HL Deb 20 July 1999 vol 604 cc854-7

(" . In section 72(1) of the Contributions and Benefits Act, at the end of paragraph (a) there is added—

The noble Lord said: This is an amendment of a rather different kind. It seeks to extend the DLA lower rate care component to three groups of people who have substantial extra disability related costs but who do not need "attention" from another person in order to cope with the disability. It effectively covers three groups: deaf people with speech and lip-reading skills who do not need a substantial communication support but may need to rely on expensive technology—a growing area of help to such people; secondly, a very different group, those who need a special diet but will incur extra costs as a result; and thirdly, those who suffer from frequent incontinence and have difficulty in coping—a subject that has been debated on many previous occasions, not least in the context of value added tax. There is some case for examining whether the present scope of Section 72(1) of the Social Security Contributions and Benefits Act is appropriate and whether it should be extended to people in that particular group. I beg to move.

5.45 p.m.

Earl Russell

I hope that the Minister will listen with care to the case for this amendment. These are all quite expensive conditions. The first is expensive because of the necessity of equipment. In the second case, the cost of a special diet, especially for acute sufferers from AIDS, can be considerable. Allowance is made for it at rates which were generous but have not always been uprated sufficiently rapidly for inflation. I remember once speaking to a brief on this subject which, as the result of a misprint, said that the rates were set at 1896 prices. I remember wondering whether it was perhaps not a misprint after all. I regret to say that the Official Report changed the phrase immediately to "1986 prices". The assumption was that I must have meant to say that even if I did not. Thirdly, people do not have the option of not buying incontinence pads. I am glad that the noble Lord, Lord Higgins, mentioned that. It is a context in which the concept of "value added" seems to have a peculiar incongruity. I hope that the Chancellor of the Exchequer will think again about the addition of VAT to the cost of incontinence pads. In the absence of that, which is wide of the amendment, I hope the Minister will consider the amendment seriously.

Baroness Hollis of Heigham

Amendment No. 127C would introduce specific disabilities into the conditions for entitlement to DLA. I can understand the noble Lord's motives in moving the amendment. However, I hope to persuade him that this is not the right approach: namely, to revert back essentially to a shopping list.

Entitlement to DLA is based on a person's needs, not on their medical condition. In the case of the care component, it is based upon their care needs. That means, therefore, that two people with identical medical conditions may none the less have very different care needs according to their circumstances in terms of their home life and therefore the DLA for which they are eligible. That was the approach taken by the previous government when they created DLA. We did not dissent front it. It is a simple and effective way of giving people the help they need. A single medical condition can give rise to a whole range of possible care needs depending on the severity of the condition and the support services that are available. We want to make sure that we give people the right help based on their needs, not their condition. I return to an earlier debate: there is no easy read-across as the amendment would suggest.

The approach taken in this amendment is different. It says essentially that a condition automatically equates with a certain rate of benefit regardless of the range of different needs that might arise from that condition. It is as though DLA had not been invented. It harks back to the days of supplementary benefit which had a multiplicity of different additions, a shopping list, in an attempt to help with extra costs in different areas. The Opposition's own assessment when in government was that that failed; and we agreed with that.

I now turn to the conditions mentioned in the amendment, the first of which is deafness. Noble Lords will recall the judgments in the Mallinson and Halliday cases, which extended DLA to people with communication difficulties. We believe that the system provides appropriate help in such cases and we have no plans to change it. We believe that it would be wrong to give blanket entitlement to a group of people when they will all have different abilities or needs.

Secondly, I am sure that Members of the Committee will agree that many people who have a special diet do not necessarily—although they may—have extra costs, nor would they be considered to be severely disabled. Provision is made by the NHS for certain foods to be available on prescription; for example, for gluten-free and low-protein diets. Does someone who needs a gluten-free diet come within the context of DLA? Provision is also made for certain infant feeding formulae if there is intolerance to cow's milk or for metabolic disorders. The amendment would take us back to the days of a complicated, inadequate supplementary benefit system consisting of a shopping list of particular needs to be ticked off.

Thirdly, there is incontinence. I should make it clear that this is already taken into account when assessing care needs. The Disability Handbook, which all adjudication officers use, has a specific section on dealing with the needs of people who suffer incontinence. In addition, services to help to meet the extra costs of incontinence are provided free by the NHS and include advice, treatment, supplies and equipment, laundry services and disposal of waste.

Those who do not get DLA can get help with extra costs from other parts of the benefit system, above all from the disability premium in income-related benefits worth £21.90 a week for single people and at least £31.25 for couples. For those in work, the disabled person's tax credit and the working families' tax credit also provide extra help.

However, I do not want to suggest that we think the DLA is perfectly designed or that we have a closed mind on where it should go. We believe that there may be ways of improving entitlement to both those benefits, including take-up, and we are looking at the possibility of using a set of activities undertaken by disabled people in managing their lives as a better means of assessing need: for example, in communicating, managing money, eating and the level of assistance required to carry out those tasks.

Research will help to establish whether this kind of approach would be fairer and easier for people to understand and could be administered with greater consistency. We would not wish to make major changes to the conditions of entitlement to DLA without clear evidence that it would lead to a better system and until their impact on disabled people had been thoroughly tested and discussed with organisations of and for disabled people. But if we were to go down that path, we would seek to produce a system based on a wide-ranging assessment of the needs of disabled people, not one built up by complex piecemeal accretions in the way that this amendment would seek to do.

In the light of that, I hope that the noble Lord will not pursue the amendment.

Lord Higgins

I am grateful to the noble Baroness for her reply. I had a little difficulty in reconciling what she said with her evidence to the Social Security Select Committee. She said: What DLA is about is not actually compensation for their disability— and that is so— it is about a meeting of the costs for which care and mobility serves as a proxy to enable them to manage their disability". That seemed to me consistent with the amendment. If not, perhaps the noble Baroness could explain exactly what the concept is that she has in mind.

Baroness Hollis of Heigham

I hoped that the noble Lord would carry on reading the Select Committee report where I sought to explain that. It was in terms of the discussion on BIP and entitlement and how errors creep into the system. I was explaining that in conjunction with disability organisations, the then government introduced the 1992 DLA. It used the need for intermittent care during the day which brought people into the lowest rate of DLA care. For example, if someone needed help with preparing a simple meal and they were unable to do it by themselves, it was one test of need. A second was continuous care, either day or night. That qualified for the middle rate. The third rate, which is the highest, is continuous care or supervision both day and night. Those bands were chosen because if someone needed care at the lowest rate, for example, help to provide a meal, it also suggested that they had problems with locomotion, dexterity or problems with sight and hearing. There might be problems of learning or similar difficulties. It was suggested that that test was a suitable proxy for those needs. It was the same with the middle rate and higher rate care.

That was the concept of DLA. So far it has worked fairly well. As I tried to hint, if we were to move away from that, we would have to think about a landscape approach not that different from the all-work test. We looked at movement, dexterity, visual impairment and communication ability. We added up the points and came up with a broad-brush approach. Whether that is preferable to what we now have requires discussion, research and elaborate work with the disability organisations.

However, we do not want the broad-brush approach—which has the merits of a simple formula of assessment of care needs as a proxy for the condition of the person and their capacity to manage it—to be complicated by an add-on shopping list, which is what the amendment seeks. That seems to me the worst of all worlds.

Lord Higgins

I am grateful to the noble Baroness. Again, we shall study what she said with care because her suggestions make a great deal of sense in the context of the basic concept; that is, unless we start afresh and enumerate everything in sight as to the reasons for a particular benefit to be received. In that context, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Ashley of Stoke moved Amendment No. 127D:

After Clause 62, insert the following new clause—