Disablement

HL Deb 14 December 1994 vol 559 cc1327-60

5.36 p.m.

Lord Campbell of Croy rose to call attention to the case for recognising the many different kinds of disablement which occur and the ways in which the community in the United Kingdom can contribute to their alleviation; and to move for Papers.

The noble Lord said: My Lords, this is an opportunity to consider the different forms of disability which exist and the varying requirements to help those who are handicapped to live lives that are as normal as possible. Because I was disabled 49 years ago, causing me to have to change professions, and having been in a wheelchair at times during that period, I feel that I can speak frankly and offer advice to my colleagues in the disability organisations.

Having also campaigned for more than 30 years in both Houses of Parliament, I welcome the Government's undertaking to introduce legislation in this parliamentary Session. Today, I am raising relevant matters in preparation for our later debates. I am aiming to help to set the scene. I shall not concentrate on any particular category. My object is to present the general comprehensive picture.

I am glad that distinguished noble Lords and Baronesses, knowledgeable on the subject and concerned, have undertaken to speak. I am sure that particular kinds of disability will receive attention. In that context, I am glad to see the noble Lord, Lord Rix, in his place, because I understood that he might not be able to take part in the debate. He and I were operating together in 1981 in the International Year of Disabled People when he was the chief executive of MENCAP and I had been invited to play a prominent part in that international year. He and my noble friend Lord Renton have drawn attention to the fact that the largest single category of disabled people is the mentally handicapped.

First, I shall recall briefly the history of efforts to assess numbers and locate disabled people. The situation over 30 years ago, when I was starting my parliamentary campaign, was that help for disabled people was restricted to war disabled, like me, and the industrially injured. People who had been disabled from birth or early youth and housewives or others who had not been in employment were not in the system at all. Their only support was national assistance—the ultimate safety net.

In the mid-1960s, I pressed the government of the day to assess numbers. One had to have a starting point. At that time no one had any idea how many disabled people there were in the country. In October 1967, I was rewarded. In reply to a Question from me, the Government announced that the Government Social Survey, as it then was, would undertake an operation to estimate numbers.

In 1971 the results were announced, in what became known as the Amelia Harris Report, by the Office of Population Censuses and Surveys—the OPCS. That survey was carried out by sampling only, and was limited to persons aged 16 and over in private households. Nevertheless, it was the first-ever reliable estimate in Great Britain. In addition, it introduced classification and so provided the very first rough estimate of the number of severely disabled people.

We now have very much better information from the 1991 census. In that census, the terms "disabled" and "handicapped" were not used. The description chosen was, "limiting long-term illness", which of course includes the chronically sick. The definition was: Any long-term illness, health problem or handicap which limits the daily activities or the work that a person can do".

When considering the forthcoming legislation that we are expecting, one should be aware of the size and nature of the subject. An estimate of 6.5 million disabled people in the United Kingdom has been made by the OPCS, based on that 1991 census. However, crucial to interpreting that figure is the fact that more than five million of them are over retiring age, and that most of them were not disabled during their working lives. The 6.5 million figure includes all forms and degrees of disability from the slightly handicapped, even those with no employment difficulties, to the wholly paralysed and unable to speak. There are many categories and combinations of handicap between those extremes; so trying to generalise about "the disabled" can be misleading.

The estimates produced as a result of the 1991 census should be of special interest to all concerned with disablement: 79 per cent. of the 6.5 million were over pensionable age (and the ages of 65 and 60 were observed for men and women respectively). That is significant, bearing in mind that all forecasts show an increase in the proportion of elderly people in our population in the future. It is also significant for the whole system of care in the community, because it is having to cater for elderly people who are increasingly incurring disabilities. There are other important findings by the OPCS.

Turning to the nearly 1.5 million who were under retirement age and to those between the ages of 16 and 59, 25 per cent. of men and 12 per cent. of women were found to be in full-time employment, and 45 per cent. of men and 30 per cent. of women were described as "economically active". There is one other helpful estimate which has recently been made, and that is that about 500,000 people, of all ages, permanently need a wheelchair. That figure is generally accepted by government authorities.

To sum up these most recently available estimates, which helpfully provide much more information than ever before, about one in nine of our population has a disability of some kind, whether slight or severe, and four out of five of those people with disabilities are over retirement age. About one in 112 of our population is permanently in a wheelchair. That comparison is important, because there are sometimes public oversimplifications to the effect that disabled people and wheelchair people are the same and synonymous. That happens, for example, at airports and at railway stations.

My noble friend Lord Mackay of Ardbrecknish is to reply to the debate. I presume that he is not yet in a position to elaborate on the Government's proposals for legislation. I am sure that we would be most grateful for anything that my noble friend can tell us before we depart for the Christmas Recess. We would also be grateful for any comments that he may have on situations which I and other speakers describe this evening.

What can we as a community in this country do to improve life for disabled people, especially the severely handicapped? One way to improvement, and not an expensive one, would be to promote further public awareness of the different kinds of disability, thus spreading information and so changing attitudes. The principles which I believe should inspire our progress as a nation, in all those matters, are equality and integration.

To able-bodied people I put the following thoughts. A disabled person who is on his feet may well have to regard every day, nonetheless, as a test to be thought out in detail beforehand in terms of mobility and effort. The attitudes of other people can vary to an extraordinary degree. A friend whom he has known for years will say, perhaps when he has a setback and has to go back to a wheelchair, "I didn't know there was anything wrong with you". In one sense that is a compliment to the success of the disabled person in coping with daily life. But, unfortunately, it also often reflects the unobservant nature of the friend.

At the other extreme, other acquaintances will treat the same disabled person as if he was totally incapable of any independent thought or action. The disabled person will encounter both attitudes within a few hours on the same day. What is his or her reaction? Unpredictable at first, but later, probably, philosophical. The public can help by learning more and by exercising good judgment, with sensitivity in extending help where needed.

I shall touch on one part of life which is difficult or impossible for certain categories of disability; namely, transport. Improvements for disabled people are in general being made; but they cannot be achieved instantly. On all sides in Parliament—and, again, in this House recently—it has been agreed that it will take about 25 years before everything necessary can be done in public transport in this country for wheelchairs. Even that time-scale can only be achieved by determined efforts.

The London Underground is virtually a no-go area for wheelchairs, besides some other disabled people, because of the many steps and the very few lifts. That situation would be transformed if a new safe system could be invented for accommodating wheelchairs on escalators. There is a challenge for inventors and designers! There are many forms of disability which do not require a wheelchair and they also meet obstacles and difficulties of other kinds.

Discrimination against disabled people is, accordingly, very different from sex or race discrimination. The completely paralysed man is unlikely ever to seek to board a bus or to work in an ordinary office. That is why I do not favour the term "civil rights" as an appropriate description of new legislation. Even the United States has not used it for the Americans with Disabilities Act which aims for "reasonable accommodations" to be reached.

Another reason why I am worried about the use of the term "civil rights" is that an impression can be given that the enactment of a Bill can, in itself, immediately remove obstacles and difficulties. I have already met that impression among some disabled people and their carers. In taking this view, I know that I part company from several of my colleagues who serve on the Parliamentary Disabled Group. I do not know what title the Government intend to use for their Bill or Bills. I offer my view for what it is worth.

This leads me to something which the right honourable gentleman Mr. Alf Moms has asked me to raise at an early opportunity. In our debate on 22nd June I referred to his Private Member's Bill which became the 1970 Act. I said that it had been drafted by the Government. That was widely understood, then and later, to be the case; and many winners of the annual ballot in another place, like him, accept a first draft from the Government.

Mr. Morris has since told me that the situation was in fact somewhat different: that the then Secretary of State, the late Mr. Richard Crossman, was strongly opposed to the whole proposition".

Fortunately Mr. Morris persisted and put together a draft Bill, with difficulty, in time for the Second Reading. The Government did then give help with drafting amendments. This I remember because I was one of the Bill's sponsors, at Mr. Morris's invitation, and I moved the amendments to extend the scope of the Bill to Scotland. They were provided by government draftsmen. I am glad to put that part of history correctly on the record. It could only have been known to very few at the time that the Minister was strongly opposed to the introduction of that Private Member's Bill.

In opening this debate, I hope I have exposed the vastness of the area of problems and possibilities within this subject—a subject we expect to be considering soon in this House over a period of several weeks at least. I suggest that many of the special problems of various disabilities require separate solutions and that these should be tackled with vigour and determination. I beg to move for Papers.

5.51 p.m.

Lord Ashley of Stoke

My Lords, I wish to congratulate the noble Lord on providing us with this opportunity of debating disability and on his speech setting the scene and outlining some of the problems. Of course I disagree profoundly with the noble Lord on the issue of civil rights, because I feel strongly about that and about the need for civil rights and calling them civil rights. But I respect the noble Lord's viewpoint and I wish to pay tribute to the splendid work he has done over many years, both in this House and in another place, in helping disabled people. As he spoke of the background to this matter, I also am delighted to see one of the great campaigners on disability in the past and now, the noble Earl, Lord Longford, who did so much about the Act to which the noble Lord, Lord Campbell of Croy, referred.

I welcome this debate on the eve of what will be unprecedented legislation to outlaw discrimination against disabled people. The Government are fully aware of the views of the all-party disablement group, of which I am co-chairman. The group believes that three essential changes are required in the Government's consultative document proposals to make the forthcoming Bill satisfactory. First, a disability rights commission is crucial to monitor, to investigate and above all to enforce the Bill's provisions. Secondly, the proposal to exclude from the Bill's protection disabled people working in businesses of fewer than 20 employees is totally unacceptable. Thirdly, a new definition is required because the one in the consultative document is too restrictive and unfair.

The first two points as regards the commission and people being excluded from protection because of the size of the business have been fully dealt with at great length both here and in another place and I do not propose to speak on those now. Tonight I want to focus on the key issue of definition. I am glad that the noble Lord, Lord Campbell of Croy, properly focused on that. Everyone, of course, recognises the problems of wheelchair users. I am especially glad to see the noble Baroness, Lady Masham of Ilton, in the Chamber, willing and able to speak on this important subject. I pay tribute to the wonderful work she has done.

Wheelchairs are, of course, visible and easily identifiable. Wheelchair users deserve great credit for campaigning so ardently and so successfully. However, there are other disabilities such as epilepsy and deafness which are invisible, misunderstood and therefore neglected. Naturally there can be obvious consequences of a medical condition. For example, some deaf people inevitably require the help of interpreters to overcome communication problems. But the social consequences, especially the stigmatising of some disabilities, can be equally or more serious. I believe that this stigma is an aspect which should be acknowledged if anti-discrimination legislation is to be effective.

Disabilities such as deafness, epilepsy and speech defects tend to provoke a reaction because they make people feel uncomfortable—with some disabilities people are perfectly happy, but others make them feel embarrassed—and they are not as easily handled as pushing a wheelchair. They cause embarrassment which is transmuted into discrimination. The same attitudes and the same kinds of discrimination prevail towards people suffering from disabilities which are visible but which also cause embarrassment to an undiscerning public, cerebral palsy for example. I am sure the noble Lord, Lord Rix, will deal with those disabilities in some detail. Cerebral palsy can easily be recognised but by its nature, distorting the physical frame and its movement, can disguise the qualities, especially the intellectual ones, of the people concerned.

Perverse as it may seem at first sight, people can suffer discrimination even though they have no disability. That is a striking comment but I believe it to be true. In those cases the disability is in the minds of others who falsely perceive a disability where none exists. People who are HIV positive—I am delighted to see present the noble Baroness, Lady Jay, who has done so much for those people—former cancer patients and those who have recovered from mental illness face discrimination because people believe them to be disabled.

I hope that Ministers will recognise these sad realities, avoid the easy options and include those suffering discrimination because of perceived disability. A comprehensive and wide-ranging definition of disability would rescue people from the wilderness of distress and even despair. To fail to do this would be an abdication of responsibility and a morally wrong evasion. Stigma cannot be abolished by legislation but it can be tackled and dealt with effectively if the political will is there. I am sure it is with some Ministers and I hope that those who are converted will convert the whole of the Government when this famous Bill is brought forward.

The question of definition of disability is therefore not one of theoretical abstraction but one of profound importance to millions of people. That is why I have tried to deal with it. It is crucial that this problem of definition should be recognised by the Government.

It is certainly recognised by some responsible voluntary societies, such as the Law Society, which favours the inclusion of "reputed or perceived disability". The Law Society suggests that it is perhaps worse to be excluded from opportunities because of something which does not exist than because of something which does. That is debatable, but it is ironic to suffer lost opportunities if there is no disability. Surely, the Law Society says, it is not suggested that such people should be excluded from protection. Well, yes, that is what is suggested by the Government. In their consultative document they suggest precisely that, because they confine the definition to those people with a substantial and long-term disability or one with such effects. Therefore, the Law Society ought to have its own word with the Government.

If consultation by the Government has been meaningful rather than a public relations exercise—and I am sure that it was intended by the Ministers concerned to be meaningful—then perhaps Ministers will change their minds on this crucial problem of definition.

The Law Society makes a further important point to which I should like to draw the attention of the House. It suggests that, although the goal of: straightforward and easy to understand legislation", is welcome, there should not be a higher standard in this field than in others if the reason is to limit protection. That is precisely the reason, and that is why we want the definition changed. If the principle of full inclusion is accepted, it should be possible for the Government to clarify it through regulation and a code of practice.

I want to conclude by suggesting that the crucial issue is the principle that discrimination encountered by disabled people is not the result of their medical condition but of social circumstances. Only when that principle is recognised shall we effectively counter discrimination.

6.2 p.m.

The Lord Bishop of Worcester

My Lords, I am very glad that this debate is taking place and am grateful to the noble Lord, Lord Campbell of Croy, for the marvellous survey in his opening speech of the diversity of disability and disablement. That is the ground on which we have to work. We must recognise that there is an immense diversity. Nothing less than recognition of that fact will do.

I should also like to pay tribute to the enormous contribution which the noble Lord has made personally to the raising of awareness of the needs of people with disablement in this country. That came out in his speech, without his intending it.

Not only is there great diversity of disablement but there is an enormous diversity of voluntary and charitable organisations seeking to help those with disabilities. The number is so large and the field is becoming so competitive that I feel that any government must look at the need for core funding for those bodies. The charitable fund-raising field—as I know because I am chairman of the Children's Society—is almost ludicrously competitive. We organised the first sponsored walk through the Channel Tunnel, raising £2 million for charity—nearly £1 million for ourselves and £1 million for the other organisations which took part. What do we do next year—have a sponsored ride to the Moon? There is great difficulty in this field. Has not the Imperial Cancer Relief Fund had to reduce its budget by £6 million this very year? There is a real problem which must be addressed.

In our own county and my diocese of Worcester, only last week I was able to invite to my house a large cross-section of purchasers of services. The whole system of provision is very complex. I offer this as a suggestion to others. We want to set up a funding forum so that whether or not voluntary societies obtain funds is not such a hit and miss affair. There are large charitable organisations with a great deal of clout and professional staff, but there are smaller ones. I think of Crossroads in the Worcester diocese which provides time out for people who have a handicapped person in their house. That is something which they need. The funding forum would exist to ensure that smaller charitable organisations may find a path to the provision of funds and so that purchasers of the services which voluntary organisations offer may have an overall plan and there is a fair distribution of funds.

I welcome the consultation on government measures to tackle discrimination against disabled people. However, we could do with a clear, global statement of commitment to the rights of those with disabilities. I am grateful that Her Majesty's Government have ratified the United Nations Convention on the Rights of the Child. I believe that we need something similar in any legislation for those with disabilities. It is not good enough merely to say that we are a caring society. Care has to be organised. I hope that there will be a clear statement in any proposals which come forward in 1995.

There is a disparity in the response to benefit claims from area to area and from local authority to local authority. Could there be some unifying guidelines so that people are treated the same all over the country? It is true that those with disabilities or those families who have to care for people with disabilities face far greater expenses. I think of someone in the depths of the Teme valley in my county who suffers from a tendency to fits. The condition is under control, but that person may not drive. Therefore, living in that rural area she is unable to go out unless she hires a taxi or gets a lift from a neighbour.

There are sometimes difficulties over personal insurance. That issue ought to be addressed.

Furthermore, in the consultation to which I have referred there is no mention of education. I heard the other day of a disabled student who had to be put in a little box room to study on her own. The teacher had to come every so often to see how she was getting on. That student very much wanted to be with the others, to be treated as one of the others and to be educated along with them.

There is the question as to whether there should be a quota system in industry. I know that the suggestion has been put forward many times, but it is problematical in that some people with disabilities do not favour it. A quota has never been enforced. Those people do not favour the enforcement of a quota system because they feel that it sets them apart in a way that they do not want to be set apart. However, we need to address the question of how to ensure that disabled people have equal access to jobs, to the fullest life of which they are capable—a participatory life in our society and in industry, commerce and the professions—and are able to live as far as they can to the height of their powers. I hope that that matter will be addressed. There is no simple answer.

With regard to the convenience of our buildings, streets and transport, and access to them, there is still an enormous amount to be done in raising awareness. A great deal was done in the International Year of the Handicapped. But people grow weary of well doing. Do we need a disability commission which will keep those matters ever before us? Certainly I believe that we should strengthen the advisory body which the Government propose and give it some teeth. However, in the first and last resort, it is a matter of educating people, of improving attitudes.

One cannot make a nation good, as is well known, by Act of Parliament. I do not believe that we can make our society one which cares in a practical and organised way for people with disabilities merely by legislation, although detailed legislation is needed. He who would serve mankind must do so in minute particulars. But I believe that the measure of the civilised standards of a nation is to be found in the way in which it treats its citizens who have disabilities. As the noble Lord, Lord Campbell of Croy, pointed out, that requires persistent research. There is in people with disabilities a treasure to be unlocked if we only will unlock it. Perhaps it is right for a Lord Bishop to say that it is the basis of a Christian view of life that all should be affirmed, all should be enabled to live to the height of their powers, and all should be so far as possible both independent and interdependent.

I am glad to have this opportunity of taking part in the debate initiated by the noble Lord, Lord Campbell of Croy.

6.13 p.m.

Earl Haig

My Lords, it is a great privilege to be able to say a few words in the debate on this meaningful subject. It is particularly meaningful for me because my mind goes back to a march in 1926, and the British Legion parade from Horse Guards to the Cenotaph. I remember being with my father. There was an enormous parade of men on crutches and many in wheelchairs. Many of my early days were spent with such problems around me.

My noble friend Lord Campbell has chosen an appropriate moment to raise the problem of the disabled in the wake of the recent Statement about discrimination and on the eve of the proposed Government disability Bill. My noble friend, with a wonderful record of service to others, despite severe war disablement, has called attention to ways in which the community contributes to the alleviation of disablement. Perhaps the Motion should also have included a phrase emphasising service to the community, and how disabled people, despite their physical difficulties, place whatever health, strength and talents they may have at the disposal of the community.

Such a two-way approach has created links between the disabled and the communities to which they belong. Many communities have been inspired by the way in which disabled ex-servicemen have overcome their disabilities. A number of young servicemen are injured every year in road accidents while on duty or on leave from their units. They are discharged and left in hospital without support from the Ministry of Defence. They are left to themselves and suffer from loneliness and lack of support. The Royal British Legion is considering the establishment of a care unit in its village at Maidstone. I hope that the Minister will offer support to that plan if and when it comes to fruition.

Another Royal British Legion enterprise which deserves support is the British Ex-Servicemen's Wheelchair Sports Association which does much to raise morale and find jobs. Many of your Lordships will have seen its members at the Festival of Remembrance at the Albert Hall and will know of their success at the disabled Olympics. The Royal British Legion is hoping to move them soon from Docklands to a more accessible part of London.

In a recent Statement on disability, my noble friend Lady Cumberlege said that the objective is to give disabled people more power over their own lives. The Government Statement proposed the establishment of a national disability council. That is welcome at a time of bitterness over the loss of the disablement Bill last summer. The new Bill is urgently awaited by the British people who are aware of the need to improve facilities for the disabled. To accomplish that the Bill must provide legislation which will be effective. Some years ago various organisations representing disabled people—ex-service organisations among them—explored the idea proposed by the noble Lord, Lord Henderson of Brompton, to establish an organisation which would work on behalf of all the organisations. We had a meeting in the House of Lords. However, the tide was not right to achieve such an organisation, because there were too many differences between younger disabled people and the established voluntary organisations. But delays in closer cohesion will be to the disadvantage of the disabled.

One example of disabled organisations getting together is the organisation called Disability Scotland. The proposed national disability council would help to ease the difficulties of co-operation. It should advise the Government at arm's length; it should be a catalyst to enable disabled people to voice their concern; and it would be required to report annually to Parliament. To do all that it would need adequate funds. Perhaps in some ways such a body would perform the functions of the disablement advisory committees on which I served as chairman in the south of Scotland. It is now more than 20 years since I handed over and since then matters have improved. In my view the quota system was difficult to enforce. I am glad that it is now to be repealed.

Although I realise the need for better buildings and transport, I still believe that the problem of employment is at the crux of this debate: how to find job opportunities for the disabled and to mesh individuals with their particular capabilities into those jobs where they will find love, companionship and fulfilment. There is now the supportive employment scheme whereby financial support is designed to help employers take on individuals whose output is reduced, on the understanding that that output is not less than between 30 per cent. and 80 per cent. of that of a normal person.

There is the access to work scheme which seeks to overcome some of the practical obstacles and to ease disabled people into jobs. Funds are available to equip disabled people to take advantage of the scheme which provides supporters for disabled people, to help them use or understand special equipment. It helps visually handicapped people to understand the technical details of machinery by having instructions read to them. It provides special chairs for people with back problems. In the Borders region, a blind piano tuner has a supporter to drive him from piano to piano.

The Scottish National Federation for the Welfare of the Blind, though welcoming the access to work scheme, has criticised some of its requirements, particularly the £21,500 ceiling over a five-year period and the shelving of employer contributions pending further investigation.

Then there is the job introduction scheme which enables employers to take on registered disabled people for a preliminary period of six weeks, during which time they can recoup £45 per head per week against the wage. That encourages employers to try out possible employees while still uncertain whether the employment will succeed on a permanent basis.

So great progress has been made these last 20 years, both in the dominion of support schemes and benefits, as well as in the dominion of public awareness of the nature of disability. There is greater support available through modern medical skills and from social workers. There is greater care available at local level from individuals and voluntary organisations.

Help from the community is needed for families who have a member who suffers from mental illness such as schizophrenia. Professional alleviation of disablement is essential, but caring community support is also needed. It is at moments of anxiety, when help is essential, moments when there is stress, when worries turn to despair, that there is a real danger that the sick person will go off and live rough in large cities. That is a move which too often ends in suicide. It is in that context that my noble friend's debate is so relevant tonight.

6.22 p.m.

Lord Rix

My Lords, I begin with an apology that at this exceptionally busy time of year I have to leave before the conclusion of the debate, to fulfil a long-standing engagement. As well as owing apologies to those who follow me for not doing them the courtesy of being here to listen to them, I owe thanks to those who have allowed me to join the middle batting order to play a brief innings.

So many of the barriers that people with learning disabilities encounter are in our minds rather than in our architecture that I particularly wanted to take the opportunity that the noble Lord, Lord Campbell of Croy, has offered us. I also wish to join with him in doubting the wisdom of pressing the phrase "civil rights", which I suspect is a red rag to a government bull. We want that hull charging ahead with effective and comprehensive legislation—not pawing the ground and glowering at all and sundry in an agony of indecision because of semantics or because they fancy going next door to the field of cows.

All those years ago, in the dawn of the era of disability politics, when the noble Lord, Lord Campbell of Croy—I am sorry that he is not in his place to hear this compliment—pointed the way to the first major survey of disabled people, he can have had only a tentative idea of the developments that would follow. In making a determined effort to influence public attitudes for the better, we cannot be sure of the outcome. Virtue is not learnt by rote or goodness secured by instruction, but we can make a substantial dent in ignorance. That is worth doing.

The Government have made a move in this direction by producing a little booklet entitled YOU and disability, and there are posters all over the place proclaiming its publication. Imbued with the spirit of Christmas, I wish I could welcome this "guide for everyone" unreservedly. Alas, I cannot; for, while recognising the need for a public education campaign, I believe that this work of the Department of Social Security fails to address the real problems and issues facing disabled people, taking a superficial view of the world as it really exists out there for them. For example, in the booklet is the story of Steven who, has a learning disability caused by complications when he was born". The story may make you feel sad for a fleeting moment, but it does not really suggest that being treated badly, as has been Steven's lot, is quite simply discrimination of a particularly unpleasant and unacceptable kind. After all, bullying at school, being ignored in company, being turned out of a swimming pool are happenings in the lives of many young people, disabled or otherwise—more's the pity. Steven's story seems relatively common. The horrors of intolerance, inhumanity and ignorance faced by so many people with a learning disability are kept well at bay, while the degrees of disability, from a learning difficulty to a profound and multiple handicap, are dealt with only fleetingly.

On the other hand, Mencap is producing a schools pack with teacher's notes which seeks to do in greater depth for the younger generation what the Government's booklet does more parsimoniously but for a much larger audience. The Mencap pack talks about discrimination and prejudice, about what people do, not knowing what they do. It tells stories of people with a wide range of learning disabilities and related disabilities, so that they can be seen as real, three-dimensional people, not types of disablement.

The worst thing we have done to people with learning disabilities is to put them in boxes of our making, with labels of our choosing. What can we do to make amends? Can we avoid the heresy of treating them all as people from another planet, without falling into the other heresy of pretending that there are no differences?

I want to offer three suggestions. One is that some of the new money for improving the access of disabled children to schools should be used to encourage imaginative projects for children with profound and multiple disabilities to share time and activity with children without disabilities in a way that will benefit both groups.

The second suggestion is that in diversifying and in plugging the large gaps in day services, we build on the experience of teaming up people with and without learning disabilities as partners in leisure. Mencap's leisure arm, the Gateway Federation, is already developing such activities and it is clearly a fertile ground on which to sow and reap.

The third suggestion is that, in celebrating the 25th anniversary of the 1971 White Paper on what were then called "mental handicap" services, we produce for a mass audience some of the success stories of community care, seen through the eyes of the people themselves. There are those out there ready to say that community care has failed; and there are communities out there which are failing as communities. Lack of money is generally blamed for any shortcomings, but I believe that the worm of discrimination is at the core of the problem.

Clearly, public education is of vital importance in any campaign to change attitudes and the Government are now coming round to the view, long held by many of us, that such a change has to be backed by legislation. A pity, maybe, but a prerequisite nevertheless. It was Alexander Pope who wrote: 'Tis education forms the common mind, Just as the twig is bent, the tree's inclined". In the first two years of life, children seem to be wholly unaware of disability. Thereafter, they learn prejudice … from us. Since Christmas begins with a small child, maybe we can drag ourselves nearer to one of the virtues of early childhood and give open-minded acceptance a chance—not only at this season of goodwill, but when the realities of the year ahead have once more to be faced.

6.28 p.m.

Baroness Masham of Ilton

My Lords, I should like to thank the noble Lord, Lord Campbell of Croy, for giving your Lordships the opportunity of discussing this subject, which involves so many families throughout the UK as well as individuals with disabilities.

A short time ago I attended a lecture at the hospital for neurological conditions in Queen Square here in London. The consultant who spoke had an enormous list of different and varied conditions which came under the umbrella of neurology. Some of these are obvious; some are not. If the conditions are not treated by the experts, who above all are interested in the problems, the complications are manifold.

Beyond the field of neurology many other conditions result in disability. I know from first-hand experience that had I not been treated in a specialist spinal unit by experts, I should not be here in this House today. If I had to set one priority for the way in which the community in the United Kingdom can contribute to the alleviation of the many different kinds of disablement which occur from genetic problems, illness and accidents, it would be to have expert medical personnel who understand the various problems. If the conditions are not treated correctly, complications will arise. Treatment, research and rehabilitation all go hand in hand: treatment for the condition; research to find ways of stopping a condition happening or alleviating it, or to find ways of mending or regenerating nerves such as those in the spinal cord, which is so complex that nobody as yet knows how to do that; and rehabilitation to make the individual as independent as he possibly can be for as long as possible. Ongoing check-ups are also necessary so that the person can keep as well as possible in the community.

Of the many changes that have taken place in the National Health Service—some of them necessary but some damaging —the most worrying is that a number of the excellent specialising hospitals feel vulnerable even though they are recognised throughout the world. This is very serious for patients, who feel that their lifeline might be cut, and it is damaging for hospital staff, who want to get on and find ways of curing or alleviating complex conditions. If staff morale is bad, patients are affected.

Yesterday I attended the parliamentary carol service. I sat next to a charming man who was using a wheelchair. He had multiple sclerosis. How important it is to give such people hope that research is continuing. With the funding of extra-contractual referrals, problems are arising. Health authorities are saying that they will not pay for patients to go to specialised units if it is for research. But without research how can we hope for any progress in these devastating and complex conditions?

I am at the moment dealing with the case of a person who suffers from the results of organophosphorus poisoning from sheep dip. The health authority does not want to pay on the grounds that it is a matter of research and may not be of benefit to the person. At the moment there does not seem to be a cure. But, with interest, and with clever doctors doing tests and observing the symptoms, advances in treatment may be made. At least there will be hope that something is being done. That case is still unresolved. The health authority is looking at it, but relationships with the family and the general practitioner involved have almost broken down.

Another case was brought to my attention on Sunday night. In that case, relations with the GP had broken down and those involved were in the process of changing their GP. This was a case of ME, where the wife had had to give up her job as a result of exhaustion. If there is not to be a deluge of people leaving their GPs because of the Patient's Charter, should there not be more training of GPs in the many and varied conditions that result in different forms of disability? When relationships break down, stress increases —and stress is not productive for anyone.

There is a new Bill before Parliament which provides for the merging of the health authorities and the FHSAs. That will cause a great deal of extra work, as mergers always do. I am concerned about the pressure on patients, whose needs should come first, because it is natural that staff will be looking to their jobs as a priority.

As I said, disability is very varied and complex. A new set of rules for people with intermittent disability will come into force in April. Such disabilities can be made worse by things that the patient does: by the exertion of walking or carrying out a task. I should like to ask the Minister: when people with those kinds of conditions come for assessment, how will the adjudicating medical officer take account of people's various levels of disability without medical evidence such as records and the advice of GPs and specialists? Will there not be many cases going to appeal? Will the new system not be more bureaucratic and cumbersome in the long run? Lots of appeals and tribunals will add stress for the disabled person. That is why I feel that there should be encouragement to general practitioners to take an interest in and understand disability. So often they just want to pass the problem on to the social services as a social issue. Given the pressure on health funding and the even greater pressure on social services, people with disabilities may well fall between the two and become very much at risk, with the danger of pressure sores, which cost the country millions of pounds, and a lack of help from social services with activities such as having a bath, which has now been cut to only one in every two weeks.

Yesterday, some noble Lords heard from the Association of County Councils that some social services were working on crisis programmes only. The tragic situation is that only severely disabled people are getting help. So many just need a little help to keep them going in the community. They are not getting that help. If the Government do not listen to the very many pleas for help, these problems will not be alleviated, they will be exacerbated.

Disabled people need adequate housing. If they use a wheelchair or have difficulty in walking, they need housing without steps, and suitable bathrooms and kitchens. The disabled population now includes those people with AIDS. There is an urgent need for flats with warden help. I hope that housing associations will extend their help here. They also need help with transport, as has been mentioned. Such help is vital, but it is not very often forthcoming in many rural areas. Such schemes as Dial-a-Ride and Taxicard are of great help. There are so many vital needs crying out for help.

As North East president of the Kidney Association, I was very concerned to read the following in the press on Monday: NHS units unable to cope with the rise in kidney patients". Wherever I look I see the needs of many people with disabilities. I wish that the lottery money was going towards meeting some of those needs. However, we welcome the money that may come for disability and the arts. At least there could be tax relief, so that people who do pay taxes can offset against tax some of the extra costs that are due to their disability.

I look forward to the Minister's reply. I look forward also to the Bill on anti-discrimination legislation, because people up and down the country who have disabilities need it in this pressurised society.

6.40 p.m.

Lord Selsdon

My Lords, I feel that the scale of the problem which confronts us—my noble friend Lord Campbell of Croy, in his inimitable way has raised the matter again and drawn attention to one of the greatest issues that face our society—is perhaps matched by the scale of the opportunity. In preparing for this debate and lacking experience in this field other than as the member of a family which has many problems of a similar sort with disabilities across the board, I wondered whether we were back in the Dark Ages.

I walked through the Royal Gallery and looked at the two great pictures of war there. I recalled that if you were an able bodied seaman and had a splinter in your leg as a result of a cannon, you would lose that leg within a few days; or if you fought in the field of war on land, similar things would happen. I recalled as a small boy talking to my grandfather, of whom I was very proud because he had won the Sword of Honour at the Britannia Naval. College. I wondered what he had done in the Great War, thinking that he must have risen to great rank. He had been invalided out at an early age because of Malta Dog. Wishing to join up, but having failed because he was disabled, he became a stretcher bearer at the front. Over Christmas he used to tell us stories of how he, as a stretcher bearer, would bring in someone with a wound and a surgeon would take off the limb there and then. He would be given that limb to dispose of and would wrap it in newspaper and bury it in a field, only to see it blown up or dug up by dogs a few days later. The horror at the scale of it—death came not from being killed immediately but from disability—made me wonder, if I were faced with the choice of being severely disabled or dying, which one I should prefer.

Things have moved on since those days. There have been technological developments based upon research over time. There has been the development of antibiotics, obviously, and in the early days the development of artificial limbs to replace the pegleg stump. More recently there has been better use of technology and new materials.

Much has been done in this field but to me it is sad to find that we, the British, brilliant though we may be in the invention of new machinery and new technology, fail to obtain the research resources to develop and apply that technology. To illustrate that point, let me choose but one area: the orthopaedic area. Noble Lords will know that these days some of the most successful and common operations are the replacement of parts—nothing more than the maintenance and repair that every car is expected to receive from time to time when components wear out. As we get older, our minds perhaps begin to outlive the capacities of our bodies. Our bodies may be in need of repair due to bone degeneration or as a result of accident brought about by a lack of stability. Such repairs are an area in which the British were pre-eminent. I refer to hip replacements, knee replacements, elbow and shoulder replacements—everything. It is of course based upon engineering.

At the end of the First World War there were many disabled who needed new limbs. Since then, there has been a need for replacements, for equipment and units, that often came from defence technology. Noble Lords will know that the retractable undercarriage ultimately led to the splendid, collapsible baby chair and often to the success of British designed cars in grand prix motor racing. But hip replacement is an area which has interested me. I am trying to help one of the organisations which raise money for those operations—the Wishbone Appeal and the British Orthopaedic Association.

In the early 1960s there were two men—Mr. McKee and Mr. Charnley—both of whom developed in parallel the first hip units. The joints were hinged and did not work very well. But to some extent they began to get rid of the disability which affects so many people: abject pain. Over time, perhaps over 10 years, that technology was developed by the London Splint Company and by Thackeray, two British companies which, sad to say, fell into American ownership. New developments arose. At present some 50,000 people in this country have hip replacements every year and with them goes the removal of pain. In the United States the replacement of knees has overtaken the replacement of hips, one of the most common operations of all time and almost guaranteed success.

But in this field, if there are no researchers, as the noble Baroness, Lady Masham, said, we fall behind. How far behind are we? I am told that, because of the technology available, we are desperately short of orthopaedic surgeons and that we have fewer doctors per 100,000 of the population than any European country other than Turkey—and there is a question of whether or not Turkey is in Europe.

These areas of development require money but they also require commitment. They require a mood. Your Lordships will be aware when a particular topic has, from time to time, captured a nation's imagination and the money, sponsorship and thought start to come forward. In the engineering divisions of our universities, there are ample numbers of people capable of pursuing and developing research alongside the Government, the orthopaedic organisations and others. One may be surprised to find that the grants that are made to universities by private individuals, often in their wills, are for the development of medical research in many fields.

It is a difficult and sad area. But I have had great pleasure when, from time to time, I have been involved in activities with the disabled. Yesterday we had our annual tea party for what are called "the children of courage". It was held after a very moving service in Westminster Abbey. Children who have committed acts of bravery are honoured and always half of them are those who have suffered from some major disability as a result of disease or an accident but they have come through smiling and shining. Yesterday, one small boy, who had lost one of his legs because of meningitis, announced with pride, as he showed his award to us all, that he was now hoping to be captain of the school football team, because of the technology that had come with the movements in engineering.

I do not know who in this country is responsible for the development of research in these fields. It is interesting that often the very people who have benefited as a result of technological development are those best able to promote and encourage the raising of more funds. Should your Lordships feel like attending, on 4th June next year we are having another of those "hippy walks"—perhaps I might invite the right reverend Prelate the Bishop of Worcester—where disabled people who have had hip replacements walk a mile along the Thames, having a great day out. They are not raising money for charity but for research. Raising funds for research should not necessarily be charitable. There are many people who, if they knew that their personal effort of sponsorship was going into that field to alleviate suffering and help other sufferers, would put a lot more into it.

We have a long way to go. The Dark Ages are long past. We have the technological ability to develop equipment and services which can turn able bodied people who have become disabled into able bodied people again. It is only a matter of technology and commitment.

6.49 p.m.

Lord Quirk

My Lords, I welcome the opportunity to contribute to the timely debate introduced by the noble Lord, Lord Campbell of Croy.

We hear a good deal in the media about care in the community. At least, we hear about it when things have gone wrong. This is of course necessary in order to trigger rectification. What we do not hear about so often is when things have gone right; and that is just as necessary if we are both to reassure the disabled and to give proper recognition and encouragement to those whose hard work and dedication have resulted in the good news that reporters ignore.

Time was when communities assumed responsibility for the local disabled without question; when their charitable instincts were all the better for it; and when indeed the disabled had precious little other recourse. That is still the position today in many parts of the world: still, also, the position in rural areas of our own islands. Given the fact that as many as one-fifth of the child population may have a "special educational need", it is not surprising that in the small farming community in the Isle of Man where I grew up, we had our share of the congenitally disabled. But in so far as their handicaps permitted, they took part in the social, educational and recreational life enjoyed by the rest of us.

Let me tell your Lordships about Bessie, a deaf-mute girl on a neighbouring farm who, so far from being isolated, had the extraordinary effect of stimulating the dozen or so girls of her age-group to acquire the then current sign language (largely finger spelling, I think). I can recall the mixture of admiration and envy I felt as Bessie and my elder sisters enjoyed silent, giggly anecdotes I could not follow. Who taught Bessie and her mother, I do not know. Nor do I know how her friends learnt the system. What I do know is why they learnt it. Bessie was part of the social circle. Her place in it depended on the co-operation of the rest. Needless to say, she benefited by being able to join her peers in reading and writing, knitting, playing cards and Christmas party games. But her circle of friends benefited too, not only in her being an addition to the very small peer group, but because they discovered in Bessie talents she possessed in greater quantity than they themselves. And they learnt to empathise with what the politically correct would now call the "differently endowed".

Of all the disabilities embraced for the purposes of this debate by the noble Lord, Lord Campbell of Croy, it is of those affecting communication that I have had most experience and it is on these that I should like to focus my few words. But they are certainly also among the most obvious of the disabilities that can be alleviated by active, informed, community support.

This is increasingly accepted within the education system, not least as a result of the inquiry conducted in the late 1970s by the lady who subsequently became the Baroness Warnock. In this respect, the Warnock Report of 1978 was following the recommendations of the Snowden working party of 1976, which on page 7 of its report stated: Integration for the disabled … means social acceptance. It means being able to be treated like everybody else. It means the right to work … to contribute materially to the community, to have the usual choices of association … to be educated up to university level with one's unhandicapped peers". Children with "special educational needs"—whether it be learning disability, hearing loss, cerebral palsy, autism, or a specific language disorder such as dysphasia or dyslexia—are immeasurably helped in their communication difficulties by being thus integrated so far as is possible with their age group peers. And as in the case of my neighbour Bessie, the benefit flows not only to the afflicted.

A recent joint publication by the Dyslexia Institute and the City Technology Colleges Trust is illuminating in this respect. Sir Philip Harris's very successful career masks the enormous difficulties he suffered as a child through being seriously dyslexic, so it is not surprising that in the South London CTC that bears his name, there is a notably active Dyslexia Centre. This operates as the engine for a "whole school" approach to supporting the unfortunate minority whose maths, writing and reading are all adversely affected by their dyslexia. To quote from this publication: The first step is for the whole school community—students, staff, head, governors, parents, neighbours—to see themselves as responsible for helping to carry out the aim", of ensuring that every disabled child has access to the entire range of education.

I have paraphrased the document here with this phrase "every disabled child", for of course such a "whole school" approach fulfils the needs not only of dyslexics. As was said recently by the head of the Humberside County Council's Education Centre: If a child has one muscle in his body which responds consistently, we can access the National Curriculum for him". Her words reminded me of the Dublin working-class mother who noted just such a single muscle in her little boy and who, along with her neighbours, nurtured that single ability until the little cerebral-palsied boy became the world acclaimed writer, Christy Brown.

In the well-structured operation of a "whole school" policy, the disabled develop their fullest potential and the rest of the school learns how rewarding it is for the able to help the afflicted. So it is—and has always been—in the world outside school: in the communities of the workplace, of the pub, of the church. And we today, as has been noted, have the enormous advantage of skilled professionals, trained in addressing the specific needs of those disadvantaged by a wide range of ills. But in fact this can have a downside. Their very existence and the professional nature of their expertise is one of the reasons for our tendency to believe that there is little that lay folk can do by comparison: little that they need to do, perhaps. We are tempted to shift responsibility to the health professionals, and turn away.

How disastrously wrong such a conclusion is can be seen by a brief glance at speech therapy, the profession most concerned with the whole range of communication disability. As I was privileged to remind your Lordships during a debate in October, here is indeed a highly skilled, deeply motivated, superbly dedicated profession. But they number only 4,000 or 5,000 for the entire country. On top of their delicate task of diagnosis, assessment, design and prescription of treatment, they are also the people who, as their name implies, are responsible for carrying out the actual therapy. This means that most therapists have a dauntingly large caseload and can sometimes see a patient for only a single session per week. It is all too easy to see how the effect of any such splendidly prepared intervention quickly wears off if it is not strenuously reinforced by loved ones in the family, teachers in school, or friends at a social centre.

But this is what I had in mind when I referred earlier to "active, informed community support". Because, in an advanced country like our own, we have these expertly trained professionals like speech and language therapists, lay folk in the community should feel that they now have access to their skills and the chance of building up precisely the kind of informed support which can indeed reinforce the specialised but necessarily brief and infrequent therapy sessions.

What I should like to see, in fact, is the health professions diverting some of their time from a one-to-one treatment of individual patients and using it to devise delegable strategies of treatment and support which can be implemented, not for one hour a week by a professional expert, but for several hours a day by family, friends, volunteers: in short, by the community.

7 p.m.

Lord Addington

My Lords, the Motion before us tabled by the noble Lord, Lord Campbell of Croy, draws attention to the wide diversity of the disability problems that we are faced with in this country today, as have the speeches that we have heard so far.

I first began to talk about one type of disability when I made my maiden speech in this House. I spoke about dyslexia. On many education Bills we have tried to get more attention paid to special needs. There are other people who know about other types of disability and they have made contributions. When discussing these Bills and these problems, we have discovered the different perceptions of what should be done, where we should go with help for the disabled and we have found out about the different kinds of problems.

I have used the example of someone who has had his movements restricted by being in a wheelchair. The case I had in mind was a classroom situation with that person being unable to go into a classroom, but being quite capable of taking the lesson. As the noble Lord, Lord Quirk, has mentioned, we have dyslexics. I am one myself and we have a different learning curve and we need different teaching processes. It may be that for certain lessons a dyslexic can very easily get in and out of a class but needs different types of tuition.

Usually, both situations can be accommodated if there is sufficient will. That is what is required to help all these groups: it is the will. The Government have legislation pending which will take steps towards giving better rights, no matter what those rights are called, whether civil rights or basic human rights. It is a question of giving disabled people rights which will enable them to be treated on a par with others. That is vitally important. We are not asking for special consideration or favours for the disabled of this country. We are asking for them to be shown enough consideration to enable them to be treated on even terms.

The legislation which we have in front of us is not as all-encompassing as many of us would like, but at least it is a start or, rather, one further step along the path. We have made progress before. The code of practice for special educational needs was a great step forward in that field. We are now moving into the world of work, but the Government are approaching it in rather a piecemeal fashion. I believe that most of us feel that they are taking a great deal of pushing to achieve their goal, but at least their appears to be some movement. One can only hope that we have overcome most of the initial inertia and that we shall make progress rather more rapidly in future.

We have to try to take on board the fact that we are dealing with a vast range of disabilities. We have to take on board the fact that we have to give knowledge about the vast range of disabilities. We have to try to educate people. Because something is not understood it should not be distrusted: one should try to get information. That means that we have to make it readily available, but at the moment it is not.

Various organisations and charities are involved in certain activities which are generally called in the charities field "awareness raising". That involves arranging a meeting, a press release or the celebration of an achievement. Then one talks about what has been achieved in that field and emphasises what could be done and also talks about the problem. The Government have not really taken that full level of activity under their wing. They have left it to the charities. I can understand that the Government would not want to try to replace all the things which charities do, but certainly they could become more involved in this field. Surely the Government should become more active in explaining consistently to people what, for instance, having dyslexia or having a learning disability means and the difference between those two types of problems and the different types of appropriate help.

When the new legislation comes to fruition the new advisory body will have a formidable task in terms of employers. When the Minister replies tonight I hope that he can give us some idea of the actual composition of that body and from where it will be drawing its expertise. That would be a help because then we would know to whom we can make suggestions.

One of the major problems is that the range of subjects is so wide that it will always be virtually impossible to guarantee that all the combinations of problems that may occur will be covered.

Another subject which has been touched upon in this debate is that of research. The noble Baroness, Lady Masham of Ilion, mentioned the need for research into various fields. Another noble Lord mentioned the idea of being able to give better assisted joints and limbs to people through other types of research. This is an area where the Government really must take the lead because charities cannot do that. Many of the disabilities which have a genetic base have, possibly, a bio-chemical origin. There is the example of gene therapy.

It is possible that these problems can be avoided. Some kind of remedial action can be taken once the danger has been spotted. Those problems cannot conceivably be addressed by the charities or other private groups. We are talking about major funding with vast amounts of resources. We are talking about open-ended funding. How many charities can afford to pump possibly millions of pounds into an area of research which may well turn into a dead end, because that is the nature of research?

I have a connection with several small charities. Putting this kind of project to them is something which may make them turn white with shock or just laugh. The charities cannot carry out such projects. The Government have to state their claim here because the charities cannot do it. If we manage to alleviate these problems or prevent them occurring again, we will be saving vast amounts of money in the long term. Not only will human tragedies be avoided, but we will also please the Exchequer.

One would have thought that this kind of investment, which may even be sold afterwards, would be something which the Government would take on and that they would say "Yes, we shall help". There is much more that can be said on this subject for the simple reason that it is so vast.

I leave noble Lords with one thought: we shall always have new problems in this field, but we can take mighty strides towards alleviating many of their symptoms even if we cannot eradicate all of them, by making sure that people know that the disabled persons whom they are dealing with are, first and foremost, people. I very much look forward to the day when we shall have it in law in this country that such people are entitled to basic rights be they civil, human or any other kind.

7.9 p.m.

Baroness Hollis of Heigham

My Lords, like other noble Lords, I sincerely thank the noble Lord, Lord Campbell of Croy, for initiating the debate which allows all of us to recognise and affirm the individual nature of disability and the distinctiveness of a disabled person's experience. My noble friend Lord Ashley of Stoke reminded us of invisible disability. The noble Lord, Lord Rix, reminded us of learning disabilities. The noble Earl, Lord Haig, spoke about the war injured. The noble Lords, Lord Selsdon and Lord Quirk, and the noble Baroness, Lady Masham, referred to those needing specialist medical and orthopaedic help.

As the noble Lord, Lord Campbell of Croy, said, the word "disability" brings to mind the image of the guide dog or the wheelchair. However, as the noble Lord, Lord Addington, rightly pointed out, tonight we are talking about the differences. It is worth reminding ourselves that, for every 1,000 people, three of us will have severe learning difficulties; another 20 will have some impairing degree of learning disability; six of us will have a significant loss of hearing since childhood and over 100 of us will be wearing hearing aids; 10 of us will be in wheelchairs and 10 of us will have dementia—namely, Alzheimer's; 17 of us will be blind or partially sighted and 100—that is, one in 10—will have mental health needs, to say nothing of those with asthma, angina or arthritis. Our needs—their needs—are different. Our abilities—their abilities and their disabilities—are different. Their aspirations are different and the demands that they may make on services and carers will be different.

The Disability Income Group has shown what that means for two real-life families. Jennifer is a five year-old child with severe cerebral palsy. Her parents already face heavy laundry bills and heavy costs because of extra clothing and bedding, fitments for the wheelchair, as well as heating costs and the like. They amount to some £60 per week. If Jennifer had a lightwriter, which would allow her to communicate by blinking, that would cost £2,400. A special chair with adaptations for her parent's car would cost between £6,000 and £7,000.

The DIG also cites the case of James from another real-life family. He is 57 and brain-damaged as a result of an accident. His sight, speech and hearing are worsening. He is sometimes violent. He is often dizzy and spends his time playing expensive computer games. His wife cares for him around the clock. She tells DIG that she has to have domestic help at £21 per week, that he needs private physiotherapy at £20 per week and that their laundry, clothing, bedding and hygiene costs amount to £50 per week. Almost £1,000 has been spent replacing furniture that has been damaged, to say nothing of the computer games.

As my noble friend Lord Ashley reminded us, someone with hearing difficulties may need amplifiers or interpreters. Those with loss of vision may need anything from a magnifying glass to a talking calculator. Someone who has broken his or her back in an accident and is now in a wheelchair but who has the capacity and the will to seek work may well need to employ a team of carers throughout the day and night.

As each and every one of us has said tonight, the abilities and disabilities are different, yet what disabled people have in common perhaps outweighs the differences between them. What they have in common is not so much their disability, but their poverty and the poverty of their carers. Two-thirds of the nearly 7 million disabled people in this country live in or on the margins of poverty. It is poverty that reduces their quality of life, disables them and excludes them from mainstream society.

Three out of four disabled people live on social security benefits. They are three times more likely to be unemployed and, if in work, they are likely to earn much less than non-disabled people. Yet, with lower incomes, disabled people and their carers face higher costs. Being disabled is extremely expensive because of taxi fares, home adaptations, special diets, extra laundry, additional heating, personal care and special equipment. Disabled people have lower incomes but higher costs and an inadequate and incomplete benefits system to bridge the two.

What is wrong with the current benefits system? First, it is horrendously complex. I tried to count the benefits. It appears that there are something like 30 different disability benefits to which a disabled person or carer may be entitled. It is a full-time job being disabled.

Secondly, the actual level of benefit for both disabled people and their carers is woefully low. If he or she is fortunate, the average carer will get an invalidity care allowance of some £35 per week if caring for someone full time for more than 35 hours per week. However, if the carer cares for two people for 20 hours each a week, the carer will get nothing at all. Therefore, the carer's income depends in turn on the type of benefit which the disabled person is entitled to claim, thus affecting all sorts of relationships.

Thirdly, the way in which and the place where someone becomes disabled, where they have worked, their age and their national insurance contributions determine what they get. So two people who are equally disabled may find a difference in their benefit of over £200 per week. What is needed is a benefit that reflects not how or why people became disabled or where they incurred their disability—or even how disabled they are—but a benefit that reflects what is necessary financially in order to provide that person with an acceptable quality of life.

Fourthly, although the level of benefits is determined nationally, the cost and quality of care in the community is locally determined, as the right reverend Prelate the Bishop of Worcester said. Whether local authorities do or do not charge for home helps, day centres or personal care is up to them, and whether they do or do not charge makes a tremendous difference to the disposable income that is available to a disabled person for heating, laundry, diet and taxi costs. Referring again to figures from DIG, Hertfordshire charges a minimum of £18 per week for three hours' care. That is about half of the entire DLA care component. In Doncaster, which has privatised its non-medical care services, clients—disabled people—are being charged over £5 per night and nearly £5 per day for care. Some authorities are even considering asking people on income support—the most minimum level of income—to pay for care services. Why? Not because local authorities are nasty, but because the Government have required local authorities to recoup 9 per cent. of their costs through charges. How are they to be met? By charging disabled people. From where do the Government expect disabled people to find that money apart from top-slicing it off their benefit, which is what they will have to do?

Fifthly and finally, I should welcome a comment from the Minister on what appears to be an emerging problem in the benefits system for disabled and partly disabled people. It looks as though people are going to be signed off what is now invalidity benefit and what will become incapacity benefit on the ground that they are fit to do some light work. Already, however, the NACAB is finding that one-third of the people who are referred to it are having difficulty being regarded as fit and available for work and so do not qualify for unemployment benefit and may not in future qualify for the jobseekers allowance. So, people are being disqualified from one benefit but are failing thereby to qualify for another. What are they to live on?

Few disabled people can survive on their benefits or on so-called "care in the community". Instead they are subsidised. By whom? Their carers. Those carers spend their own money on diet, heating, laundry and transport for the disabled person. In the process, the carers exhaust their own savings and too often go into debt. Indeed, they are often dependent on benefits themselves. When their caring responsibility ceases—I hope that the Minister will tell me that I am wrong on this—they will apparently not be eligible for benefit because a disqualification from unemployment benefit will be carried over to the JSA if they relinquish a caring responsibility and, as a result, have fallen short in terms of their national insurance contributions. So they are poor. They are often in poor health. The result of being a carer means that they in turn become so socially isolated that they lose the opportunity of being cared for in their turn when they need it.

The Alzheimer's Society has told us that half of all its carers spend more than 80 hours a week employed in care: two-thirds of them are stressed or tired; a third are lonely; and a third are in poor health themselves. That is why I hope—again I should welcome the Minister's comment on this—that the Government will look sympathetically at the Bill being promoted by the Carers National Association —the Carers (Recognition and Services) Bill—that my honourable friend Malcolm Wicks is introducing in the other place this afternoon which would require local authorities to assess the needs of carers and to be responsible for providing services such as respite care to carers.

As we all know, many disabled people do not want, and rightly do not want, to be dependent upon a carer to be cared for. They are able to care for themselves if they have the income to do so. That is why direct payment—we welcome the Government's proposed initiative on that—may become important to empower a disabled person to make the choices that all of us here take for granted each and every day. For other disabled people, especially those with learning difficulties, dementia, a fluctuating condition, chronic illness or who are in pain, their carers are their lifeline.

The relationship between a disabled person and his carer is not always easy. It is sometimes reluctant; it is sometimes conflictual; but care is usually offered with tenderness and generosity, and usually accepted with courage and grace. Let us be in no doubt that the most appropriate way in which the community can respond to disability is by ensuring that disability no longer means poverty; that carers' needs are assessed and met; and that disabled people enjoy the rights, opportunities and choices that only a proper civil rights Bill will guarantee.

7.22 p.m.

The Minister of State, Department of Social Security (Lord Mackay of Ardbrecknish)

My Lords, I thank my noble friend Lord Campbell of Croy for giving us the opportunity to debate disability and to keep it on the agenda. Over many years my noble friend has kept the issue on the agenda. He is walking proof, even with the disability that he suffered in the Second World War, that one can be very active in one's chosen career and reach the top; that is, I suppose, if one considers being Secretary of State for Scotland being the top.

My noble friend represented a constituency just about as far away from Westminster as one could get. Travel arrangements which today are very simple—my noble friend began as the Member of Parliament for Moray and Nairn—were, I imagine, very complex. It is a big constituency, although not as big as the one that I had the honour to represent. My noble friend did not just represent the people of Moray and Nairn well for many years; he became Secretary of State for Scotland, and anyone who has served in government at any level—I never reached those exalted levels—will know that that involves a great deal of work, a great deal of travelling and a great deal of meeting people. My noble friend is an example to all disabled people that one can overcome such problems and reach the top of one's chosen career or profession.

Over the past 15 years the Government have notched up an impressive record. Increasingly, disability has been given a high priority. We have pursued a range of reforms, from widening and improving the benefits system, to the introduction of community care and the introduction of the Access to Work programme, to list but a few. They were all designed to improve the lives of disabled people.

Some 10 years ago, the Government commissioned the most thorough and comprehensive survey of disability ever undertaken in Great Britain. In the light of that survey, we introduced a coherent and integrated package of changes. In introducing the debate, my noble friend Lord Campbell of Croy attempted to show what was behind the ballpark figures that are often thrown around without too much thought. The most interesting point may have been the distribution of people who are elderly as well as disabled within the 6.5 million—which I noticed during the course of the debate grew to 7 million. It does not help too much to expand numbers beyond those upon which we agree.

The main changes from April 1992 focused additional help with the extra costs of disability on those people who are disabled from birth or early in life, on those who are unable to work or to save and on those who received no help from the previous system. They provided help for disabled people who can and who wish to work by making it easier for them to keep or take work. To date, that package has provided extra help for about 1.5 million disabled people at an estimated additional cost of £625 million this year.

By introducing better targeted benefits, we have been able to direct significantly more help towards disabled people. Total spending on benefits for long-term sick and disabled people and their carers has trebled in real terms since 1978–79 to about £17 billion in 1993–94. I shall repeat the figure because noble Lords who perhaps listened to the noble Baroness, Lady Hollis, may have been forgiven for assuming that almost nothing was being spent in that field: £17 billion is a considerable amount of money, and a 237 per cent. increase from the days when her party was last responsible for such matters.

In addition to the benefits system, Section 2 of the Chronically Sick and Disabled Persons Act 1970 requires authorities to provide a range of services, if necessary, to meet assessed disablement. They include the provision of recreational facilities, home adaptations, clever devices and new materials which, with the improvements in technology, have come on by leaps and bounds; practical assistance—for example, in holidays and meals, telephones and various items of special equipment, which are increasing in number all the time. Local authorities are fully aware of those responsibilities and I believe that they face up to them all over the country.

The noble Baroness, Lady Masham of Ilton, asked me about the incapacity benefit in relation to targeting benefits. The introduction of that benefit represents a fundamental reform to achieve a more coherent approach to incapacity provision and a more affordable system. I assure the noble Baroness that adjudication officers will consider and weigh all the evidence from the claimant, the claimant's doctor and the Benefits Agency's own medical staff in deciding whether a person is incapable of work. I trust that that covers the point she raised about people with intermittent difficulties.

The community care reforms gave thousands of disabled people the chance to stay in their own homes rather than lose their independence and go into care. I was grateful to the noble Lord, Lord Quirk, for saying that there may be the odd horror story in the newspapers—who can believe the scale of them from what the newspapers say?—but let us not forget that up and down the country there are excellent success stories which it would be nice to see reported to encourage everyone in this new, excellent idea of looking after people as far as possible in the community and in their own homes.

The implementation of that policy has been a good story for disabled people. The new arrangements give local authorities the flexibility they need to tailor services to individuals. The point made by my noble friend Lord Campbell of Croy and other noble Lords was that these people are individuals, and it is not easy to classify them in great chunks of disability. People with the same disability may have a different range of difficulties within that same disability, and there are all the differences between various disabilities and the problem that people often have multiple disabilities—something of which we should not lose sight.

We believe that the new arrangements mean that the users and the carers are fully involved in the process of developing the care package and that their preferences are taken into account. This year local authorities in England have received £4.6 billion for community care services. That includes additional resources of more than £1.2 billion to meet their new responsibilities to implement the new reforms. In the coming year they will receive £5.1 billion for community care services, including £1.8 billion for their new responsibilities.

A major aim of the Government has been to encourage more employers to concentrate on the abilities rather than on the disabilities of employees. Progress towards this aim has been made, with more than 950 employers now using the disability symbol that signals their commitment to the employment of disabled people. The Access to Work programme, mentioned by my noble friend Lord Haig, was introduced in June and it is a positive step in the right direction. It provides a wider range of help for people with disabilities, helping them to overcome physical barriers and with transport costs. Assistance is flexible enough to meet individual needs; for example, it can provide communicators for deaf people and support workers for those with learning difficulties. That will help to make work a reality for many more disabled people.

But we still have a long way to go. Attitudes cannot be changed overnight and it will take time before disabled people are totally accepted as full members of our economic and social community. A number of noble Lords made similar points today. Discrimination exists. Much of it may be unintended or accidental; it may be caused through ignorance or fear. Nevertheless, it exists. Disabled people wish to be able to study, work, travel and enjoy leisure activities in the same way as the rest of us.

As your Lordships are aware, in July we published a consultation document on a wide range of proposals to tackle discrimination. One thousand organisations and individuals responded. In the light of those responses, on 24th November we announced a package of measures which go a good deal further than the original proposals. The noble Lord, Lord Ashley of Stoke, said that this was unprecedented legislation to outlaw discrimination. I hope that he was referring to the proposals, and I was delighted to hear him say that. I know that he would like to push the Government a little further but I hope that his disappointment in us not going the whole way will not overcome his thinking on the subject to the exclusion of the fact that he welcomes the unprecedented legislation. It would be a great pity if we squabbled overmuch about the issues upon which we disagree but did not underline the issues upon which we agree.

Lord Ashley of Stoke

My Lords, I should like to place on record my thanks to the Government for responding to the pressure from disabled people and the disability lobby, and for introducing this legislation.

Lord Mackay of Ardbrecknish

My Lords, I thank the noble Lord and I hope that when the Bill comes to this House we can continue the spirit.

The right reverend Prelate the Bishop of Worcester mentioned employment, as did my noble friend Lord Haig. Many employers have taken advantage of our initiatives; but, clearly, there is plenty of evidence to show that discrimination continues. It is also clear that the quota system is not working as originally intended, not least because of a reluctance on the part of disabled people to register. We therefore propose to replace the quota scheme with a new right which will outlaw unjustifiable discrimination on the grounds of disability in all areas of employment. It will be unlawful for an employer to treat a disabled person less favourably than he or she would treat a non-disabled person, unless there are justifiable reasons. Employers will be required to make a reasonable adjustment to the workplace or to working practices where that would overcome the practical effect of disability.

Of course, it is essential to ensure that undue burdens are not placed on business. It is partly for that reason that we have decided that firms of fewer than 20 employees will be exempted. The noble Lord, Lord Ashley, was not happy about that proposal, and no doubt we will return to it on a number of occasions. The American Disabilities Act excludes small firms. Indeed, the bulk of small firms are one and two-man or woman shows and do not add up to many employees. I did not hear it said tonight—which perhaps means that the argument has been made—but it can be said that, individually, 95 per cent. of businesses in the country employ fewer than 20 people. However, another statistic shows that those firms employing more than 20 people account for 83 per cent. of employees in the country. I hope that we do not lose sight of that simple fact. We believe that we must introduce the lower limit for the sake of good business and affordability and the difficulties that small firms will have. However, we must not lose sight of the fact that those above 20 employees cover the vast majority of employees in this country.

Disabled people who experience discrimination in the field of employment will have recourse to industrial tribunals. The procedure will be broadly the same as for complaints under other discrimination legislation. A statutory code of practice and guidance will be available for employers and disabled people following further consultation. The availability of good advice and information for employers and staff alike should reduce the likelihood of disputes arising in the first place. I am sure that we should all like to aim for that.

As regards rights of access to goods and services, in the consultation document we recognised the importance of improving access to goods and services. As your Lordships are aware, our proposals have gone further than we originally proposed. We listened to what respondents said, and we acted upon their advice. The entire exercise has been an excellent demonstration of the value of consultation. The new right of access will prohibit any direct exclusion of disabled people. Where it is reasonable, proprietors will also have to provide aids and services to improve access for disabled people. In addition, they will have to remove physical barriers where that is readily achievable.

The overall costs may be subject to a financial limit, depending on the outcome of further consultations with disabled people and service providers. Where barriers are not removed, goods and services will have to be made available by alternative means, provided that that is practicable. It would be fairly naive to believe that these changes could be effected without hiccups. There will be a learning period for us all, especially the service providers. That is why we intend to set up a conciliation service which will be able to look at and, in the majority of cases, settle disputes.

The right reverend Prelate the Bishop of Worcester mentioned in particular financial services and the insurance industry. Equal treatment in financial services was not included in the consultation document. However, in the light of the views expressed, we propose to include them in the new statutory right. The proposals will outlaw unjustified loadings on the insurance premiums of disabled people. In consultation with the insurance industry, we will be looking closely at how legislation can best be framed in this particular field.

I turn briefly to the issue of definition because I suspect that we shall return to it. The word "disability" covers a wide and diverse range from slight to very severe. Many disabilities are caused by complaints associated with ageing. Arthritis and hearing loss are two of them. For that reason, it is generally agreed that important new rights should not include those whose condition has relatively minor effects. We would risk bringing these measures into contempt if they were extended to cover minor ailments and complaints. That is why the rights will apply to those persons with a physical or mental impairment which has a substantial long-term effect on the person's day-to-day activities.

The noble Lord, Lord Ashley, made some comments about that. Perhaps he will accept that if we go down the road that he suggested, we shall move considerably beyond the more medically-based approach suggested by us in the consultation document. I assure the noble Lord that we shall take powers to add conditions to the definitions by means of regulations. We have it in mind also to issue a code of practice to ensure that there is a full understanding of the Bill's employment provisions especially.

The National Disability Council is another subject to which I am sure we shall return. The Government propose to establish a National Disability Council. That will be a new independent body focusing on issues affecting disabled people. We believe that it will provide a powerful voice for disabled people and it will present an annual report on its activities to the Minister for Disabled People. That report will be laid before Parliament.

The noble Lord, Lord Addington, asked me about the composition of the council. The Secretary of State will appoint the chairman, the deputy chairman and members of the council after consultation with individuals and organisations. Fifty per cent. of the members will be disabled people or parents or guardians of disabled people. In appointing members, the Secretary of State will be keen to ensure that the members also include representatives of business, industry and the professional groups.

The subject of education was raised on a number of occasions in the course of the debate. It did not surprise me that the noble Lord, Lord Quirk, dwelt on the importance of communication in education, not only from the point of view of the professionals but also that the professional advice should be backed up by active and informal efforts in the community and with the help of lay people, especially given some of the new technologies that have come along to help people with communication. I could not agree more with that.

The more that disabled children can be educated alongside non-disabled companions, the less we shall see adults avoiding and ignoring them, and the more integrated they will feel. However, our education legislation does indeed recognise that there are many different kinds of disability. Accurate identification and assessment of children's individual needs are essential. That is the thrust of the new code of practice which your Lordships approved so warmly in May this year.

There is a spectrum of different needs and there must be a continuum of provision to meet those needs. Our policies are designed to create educational diversity and to maximise parental preferences for disabled children. The 1993 Education Act was a major advance in meeting special educational needs. We believe that the Funding Agency for Schools which we propose will help with access for children to the schools, because we must not only make available the education; we must make sure that the children can get into the schools.

I have taken more time than I meant to, so I will merely say on the subject of community care that the important feature of the package that has been announced recently is direct cash payments in lieu of community care services. We believe that that will give disabled people and their carers greater choice about the care that they receive. That initiative complements directly our aim to give greater independence to disabled people and has been widely welcomed.

The noble Lords, Lord Selsdon and Lord Addington, introduced some interesting matters into the debate. I should have liked to be able to spend some time dealing with those. My noble friend Lord Selsdon quite rightly pointed to the advances in technology, in what might nowadays be called "spare parts surgery" and its importance in bringing back to people, perhaps especially elderly people, the mobility which they thought that they had lost through problems with joints, hips and so on. There are great advances still to be made in those particular fields.

The noble Lord, Lord Addington, invited me to go into rounds of research deeper than that. But a great deal of money is spent on research through the medical research councils and through the various departmental and NHS budgets. There is a big programme with research. It is always difficult for the people who make those decisions to decide what is the best way to spend the money; which piece of research is most likely to produce results, and so on.

The noble Lord moved into the field of genetic engineering research. I always tiptoe into that one with some trepidation because it may stimulate some difficult moral dilemmas which may well be just round the corner for us when medical science produces some very clever ways in which to prevent genetically inherited diseases.

The noble Lord, Lord Rix, who unfortunately is not able to be here at present, mentioned the importance of improving public attitudes and he mentioned the campaign of which my honourable friend Mr. William Hague launched the first phase last week. It is important in any public campaign that it should be directed not only at the disabled but also at the able bodied. They are the people to whom the disabled must look, necessarily, when they need help to do whatever it is that they are doing, they are finding difficult to do.

I am sure that all noble Lords on all sides of the House will agree that this has been a notable year for disabled people. Our Statement held some surprises and went further than most people imagined. The Bill will be published shortly and noble Lords will be able to see just how far it has moved. This is not just about legislation. We need education, persuasion and increased public awareness. Let us not forget the importance of following a course which is not only achievable but which is also practical and balanced. I feel sure that most sensible people will agree that, taken together, the Government's proposals represent an historic advancement for disabled people in this country and will enable them to achieve the dignity and independence that is their rightful expectation.

Baroness Hollis of Heigham

My Lords, before the noble Lord sits down, I realise that he was pressed for time but I did put three or four questions to him, none of which he has had time to address. May I hope that he will write to me with those answers? They are of vital concern to disabled people.

Lord Mackay of Ardbrecknish

My Lords, I shall read the speech of the noble Baroness with some care and interest. I am always reluctant to deal with hypothetical cases or even real cases across the Dispatch Box when I do not have the proper information at hand to decide what are all the factors. I shall certainly read the speech with some interest and will write to the noble Baroness if there are points which require answer. I may also try to cost some of the proposals made by the noble Baroness.

7.47 p.m.

Lord Campbell of Croy

My Lords, I thank all those who have taken part in the debate. The speeches have illustrated more than I could have hoped the wide diversity of disabilities to which I aspired to draw attention.

I have a little time left now at the end of the debate but I shall comment only on a very few points. The noble Lord, Lord Ashley, drew attention to the fact that with such a wide field of different conditions it is important that any legislation should contain a definition of "disabled people". I hope that the Government have taken that on board and will do their best to meet the point.

The right reverend Prelate the Bishop of Worcester mentioned the part which charities are playing and the part which they can play in the future. Again, I hope that the Government will take note of that.

The noble Baroness, Lady Masham, drew to our attention the availability and the need for medical expertise and care in dealing with the many different kinds of disabled people.

My noble friend Lord Selsdon spoke about replacements and in particular, hip replacements. I believe that he would be interested to know that through disability organisations I came to know the late Professor Sir John Charnley, who was one of the pioneers of hip replacements, which of course have been possible only in the past 30 years. He told me that he took his degree in engineering before he took his medical qualifications. That very much confirms what my noble friend said about replacements being engineering. His expertise was in surfaces and friction, so he had all the knowledge required—that is, both engineering and medical —to work out how artificial hips could most effectively be manufactured. He and his colleagues in that field have brought immense benefit to the human race and have also been the cause of the relief of much pain.

The noble Lord, Lord Quirk, spoke about speech therapy. I was hoping that he would do so. The noble Lord headed the timely and important inquiry which reported on speech therapy in the early 1970s.

The noble Baroness, Lady Hollis, spoke of the complexity of the present system of benefits. I entirely agree with her. The noble Baroness may recall that in my opening speech I described how there was none in the 1960s, except for the war disabled and those industrially injured. While the introduction of allowances and benefits since that time has been universally supported, they have appeared separately to meet particular situations and the number of them now causes confusion. I realise that a rationalisation may be difficult to carry out as we should all want to ensure that no one would suffer by losing anything which they are now receiving as a total of benefits. That is perhaps one of the main difficulties that has prevented more rationalisation taking place.

I should very much like to thank my noble friend Lord Mackay for his reply and for dealing with so many of the points raised by speakers in the debate. I should just like to mention one; namely, the quota scheme and the new proposals for employment about which my noble friend spoke. I initiated a debate in this House on 13th April on the quota scheme, so I shall not repeat what I said then. However, I suggest one reason for not including small firms—and the present quota excludes those employing 20 people or under—is that they would then be required to employ a decimal point of a person. I say that because unless a firm employs 33 people, it is in any case required only to employ fewer than one. That has always made it difficult.

I must confess to being congenitally numerate and, therefore, such things always hit me. But, so far as concerns small firms, I believe that they have just been encouraged in the past to play their part in employing disabled people. In any future legislation the Government should try to find a way in which they can be further encouraged to employ disabled persons. Of course, for the mathematical reasons that I have just suggested, that cannot be on the same basis as a quota system.

Again, I should like to thank all speakers who have taken part in the debate. I beg leave to withdraw the Motion.

Motion for Papers, by leave, withdrawn.

House adjourned at eight minutes before eight o'clock.