carry on its good work. The two new funds are also designed to enable the severely disabled to live in the community outside institutions. I remember when the ILF was created in 1988. There were then doubts and criticisms expressed, including from the Opposition Benches in both Houses of Parliament. Now there is general agreement that it has been a success. The noble Baroness, Lady Hollis, has just spoken of it in generous terms. It was intended to cover only a limited period of time until the community care system started.

In 1988 it was estimated that about £5 million a year in grants would be expended. But in the event after four years the figure reached about £100 million a year. It was also providing grants to some 21,000 severely disabled people. I wish to say a few words here about numbers. It may be pointed out by some that that is a very small proportion of the estimate of the total of disabled people in the United Kingdom which is thought to be over 6 million. The clear explanation must be made that these new funds are for severely disabled people who can, with help—and who wish to do so—cope with life without institutional care. The figure of over 6 million comprises disabled of all kinds, including people with minor handicaps, although the degree of handicap is sometimes not obvious. For example, the loss of one finger may not seem a serious disability but of course it has serious implications for a professional pianist. Moreover, about 80 per cent. of the 6 million are elderly people whose disabilities have arrived with age. They were able bodied in their youth and during their working lives. The large majority of these people who need help should be served by the general community care system now in operation. That new system caters for both disabled and elderly people. Many of its clients will be in both categories. This should assist local authorities in their organisation of functions. That, of course, is a wider subject and I hope it will be debated on another day.

I am glad that both in the general community care scheme and in this Bill which deals with the severely disabled the principle is to promote independence, if possible. Choice must remain because a few people prefer institutional care. We must remember that a choice must be given. Some of your Lordships will know that I have been advocating this principle in both Houses of Parliament for over 25 years. Therefore it will come as no surprise to noble Lords to learn that I support the principle of independence, where possible.

In the mid-1960s the only disabled persons who received benefits related to disability were the war disabled and those who had received industrial injuries in certain circumstances. Others, however severe their disability— it may have been a lifelong condition—were subject to ad hoc care from their families, local communities, institutions, voluntary organisations or in enforced hospital life.

However, a voluntary organisation was founded in the mid-1960s with the aim of changing that situation. It has already been mentioned in the debate; it was the Disablement Income Group (DIG). After its earlier successes I was delighted in 1988 when it was chosen by the Government to manage the ILF upon its creation. I am sure that DIG contributed much to the ILF's achievements. Incidentally its founder, Mrs. Megan du Boisson, who died in a tragic motor accident four years later, was the first person in a wheelchair to ascend to the public gallery in another place. The then Serjeant at Arms co-operated admirably to enable her to hear one of the first parliamentary debates on disabled people. I initiated that debate as I had the good fortune to win a ballot.

I trust that comments in this single debate on the Bill in this House will be fully considered by the Government when bringing its provisions into effect. I shall now make my own comments. The noble Baroness, Lady Hollis, has already mentioned direct cash payments. These are cash payments to individuals but they are not included in this Bill although they were part of the former Independent Living Fund system. The same principle is in the Bill being sponsored in this House by my noble friend Lord McColl of Dulwich. It worked well with the ILF and the Government's objections appear to be technical. I understand the Government object because the trustees are already in place in conditions which have already been accepted. Surely the Government can find a way of changing this without necessarily changing the terms of the Bill.

Accountability is, of course, needed, but that has been arranged successfully in the recent past. The principle of direct payments to individuals also extends choice. That is an aim of the Government in this field. Costs would not be increased but there would probably be better value for money as the payments would meet the particular requirements of an individual.

I shall now comment on right of review; that is, a right to have a decision independently reviewed. Admittedly this did not exist under the former ILF scheme, but that scheme was temporary. I understand the Government have said that there will be a review mechanism, but will it be based on an independent body or person as that is the vital element if it is to be a proper review?

I now turn to Motability. The Bill is rightly being used as a timely means of continuing grants to this charitable organisation which runs an excellent scheme of helping to provide vehicles for disabled people. About 140,000 people are at present being helped in this way, mainly through favourable terms for leasing and hire purchase. Some 330,000 vehicles have been provided under the scheme since it started. Motability certainly deserves continued support with our approval.

I have a question for my noble friend. How do the funds relate to mental disability, a subject in which I am much involved? I was especially involved with it when I was the chairman of the Scottish committee during the International Year of the Disabled in 1981. As a result I am the patron of one of the mental illness organisations. Were some mentally disabled people included among those receiving grants under the old ILF scheme? I do not expect the Minister necessarily to reply today, but perhaps he could write to me later. Will such people be included in the new schemes?

I make clear my own view that the new fund is not likely to be applicable to the usual cases of severe mental illness because the individuals do not need physical help and their state is often highly volatile. They need understanding and sensitive supervision. When relapses occur, perhaps because on a whim the person has decided not to take medication, temporary institutional care is probably the necessary remedy. In other words, either the individuals are in the community or hostels under observation, or they are in hospital in a crisis.

The noble Lord, Lord Rix, is due to speak later in the debate so I have restricted my observations to the mentally ill. He may have more to say about other mentally disabled people.

To sum up, the old ILF was temporary and, contrary to some forecasts, has set an exemplary pattern. The new funds will be launched with the best hopes of most Members of this House. The Government will be wise to bear in mind the main comments made today in this debate.

4.1 p.m.

Lord Murray of Epping Forest

My Lords, we should welcome the fact that the ILF survives at all. Half a loaf is better than no bread. This is only half a loaf, but at least it gives us something to build on and to improve by continued pressure in the future. As my noble friend Lady Hollis spelt out so distinctly, this Bill certainly needs some improvement.

Incidentally, something else which needs improvement is access to this House for disabled people for the purpose of listening to our debates, particularly for those who use wheelchairs. I hope that that matter may be given consideration at some time.

This debate has demonstrated the widespread support for giving disabled people the resources with which they can buy the services which they need in order to live in the community. That was overwhelmingly clear in the other debate on the Bill to which reference has been made, initiated by the noble Lord, Lord McColl, a debate in which we who spoke scored all the goals but after which the Government Front Bench team awarded themselves the victors' medals.

The history of the Government's attitude towards grants for disabled people has been chequered. They have not so much moved the goalposts in the course of their consideration of the matter as changed their jerseys. Now we are told by Downing Street that we are to have a listening government. As the noble Lord, Lord Campbell, emphasised, it is critically important that the Government should listen to disabled people on this issue. They should listen to social service departments. They should listen, as I have, to those who are charged with assessing the needs of disabled people under community care, who are in no doubt whatever about the superiority of direct grants. They should, and I hope will, listen to their own Back-Benchers who have spoken this afternoon and on other occasions.

The Minister's right honourable friend the Minister in another place, speaking on the Bill said: I have a feeling that I will be constantly reminded of the arguments that have been put forward and that the Government will have to reconsider this from time to time to see whether the new arrangements are bearing up or what changes may be necessary".—[Official Report, Commons, 27/4/93: col. 902.] Given the constitutional position, all we can do this afternoon is to put up some flags charting the areas on which we shall concentrate in the future. My noble friend Lady Hollis has done that very ably. Her comments were based on the proposition that assistance to disabled people to live an independent life should he a right. That assistance could take the form of providing the disabled person with the means to make decisions about his or her own care arrangements and providing the necessary resources. The Bill falls short of that test.

Those resources should he provided on the basis of common standards and common conditions, avoiding inconsistent treatment. No scheme which depends basically on assessment by a multiplicity of local authorities can meet that test. Finally, assistance should be available to anyone who passes the test of being able to cope in the community, and the Bill falls short on that score also.

I recognise that the Bill goes at least some way towards meeting the needs of disabled people, but it puts unnecessary hurdles in the way of disabled people. That is the very last thing we ought to do to persons who use wheelchairs or who have, for example, impaired vision.

My noble friend Lady Hollis made an overwhelming case. I should like to underline two of the points which she made in relation to the Independent Living 1993 Fund. The first is the fact that individual local authorities will decide whether people have access to the fund at all, and before an application can even be made the local authorities must be making a contribution or providing services of the order of £200 a week, an amount which very few local authorities spend on individual cases now. Local authorities have not been meeting the full needs of disabled people. As my noble friend illustrated, they are now telling us that they cannot meet them in future. We know that assessors are being told to keep down the provision which they make. They are being told in effect to deprive Peter in order to support Pauline. What ought to be a needs led service is obviously incompatible with budget limited provision.

We accept that there have to be some financial limits, but the likelihood is that different local authorities will interpret needs in different ways. That will lead to inconsistent treatment of people with similar needs. I hope that the Government will monitor that issue very carefully. I can assure the Minister that organisations for disabled persons and those of us who are sympathetic to them will be doing so.

My second point relates to the fixing of the upper limit at £500 a week, to which other noble Lords have referred, and the limitation on the ability of the 1993 fund to provide a cash top-up if the cost of the whole package is more than £500. Reference has been made to the uncertainty which surrounds that provision. I heard with interest my noble friend Lady Hollis claim that the local authorities would have to pay the whole of the cost. If that is so it is news to me. I hope that the issue will be clarified by the Minister beyond peradventure.

More important is the question of the £500 limit itself. It is my understanding that the extension fund can pay up to £560 a week whereas the 1993 fund can pay only up to £500. If that is so, why is there that difference? Independence should be based on an assessment that the person can cope and not on a cash limit. As has been said earlier, in effect the Government are saying that £500 a week is to be the price of freedom. I accept that there has to he some limit on the amount of cash made available, but this is unreasonably restrictive. There cannot be many disabled people whose costs exceed £500 a week, and surely the fund grants can be made sufficiently flexible to accommodate the few marginal cases which would be affected. The alternative is residential care, or possibly nursing care.

My final point, echoing what my noble friend and others have said, concerns the upper age limit which applies to both funds, namely the limitation of entitlement to people of working age—presently 60 and 65. That limit is being questioned strongly, not least by the Government themselves. It has been far too arbitrary in terms of defining the possibility of making contributions or the point at which needs begin to emerge in the community. We are told that drawing that line will save £2 million in 1993–94, £9 million in 1995–96. But that is marginal when we consider the amounts of money involved.

Previous speakers have emphasised the way in which the provisions will affect old people and their carers, many of whom are themselves beyond working age. It was said that old people have savings. Some do; but the recent Carnegie report on the third age has demonstrated the wide and increasing gap between the incomes of third agers generally, on the one hand, and the poorest of them, on the other, and the steady decline of income with age. It is also said that local authorities can provide additional services, if necessary. But those people do not want local authority services. As has been said, they wish to be able to choose.

I repeat what I have said in earlier debates. That provision is analogous to giving old-age pensioners grocery tickets instead of cash. The gross cost will be £2 million. However, instead of that money being made available local authority services in kind will be provided which will be more costly. Alternatively, some people will have to go into residential care which will also be more costly. On the grounds of the economical use of resources, it would be sensible to build adaptability and flexibility into the operation of the funds. I hope that it is not too late to review that proposal and to consider again the agreement that has been reached between the Government and the trustees. At the very least high priority should be given to extending provisions in that way as part of what must be an ongoing and regular reassessment of whether the funds are achieving the objectives that the Government themselves have set. The Minister said that he expects the Government to be under pressure on those and other points. He will not be disappointed.

4.12 p.m.

Lord Rix

My Lords, this is the first time that I have had the rather unusual experience of speaking in your Lordships' House during a debate on a money Bill, with its somewhat arcane restrictions. I am reminded of Harry von Tilzer's famous old music hall song of long ago—1900 to be precise—of being "A bird in a gilded cage". Admittedly, I am of the wrong sex. But as any amendments that I or other noble Lords care to proffer can be disregarded, emasculation rather than emancipation is a word which is more easily spoken "trippingly on the tongue". That is a pity, for there are many amendments which were offered by both sides of the House in another place which could have greatly improved the new Independent Living 1993 Fund and the Independent Living Extension Fund. Alas, those were largely disregarded.

We now face a Bill which has caused a number of grave concerns to be voiced by MENCAP and other organisations working with or on behalf of people with disabilities, as well as the Disability Alliance itself. Perhaps I may quote the words of Lorna Reith, the director of the alliance. She said: What is at stake is the quality of life and the right to live independently of the most severely disabled people in the country". Other noble Lords, including the noble Baronesses, Lady Hollis and Lady Masham, have spoken eloquently and movingly on those grave concerns. With your Lordships' indulgence, I wish to summarise those anxieties.

The first concerns the problems to be faced by those affected by the upper age limit, with its ludicrous denial of funds for people over 65. Of all those receiving help from the old ILF, 34 per cent. were over that OAP limit. The second anxiety is over the £200 local authority contribution which can no longer make cash payments to an individual. The third involves the upper ceiling of £500 overall, with its overt threat of residential care being seen as the preferred alternative once that figure has been reached. The fourth is the right of review being qualified by those dread words "if necessary". The fifth refers to ensuring adequate provision for existing beneficiaries as promised in the Government's manifesto commitments but now capable of being set aside. The sixth involves confidentiality, which will now be breached by the disclosure of all carers' names, addresses and national insurance numbers to the Secretary of State.

The seventh anxiety involves the parliamentary accountability being promised in a very half-hearted way by the Parliamentary Under-Secretary of State, Mr. Alistair Burt, who said in another place on 23rd March, at col. 18 of the Official Report, that, as the fund is new, if time is available, a date would probably be appropriate after a year to see how the running of the new fund is progressing". Another ministerial statement made a month later on 27th April, at col. 902 of the Official Report, seemed to anticipate U-turns ahead, as we have already heard from the noble Lord, Lord Murray of Epping Forest.

Finally I come to the dread hyphenated words "ring-fencing". The Disablement Income Group Report, Cause for Concern, found that only 57 per cent. of directors of social services surveyed were planning to spend their independent living allocation on funding the first £200 of individual care packages. Ring-fencing of those funds and others would assuage our fears on that and on community care as a whole.

That leads me in a general way to MENCAP's fears, as anticipated by the noble Lord, Lord Campbell of Croy. For those among us with a severe learning disability and additional sensory and/or physical disabilities, community care plans promise, at best, further thought and for the most part nothing, even though 12 years ago, and many times since in similar words, government have set out their community care priorities as being, to maintain a person's links with family and friends and normal life and to offer the support that meets his or her particular needs". Five years after Care in Action the then Secretary of State for Social Services told the annual conference of the Association of Directors of Social Services: The reality is that community care policies have significantly improved the lives of many people who would otherwise have spent years in institutions cut off from normal living. None of us would wish to see the people for whom we care confined to that sort of existence indefinitely". The vast majority of people with profound intellectual and multiple disabilities at present live at home with their parents. As the noble Lord, Lord Campbell of Croy, said, we want a flexible system which will support them more adequately while they live in the family home. Most care packages, to use the jargon, probably cost local authorities well under £200 a week. Some families receive negligible help. Beyond the family home most profoundly disabled people will in time need good quality residential care. For some the old ILF did, and the new ILF could, offer an imaginative alternative. That imaginative choice is ruled out by the Minister's statement in the Adjournment Debate on 25th February last that beyond an upper limit of cost, choice will be denied. Once again the most severely disabled people have least, or zero, choice.

If the Disability (Grants) Bill is not amended, many severely disabled people may well find themselves in the 1986 phrase uttered by the then Secretary of State, confined to that sort of existence indefinitely". Old Harry von Tilzer was pretty close to the mark, was he not? He might well have been writing about community care and the ILF—might he not—with the words: She's only a bird in a gilded cage, A beautiful sight to see You may think she's happy and free from care, She's not, though she seems to be"?

4.19 p.m.

Lord Swinfen

My Lords, I welcome the Government's efforts to continue the excellent independent living fund with the Independent Living Extension Fund and the Independent Living 1993 Fund. However, that may be as far as my welcome goes today.

I have seen suggestions that the overall level of funding for the two new funds, with the number of severely disabled people who will be eligible under the funds, will produce a shortfall. Can my noble friend assure the House that sufficient funds will be available and, if not, the shortfall will be made up?

As the law stands, the inability of local authorities to make direct payments is disastrous to the working of the fund set up under the Bill. If the Government were to take on hoard the Bill proposed by the noble Lord, Lord McColl—the Disabled Persons (Services) (No. 2) Bill—and see it safely through not only this House but the other place, it would help to make the Bill that we are now discussing work properly.

The first £200 worth of funding for severely disabled people under the Bill has to be provided by means of services from the local authorities. As I understand it, that means that there will be little choice. A number of disabled people who are currently working, paying tax and playing a useful part in society will be unable to continue their work because they will not have the flexibility under the local authority services that they have at present.

The upper limit, the additional —300 over and above the —200 in services, can be provided in the form of cash. That will make an absolute mishmash and it will be very complicated. It would not be difficult for local authority staff to run, say, 50 or 100 severely disabled people and all that the staff would have to do would be to monitor the accounts of the special funds set up at banks and check the receipts for the money expended.

I gather that in the other place the Minister, when dealing with the Bill, suggested that once people needed more than £500 per week spent on them they would have to go into residential care. I work for a voluntary organisation which runs a number of good residential care homes, providing the kind of services to severely disabled people who, the Minister says, would have to go into homes and for which those people would have to find the funds. The cheapest I could find was £535 per week, and it does not include all the services that such people would require. For disabled people who need help with all bodily functions and feeding the cost works out at £635 per week. By my calculation that is 27 per cent. above the £500 that the Government say will be the cut-off point at which people will have to go into a home. Far better value for money could be obtained through increasing the grant, making it more flexible and allowing people to choose their own staff. It would be much more satisfactory for the disabled person and allow local authorities to distribute cash over the whole range, thus reducing administrative costs. There is no doubt in my mind about that.

The other point is ring-fencing, also mentioned by other noble Lords. I gather that the funds being produced under the Bill will not be ring-fenced. What steps will my noble friend the Minister take to ensure that the funds given under the Bill to local authorities are used properly and not for other social services? They should not just be frittered away. I am sure that local authorities will not be able to use the funds for totally different purposes, but it is essential to ensure that the money provided under the Bill is used for those for whom the funds are set up.

4.25 p.m.

Lord Desai

My Lords, with the permission of the House I wish to speak in the gap. I should like to make two simple points. As a preface, in the 1960s and 1970s the first attack on the welfare state was started by friends of the Government in the various think-tanks, including the Institute of Economic Affairs and other places. It was said that what was wrong with the welfare state was that it provided things in kind. It would be much better if the cash were provided.

The fundamental attack that people like Professor Friedman find Professor Hayek made on the welfare state was that by providing things directly in kind, the state denied people a choice. We have now come full circle, after 30 years. The Government who profess to defend choice now say, "No, you can't have cash, you must have things in kind". Clearly, as many noble Lords have pointed out, that will be a severe restriction on people's choice to live independently, as many will wish. It is also paradoxical that, as many people pointed out, that is a more expensive way of doing things than getting value for money.

I wish particularly to comment on the various parts of the so-called "sandwich" of £500 and above. It has been pointed out and corroborated by surveys that local authorities do not currently provide anything like sufficient help to the severely disabled to justify the £200 requirement in the present provision. People are required, under present legislation, to take £200 worth of services in kind from the local authority before they apply for the £300 in cash. That seems to be a perverse rule because I could easily imagine someone receiving, say, cash of £250 and being able to provide much better for themselves than if they had to go to the local authority for £200 for an activity which the local authority may or may not have the capacity to provide. What is more, if such rules are imposed it will lead to cost inflation. Services will be increased to £200 worth in order to allow a person to claim the next £300. Clearly, cost inflation is unnecessarily built into the sandwich. A direct payment of cash would save on expenses.

However, what about people who need to spend more than £500? As we know, most of us are able to make our own decisions on when to get up, when to eat, and so on. For other people it would cost a considerable amount to have such freedoms: for some it may cost more than £500, for some less than £500. What is the logic of the cash limit of £500? I do not understand it. It is not as though people will go on a bonanza if there is no cash limit.

I wish to put a question to the Minister and I apologise for not giving him notice of it. It relates to the top of the sandwich. If a person has a problem which costs £550, could the services for that person be unbundled so that he or she could buy £200 worth from the local authority and exactly £300 from the Independent Living Fund, with £50 coming from somewhere else?

There was an indication from the Minister in another place that some unbundling would be allowed because part of the sandwich could be bought one way and another part another way. However, if it is the case that someone who costs more than £500 would receive nothing from the Independent Living Fund, that is a severe restriction and, if I may say so, a silly rule. It helps no one. All it does is to take people into the much more expensive residential care option. Surely that is not what the Government wish. If they want to save money they should find a better way than they have found so far.

I should like to make one last point, about the elderly. We are experiencing a growing population aged about 75 and almost 80. Many are women. Many do not have private pension funds. Demographically it is also true that the generation which is now entering the 75-plus age group had fewer children than the generation which grew later on. That was the effect of the First World War. Those people do not have children. Therefore, if a person aged about 75 were to have an accident and suffer a severe disability, under the present rules that person would have nowhere to go. If the Government do not want that to happen, surely they must rethink the rules about the elderly not being eligible for the new fund which has been set up. I urge the Government, if they want to save money and to provide choice —both of which I entirely approve of—they must rethink aspects of the current Bill and, before too long, improve it in its implementation.

4.30 p.m.

Lord Carter

My Lords, as always when one winds up a debate of this nature, most of the points have been adequately covered and I can therefore be reasonably brief. As has been said, the Bill is a money Bill. We have no chance to probe or amend it at Committee stage. Even if we put down amendments, they would have to fit the Long Title of the Bill, which is about the making of grants. It is therefore important that when the Minister comes to reply he answers the many questions that have been raised in the debate. I am sure that he will.

It is a money Bill in another respect. It is a Treasury Bill, all about the limiting of cash and the rationing of provision. That has been made extremely clear by a number of speakers. I have no wish to go through the various points again in detail. It occurred to me that it would be interesting to go back to 1988 when the ILF was set up. I moved an amendment to the 1988 Social Security Bill at Report stage which was intended to probe the intentions of the Government in setting up the ILF. That debate makes extremely interesting reading now.

The amendment was purely a probing amendment, but I see that it included arrangements for adjudication and appeal concerning grants from the ILF. That point was well made by the noble Lord, Lord Campbell of Croy. At the time there was considerable interest in the number of people who were likely to benefit. I see that I said: In the week of the announcement, in a radio broadcast, the Minister referred to 'a few hundreds'. In the other place he referred to 'hundreds and not thousands'. I understand from the Disablement Income Group that it believes that the number of claimants might be of the order of 1,000 to 2,000". [Official Report, 3/3/88; col. 295.] I asked the Minister if he could give the latest estimate of the department. The Minister, the noble Lord, Lord Skelmersdale, in his reply, said at col. 303: Our evidence is that this is likely to amount to a few hundred people. I have conceded already that 250 may not be exactly the right number, but we are in broad agreement with DIG that the numbers are small. We both agree that it is a few hundreds: up to 1,000". I quote not in any sense of disparagement. We were all wrong. The estimates were wildly incorrect, and they merely revealed the paucity of adequate statistics concerning the incidence of severe disability.

We hear much now, in terms of community care, about unmet need. The success of the ILF proves that there was an unmet need which the ILF identified and met. I cannot help wondering whether, if the Government had known then what they know now concerning the numbers of people who would be helped by the ILF and the cost of that help, they would have been so keen as they were to set up the fund. It is clear that the ILF has been a very considerable success. I admit at once that the reservations and fears that I had, and that many others in this House and outside had, at the inception of the scheme, have proved to be unfounded. I am delighted that we have been proved wrong.

What is so worrying about the new arrangements, proposed in the Bill, is that they seem almost expressly designed not to build on the successes of the ILF or to deal with the problems that its operation has revealed. For example, the ILF weekly awards have maxima of £450 to £560 a week, excluding the value of local authority input where that exists. That compares with the much lower figures now proposed by the Government.

The Government make great play of local authority responsibility in providing community care, as if that were to wave a magic wand over the problems. The successful operation of the ILF has revealed the paucity of local authority effort and, above all, expertise in this area.

Enough has been said about the value of direct payments without my adding any comment, save to say that once again the DSS (or is it the Treasury?) seems to be flying directly and deliberately in the face of ILF experience. We can all understand that the limitation on grants of those under 65 is a deliberate exercise in cash limiting. It has no other rationale. The point was well made by my noble friend Lady Hollis. The majority of the elderly disabled are women.

The new arrangements seem almost perversely designed to drive severely disabled people into residential care—the precise opposite of the fundamental of the principles of community care that we all worked so hard to introduce in the 1990 Act. The situation is extraordinary. The ILF has developed a successful and flexible operation. It is ring-fenced. It can make direct payments to disabled people. It provides an expertise that most local authorities lack. It keeps people in their own homes and out of residential care. Do the Government attempt to build on that success and develop it? No, they do not. The dead hand of the Treasury intervenes and effectively kills the. scheme so far as the future is concerned. The buck is passed expertly back to the local authorities and to the new ILF fund. The Government are effectively able to wash their hands of the financial problem that the success of the ILF created for the Treasury.

I have referred to the problem over estimates of numbers at the inception of the ILF. I ask the Minister: what is the basis of the Government's estimate of 1,500 people and £4 million for the new fund? I hope that we are not about to have a repeat of the numbers game that we had with mobility allowance when a mysterious entity—the OPCS data tapes—was called in to justify the Government's under-estimate. It proved to be wrong by about 10 times when the final figure emerged.

I put another direct question to the Minister: what will the Government do if their estimate of 1,500 people and £4 million proves to be wrong? Will they increase the fund? Will they alter the criteria to constrain the cost? Or will they attempt to pass the buck to the local authority and the social services departments?

We have heard about the curious concept referred to in the other place of the "sandwich". I cannot resist passing on the comment of one disabled worker, who said that so far as she could see the main contents of the sandwich were pure boloney. How is that curious mix and match of local authority provision, the contribution of the ILF and the upper cash limit intended to work? The point was made extremely well by the noble Lord, Lord Swinfen, with his great expertise.

The question of the calculation of the £200 of services that the local authority has to provide is, as the Minister will know, causing considerable concern. Can he tell us how that is to be estimated? Will the cost of making the assessment be included in the £200? The press release from the DSS, which announced the new arrangements on 1st April, says: Prospective applicants should apply first to their local authority. If the application is supported a package of care will be drawn up by the Fund's social worker, the local authority social worker and the disabled person or their representative. The local authority will arrange care services to the value of about £200". I cannot believe that it is proposed to include in that £200 the cost of the local authority social worker. I have been asked to make that point and put it to the Minister. If that sum were included, we would have the absurd situation of the cost of the bureaucracy created by that arrangement reducing the amount of direct services provided. I ask again for details of the guidance that the Government are giving regarding the calculation of the £200.

To pick up extremely briefly a few points that were made in the debate£and in the formidable analysis provided by my noble friend when she opened it—can the Minister explain the inexplicable? Why at least were not some of the trustees of the old fund asked to carry on in the new fund? Everybody concerned with this matter is baffled by the department and its failure to build on the expertise that those people have. An unelected and appointed independent trust, removed from parliamentary scrutiny, is allowed to make direct payments while local authorities, democratically elected and accountable, are not allowed to make direct payments to disabled people; as my noble friend pointed out, they make direct payments to many other people.

I am not sure whether the Minister has seen the study entitled Paying for Independence—the first findings of a new survey of more than 1,000 disabled people—published only last Friday by the independent Policy Studies Institute. It concluded that most disabled people preferred to employ people they already knew and trusted. Local authority services were seen as inflexible, difficult to obtain and vulnerable to cutbacks. Regular guaranteed payments from the ILF gave disabled people peace of mind that help would not suddenly be withdrawn.

It seems extraordinary that the Government have a policy—which we all welcome—of reducing bureaucracy and regulation in industry and other areas of our national life but are responsible for a Bill which will result in an increase in bureaucracy for severely disabled people. If we take the case of a severely disabled person trying desperately to maintain an independent existence in his or her own home; having to struggle with two rates of attendance allowance and a matrix of 11 variations of disability living allowance; having to negotiate a care package with the local authority and the ILF worth up to £200 (but with the calculation of the £200 still largely an unknown quantity); and, then having to obtain up to £300 of direct payments from the ILF and all the time worrying that if the total requirement exceeds £500 he or she may have to go into residential care, one wonders how all that is supposed to be an improvement on the existing arrangements.

The first Motion that I ever moved in the House was to draw attention to the needs and problems of people with disabilities. In that debate I coined the phrase "the disabled divide"—the gap between the expectations and the living standards of the disabled and the non-disabled. There is nothing in the Bill which helps to narrow that gap, and I fear that it will make it wider.

4.42 p.m.

Lord Henley

My Lords, let me reiterate the reason for the Bill. The need for it arose because doubts were raised in 1992 as to whether Section 64 of the Health Services and Public Health Act 1968 could properly be relied upon to cover payments made by the Secretary of State for Social Security to the ILF and its successor bodies. It is concerned with the payment of public funds to those new trusts. I must make it clear that the fact that that makes it a money Bill is entirely a matter for the Speaker in another place. The noble Baroness, I believe, claimed that the Government were trying to evade parliamentary scrutiny. That is not so and it is wrong of the noble Baroness to suggest that.

Baroness Hollis of Heigham

My Lords, I thank the Minister for giving way. I was clear in my opening remarks that the Bill, as drafted by the Government, meant that it was necessarily certified by the Speaker as a money Bill. I was careful to draw that distinction and it is unreasonable of the Minister to confuse it.

Lord Henley

My Lords, I was trying to make clear the purpose of the Bill, which is purely to fund the ILF. Both the previous and existing ILF organisations were set up as independent trusts by the Government and therefore all that was needed was a mechanism for funding them. We thought that Section 64 of the Health Services and Public Health Act was appropriate; it was not. That is why the Bill comes before us. It is wrong of the noble Baroness to suggest that we were trying to evade parliamentary scrutiny. Having said that, I accept, as my noble friend Lord Campbell put it, that we will take note of all the concerns put forward. I accept that that, to some extent, is the point of the debate. As the noble Lord, Lord Murray, put it, we shall certainly listen.

The noble Lord, Lord Addington, said that, strictly speaking, to move amendments to such a Bill was a matter for the privilege of another place. The Bill should not go to Committee. The House generally agrees not to commit money Bills. That is a well understood convention. We agreed in a Business of the House Motion moved by my noble friend the Lord Privy Seal last week to take all the remaining stages of the Bill in one day. Again, that having been said, I have no intention of not listening and not responding to the various points made by speakers in the course of the debate.

I shall begin by referring to some of the comments concerning delays that occurred in payment of disability living allowance. The noble Baroness said that I had not apologised for an occasion when she claims that I misled her. I reject the claim that I owe her an apology. I do not believe that I misled her on that occasion. However, I repeat the apologies made that the procedures for paying the disability living allowance did not meet the usual high standards of the Department of Social Security. Many people suffered some delay in receiving their payment. I am not sure that the noble Baroness has yet apologised for her own party taking over four years to bring back mobility allowance to its recipients in the early 1970s. I would certainly prefer to wait one year rather than a total of four.

The noble Baroness suggested also that the trustees were not consulted over the change-over. They always knew that their trust fund was an interim measure with a limited life, as I stressed in my opening remarks. It was the choice of the trustees to decide the point at which they would stop accepting applications in order to be able to process them by 31st March. There was no question of either the November decision on new applications or the 31st March final closure date being unknown to the trustees.

The noble Lord, Lord Carter, asked why none of the old trustees is continuing to serve under the new system. I stress that there will be a degree of continuity in terms of the staff. But I must make clear that we are talking of a different animal. The important new trust is the 1993 fund. The extension fund will merely mirror the old arrangements for the existing recipients.

Lord Carter

My Lords, perhaps the Minister will give way. Is he saying that it is the same bureaucrats but different trustees?

Lord Henley

My Lords, not entirely. As the noble Lord will be aware, there is a new director. But many existing members of staff are continuing in their jobs. The 1993 fund is the important one for the trustees looking after it because that is the one that will grow as the extension fund, sadly in the nature of things, gradually shrinks. We are not comparing like with like. The 1993 fund will operate in a different way.

The noble Baroness, Lady Hollis, the noble Lord, Lord Murray of Epping Forest, and the noble Lord, Lord Rix, in his theatrical intervention, questioned the £200 of services that the local authorities must provide before involving the ILF and the fact that local authorities would control access but not necessarily manage to meet all needs. A key feature of the 1993 fund is the partnership with local authorities. The scheme will help people who are the most severely disabled. That is the important point. The £200 threshold is a quick test for local authorities as to whether a person may be classed as severely disabled. If an individual is severely disabled it is absurd to think that local authorities would spend less than £200 on his or her care needs. Therefore, the £200 threshold should not exclude any of the people intended to be helped by the 1993 fund. As has been mentioned by various noble Lords, local authorities have been given an additional £27 million to meet the cost of providing the first £200 of care. I shall be turning to that somewhat later.

I turn now to the £500 limit which was the concern of many noble Lords. Again, I stress that the 1993 fund—the extension fund mirrors the old arrangements—is designed to target help towards a select group of people; those whose care needs are greater than £500 are outside that group and cannot be helped by the fund. When care exceeds £500 the local authority becomes solely responsible for meeting the individual's needs, as the noble Lord, Lord Murray, asked me to confirm. It may decide to provide intensive services to that individual or, in consultation with the disabled person, that his or her care needs can best be met in residential care. We believe that the numbers affected will be tiny.

Lord Swinfen

My Lords, I thank my noble friend for giving way. He said that the local authority might decide in consultation with the disabled person whether or not residential care was the right solution. What happens if it is not prepared to continue to give care at home and insists on the disabled person going into residential care much against the wishes of that individual and his family?

Lord Henley

My Lords, what I am trying to make quite clear to my noble friend and other noble Lords is that the £500 limit will not itself force any individual into a residential home. If the limit of £500 is exceeded it will be a matter for consultation between the local authority and that individual. My noble friend will have to accept that there will always be constraints on the expenditure of public money by both local and central government. Obviously, there may be occasions when in the end the local authority will have to say that the individual's needs are such that they can be met at reasonable cost only by means of residential care. I cannot give a guarantee that every local authority on every occasion will be able to say that any individual will be able to stay in the community. In passing, I stress that the old ILF had a countrywide higher limit that ranged between £450 and £560. Therefore, I do not believe that it is unreasonable that a limit should be imposed in the case of the new 1993 fund.

The second principal question raised by the noble Baroness and repeated by many noble Lords was why local authorities could not pay directly to individuals what we insisted they should provide in the form of services. The policy on direct payments is well established. I understand the strength of feeling on this point. We do not believe that now is the right time to add to their already full agenda as they set up community care. We firmly believe that direct payments should continue to be the province of the social security system. As the noble Baroness reminded us, this point has been extensively discussed during the passage of the Disabled Persons (Services) (No. 2) Bill. I do not wish to have a long debate about a supplementary issue at this point. However, I reiterate that this Bill is about the provision of funding for the new independent living funds. I do not believe that it is the right vehicle to change the way in which local authorities work merely to suit what, in the case of the 1993 fund, will be a very small number of people to be helped each year.

Baroness Hollis of Heigham

My Lords, I thank the Minister for giving way. I also thank him for his conciliatory remarks about direct payments. The main reason he found against it was that local authorities should not be asked to add to their already overburdened agendas for community care. Does he accept that if the local authorities themselves seek that power as a way of reducing their overburdened agendas for community care the department will in consequence respond?

Lord Henley

My Lords, I will not go as far as the noble Baroness. I was hoping to be relatively conciliatory. I do not believe that now is the right time, nor do I think that this is the right Bill. If others come forward with further plans no doubt they and the noble Baroness will discuss them further in relation to other Bills to which I have referred. But this Bill is certainly not the right vehicle.

I turn to another issue that vexed a great many noble Lords: the 65 year-old cut off. The noble Lord, Lord Carter, suggested—it was reminiscent of the old days in dealing with earlier social security Bills—that this was merely a Treasury Bill. To be reminded that the noble Lord had not changed his spots and was still prepared to spend money indiscriminately without any let or hindrance was most welcome. But at last we had an admission from the noble Baroness that resources were finite. Sadly, that was not echoed by the noble Lord, Lord Murray, but at least the noble Baroness from the Front Bench recognised the finite nature of funds available for all government spending, in particular by the department that spent most of the taxpayer's money: the Department of Social Security.

I stress that, given those limited resources, it is reasonable to limit the scope of that fund to people between the ages of 16 and 65. People in that age group are the most likely to have longer-term care needs. Those disabled early in life have often lost the opportunity to earn and save. The highest priority for independent living must be those for whom the usual pattern is to live and work in the community. Whether we like it or not, for elderly people residential care is often a necessity. Although the Government have every sympathy for people who are disabled after the age of 65, our research evidence has also shown a significantly greater disparity in income between younger disabled and non-disabled people than between those over pension age.

Nor do I accept that the provision of part of an individual's care needs by giving services necessarily reduces the choices available to the disabled person, as the noble Baroness and others suggested. It seems to me that people become rather confused when they discuss this issue and relate cash payments purely to dignity via the concept of choice. I cannot accept that if no cash is given a person automatically loses some of his or her dignity. However, I accept that it is extremely important to provide care services in a professional and co-ordinated manner. It is that which gives the individual dignity, not the provision of cash alone.

I turn next to the vexed matter of ring-fencing that was raised by my noble friend Lord Swinfen. I agree that the £27 million to which we have referred is not separately ring-fenced, but it is ring-fenced as part of the wider community care funding of some £539 million. Because of the very small number of people involved—we estimate about 10 per local authority —we believe that it is not sensible to ring-fence this relatively small amount of money separately, but as part of the wider provision it is ring-fenced within community care costs.

I deal briefly with the point made by the noble Baroness, Lady Masham, about the requirement to provide employment details of carers and the fact that this was degrading. I believe that it was the noble Lord, Lord Rix, who suggested that this could lead to some breaches of confidentiality. I would certainly be prepared to look at that suggestion to see whether there was any merit in what the noble Lord said. The old ILF asked applicants to provide the names and addresses of their carers. The new funds simply repeat that requirement in the trust deed, with the addition of a request for the carer's national insurance number. I believe that to be a perfectly reasonable check to ensure that payments are not abused.

Baroness Masham of Ilton

My Lords, perhaps I may ask the Minister whether that is also true of severely disabled people in the area of AIDS where confidentiality is very important. Those people fall into this category.

Lord Henley

My Lords, I do not think I can answer the noble Baroness off the cuff but I will certainly look at what she said. If necessary, I will write to the noble Baroness.

The noble Baroness, Lady Hollis, seemed to suggest that my right honourable friend the Minister of State in another place was encouraging local authorities to get round the law by devising schemes to make direct payments from local authorities. What my right honourable friend said was that it was up to individual authorities to ensure that any innovative and flexible schemes satisfied the district auditor. Obviously, it was not a matter that we should be looking at; it was for the district auditor to consider when he went through the accounts of the particular local authority. Many schemes appear to be running perfectly satisfactorily to the benefit of those authorities and disabled people. We welcome that.

I refer to the question of appeals and the review procedure. This matter was raised by my noble friend Lord Campbell and the noble Lord, Lord Rix. The new funds, like the ILF, are independent bodies which will be managed by trustees. Because of their independent nature and the fact that they are outside the social security system, we believe that it would be wholly inappropriate for their individual decisions to be subject to external scrutiny or inquiry. The ILF had an established internal review and appeal procedure. I could detail it now at the Dispatch Box but I do not think that that would be an appropriate use of the time of the House. It had a review and appeal procedure which the new trustees have certainly decided to adopt. I believe that it has worked very well in the past and there is no reason to think that it should not work well in the future.

Perhaps I may also respond briefly to the point raised by my noble friend Lord Campbell and the noble Lord, Lord Rix, on mental disability. I understand that the old ILF was able to help people with learning difficulties—what used to be called mental handicap—but the fund was never primarily intended for people with mental illness. They do not generally need the kind of personal, domestic services for which the old fund was intended. The new fund will, similarly, not generally be a suitable support for this group.

Lord Rix

My Lords, perhaps I may clarify one point. The noble Lord, Lord Campbell of Croy, mentioned mental illness. I mentioned learning disability or what used to be known as mental handicap. The two are different. I hope that that is clear to the Minister.

Lord Henley

My Lords, there is certainly clarity in my mind about this issue. What I am trying to say is that for mental illness in itself this is not generally the suitable vehicle to help. But for those with mental disability, there might be physical consequences for which the ILF might therefore be able to provide suitable help. I certainly see the distinction.

Lord Campbell of Croy

My Lords, I am grateful to my noble friend for giving way. He is confirming what I said. I assumed that the old ILF and the new one were not relevant to severe mental illness. There is in the community care system now the ring-fencing of mental illness, which I welcomed at the time and which is now in the form of the mental illness specific grant.

Lord Henley

My Lords, I thank my noble friend for bringing even greater clarity to what clarity I thought I had on this matter.

Perhaps I may comment briefly on payments in Scotland. The noble Baroness, Lady Hollis, suggested that they were legal in Scotland. I understand that local authorities have power to make cash payments but it is a very limited one. Cash payments may be made only in an emergency and where this would be cheaper than some other form of assistance or where aggravation of the individual's need would cause greater expense to the authority on a later occasion.

Lastly, I turn to the question of adequacy. The noble Baroness questioned, as she normally does, despite her earlier return to fiscal responsibility, whether the —27 million was adequate. We estimate that some 1,500 people a year will be helped by the fund. That —27 million was costed on the basis that the caseload would build up over the year and not all come on-stream on 1st April. Funding of —27 million allows the entire 1,500 we expect to join the fund this year so long as they receive the first —200 of services from their local authority.

The noble Lord, Lord Carter, quite rightly asked how we estimated that total caseload of 1,500. We took the total caseload of the ILF and then excluded people with care costs lower than —200 and higher than £500 and then excluded all people over the age of 65. Four million pounds provides for a weekly payment calculated on the basis of the ILF experience allowing for a gradual take-up of 1,500 people over the years.

The noble Lord, Lord Swinfen, asked for a cast-iron assurance that any shortfall will be made up. I have to say, of course not, but I ask noble Lords to look at our record on expenditure on ILF over the years. In its first year the total spend (the estimate was some £5 million) was more than £1 million; in the second year it was £8.5 million; in the third year it was £26.4 million; in the fourth year it was £49.8 million; in the fifth year it was £95 million. The estimates for the current year for the two funds are some £124 million. If one takes the total expenditure on independent living, by adding in the £27 million to local authorities, there is total funding for independent living of some £150 million. That is expected to rise—these figures are provisional—in 1994–95 to £197 million and in 1995–96 to £241 million.

I could go on and list the increased caseloads for all our disability benefits and the dramatic growth we have seen over the past few years as we have made benefits available to greater numbers of people. Attendance allowance has gone up from around £250,000 in 1978–79 to jolly nearly £1 million; mobility allowance has gone up from under £100,000 to over £650,000. I could go on.

Many noble Lords have spoken as if the new independent living funds are the sole source of help to those who live in the community. That is to get the picture out of perspective. Those new funds are an extra resource available to provide extra help to a limited group of the most severely disabled people. The community care reforms were all about making choice and dignity available to all disabled people. These new funds will supplement this help, not replace it. It will not, as the noble Baroness, Lady Masham, put it, be the death knell of independent living but merely takes it forward further into the era of community care. I beg to move.

Lord Swinfen

My Lords, before the noble Lord moves the Second Reading, as I did not wish to interrupt his flow earlier, perhaps I may ask a question arising out of an exchange between him and the noble Baroness, Lady Hollis of Heigham. If local authorities were to indicate that it would reduce their over-burden to make direct cash payments to disabled people, would the Government accept the Disabled Persons (Services) (No. 2) Bill currently before the House, or would they bring forward their own legislation to the same effect?

Lord Henley

My Lords, I am not going to comment on that Bill. My noble friend Lady Cumberlege has done so. I was trying to make it clear that I did not think that this Bill was the right place for such provision; nor did I think this was necessarily the right time in the early days of community care when local authorities had, as I put it, a great deal on their agenda and a great deal to learn.

On Question, Bill read a second time; Committee negatived.

Then, Standing Order No. 44 having been dispensed with (pursuant to Resolution of 13th May), Bill read a third time, and passed.