Deafblind Persons Bill [H.L.] (Hansard, 14 April 2000)

§ Lord Ashley of Stoke
My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.
Moved, That the House do now resolve itself into Committee.—(Lord Ashley of Stoke.)
On Question, Motion agreed to.
House in Committee accordingly.

§ Lord Ashley of Stoke
moved Amendment No. 1: Page 1, line 10, after ("the") insert ("numbers and the"). The noble Lord said: In moving the amendment, I shall speak to Amendment No. 2. With regard to the amendments in my name, I am grateful to Sense, and in particular Caroline Ellis, for the excellent briefing they have provided. It is help I warmly appreciate.
The purpose of the amendment is to clarify and emphasise the necessity, in order to plan and provide services, for each local authority to have access to reliable statistics about numbers of deafblind people in their area. The Department of Health should also have accurate information for formulating policy and developing nation-wide deafblind services. The estimate of 40 per 100,000 people was based on the average numbers of deafblind people identified across a number of local surveys in the 1980s and 1990s. But some recent surveys have found a higher incidence.
While I welcome the consultation announced to the House by my noble friend Lord Hunt at Second Reading, the Government will not gain accurate 398 numbers as regards deafblind people from a consultation exercise. That will only result from implementing the provisions of the Bill. I believe that the Government are making a great mistake if they intend to pursue their opposition. They are making a rod for their own back. Interest is already being expressed in the House of Commons.
Amendment No. 2 raises the issue of the contribution of my noble friend Lord Hunt at Second Reading. He seems to think that there is no need for specific provision for deafblind people in law. He could not be more mistaken. There is currently no requirement on local authorities in primary legislation, or by direction from the Department of Health, to identify, locate or register separately deafblind people. As the law stands, it provides no guarantee that deafblind people will be identified. I believe that that is an irresponsible omission which this House will hope to change.
The evidence and experience available to deafblind organisations point to a duty to identify and separately register deafblind people. The crux of the issue is a separate register. It is an essential prerequisite for monitoring and meeting needs, and planning service provision for those people.
Many local authorities still claim that they have few or no deafblind people in their areas. Alternatively, they say that they do not know the number. That is not good enough. Yet according to Sense, when those local authorities specifically set out to identify deafblind people, they find at least 40 per 100,000 people, if not more. If local authorities do not know how many deafblind people they have, or where they are, they are unable to provide for their needs. They are unable to monitor or assess those people. Nor will they provide the essential specialist one-to-one support services required. That is impossible, by definition.
My noble friend may have been right to say at Second Reading that only a small proportion of visually impaired people are likely to be registered, and that an even smaller proportion are hearing impaired. It is a problem, but not necessarily a harrier to deafblind registration. Nor is it an argument against registration.
The essential point is that deafblind people are a different group with distinct needs for specialist services. Being registered blind, for example, is only one way in which the deafblind person inight—I emphasise the word "might"—eventually come to the attention of social services as someone who requires a different and distinct approach.
Deafblind registration is an issue of a different order. I see those people, as I am sure other noble Lords do, as having an entirely different species of disability. In the provisions of the Bill, a deafblind register would involve an identification and location exercise using a range of methods of which cross-references of existing registers are only one small part. Such exercises have involved checks on records held on elderly people and people with learning disabilities, and close liaison between social services departments, education departments, health authorities, voluntary 399 organisations, general practitioners, audiology and ophthalmology departments, geriatric wards of hospitals, residential care homes and ethnic minorities. All are involved in one way or another and all must be tapped and consulted and have all their records checked.
We need a deafblind persons register to be actively maintained because of the extreme isolation and vulnerability of deafblind people and their tendency to lose contact with local authorities, often as a direct function of their disability. It is essential that we tackle this isolation. If the House agrees to the register, local authorities will have to have a system of updating and maintaining their register which means that deafblind people are regularly monitored. Without the monitoring, the registering could simply wither and die.
Both those receiving services and those who at some future date might need help will be assisted. This is particularly important given that many deafblind people have deteriorating conditions. At one stage in their lives they do not perhaps require urgent help, but they may need it later because of the deterioration. Only by the register being kept up to date can we guarantee that they will be cared for.
The essential point of the amendments is that deafblindness should be treated as a specific, special category of disability. When it is established, the Department of Health might pursue deafblind registration as a benchmark for improving the registration of other groups. This is an opportunity for the department and the House to strike a great blow for many disabled people, but specifically today we are dealing with deafblind people. I hope that the two amendments will be accepted. I beg to move.

§ Lord Swinfen
I strongly support both amendments. It is interesting that local authorities are obliged by the National Assistance Act 1948 to keep registers of blind and partially sighted people and of those who are deaf and hard of hearing. I wonder how they gather their information. Will the Minister be kind enough to tell the House?
I have worn a hearing aid—supplied by the National Health Service, I am happy to say—since 1972. Therefore, I must by definition be at least hard of hearing. But no one from the local authority has ever approached me to make certain that I am on its register. Neither have I approached the authority. And as far as I know, the medical practice that looks after me has not done so, and neither has the hospital that supplied me with the hearing aid. How, therefore, do local authorities at present find the names of those who should be on their registers?
The amendments of the noble Lord, Lord Ashley, are particularly important because life can be very difficult under certain circumstances if one is hard of 400 hearing. It is also very difficult if one is partially sighted, but having a combination of the two makes life at times virtually impossible.

§ Lord Morris of Manchester
I have often heard people talk about whether deafness or blindness is the more severe disability. There is no common view; but what everyone must recognise is that being deaf and blind is vastly more disabling than either and especially where deafness is prelingual.
My interest in people with the dual handicap goes back to my school days when I lived, in Manchester, near to a boy of the same age who was deafblind. Even then I knew that there could be few more cruelly devastating disabilities. Thus I counted myself extremely fortunate to be able to include in my Private Member's Bill that became the Chronically Sick and Disabled Persons Act 1970 the first legislation in this or any country to address the very special needs of people with the dual handicap. But that was 30 years ago and these amendments, like the others on the Order Paper today, are about further advance for some of the most needful people in Britain. By any standard they are eminently deserving of all the help we can give them.
The provision the Chronically Sick and Disabled Persons Act made for them is in Section 25. It imposed a duty on local education authorities to provide the Secretary of State with information, at such times as he may direct", on their provision of special educational facilities for children and young people with the dual handicap. The section also made clear that the arrangements made by a local authority for its special educational treatment of deafblind children and young people must be given in a school maintained or assisted by the authority.
The specific involvement of the Secretary of State in implementing Section 25 gave him or her a major share of the responsibility for failure in any locality to make satisfactory provision. It ensures that any shortcomings in provision are as much the responsibility of central as of local government.
In a message sent to me by Sense, the admirable charity whose unrivalled efforts to help people with the dual handicap are so widely acclaimed, the progress achieved by Section 25 is documented, and it goes on to say: It is in education that we have seen some of the biggest advances for deafblind people: Section 25 of the Chronically Sick and Disabled Persons Act began a sea change. Because local authorities had an obligation by law to recognise deatblind children and young people, and also to provide information on the provision they make for special educational facilities, it is much easier for our specialist workers to go in and work in partnership with them—providing special assessment as well as support for families—and it has helped parents to campaign. Sense says, too, that there have been "huge developments" since Section 25 became law. But much remains to be done and more can be done if the purpose of the first of these amendments is met.
401 It must be vitally important for local authorities to have access to reliable information on the numbers of deafblind people in their areas —as well as their location—if the planning, development and provision of services are to be well conceived. Otherwise policy-making itself is severely handicapped. Without accurate statistics, policy-makers in both local and central government are at sea without a compass.
Turning briefly to the second amendment, again I am very happy to support my noble friend Lord Ashley. In doing so, I want strongly to emphasise the importance of registration if we are to make sure that a deafblind child known to the LEA is to go on to the deafblind adults' register at 18.
Schedule 2 to the Children Act 1989 requires social services departments—SSDs—to keep a register of children with disabilities, a provision which is designed to help their service planning and monitoring. And the guidance on the Act, in volume 6, emphasises many important principles in relation to disabled children's registration that might usefully be applied to deafblind adults' registration. It stresses as well the importance of updating registers regularly and says that SSDs should liaise with their education and health counterparts to secure early identification, to facilitate joint working, to encourage parents to agree to registration and to plan services for the individual child and children in general.
The guidance says also, first, that the creation of a joint register by health, education and social services authorities will greatly facilitate collaboration in identification and a co-ordinated provision of services; and, secondly, that when a child is identified, parents should be given clear and comprehensive information about the purpose and use of the register in accessible formats and be fully involved in recording the needs of their child.
These principles should inform the process of deafblind registration: indeed, they are crucially important to its success. That is the case for the second amendment. It really is essential to ensure that deafblind children go on to the deafblind adult register at 18 if they are to achieve a smooth transition from children's to adult services. At the moment, adult services have little idea how to work with young deafblind people and the second amendment can help them to do so. I know that my noble friend the Minister will want to respond to both amendments with understanding and as helpfully as he can.

§ Lord Skelmersdale
First, I apologise to the Committee and to the noble Lord, Lord Ashley, for being absent at Second Reading. However, as we had a synopsis of the Second Reading debate in the previous three speeches, perhaps that apology is unnecessary.
I fully agree that a register of deafblind people is required and I fully agree with Amendment No. 1. Knowing the location of such people is not good enough; you must know the numbers involved and the register must be kept up to date. However, if you must permanently inform yourself of the number and 402 location of a particular group of people, by definition you must have an active register. Therefore, while I fully agree with the first of the amendment,, the second seems to be totally unnecessary.

§ Lord Astor of Hever
I, too, support the amendments. The noble Lord, Lord Ashley, clearly set out the reasons behind them. We believe that it is important to maintain a reliable register. As the noble Lord said, there is no requirement on local authorities to identify, locate or register deafblind people. Deafblind people have distinct needs for specialist services.
As the UK population grows progressively older, dual sensory impairment becomes more prevalent. Seventy-five per cent of deafblind people are over the age of 75, and 85 per cent of people over the age of 85 have combined sight and hearing difficulties. It is vitally important to contact those people and to offer deafblind link workers. The active element of the register will ensure that elderly people with, for example, sight loss and a progressive hearing loss will not slip between the geographical loopholes.

§ Lord Addington
I believe that both amendments would strengthen the Bill. It does not matter whether we are over-egging the pudding by making the same provision twice because the register must be accurate. In ensuring that there is good, accurate, up-to-date information, it does not matter how you do it.
Getting information across in particular to people who need help has been a theme of mine for some time. I believe that the Government should be better at it. I suggest that they should be gathering information in order to establish a more successful interchange. I suggest that the Bill would be improved if contained one if not both amendments.

§ Lord Burlison
I thank my noble friends Lord Ashley of Stoke and Lord Morris of Manchester for the many helpful points which they made. I know that the commitment and sincerity with which they spoke is strongly felt. However, they will not be surprised to learn that the Government believe that the amendments to Clause 2 are unnecessary. Authorities already have a duty, under Section 1(1) of the Chronically Sick and Disabled Persons Act 1970, to inform themselves of the number of persons in their area to whom Section 29 of the National Assistance Act 1948 applies. People who have a permanent and substantial disability clearly fall within the scope of Section 29 of the National Assistance Act 1948.
The noble Lord, Lord Swinfen, commented on how local authorities compile the registers. Those who meet the criteria of blindness when assessed by the ophthalmologist are offered inclusion on the social services register. That is achieved by the completion of form BD8, which is sent to social services. Section 29 makes specific mention of deafblindness and, rightly, authorities have used the power to provide services not only for deafblind people, but also those with other disabilities. Those who are hard of hearing or deaf inform social services of their desire to be registered. 403 Members of the Committee will appreciate that not everyone in those circumstances will want to be registered.

§ Lord Swinfen
I thank the Minister for giving way. Speaking from personal experience, I do not recall being asked whether I wanted to be registered. Is he sure that all audiologists ask their patients that question? If they are not asked, and they want to be registered, they will not be placed on the register.

§ Lord Burlison
I thank the noble Lord for his comment. Only ophthalmologists have that relationship with local authorities. It is my view that under those circumstances the lead will come from them and be passed to the local authority. As regards whether information on everyone is passed on, I assume that, yes, they would inform the local authorities. It would then be for the local authorities to decide what action to take.
The Department of Health is currently involved in a consultation with deafblind service users, Deafblind UK, Sense, local authorities and the Local Government Association which is looking at, among other things, improving the ways in which local authorities carry out this duty. The consultation is being carried out on a joint England/Wales basis, involving Sense Cymru, the Wales Council for the Blind, the Wales Council for the Deaf, and the Welsh Local Government Association.
For those reasons, we cannot support the amendments.

§ Lord Morris of Manchester
My noble friend has laid great emphasis on the importance in this debate of Section 1 of the Chronically Sick and Disabled Persons Act 1970. What monitoring has his department carried out of the adequacy of registration by local authorities? Can he tell me how many disabled people are now registered by their local social services authorities and, therefore, what is the gap between the Government's estimate of the number of substantially disabled people—their latest figure being upwards of 8 million—and those who are registered under Section 1 of the 1970 Act, on which he has placed such emphasis in this debate?

§ Lord Skelmersdale
Perhaps I may add to the question of the noble Lord, Lord Morris. Can the Minister inform us whether the disability register under the then Bill of the noble Lord, Lord Morris—now, of course, the Act—separately identifies groups of causes of disability? That is the key point in this particular debate.

§ Lord Swinfen
It may be for the convenience of the Minister and the Committee if he deals also with my question. I understood his response to this amendment to say that ophthalmologists but not audiologists reported cases of people who were blind and partially 404 sighted to their local authorities. Therefore, how do local authorities maintain a register of those who are deaf and hard of hearing?

§ Lord Burlison
My noble friend Lord Morris raised the issue of adequate monitoring of the various figures. We know that approximately 25 per cent of those who are registrable as blind have chosen to register. I do not have the figures at hand for deaf people, and I certainly do not have at hand the figures in relation to those with other disabilities who are registered under this particular section of the legislation. So far as concerns the question raised by the noble Lord, Lord Skelmersdale, the answer is "yes".

§ Lord Swinfen
Perhaps the Minister will allow me to intervene. What proposals does he have to make certain that the full provisions of the 1948 Act are properly carried out by local authorities? At the moment, it appears to me that they are not.

§ Lord Burlison
In respect of the monitoring of this particular issue by local authorities, there is a relationship between the department and local authorities to ensure that constant reporting of the situation takes place between local authorities and the department. Therefore, we are satisfied that at least the monitoring aspect of this issue is up to date and carried out thoroughly.

§ Lord Ashley of Stoke
I have never heard such a complacent speech from the Department of Health. I am deeply disappointed. I want to make it very clear to the Committee that I do not blame my noble friend. I blame the Department of Health for saddling him with a shocking speech. It is impossible for me to understand how the Government can reject these amendments. My noble friend has heard Members from all sides of the Committee supporting the amendments—the support has been unanimous—yet he says that the Government cannot accept them. What on earth is happening?
My noble friend says that he cannot accept the amendments because they are unnecessary. That is simply not true. He should never have been given that kind of brief. It is a disgrace that the department should have done so because the Chronically Sick and Disabled Persons Act simply does not provide what we require in this Bill. We require provision for the location, identification, and assessment of individuals. That is something entirely new. How the department can ask my noble friend to say what he has said is beyond my understanding.
I believe that my noble friend was confused about the contribution of the noble Lord, Lord Swinfen. The noble Lord, Lord Swinfen, was quite right: there is no doubt that audiologists and ophthalmologists simply are not concerned with registration. I have never even heard that matter raised, and I have been interested in the world of deafness for some 30 years. Therefore, how people can saddle my noble friend with that kind of information, again, beats me.
405 My noble friend mentioned consultation. I warmly welcome consultation. I believe that that was a great step forward by the Government. However, consultation is not a panacea; it is not a magic word, and it does not give us a register. Consultation is one aspect of the issue. I am left in the position of being really annoyed at the response of the Department of the Health; I am not annoyed with my noble friend. If I could vote against the Government now, I should certainly do so. However, because I cannot, I shall, regretfully, withdraw the amendment. I do not believe that I have an option.

§ Lord Skelmersdale
Perhaps I may say to the noble Lord, Lord Ashley, that it is his Bill. If he wishes to put these amendments into it, he is perfectly entitled to do so.

§ Lord Swinfen
I shall strongly support the noble Lord, Lord Ashley, if he wishes to press the amendments. I should not like it if he was to withdraw them. So far as concerns the Government, I believe that neither of the amendments will do any harm whatever, and I would consider it to be extremely bad manners and in bad taste if the Government were to try to vote against them. I hope that the noble Lord will press his amendments.

§ Lord Addington
I wish to make it absolutely clear that I believe that the noble Lord, Lord Ashley, is totally in charge of this Bill. I consider that the amendments would improve it. Therefore, I suggest that there is absolutely no reason why they should not go into the Bill.

§ Lord Ashley of Stoke
I am not very hot on procedure, but my intention was to bring back this matter on Report and to vote on it then, if necessary. Therefore, in view of my understanding of the procedure, that may be the best thing to do. I am banking on the support of my noble friends when we reach Report. I do not believe that a vote now would mean very much. I give way to the noble Lord.

§ Lord Skelmersdale
It is extremely unlikely that there will be a vote. Rather than go through the whole debate again on Report, would it not be far better to settle the matter now?

§ Lord Ashley of Stoke
No. I believe that the best thing is to follow normal procedure. I warn the Whips that I shall call for a vote on Report and then we shall see what happens.

§ Lord Swinfen
Perhaps the noble Lord will allow me to intervene. If the voices were taken and the Committee were to be Not-Content, I should find that extremely strange. Everyone who has spoken in the debate, except the Minister, has been in favour of the 406 amendments. If by some chance the noble Lord were to lose the debate, he could come back at the next stage.

§ Lord Ashley of Stoke
I am torn on this. I am willing to vote. However, in view of the powerful speeches made on all sides, I hope that the department will think again. That is the possibility that I hold out. It is my decision and I believe that the responsible thing to do is to give the Government an opportunity. I shall let them consider the matter and, if they will not move—they jolly well should move!—we shall vote. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.

§ Lord Addington
moved Amendment No. 3: Page 1, line 11, at end insert— ("(1B) It shall be the duty of every local authority to actively identify and locate deafblind persons within ethnic minority groups in their area and to ensure their register of deafblind persons includes arrangements for monitoring by ethnic origin.""). The noble Lord said: I move this amendment with a degree of deference because one is talking about ethnic minorities. We surviving hereditary Peers are not, generally speaking, the best group to talk about ethnic minorities. This amendment is based once again on the principle of gathering information. It has been put to me that deafblindness occurs approximately twice as often within the ethnic minority groups as it does within the rest of the community. That alone deserves to be looked at.
Much of this Bill is concerned with making sure that there is access to information in order to take corrective action. It has been pointed out to me by virtually everyone who has spoken to me about this matter—the main conduit is Sense— -that if someone comes from another country and English is not the main language, there are problems with exchanging information. The problem with these disabilities is in not having information passing between the end user and those providing the services. There is a particular problem with the first and second generation of the ethnic minorities.
Deafblindness is often caused by rubella. If a link has not been established between vaccination and a greater ethnic weakness or susceptibility to that disease, particularly in the Asian groups in this country among whom there is a higher incidence of that disease, and if there is a danger that that higher incidence of the disease is due to the fact that there is not the same access to vaccination, then surely we should be gathering the appropriate information. Once we have it we shall know where to place the correctly trained workers to help the persons whose first language has not already been established and also the carers. We need information.
If I am told that the wording of the amendment is defective I shall bow to that, provided it is done with the usual degree of authority and grace. If that happens I shall be prepared to give way. This 407 amendment concerns extracting more information so that we can give the correct help. I hope that all those concerned will be favourably disposed to at least the intention behind the amendment. I beg to move.

§ Lord Swinfen
I support the amendment moved by the noble Lord, Lord Addington. It is extremely important that the first language of deafblind people is known to the authorities so that the help provided is given in as intelligible a form as possible. One must also take into account religion. Help may come in the form of meals. With some groups the food needs to be kosher or halal. Some religions are purely vegetarian. In addition, in strict Moslem families it is no use having a male social worker going into a Muslim house to help a female member or, indeed, a male member of that household, where the family does not feel that there is proper provision for the protection of the womenfolk. Therefore it is an important amendment. The noble Lord said that its wording might be defective. So be it. That can be corrected at a later stage. However, the principle behind the amendment is extremely important and something should be put into the Bill on this issue in the long run.

§ Lord Astor of Hever
Very reluctantly, we on these Benches cannot support this amendment on account of the defective wording. We support the spirit of the amendment. I assure the noble Lord that I know that it is very well intentioned. We accept the high incidence of deafblindness among ethnic minority groups. On these Benches we would want to ensure that local authorities give particular regard to these important groups.
As a matter of good practice, local authorities already monitor ethnic origin in areas such as child health and special needs. I accept that that monitoring has highlighted flaws in services which need rectification. We believe that it is fundamentally wrong for one group to be singled out in this way. Local authorities should, and must, ensure that there is fair treatment for all deafblind people.

§ Lord Ashley of Stoke
I am sorry to disagree with the noble Lord, who is giving such strong support to the Bill generally. I support the contention of the noble Lord, Lord Addington. He is quite right in the arguments that he put forward about ethnic minorities. If they are disadvantaged in being unable to articulate the problems, as obviously they are when English is not the first language, that is a very good reason why we should give special consideration to ethnic minorities. The incidence of these disabilities is much higher, according to Sense, in the ethnic minorities, and that is another reason why we should support this amendment. We should not risk missing the opportunity to help any ethnic person who is deafblind. This amendment should be accepted by the Committee. I hope that my noble friend will not argue about it that it is inadequate or inappropriate. As has already been said, it can be changed at Report stage. I support this amendment.

§ Lord Burlison
There have been a number of speakers on this particular issue. Authorities have a duty under Section 1 of the Chronically Sick and Disabled Act 1970 to inform themselves of the total number of persons in their area to whom Section 29 of the National Assistance Act 1948 applies.
The particular aspect of this issue is identifying, assessing and providing services for the people within the area. We would expect local authorities to take into account the cultural diversity of the communities they serve. We recognise that people from ethnic minorities may have particular needs. That will be reflected in any guidance which results from the ongoing consultation of the Department of Health on deafblindness.
Step by step the Government are modernising the National Health Service and the social services so that they are fit to meet the needs of everyone, including black and minority ethnic groups. There are the evolving structures and functions arising from national strategies, including Modernising Government and The New NHS. There is Saving Lives: Our Healthier Nation, besides Modernising Social Services, the appropriate White Papers and the working together of the human resources framework. They will enable us to ensure mainstream race equality in all service provision and workforce development. For those reasons, the Government cannot support this amendment.

§ Lord Addington
When the two Front Benches decide that there is something wrong, one feels that one should listen long and hard. The noble Lord, Lord Astor, said that he did not think that any one group should be singled out in that way. I agree in principle but disagree in relation to one matter. The information I have shows that certain groups of people are three times more likely to be deafblind than others. As I said previously, that is probably due to genetic conditions caused by years of living in other climates and so on.
Communication is clearly a problem. The issue is how best to deal with it. The Government say—I paraphrase—that this should be happening already. Members of the Committee would not be taking part in this discussion if they felt that it was happening already. On virtually every single Bill on which I have spoken in this House, something was in place beforehand which, if we had got it right, would be working properly. Indeed, if we managed to pass legislation which worked properly first time round, Parliament would sit for about three days a year. Therefore, I cannot really take that seriously. Everything changes.
There are two areas of disagreement here. Perhaps the noble Lord will undertake to look at another amendment which will achieve the same ends. I am quite prepared to talk to him. Indeed, it may be that the noble Lord, Lord Ashley, is willing to talk to me about this matter so that we can achieve what we wish more satisfactorily before the next stage of the Bill. I should be more than happy to engage in those discussions. With that understanding, I beg leave to withdraw the amendment.
409 Amendment, by leave, withdrawn.
Clause 2 agreed to.
Clause 3 [Assessment of needs]:

§ Lord Ashley of Stoke
moved Amendment No. 4: Page 1, line 16, at end insert— ("( ) the Disabled Persons (Northern Ireland) Act 1989,"). The noble Lord said: In moving this amendment, I shall speak also to Amendments Nos. 5 and 9. These amendments will ensure that when deafblind people living in Northern Ireland have their needs assessed, the assessment will include and specify the need for deafblind link services and the services will then be provided.
Deafblind people in Northern Ireland need this legislation as desperately as their counterparts in England and Wales. The current constitutional position is that the legislation must come from Westminster. Northern Ireland has a population of 1.6 million which, taking the incidence of 40 per 100,000, means that there is an estimated deafblind population of 640. Those 640 or more people really need the provisions of this Bill.
Sense tells me that Northern Ireland has developed a personal support workers scheme which can provide a service similar to the communicator-guide service. That could possibly be extended under the aegis of this Bill and this amendment, I hope that it will be sympathetically considered by the Government. I beg to move.

§ Lord Astor of Hever
I support the amendments. Only a tiny number of deafblind people in Northern Ireland currently have access to deafblind link services. It must be right, as the noble Lord, Lord Ashley, said, to ensure that when deafblind people living in Northern Ireland have their needs assessed, the assessment will include and specify the need for deafblind link services.

§ Lord Addington
If it is going to occur in any part of the United Kingdom, surely it should occur in Northern Ireland.

§ Lord Swinfen
If the listing by authorities in Northern Ireland is anything like as bad as that in England, which has already been admitted by the Minister, then this amendment is essential.

§ Lord Burlison
The Bill deals with a transferred matter; that is, a matter on which the Northern Ireland Assembly may legislate. Northern Ireland has its own body of legislation dealing with transferred matters and during the suspension of the Assembly, primary legislation on matters falling within the transferred field may be made by Order in Council.
I hope that my noble friend and Members of the Committee appreciate that accordingly it would not be appropriate to extend the provisions of the Bill to Northern Ireland.

§ Lord Swinfen
Before the noble Lord sits down, it may be possible to make an Order in Council but what 410 harm would it do to have this amendment in the Bill. We have no idea when the Assembly is to be reconvened in Northern Ireland. It is hoped that it will be shortly but it could be quite a long time. With the admission which the noble Lord has already made about the paucity of making the proper lists in this country, which probably extends also to Northern Ireland, he is doing deafblind people in Northern Ireland a disservice by what he has said on the amendment.

§ Lord Burlison
I hope that my comments do not do a disservice to any deafblind people. It would certainly not be my intention to do that. But I hope that Members of the Committee will appreciate that in relation to the Northern Ireland issue I do not want to digress from the recommendations and advice I have been given; namely, that, legislatively, it would be inappropriate and unique to go down the line suggested by the amendment.
I have made the point, to which the noble Lord, Lord Swinfen, referred, that matters falling within the transferred area may be dealt with by Order in Council. I hope that the Committee will understand the situation.
Of course, along with my department, I should be prepared to have further discussions if that was felt necessary. But at this moment I hope that my noble friend will see fit to withdraw the amendment.

§ Lord Ashley of Stoke
I am grateful for that offer. Of course we want those discussions. I hope that my noble friend will go back to his department and explain the strong feelings which have been expressed on all sides of the Committee. Not only would the amendment not do any harm; it would do positive good.
I do not want to embarrass my noble friend any further. But we want Northern Ireland deafblind people to be provided for one way or the other. I shall take his word on this occasion. I shall withdraw the amendment on the clear understanding that the issue will be raised again. I hope that between now and Report stage there will be consultation between Members who have spoken in the debate and the department. On that basis, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.

§ Lord Ashley of Stoke
moved Amendment No. 6: Page 2, line 5, after ("a") insert ("severe degree of"). The noble Lord said: This amendment is intended to meet the Government's wish for a "tighter" definition in so far as that is possible and to tie the definition in the Bill more closely to that used for the purposes of planning services.
On Second Reading, my noble friend Lord Hunt referred to the definition adopted by the Deafblind Services Liaison Group. In 1988 the group published 411 a report, Breaking Through - Developing Services for Deafblind People. In the report, the group used the following definition: Persons are regarded as deafblind if they have a severe degree of combined visual and auditory impairment resulting in problems of communication, information and mobility". The emphasis is on, a severe degree of combined … impairment". The report went on to say that the category will include persons who have had severe vision and hearing impairment since birth or early childhood and those who develop dual sensory impairment in adult life. It will include also persons who, having one severe sensory impairment, are in the early stages of a second sensory impairment with a prognosis of further deterioration; people who are born deaf and have an acquired visual loss, and people who are born blind and have an acquired hearing loss. It will, in addition, include those people whose degree of vision or hearing impairment is difficult to assess, perhaps because they have learning disabilities, but who function as "vision and hearing impaired". The majority, at some point in their lives, are likely to need the link services for which the Bill seeks to legislate.
The identification projects subsequently carried out for or by local authorities have used that definition successfully. I refer, for example, to the Royal National Institute for the Blind's research into services for deafblind people in Essex which identified people with dual sensory disability. The partners in that project, RNIB and Essex social services, stressed that they were seeking to identify people less by the degree of sensory disability and more by their functional response to a combined hearing and sight impairment. They emphasised that the severe combination of sight and hearing loss creates a separate, complex and potentially isolating situation and that even less severe levels of loss, when in combination, occasion profound disability and resulting handicap. That combination is the heart of the matter. If one has a sight impairment, it is difficult. A hearing impairment is difficult. But the combination creates an entirely different—indeed, a unique—disability. That must be driven through the heart of the debate. A recent project in my former constituency, Stoke-on-Trent, in Staffordshire, also emphasised that, it is not just a matter of adding two disabilities together and should be recognised by all agencies as a distinct disability". Where different combinations of sight and hearing loss have been used as categories or classifications for the purposes of identification, they have usually included the following combinations: deaf/blind; partially hearing/blind; deaf/partially sighted; and partially hearing/partially sighted. The latter category is as important as the others. That is because of the compounding effects of dual sensory loss. The effects of a partial hearing loss and partial sight loss are multiplicative. Where one sense is impaired, as I have just mentioned, even a slight problem in the remaining sense assumes an importance out of all proportion with the actual measured degree of impairment in the second sense. It is not necessary to be totally deaf or 412 totally blind to be deafblind. One can be partially one and partially the other and have an extremely severe disability.
What we need now is a legal definition of "deafblindness" as provided in Clause 5 to ensure consistency in the identification process and in the planning of services to facilitate an appropriate response from local authorities. Such legal definitions as apply to deafblind people—for example, in the "deaf" and "blind" provisions within the Disability Living Allowance Regulations—have been deeply unhelpful and disfranchising, based upon purely medical criteria and failing to take into account the compounding effects of dual sensory impairment. I believe that that is why most people do not understand the problem of deafblindess. They see one aspect or the other, but they do not really comprehend the unique nature of the disability. We should try to get the definition on to the statute book in this clear form and make provision for people who have been neglected for many, many years.
It will be impossible to develop any measurable performance indicators for deafblind people unless the Government, first, adopt a definition which all local authorities can use consistently and, secondly, impose a clear, specific duty on local authorities to identify people who fall within that definition. I beg to move.

§ Lord Astor of Hever
I rise to support the amendment. The noble Lord, Lord Ashley, has explained the problem clearly. We agree that a legal definition of "deafblindness" is needed to ensure consistency in the identification process and in the planning of services and to facilitate an appropriate response from local authorities.

§ Lord Burlison
I thank my noble friend Lord Ashley for tabling the amendment. It brings the definition of "deafblindness" in line with that used by local authorities and the Social Services Inspectorate. People who have a permanent severe degree of combined visual and auditory impairment resulting in problems of communication, information and mobility come within the scope of Section 29(1) of the National Assistance Act 1948. With that in mind, we are happy to go along with the amendment.
On Question, amendment agreed to.

§ Lord Ashley of Stoke
moved Amendment No. 8: Page 2, line 11, leave out ("or") and insert ("and"). The noble Lord said: This is a purely technical amendment. This clause needs to state clearly that the role of a deafblind link service is to encompass the functions of communication, access to information and to mobility, which are, after all, inseparable. That is what makes the service a unique solution to what are unique needs. If one is guiding a deafblind person, one will need to stop and communicate environmental and verbal information to him via his 413 preferred communication methods: deafblind manual/ hands-on sign or other methods. It is no use a person being guided by someone who cannot communicate with him, or to have someone who may be able to communicate with him but has not been trained in how to guide him. That will not meet a deafblind person's needs. Because this is a simple and purely technical amendment, I am hoping that the Government will be as generous and as helpful as they were on the previous one. I beg to move.

§ Lord Burlison
Once again, I thank my noble friend Lord Ashley for the amendment. We believe that its intention is to clarify that a deafblind link service will cover all those services, rather than just one on the list. We recognise that one-to-one support workers will provide any or all of the services listed in the clause. One-to-one support workers can be provided under Section 2(1) of the Chronically Sick and Disabled Persons Act 1970. In view of that, we are pleased to give the amendment our support.

§ Lord Ashley of Stoke
I am most grateful to my noble friend. I was remiss not to thank him on the previous amendment. I thank him for accepting both amendments. I am very grateful.
On Question, amendment agreed to.
Clause 5 agreed to.