Sitting of 5 December 1969

Preamble
The House met at Eleven o'clock
PRAYERS
[MR. SPEAKER in the Chair]
ORDERS OF THE DAY

  CHRONICALLY SICK AND DISABLED PERSONS BILL
  Order for Second Reading read.
  11.5 a.m.
  Mr. Alfred Morris: I beg to move, That the Bill be now read a Second time.
  The Bill deals with many problems, all of them intensely human, but has a single intention. This intention is to increase the welfare, improve the status and enhance the dignity of the chronically sick and of disabled persons.
  I am told that it is a big Bill, but then it deals with a big and important subject. The House will recall that the principal Private Member's Bills in recent Sessions have all been concerned with subjects of major social importance, such as capital punishment, abortion and homosexuality and divorce law reform. Thus one need hardly apologise for the size and scope and purpose of this Bill.
  The Bill was conceived scarcely more than three weeks ago as an essay in helping the disabled. Clearly, there may be imperfections of phrasing in parts of the essay which will require careful study if, as so many people profoundly hope, it receives a Second reading today. There are points, too, which may not entirely please, nor even survive, the assessors in Standing Committee when we reach the stage, as it were, of viva voce examination.
  The Bill is a collective essay to which hon. Members on both sides of the House, and countless organisations and individuals outside, including Mr. Clifford Hilditch, Chief Welfare Officer of the
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  City of Manchester, and his colleagues in other towns and cities, have contributed proposals for helping the very sick, the halt, the blind, the deaf and many other groups of chronically sick and disabled people.
  I warmly acknowledge the extremely generous help I have had in preparing the Bill. I should also like to thank my brother, my hon. Friend the Member for Manchester, Openshaw (Mr. Charles R. Morris), who entered my name in the Private Member's Ballot and who, therefore, more than anyone else, with the possible exception of you, Mr. Speaker, is responsible both for my success in winning the first place in the Ballot and for my having the opportunity to introduce the Bill today. I know that no subject is nearer to his heart than this one.
  It has been put to me, of course, that good ideas, even good ideas for helping the disabled, cease to be good if they cost money. This is neither humane nor imaginative. In discussing the welfare of the disabled, can we not at least agree to talk less of cost and more of net cost? There are many distinguished experts who argue that, for example, increased domiciliary care can lead to a net saving of public expenditure.
  Again, it has been impressed upon me by some very experienced administrators in this field that even a modest improvement in the standard of welfare services provided by the less progressive local authorities could well relieve much of the present strain on the hospital service. Increasing the mobility and employment opportunities of disabled people could also very well lead ultimately to a net saving of public money, as well as relieve the pressure on their families and reduce the health risks to which they in consequence become exposed.
  What most disabled people want more than anything else is to lessen their dependence on other people, to get on with living their own lives as normally as they can in their own homes amongst their own family, and, wherever possible, to have the opportunity of contributing to industry and society as fully as their abilities allow. Investment in people, disabled people no less than fit and strong and fortunate people, is much the best of all investments.

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  But what if it is still insisted that initial outlay is more important even than the possibility of ultimate net savings? My reply is that there are provisions in the Bill which will require very little public expenditure and which in terms of priority are wholly admissible on grounds both of social justice and priority. Under the present Government, the hospital building programme has nearly doubled in the past five years and is now five times as great as it was ten years ago. New projects to the value of £116 million are in hand for the current year, while the average for the 16 years to 1964 was only £17 million.
  Five years ago, £270 was spent on the social services for every £100 spent on defence. This year, £370 is being spent on the social services for every £100 spent on defence. The number of qualified nurses and midwives has risen by 32,000, or 30 per cent., in the last five years and there have been other impressive achievements in health and social welfare.
  Yet, even with a Government who have done so much to improve the social services, we still live in a society where more is heard of the complaints of the affluent and the strong than of the legitimate claims of those in special need. While there are millions of people, including many of the most vocal critics of increased public expenditure on health and welfare, whose main problems are trying to diet and knowing where to park their second car, there is still a shortage of hospital beds for the young chronic sick, many of whom even now have to spend the final years of their young lives in geriatric wards.
  For those who believe in the ideal of:
  "From each according to his ability, to each according to his needs"
  it is distressing that less than a tithe of what is spent by the affluent on their pleasures would be more than enough to meet all the legitimate and pressing claims of the chronically sick and disabled. As the Pearson Commission puts it in another context,
  "… it is only right for those who have to share with those who have not."
  There is a near consensus among the organisations working to help those who are disabled that the maintenance of a register of the names of disabled per-
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  sons, regardless of whether they apply for assistance, should be mandatory upon the local authorities, subject only to a person's willingness to have his name included and the assurance of a reasonable degree of confidentiality. This already applies to the registration of blind persons and I see no reason why it should not be extended to all disabled persons, so that the information available to the public authorities on the extent of disablement is both accurate and uniform.
  Schemes submitted by local authorities under the provisions of Section 29 of the National Assistance Act, 1948, usually contain the following:
  "The … Council shall keep a register of handicapped persons who apply for assistance and whom the Council assist under this scheme and shall include therein such particulars as they think fit, including any which the Minister may from time to time direct".
  At first glance this appears to be mandatory, but the important words are "persons who apply for assistance". If the authority is not anxious to assist the disabled, it can obviously fail to advertise its services, and this inevitably limits the number of persons who apply for assistance. Thus, the keeping of uniform registers with the safeguards to which I have referred is a matter of central importance in terms of improving the welfare of disabled persons.
  Mr. John M. Temple: The hon. Gentleman knows that I support him wholeheartedly, but there is a point which is worrying the local authority associations and myself. It is that there is no definition in the Bill of chronically sick and disabled persons. Would it be the hon. Gentleman's intention at a later date to introduce a definition? That would be of great assistance.
  Mr. Morris: In Clause 20(3) I attempt to define the younger chronic sick. I am deeply conscious of the need for further definitions as we proceed, as I hope we shall, to more detailed consideration of the Bill in Standing Committee.
  The hon. Member for Moray and Nairn (Mr. Gordon Campbell), who has consistently stressed the urgency of the need to compile a full and meaningful register, has written to me to say how sorry he is not to be able to be with us today.

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  The House knows of his sincere and abiding interest in the aims of the Bill and, in particular, the provisions of Clause 1, and of the part he has played in emphasising the importance of registration.
  The reference in Clause 1 and in other Clauses to the local health authority is not, of course, intended to mean that the duties should be the responsibility of the local authority's medical officer of health, or of the health committee. These duties would normally be the responsibility of the welfare services committee, or its equivalent, and my hope is that all the provisions of the Bill will soon become the responsibility of new social service committees.
  Clause 2 sets out the information that should be available to the chronically sick and the disabled and emphasises the importance of communicating this information, in whatever form may be appropriate to the individual. This cannot be done unless we know where the disabled are, and the register is therefore of primary, not to say crucial, importance.
  That local authorities are not providing adequate information at present is well evidenced by a letter sent to me by Mr. Marsh Dickson, the well respected President of the National Campaign for the Young Chronic Sick. He writes:
  "My wife, Dorothy, suffers from advanced multiple sclerosis and is unable to read, write, feed herself or stand, and her vision is very much impaired. She has available aids such as Possum, Ripple Mattress and a battery operated Ripple Cushion for her chair."
  Mrs. Dickson was entitled to the possum and her general practitioner was asked to arrange a visit to the consultant at the Middlesex Hospital. I am told that the Middlesex Hospital did not realise the entitlement and was most discouraging, saying that people with her disease to the best of its knowledge were not entitled. Mr. Marsh Dickson writes:
  "Fortunately, I knew this not to be true and we fought on, eventually gaining the support of the Consultant and obtained the Possum…Again, when we discovered about the Ripple Mattress and the Ripple Cushion our G.P. immediately got on to the local authority who then proceeded to obtain them for us. It is interesting that the Social Workers concerned had never heard of a battery operated Ripple Cushion."
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  It will be seen from the above that Mrs. Dickson was not informed either by the hospital or the local authority about any of these important aids. And there must be many other sufferers from advanced multiple sclerosis who still know nothing of their entitlements.
  Mr. Dickson's letter goes on:
  "In the boroughs of Kensington and Chelsea there are three Possums. In no case has the information about Possums come from either the hospital or the local authority…Moreover it is interesting that the three Possum users are all of middle-class background with access to information from campaigns or voluntary organisations. My wife knew of these aids through the National Campaign for the Young Chronic Sick. How many people in North Kensington need these things? How are they to get to know about them—especially those who, because of lack of education or background, have no way of finding out for themselves?".
  One need hardly say more on the need for adequate communication between local authorities and those who need their help.
  Under Clause 3, subsections (1), (2) and (3), provisions for the disabled which are now permissive would be mandatory upon local authorities. The whole Clause is intended to standardise local provision on the basis of the best existing practice. None of its requirements would be resisted by any self-respecting local authority. Indeed, such an authority would already be doing all, or almost all, that is required by the Clause. But there are still far too many local authorities whose provisions for their disabled citizens are both nebulous and ineffectual.
  I should like to read from a letter sent to me on 19th November by the head occupational therapist of a hospital management committee in Lancashire, who said:
  "Again, depending on the local authority, it can take many months and quite a lot of 'nagging' from the consultant and from me to provide aid which may in itself cost very litle. One patient was assessed in January, 1968, for a raised lavatory seat at a cost of £2 10s. After much nagging, the local authority supplied this in April, 1968, only to take it way again the following March in order to give it to an older person."
  That is just not good enough, even by the lowest standards, and it points to the importance of Clause 4, where I refer to the housing needs of the disabled and the

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  need for adaptations, as well as of Clause 3.
  I have received comments even more derisive than that which I have just quoted. With some bitterness in its phraseology, one letter informs me that the local authority of a very well-known Lancashire seaside resort spends more on its annual end-of-season illuminations than on its disabled citizens.
  At present the services and facilities available to the disabled, both medical and others, depend on geographical luck. Again, this is just not good enough. Why should the father of a disabled child be forced to reject promotion in another town or city because the facilities available to his child would be so poor compared with those in his existing local authority? This often happens now, and the purpose of Clause 3 is to stop it happening in the future.
  The city of Manchester provides a very good example of concern for the disabled, in the provision it makes for mentally recovered patients in welfare homes like "Weylands" in my constituency of Wythenshawe. That home was the first of its kind built in this country. Fortunately, there are now three in the city of Manchester. They are places where mentally recovered patients can adjust to normal living. Such places show how much the less progressive local authorities can learn from those local authorities which have been leading the way in this so important field of helping the chronically sick and the disabled.
  Subsections (2) and (3) of Clause 3 are no less important than subsection (1). The permissive schemes for handicapped persons other than the blind operated by the local authorities usually include the following provision for sheltered workshop employment:
  "The…Council may provide such sheltered workshops as the Minister may approve in which handicapped persons may be employed in suitable work or may be trained in pursuance of the Disabled Persons Employment Acts, 1944 and 1958."
  The Bill seeks to make that function mandatory.
  As the House knows, the Government's Remploy scheme caters for many thousands of handicapped persons, but there are handicapped people who are so disabled that they are unacceptable to Remploy. Therefore, unless the local
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  authority operates a sheltered workshop scheme, either directly or through an agency, there is always the possibility that there are still disabled persons who could undertake useful productive work but who lack local opportunities for such work. In Manchester, in the sheltered workshops for the disabled, there is a good number of men who are rejects of Remploy but who are now engaged in useful productive work. What is more, these so-called rejects now have a higher basic minimum wage than their erstwhile colleagues in Remploy.
  Another facility which appears in most councils' schemes relates to home employment. The usual phraseology is as follows:
  "The…Council, in consultation with the Minister, may assist under supervision handicapped persons who are capable of earning at least such reasonable weekly sums as the council may determine, by the production of saleable goods or the tendering of useful services, to engage in activities to that end in their own homes or elsewhere other than in sheltered workshops."
  I know from contact with administrators concerned that home employment, which is usually called outwork, is difficult to operate. But that should be a secondary consideration, as these administrators themselves concede, because the interests of disabled persons should count for more than administrative difficulties. A vast amount of work is not necessarily needed to keep numerous disabled people in out-work, for there is a statutory limit of £2 a week placed on their earnings before their National Insurance benefit is reduced. But the satisfaction gained by the disabled employee makes the administrative problems involved so very well worth while.
  I have naturally been in conversation recently with Miss Mary Greaves, who now leads the Disablement Income Group, succeeding in her present office a lady whose memory is revered and cherished by so many right hon. and hon. Members on both sides of the House. I refer, of course, to the late Megan du Boisson. I must emphasise a point that was put to me strongly by Mary Greaves in talking of the importance of employment opportunities for those who are disabled. She told me that the disabled person who becomes a worker experiences a great thrill, the thrill of joining industrial society. She emphasised also,

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  of course, that this is so important to the attitude of mind of disabled people, for if one is told that there is no job life can lose its meaning. Perhaps I hardly need speak further about the importance of the need for all of us who are active in public life to give much more emphasis to the importance of helping the disabled in the matter of employment opportunities.
  Clause 4 refers to the housing needs of the disabled. The first action of an owner-occupier whose wife becomes, say, a rheumatoid arthritic, is likely to be to adapt the home to save his wife avoidable pain and suffering. But tenants of local authorities rely on enlightened policies from those authorities to save members of their families who are disabled from preventable suffering and distress.
  I have a letter from Mr. A. G. Morren, who is a member of the North Cheshire Multiple Sclerosis Society, who says that a lot more could be done to provide two-room bungalows for people suffering from multiple sclerosis, for such people have
  "to contend with stairs which they are not fit to manage and this causes untold falls. There has just recently been a little estate of these built in Chorlton, Manchester, but the cash was all raised by the Society. The joy of those moved in has to be seen to be believed at not having any steps to contend with."
  I pay warm tribute to all those dedicated people who work in the voluntary organisations. Without their help, the problems throughout the whole field covered by this Bill would be very much greater.
  There are tens of thousands of families in this country who, because of the severe disability of the man or wife, seek transfers from one council house to another or, more usually, from a council flat to a council house. Clause 4 suggests that local authorities should adapt the homes of the disabled in every possible case. There are hon. Members present, including the hon. Member for Lowestoft (Mr. Prior), who have emphasised the importance of provisions similar, not to say in some respects identical, to the provisions I am now proposing. In the City of Manchester, disabled families are sometimes preselected for houses that are in the pro-
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  cess of being built so that the houses can be adapted to meet their needs. This also could be emulated by other authorities.
  Clauses 5 and 6 deal with another important aspect of this problem. In Clause 5 I refer to the need for toilet facilities to be signposted and publicised and for improved access for the disabled. The City of Norwich leads local authorities throughout this country in the provision which it makes in this respect. I commend to the leaders of other local authorities the idea of making a journey to Norwich to see the practical concern which is taken there in the problem of giving disabled people access to public buildings.
  The Co-operative Party, with which I am very proud to be associated, passed a very important resolution at its annual conference this year on giving disabled people easier access to public buildings. I am very pleased to be able to acknowledge the important contribution made to thinking about this in the Labour Movement by the Co-operative Party. There have been resolutions on caring for the aged, including the elderly disabled, not just recently, but at one annual conference after another of the Co-operative Party.
  In Clause 9 I refer to young people under the age of 18 suffering from severe visual defects. This Clause has its origins in a case in my constituency concerning a young person with very severe visual defects who found it extremely difficult even to continue her education after the age of 16. I should like to quote a letter from my constituent, Mr. Frank Greaves, who refers to a girl of 16 and a boy of 12 years in the same family who is also semi-blind. Their father is a civil servant at Ringway Airport with a take-home pay of £13 10s. Mr. Greaves says that
  "…she has to walk in all weathers in inadequate clothing two miles to her school in Barlow Moor Road from 29 Kenworthy Lane, Northenden, and two miles back again…".
  My local newspaper, the Wythenshawe Express has said that:
  "The decision is not only causing a great deal of financial hardship, but it is also putting the blind girl's education in jeopardy. If she has to give up attending Braille classes and the other special sessions, she will not be able to teach. That is what she wants to do, if she finishes her course."

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  I know that my right hon. Friend the Minister of Transport will give every possible consideration to the proposition in Clause 9 and the case of my unfortunate young constituent and her family.
  Other right hon. and hon. Members have specialised in various subjects dealt with in the Bill. The hon. Member for Banbury (Mr. Marten) and my hon. Friends the Members for Caerphilly (Mr. Fred Evans) and Eccles (Mr. Lewis Carter-Jones) and others will speak about the importance of Clauses 17, 18 and 19. Motoring for the disable is not a luxury. It is a necessity if they are to have contact with the rest of society. Moreover, haemophiliacs, in particular, may suffer further injury if they travel in the wrong kind of vehicles. I hope this debate will enable both sides of the argument about vehicles for disabled people to be fully deployed.
  Clause 20 has caused me much the deepest concern. I refer to the admission of the younger chronic sick to geriatric accommodation. I appreciate that if geriatric accommodation is the only accommodation available the younger chronic sick must be admitted to it. But there are some very distressing cases. There are young people languishing in wards where the average age of the other patients is over 80 and who, in the phrase of one of them, are learning to grow up in geriatric accommodation. I very much hope that the Minister, in replying to the debate, will accept that there is very deep concern on both sides of the House about the problems of geriatric accommodation.
  I should have liked to deal with other Clauses. My hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) and my hon. Friend the Member for Willesden, West (Mr. Pavitt) than whom there are no two greater experts in this House on the problems of the deaf and the hard of hearing, will speak about the Clauses which refer to the problems of the deaf and the problems of deaf-blind children. As my hon. Friend the Member for Stoke on Trent, South has pointed out on other occasions, children who suffer the dual handicap of being deaf and blind may in some cases be taught as deaf children or as blind children. They have the dual handicap and need special provision. There are the problems also of the autistic children.
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  I read recently that there are 21 units to help autistic children, 18 of them being in the South-East of England. The other three cover the rest of the country.
  I must, however, refer to Clause 25, which will be of considerable help to disabled children. The purpose of this Clause is to allow certain types of slow-moving invalid carriages to be used on the footway without being subject to the requirements of the Road Traffic Acts concerning the use of motor vehicles on roads. In particular, it will allow these invalid carriages to be used by child invalids who would normally be under the minimum age for driving a motor vehicle.
  It is hoped that the Clause will be of particular help to the thalidomide children, who have been provided with small battery-driven cars, not unlike children's pedal cars, which hitherto have not been allowed to be used outside the children's own homes. The Clause should also help handicapped children suffering from a variety of other disabilities, such as muscular dystrophy, who are also able to propel themselves about in small specially coverted powered chairs.
  The Clause will be of assistance to certain adult invalids, often elderly, who also have the use of power-driven wheel chairs which, at present, can be used only on the roads and not on pavements and which must be controlled by a pedestrian who is licensed to control this kind of vehicle.
  The Clause gives the Minister of Transport power to make regulations about the vehicles which may take advantage of this concession and about the way in which they are to be used. Clearly, the the Minister has responsibility for the safety of other pedestrians as well as for the invalids themselves. If the Bill is passed, the Minister will be able to make regulations concerning, for example, the maximum weight of the vehicles and their maximum speed. This will ensure that only vehicles which are suitable for use on pavements will be able to take advantage of the concession. The Minister will also be able, if he thinks fit, to specify a minimum age at which invalid children can use these vehicles or to require that if a child is below a certain age, a pedestrian should accompany the vehicle. The Clause should do

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  a great deal for certain disabled people, particularly children, without imposing serious risk on other road users.
  Mr. Speaker, if we could bequeath one precious gift to posterity, I would choose a society in which there is genuine compassion for the very sick and the disabled; where understanding is unostentatious and sincere; where needs come before means; where, if years cannot be added to the lives of the chronically sick, at least life can be added to their years; where the mobility of disabled people is restricted only by the bounds of technical progress and discovery; where the handicapped have the fundamental right to participate in industry and society according to ability; where socially preventable distress is unknown; and where no man has cause to be ill at ease because of disability.
  Several Hon. Members Several Hon. Members rose—
  Mr. Speaker: As the House will know, there are many aspects of this very human problem which hon. Members with experience and special knowledge seek to canvass. If speeches are reasonably brief, I would hope that we should have a wide-ranging debate on the various problems of disability as raised in the Bill.
  11.44 a.m.
  Mr. Neil Marten: I am sure that we would all wish to congratulate the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris) on his good fortune and to congratulate his brother, the hon. Member for Manchester, Openshaw (Mr. Charles R. Morris), on fixing it so well that he should get top of the list with this Bill. I do not mean "fixing" in any wrong way; I am sorry if I have, perhaps, used the wrong word. It is extremely good that the hon. Member should have chosen this subject, because when one thinks of all the subjects in our life that he might have chosen, I am very glad that he has chosen a Bill to deal with human beings and not chosen animals, much as I like them, as the most important subject for attention.
  There is one point that the hon. Member might refer to his right hon. Friend the Leader of the House, with whom he works so closely. It is an unfortunate
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  situation that a person who draws top place in the list and whose Bill is likely to get through—we hope, in some form at least—has the shortest time in which to prepare it. I know that the hon. Member has been under great pressure. It would be rather nice if we could give thought to this matter so that a little more time might be allowed for the preparation of a Bill which, I hope, will find its way on to the Statute Book. I congratulate the hon. Member on his speech and all the work that he has devoted to this subject. We are likely to have a fairly lengthy time in Committee and for my part I foresee certain Amendments and discussions about cost and other matters, with which I will not waste the time of the House this morning.
  As the hon. Member for Wythenshawe said, I wish to confine my remarks to a limited front and to speak for a very short time on the question of vehicles for disabled drivers. I am, however, glad that Clause 6, which deals with access to buildings, has been included in the Bill. This matter is getting more and more important. Indeed, we had better look at our own House as well. I doubt whether many disabled people have been able to get in upstairs. I know that when we have meetings downstairs with the Disabled Drivers' Association, an all-party group, there are substantial difficulties in getting people in. I am glad, therefore, that Clause 6 has been included.
  I would like to say a word about Clause 17 and the haemophiliacs. I do this with a certain sense of modesty because I see opposite me two practising or ex-practising doctors and a former junior Minister of Health. I would like to remind the House about haemophilia because it is an extraordinary illness. It is a lifelong illness, a hereditary bleeding disorder due to the lack of protein in the blood plasma which is necessary to cause the blood to clot.
  Probably everybody knows that haemophiliacs get substantial bleeding, which continues for a long time, from an open wound, but the experts tell me that the chief disability of haemophiliacs is from repeated internal haemorrhages, particularly in muscles and joints, and that these can arise from a sudden twist

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  or jolt which might be sufficient to start an internal haemorrhage.
  Therefore, the case of the haemophiliac is, perhaps, different from most other disabled people, because most others—for example, those suffering or who have suffered from poliomyelitis—have a permanent disability but it is a fixed one, whereas the haemophiliac never knows quite when a haemorrhage will come on and overtake him.
  The simple fact, from the vehicle viewpoint, is that we want to give the haemophiliacs a vehicle which will lessen the number of twists or jolts which bring on internal haemorrhage. They need a smooth ride and the minimum amount of strain in, say, turning the wheel, a movement which in itself can bring on bleeding. They also require a vehicle in which they can carry a passenger, because a bleed might commence as a result of driving a three-wheeled vehicle while actually going along, in which case the haemophiliac would want to hand over to his passenger.
  I believe that between bleeding sessions the life of haemophiliacs is fairly normal. Therefore, for most of their time they want a normal vehicle which relates to their otherwise normal life. As many of us have said before, that vehicle is a four-wheeled vehicle.
  I had a case recently—and I have sent details of it to the Minister—in my constituency where a three-wheeler was being driven along in a very high wind, and then the thing which I have always feared with three-wheelers happened. It was blown over by the wind. It went upside down into the ditch. The disabled driver driving that vehicle was not a haemophiliac. For 14 hours, I think it was, certainly for 12, he was trapped in his three-wheeled vehicle. As his disability was paralysis from the waist downwards, he could not get out. Nobody saw him till the following dawn, when a passer-by saw the upturned wheels in the ditch. He came up smiling. He was a great character. After a cup of tea and a rest he was all right. But had he been a haemophiliac he might have been dead from bleeding.
  The number of haemophiliacs who have invalid tricycles issued by the Ministry of Health is very few—under 100, I believe. Therefore I do very much
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  support this Clause. I do not think it would cost very much if we just brought haemophiliacs straight away into the category of those who have four-wheelers, but their lives would be made a lot easier.
  I asked the Minister a Question on this on 24th November and he replied:
  "Haemophiliacs will continue to be given priority for the improved three-wheelers now available, and for those with automatic transmission in due course. The interiors are specially modified when necessary."—[OFFICIAL REPORT, 24th November, 1969; Vol. 792, c. 5.]
  Not a word about four-wheelers, and I would ask the Minister to reconsider that reply.
  Clause 17(b) is the one which has more to do with this than is apparent on the surface. It is the one about bringing civilian disabled into line with war pensioners. War pensioners get four-wheelers. This is a remarkable Clause because it would, if it went through, achieve the object of those of us in this House who want four-wheelers for all the disabled. This is a short way of achieving our object, by putting in this Clause in the Bill. I thought I had better be quite fair and point that out to the Minister unless he had not noticed the purpose of it.
  The war has been over almost 25 years and from the war pensioner's point of view it does not matter that civilian disabled should be given equal treatment with themselves. The force of that argument is beginning to fade.
  Mr. John Horner (Oldsbury and Halesowen): Is it not a fact that this provision of four-wheelers extends to anyone in the Armed Forces at the moment who may be disabled as the result of any accident or any illness in the Armed Forces today?
  Mr. Marten: That is so. I hope that the hon. Gentleman catches Mr. Speaker's eye and can make that point once again. We want civilians treated in the same way as those who rightly served their country and deserved well of their country in the years after the war.
  There is the prototype P5 three-wheeler coming next year or the year after. It is a very good three-wheeled vehicle. My wife and I went to the centre at Blackpool and drove it and we were very impressed with it. For those who want a

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  three-wheeler it is a great advancement. One of the troubles about it is that still, although it is a two-seater vehicle, the driver is not allowed to carry a passenger. The second seat, or, rather, place for a seat, is for the driver's wheelchair. Not having a wheelchair myself I had my wife alongside me, and the two of us drove it very satisfactorily.
  However, of all the drivers on the roads who might need help, who, in a crisis or in any accident might need the help of another person, the disabled drivers are the ones who most want this help, and we provide them with three-wheelers without the ability to carry passengers, and so we deny them the very help they want. These people have the extra burden of disability to bear throughout the whole of their lives. Although we try as far as we can to make their lives as normal as possible yet in the provision of vehicles we do not allow them to carry passengers In the ordinary way of life a man driving out wants to take his wife and family with him. As soon as we can we ought to get through this House a change in the provision for disabled drivers to allow them to have passengers. Disabled drivers are, of all people, people who do not want to draw attention to themselves. They want to appear to be absolutely normal, and yet if there is one vehicle on the road which is absolutely identifiable it is the Ministry's three-wheeled vehicle. Everyone can say "There goes a disabled driver", and that is the one thing which the disabled drivers do not want to happen. They do not want to be identified.
  I know the problems and the arguments which there are about resources and about the availability of the vehicles, but I ask the Minister, when he intervenes, as I hope he will, to let us know how the Ministry's investigation is going into these problems and about the numbers. How many would want these vehicles? I believe that in the Ministry there may be an exaggeration of the numbers and, therefore, of the cost of the whole project, because when in February, 1967, the then Minister of Health extended the categories of people entitled to four-wheelers he said in his statement that it would extend to 1,600 households. In fact the number at the end of last year was not 1,600, it was, I believe,
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  only 150 vehicles which have been issued. Therefore, with great respect to the Ministry, I suspect that it has got its calculations wrong, and I would ask the Minister to have a totally fresh look at the figures and the costs involved in doing what we want, which is to give four-wheelers throughout.
  Clause 18 I shall not dwell on. That is about disabled passengers. What I have said about disabled drivers applies a fortiori to the disabled who cannot drive themselves. We should not forget that they are equally deserving as disabled drivers, and their problem is basically the same.
  As I said before, I know that this will be somewhat costly. We may have got our figures wrong. However, my hon. Friends on both sides of the House in our disabled drivers' group and I will go on pressing for this provision, whether we get it in this Bill or not. We shall continue to press for it. Certainly I shall, because I am fit. At least, I hope I am fit. I have had an awful letter in my mail this morning and I have not read it yet, and it is from the Heart Foundation. But I think I am fit, and I just count the blessing that I am fit. Because I am fit I am determined to do what I can to help those who suffer these disabilities all their lives.
  Mr. Speaker: Mr. Ashley, whom we would all congratulate on his own triumph over disability.
  11.59 a.m.
  Mr. Jack Ashley: Some months ago the then President of the Board of Trade had a fall and injured one of his elbows. He broke his elbow, and there was a great deal of sympathy expressed with him. He was photographed in hospital and people everywhere wished him a full and speedy recovery, and my right hon. Friend had a speedy recovery, but the overwhelming majority of the chronically sick and disabled are not only bereft of that kind of public sympathy which was expressed to my right hon. Friend but, in addition, are faced with the existing burden of public indifference.
  The public are rarely slow to respond to dramatic situations like Biafra or Aberfan, which they can easily comprehend, but they are less able to compre-

  1869
  hend permanent darkness, permanent silence or permanent immobility, and they are less willing to do so. This is because in our conformist society there is almost a superstitious fear of those who are different and a lack of understanding of what those differences involve.
  The chronically sick and the disabled need all the champions they can get. They have no powerful, militant trade union fighting for them, and that is why thousands of these people will owe a debt of gratitude to my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) for bringing forward this proposal. I know that it is the pleasant, formal tradition of the House to thank hon. Members for initiating debates, but there is nothing formal in my appreciation of my hon. Friend for initiating this debate, because this is not so much a Bill as a charter for the chronic sick and disabled. The Bill will help to transform the public attitude towards the disabled and will lay on local authorities clear statutory requirements.
  The first nine Clauses will ensure that local authorities will have, instead of a moral responsibility, a legal responsibility to the disabled. Some local authorities have a fine record of service to the chronically sick and disabled, but they are a minority, and the majority of local authorities in Britain have an attitude which is both apathetic and indifferent. The voluntary register of the disabled varies from 1·3 per 1,000 to 7·9 per 1,000, which is a clear indication that some local authorities are much more concerned than others, and this is why the provisions in the Bill are so important. The Bill will ensure that the lazy authorities render the same services to the chronic sick and the disabled as those given to the best local authorities.
  In an eloquent plea in 1967, the late Megan du Boisson, to whom my hon. Friend referred, begged the representatives of local authorities for compassionate consideration for the disabled. She outlined in detail the many ways in which the chronically sick and the disabled can be assisted. She mentioned provision for housing, rent and rebate schemes, children's grants, welfare foods, meals on wheels, school meals and uniforms and all the rest. In appealing to
  1870
  those local authority representatives she said this:
  "I beg of you, as you implement your many powers, some of which no doubt lie neglected or incomplete, please remember the words of one of our correspondents: 'When you haven't much, pride is all you've got.'"
  She went on:
  "Don't take that away in the manner of giving."
  Some local authorities have ignored that phrase and have taken away the pride of the sick and disabled in the manner of their giving. The provisions in the Bill will remove from local authorities the ability to take away that pride, and that is one of the most powerful and cogent arguments, not merely for supporting the Bill but for the Government to support it.
  The House will understand that I have a particular interest in deafness. I understand this problem perhaps as well as any hon. Member, and I have spent much of this week at an international conference dealing with deafness. Deafness is a very curious disability. No disability presents a greater challenge to the imagination, because it is invisible and it cannot be simulated. It is an unseen individual cage, and sudden deafness can be a shattering experience which devastates and sometimes drowns a man in a sea of silence. Yet, what Dr. Johnson called the "most desperate of human calamities" drifts belatedly in the medical backwaters. Although medical science can help with some forms of deafness by surgery and with hearing aids, the basic problem is nerve deafness which cannot be helped in these ways.
  It was agreed only yesterday at the international conference that what is needed to tackle this problem is a multi-disciplinary approach, so that not only otologists but pathologists, physiologists, neurologists, physicists, zoologists and geneticists can all combine in an attack upon this basic problem of nerve deafness.
  In Britain we have no such multi-disciplinary approach; we do not have even an institute for otologists. The deaf of Britain resent this scandal of the failure to provide a national institute where otology and all these other disciplines can be combined. For far too long the deaf have been ignored. They have been the Cinderella of the disabled, and I hope the Government will take careful note of the powerful feeling which exists at local,

  1871
  national and international level and will give sympathetic consideration to the Bill.
  I respect your wish for short speeches, Mr. Speaker, and I will say a final word on a further provision in the Bill. If the deaf of this country are faced with difficulties, how much greater are the difficulties of the deaf-blind. We do not know how many deaf-blind there are; the public does not know; the Government do not know. When I asked the Minister of Education and Science earlier this year about this matter, he said he did not know. It is remarkable that men, women and children live in a world of total silence and total darkness and yet we have not even bothered to find out how many there are. It is time the Government began to take the problem very seriously indeed. The first step surely is to find out how many there are.
  What the Government in fact know is that there are 208 children who are deaf-blind, dual-handicapped. These children need special units which can cater for that dual disability. But out of the existing 208 deaf-blind children under the age of 8, only 44 are in special units for deaf-blind. Can the House believe that? There is no point in placing a deaf-blind child in a deaf unit. They do not understand. There is no point in placing a deaf-blind child in a blind unit. They do not understand. There is even less point in placing a deaf-blind child in a sub-normal unit because they, too, do not understand.
  There is an urgent need for special provision for the deaf-blind. They need diagnostic assessment. They need small, local units. They need more skills and continuity of provision.
  We are today debating issues which will affect the quality of the lives of thousands of men, women and children who cannot be present today, the future of many chronically sick and disabled people. I say to my hon. Friend on the Front Bench and to my right hon. Friend who I hope will take note of this debate, that the time is not convenient for action. The time never was convenient for action, the time never is convenient for action, the time never will be convenient for action. But I hope that the Government will place obligation before convenience
  1872
  and ensure that the chronically sick and the disabled will not be let down.
  12.13 p.m.
  Mr. John Astor: I am particularly grateful to have the opportunity to follow the hon. Member for Stoke-on-Trent, South (Mr. Ashley). We all have the greatest admiration for the way in which he has shown how it is possible to overcome a severe disability and for the work that he has put in on behalf of disabled people throughout the country.
  I also wish to congratulate the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris) on his good fortune in the ballot, albeit by proxy, but more particularly for the choice of subject and for the admirable way in which he introduced it. As he said, it is a humane Bill about an intensely human problem and it was in that spirit that he spoke.
  We are all conscious that in recent years there has been growing pressure to remedy some of the anomalies and shortcomings which have come to light in the existing provisions of the social security system. This is especially true in respect of the so-called civilian disabled. The Bill will go some way towards improving the situation. I believe that the Bill will be widely welcomed in all parts of the House as well as in the country at large.
  In recent years there has been a growing understanding of the problems of disablement. This in large measure is due to the Disablement Income Group, originally under the leadership and inspiration of the late Megan de Boisson, whose work is being ably carried on by Mary Greaves. I am sure all hon. Members in their constituencies will have knowledge of severely disabled people who not only are struggling to overcome their disabilities but also are having to fight against the twin economic forces of increased cost associated with disability and a reduced earning capacity. Some understandably have not been able to overcome these problems living at home, and have been admitted to hospitals, or often to inappropriate accommodation in geriatric wards. I am particularly pleased that the hon. Member for Wythenshawe drew attention to this problem and has made provision for it in Clause 20.

  1873
  For those who have been able to remain at home, the financial struggle has often imposed great strains and sacrifices and anxieties on the whole family. In many cases the family resources are fully committed to just existing, with no provision available for adapting the home to make it more convenient for the disabled person, with little or no possibility of holidays or entertainment either for the invalid or sometimes even for the rest of the family. This can put an even greater strain on an already difficult family relationship.
  I am sure that it is now widely accepted that, provided medical circumstances allow it, it is greatly beneficial for disabled people to live at home with their families wherever possible rather than to be institutionalised, however humanely the hospital may be run.
  Therefore I specially welcome Clauses 3 and 4, which provide for practical and financial assistance in enabling disabled people to adapt their homes and also require local authorities in their new housing programmes to make provision for the disabled who live in their areas. This kind of assistance is necessary to complement the attendance allowance, and the invalidity pension which the Government propose to include in their new social security Bill.
  I should like to welcome the fact that the Government have accepted the principle of an attendance allowance for very severely disabled people and also the principle of invalidity pensions. I hope that when the rates of the benefit are announced they will be sufficient to allow people to continue living in their homes.
  The severely disabled people that I have been privileged to meet have always struck me as being an intensely proud group. Apart from their physical handicaps, they are in every way normal citizens anxious to lead a full, useful and constructive life. I do not believe that they are asking for special privileges in the normally accepted sense of the term, but merely that they should have some help to enable them to overcome the handicaps with which they are afflicted, both physical and economical, so that they can live and compete, on as near equal terms as possible, with their fellow citizens.
  1874
  It is vitally important that they should be encouraged to earn their own living wherever this is at all possible. Subsection (3) of Clause 3 is particularly important in this respect. I hope that the word "assistance" will extend to the provision of equipment to make it possible for disabled people to work in their own homes. I am not certain whether in future responsibility for this type of equipment will rest with local authorities or the Department of Employment and Productivity. At the moment this Department can and does make equipment available, but very often, though the practice may vary in different areas, the Department requires the disabled person to prove that he can use the equipment economically before it will supply it. This produces a difficulty because the invalid has no resources with which to buy, or even hire, such equipment. Therefore he has no opportunity to prove his capacity to use it.
  The other day I came across an example of a young man who had been trained as a watch repairer and who became seriously afflicted. It would have been possible for him to continue his trade by working at home if he could obtain the use of a fairly expensive piece of equipment. Perhaps not unnaturally, the Department took the attitude that he must first prove that he could use it. In this case, an individual organisation heard of the problem and arranged to hire the equipment for a trial period so that he might have an opportunity to demonstrate his capacity. He was entirely successful, and eventually the Department purchased the machine, and now all is well. I hope that in future whoever is responsible for supplying equipment will show a little more flexibility and be able either to hire out or lend the equipment to anyone confronted with this problem.
  It is of great importance for a disabled person to feel that he can earn his own living. Even a limited degree of independence is of special significance. The physical handicaps of the disabled often mean that they are substantially dependent on others for everyday living. Minor matters like washing, feeding and mobility, even the opening or shutting of a window, are impossible. They are the sorts of activities which we take for granted. It must be extremely frustrating

  1875
  for the disabled to have to be wholly dependent on other hands. I am sure that the degree of independence attained by a person being able to earn his living is of vital importance.
  I have slight reservations about special concessions for any group of people. I am thinking of such matters as reduced costs of wireless licences, and so on. In general terms, it is better if the disabled can have a sufficient income, either through their own earnings or through any benefits to which they may be entitled, to be able to afford what might be termed the minor luxuries which in some cases are almost necessities, and make the choice of how they wish to spend that money. In present circumstances, the incomes of many disabled people are not sufficient to meet those needs, so it may be that there is a case for special concessions. However, I would prefer to see their general income level sufficient to meet those needs.
  My hon. Friend the Member for City of Chester (Mr. Temple) drew attention to the problem of defining the chronically sick and severely disabled. A lot of the benefits of the Bill will apply to everyone. I have in mind improved access to public buildings, and so on. However, some of the provisions require the spending of money on individuals. Assuming that resources are likely to be limited, I hope that they will be concentrated on the severest disabled. I think that we all agree that many who receive partial disability pensions as a result of war service are not totally incapacitated from earning a living. They may suffer great inconvenience, and pain, and, of course, no one would deny their right to a pension. However, I hope that where financial resources are restricted they will be concentrated upon those who are really severely disabled and incapable of earning a living.
  I welcome the Bill, and I wish its sponsor every success with its progress.
  12.24 p.m.
  Mr. Laurence Pavitt: The hon. Member for Newbury (Mr. Astor) has voiced the theme which will run throughout this debate. It is one of compassion for those whom we are trying to help. I pay tribute to my hon. Friend the Member for Manchester,
  1876
  Wythenshawe (Mr. Alfred Morris) for bringing in the Bill and for his understanding of the way in which, in committee, we shall have to do a good deal to improve it.
  Any welcome to the Bill must include a tribute to the courage of those with whom it is concerned and the way in which those of them in this House are able to help others in similar circumstances and are prepared to use their time to that end, in spite of their disabilities. Not least in that category is my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley), who has made such a splendid contribution to our debate.
  We must also pay tribute to the Disablement Income Group, the National Campaign for the Young Chronic Sick and, perhaps I might add, the Chelsea Labour Party, which has done so much in this regard and shown that the Labour Party in that area has a soul in this matter, as it has in so many others.
  The Bill is designed to help people to cope with their difficulties. If a person has a disability and is trying to cope with it, he does not ask for pity. He requires a helping hand to enable him to do the job. My hon. Friend the Member for Wythenshawe has outlined the case for helping people who live at home and not in institutions and to help them play the fullest possible part in the community, so that they become part of it and not an object of embarrassed curiosity or pity. I think that that is what my hon. Friend has succeded in putting into legislative language.
  He was right to remind the House of the tremendous achievements of the Government. It is a background which is extremely impressive. Very few countries provide free motorised vehicles. We are so civilised that not only are they taken for granted but we are fighting to improve them, and so we should. However, we should not ignore the fact that we have done more than any other country in this regard.
  Last year, we spent £132 million more on health. Since 1949, we have 40 per cent. more physiotherapists. The number of radiographers and occupational therapists has more than doubled. Last year, new artificial limb and appliance centres opened at Oxford and Newcastle, in addition to major extensions at Leeds.

  1877
  Hon. Members will know that I, too, come to this Huse with my own disability, and I remember that free hearing aids issued since 1948 now total 1,035,000. Last year, 64,465 patients were fitted with free Medresco aids.
  I differ from my hon. Friend the Member for Stoke-on-Trent, South in only one respect. I am one of those who suffer from perceptive deafness. Surgery cannot help us, but, he will be pleased to know that thanks to the advances made in audiology electronics, we can receive marginal help. As a result, I can take my part in this House with a crutch in each ear to help me get along.
  I am grateful to my hon. Friend the Member for Wythenshawe for permitting me to insert three Clauses in his Bill. I refer to Clauses 22, 23 and 24. The needs of the blind and the general class of handicapped are now broadly understood by members of the public, who are always ready with help and understanding. The needs of the deaf, on the other hand, are not yet fully understood. Members of the public generally do not appreciate the sense of isolation which deafness can bring. Those Clauses are designed to meet this disability.
  Deafness brings with it loneliness and the feeling of being cut off from human fellowship. Beethoven, himself a sufferer, once wrote:
  "I was soon obliged to seclude myself and live in solitude. If at times I decided just to ignore my infirmity, alas, how cruelly was I then driven back by the intensified sad experience of my poor hearing. Yet I could not bring myself to say to people: 'Speak up, shout, for I am deaf'."
  One of the saddest places in the world for a person with hearing loss is the Tea Room of the House of Commons. One is not lonely when by oneself, but one is lonely when, surrounded by friends and colleagues with mutual interests, and yet outside. It is not possible to join in the gossip and laughter. One worries if there is any criticism of the apparent standoffishness because one dare not participate in what is going on. These clauses in the Bill try to help overcome that feeling.
  There are two groups among the deaf. My hon. Friend the Member for Stoke-on-Trent, South is completely deaf and has been forced to find substitutes for
  1878
  his lost hearing. There are others who suffer deafness, but not total deafness, and who are seeking ways in which to remain in the community. Clause 3(1)(vii) recognises a very real need in this way. Those of us trying to cope may have a hearing aid, but unless we are taught to use it it is like having a piano in the front room that one cannot play. So far, there are adequate facilities for deaf people to receive aids, but not sufficient for them to be trained to use them. It takes about three months successfully to be trained to use it, so I regard Clause 3(1)(vii) as particularly important.
  Clause 22, dealing with employment, is to be compared with what has recently happened with regard to epilepsy. Until very recently a person disabled through epilepsy was forbidden to drive a car, but legislation has now been introduced to get over that difficulty. Thanks to medical science and pheno-barbitone it is possible for an epileptic person to be a safe and satisfactory driver. In the same way, many areas of employment which were previously impossible for a deaf person are now possible thanks to hearing aids. The Clause seeks to provide a safeguard that they shall not be debarred from employment merely on account of their deafness.
  Clause 23 supplements facilities already available under the Department of Employment and Productivity, where a rehabilitation officer covering the whole range of disability is at the service of the community in a local departmental office. But there is no specialist in deafness at the headquarters of the Department. There is a need for a similar kind of approach for the deaf as there has been for the blind. In the same way as blind people can be trained to be excellent telephonists, there are special skills that the Bill would enable deaf persons to acquire. We put a statutory responsibility on the Department to provide the necessary training facilities.
  My hon. Friend the Member for Stoke-on-Trent, South, has referred to the need for an Institute of Hearing Research, for which Clause 24 asks. At present the whole situation is very scrappy. There is an Institute of Ology and Larynto-gology in Gray's Inn Road. It is part of the Ear, Nose and Throat Hospital there. But there is also the Medical Research

  1879
  Council in Queen Square, with a special otological and hearing lean. This, I hope, is shortly to be upgraded and become an M.R.C. Unit. I look forward to a little more finance for this purpose coming from the Department of Education and Science. The problem is that we have the Medical Research Council under one Secretary of State and help for the deaf under another, while local government comes into the picture as well, together with the Department of Employment and Productivity. So there is, as my hon. Friend the Member for Stoke-on-Trent, South said, a great need to centralise these matters in one Institute of Hearing Research instead of their being scattered over the Sound and Vibration Unit at Southampton, and over Manchester, Reading and Bristol Universities, the Salford Department of Electrical Engineering and the Institute of Otology and Laryngology. As a result of this scattering, resources are wasted, and there is no centre large enough to attract scientists of the highest calibre. There is a danger of research being duplicated.
  A central research institute would be able to attract the best scientists into one co-ordinated team of not only the otologists, laryngologists, neurologists, audiologists and electrical engineers but also the paediatricians and the geriatricians and all the other qualified people from different disciplines so vital if one is to create one combined team. As I have said, there are at present too many scrappy approaches which are not effectively co-ordinated. Therefore Clause 24 is one of the most important in the Bill.
  Many other hon. Members wish to speak, so I shall end by pointing out that modern science now gives us the means, while welfare services, statutory and voluntary, give us the machinery. The Bill will give us the impetus to match the means and the machinery with sympathy and compassion, to fetch back into the main stream all those who by chronic illness or disability have been pushed to one side and too often forgotten.
  12.34 p.m.
  Sir Clive Bossom: It is always a pleasure to follow the hon. Member for Willesden, West. He is Chairman of the Health Committee of
  1880
  his party, and speaks with a deep knowledge on health matters and matters concerning the deaf.
  I congratulate the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris) on putting together this vital and humane Bill and introducing it in the way he did. He has taken immense trouble to canvass those on both sides of the House who have special knowledge of, and interest in, the chronically sick and disabled, and he has done a remarkable job in a very short time. The Bill includes several benefits and concessions which could make a tremendous difference to the lives of many disabled people. The Bill may be criticised for being too ambitious, but every Clause in it is urgently needed. My special interest is the Ex-Services War Disabled Help Organisation, run jointly by the British Red Cross and the Order of St. John. There are about 400,000 war disabled pensioners.
  I should like to make two points that I think will help the disabled, including the war disabled. I agree with the views about concessions expressed by my hon. Friend the Member for Newbury (Mr. Astor). When disabled have not got the ready money, which many of them have not, then some of these concessions would make a very great difference. The first is in Clause 29, on television and wireless licences. A television and wireless are not luxuries for someone who is housebound. They can make a tremendous difference to such a person's life. Most disabled live on a very low income, so £6 is a very large sum to spend on a television licence, and so is 25s. on a wireless licence.
  After World War I the blind were supported by a very strong lobby. I do not in any way begrudge the concessions to them, but they do not have to pay for a wireless licence and 25s. is deducted from the television licence, so that they can listen and enjoy various programmes on television. But could not that concession be extended to include the chronically sick and disabled? Perhaps the Minister of Posts and Telecommunications cannot see his way completely to eliminate the entire payment, but could not he reduce the £6 fee to £3 and make a similar reduction in the wireless licence fee?

  1881
  The same applies to Clause 28. It seems a little hard on a disabled man that he must pay extra for the installation and rental of a special telephone equipment which he probably needs for his work.
  Another concession which could be added to the excellent Clauses 17 and 18 is with regard to the licence of vehicles. Many disabled people cannot use public transport. A car is not a luxury but a necessity for a disabled person going to work. The war disabled have three-wheelers and cars supplied by the Ministry, and are exempt from the licence payment. There are also borderline cases which are often met by the Joint Committee of the Red Cross and St. John and other voluntary and generous organisations which give disabled people a car. The full £25 licence fee has to be paid for those cars. Could not that sum be slightly reduced? It is possible to define a war disabled or civilian disabled person. Mobility means so much to them. To be able to go shopping under one's own steam or to go to a library or a pub gives an enjoyment that those who are not disabled cannot appreciate. To get out and about is a real pleasure, and it must be a grim thought to know that one is completely housebound.
  As has been said, the three-wheeler is a tremendously useful vehicle, but the four-wheeler is that much better because the disabled person can take his wife and family out with him.
  Clause 4 is excellent. What is now needed is a policy of uniformity right across the country. At the moment the situation varies from city to city, and from county to county. What every disabled person wants is the ability to live a "disabled life" in his own home. If he does so, there is a considerable financial saving to the country, but, much more important, he is a much happier man if he is able to be there with his wife and family.
  Turning to Clause 11, something is being done about attendance allowances, but what is needed is a much more generous allowance so that a disabled person can employ the home help service, so that he can use a little more of it and have a little more help by having
  1882
  somebody come in and do the chores in the house.
  Most local authorities are beginning to be as helpful and constructive as they can afford to be with housing, but, if it is possible, could not more generous grants be given to convert and adapt houses for the disabled? This would encourage local authorities to do more than they are doing now. A small percentage of local authorities put up "purpose-built houses" for the disabled, but such authorities are few and far between. As I said before, there is a need for a policy of uniformity right across the country and the lead must come from the Government.
  I know that this has little to do with the Bill, but what would help the chronic sick and disabled most is more nurses in our hospitals. I am sure that the only way to do this is to offer better pay and conditions which will improve the recruiting position of nurses. I should like to put forward a suggestion which I believe would help. Last December, just over 1,500 nurses from the Commonwealth and abroad were doing their three years' training in this country. I should like to see a campaign initiated, backed by the Government, to encourage all foreign nurses to remain for one extra year. One cannot compel them to do this after they have completed their three years very extensive and expensive training, and by then they have become State Registered Nurses with qualifications which are recognised nearly anywhere in the world, but if they could be induced to stay on for this extra year that would be a form of repayment and gratitude to this country for giving them their training, and it would greatly help many hospitals. I am thinking of a hospital such as the Star and Garter at Richmond which looks after war disabled, but where the shortage of nurses is acute.
  Clause 20 talks about the chronic sick. I should like to see this Clause slightly widened to help the desperate plight of the disseminated sclerosis men in the 30 to 45 age group. A man so afflicted may have a youngish wife with a family who goes out to work, while at the same time she tries to look after a husband who is becoming increasingly incapacitated. When she reaches a point of breakdown, the normal solution is for the State to offer that man a place in a geriatric ward

  1883
  of a general hospital. For a mentally active man it is a "living death" to go into a ward like that. It is distressing to him and the social workers who try so desperately hard to find a congenial place for him.
  The Star and Garter Hospital has to impose a ceiling on the number of people it can accept. I understand that there is a waiting time of up to eight years before a person can be taken into that hospital. Very few hospitals are geared to take the type of patient to whom I have just referred. There is a gap in our health services, and we must therefore try to make better provision for the younger and middle-aged disabled men.
  It may be that this humane Bill is trying to be too ambitious, and trying to deal with too many aspects, but I have been in the House for 10 years and I think that this is one of the most needed Measures ever to be presented to the House during those 10 years. I apologise for not being able to remain until the end of the debate, but I have a long-standing engagement in Hereford which I want to try to reach this afternoon.
  12.55 p.m.
  Mr. Lewis Carter-Jones: I am reminded of the words of Hazlitt, that man is the only animal who laughs and cries because he is the only animal who knows the difference between things as they are and things as they ought to be, and probably my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) has that in mind with his desirable and worth-while Bill. It is a big Bill, and will take a lot of piloting through the House. Hon. Members who have taken part in the debate, if they are selected, will probably spend a lot of time on this Measure in Committee, but they will do so in a very worth-while cause.
  I have spent a considerable amount of time on research into the economics of disability. The facts and figures on the economics of looking after the disabled are so spread about, and so coloured with opinions, that no real cost analysis has ever been done of the problem. Perhaps I can rectify the position by giving the House information about a few cases, but I have hundreds which can be put at the disposal of the Ministry.
  1884
  George Bernard Shaw said: "Scientists learn facts and ask why. We dream dreams and ask why not." My hon. Friend the Member for Wythenshawe, together with many of us with an interest in the disabled, will ask "why not" when it comes to caring for the disabled. Our attitude to this matter reminds me very much of the fifth century. We tend to say that not much can be done, that it is the will of God, so let us not tackle the problem. But this is the twentieth century, and we ought to be using twentieth century methods to solve the problems of the disabled.
  Perhaps I might deal briefly with a few of the cases that I have come across which I think highlight some of the problems. I shall start with a simple case, and end with an extremely complicated one. I ought at the outset to declare an interest. In all my work on this subject I have never come across a case in which the State is worse off economically by giving help. In no case that I have investigated has the State suffered by giving help.
  A man who came to my "surgery" was suffering from spina bifida, and he was terribly worried because he was dependent on his wife. From time to time his apprentice son gave him a packet of cigarettes. He is a skilled draughtsman, and he was feeling low and depressed. He was drawing £5 18s. a week from the State, not a great sum, but that was what it cost the State per week. He was able to carry on his work as a draughtsman at home, but he had a communications problem. How could he get in touch with potential employers, and how could they get in touch with him? The answer was very simple. He needed a telephone, but to afford a telephone on £5 18s. a week is a very difficult proposition indeed. The Department of Employment and Productivity was most helpful when I approached it, and the man now has a telephone. He will suffer for the rest of his life from this dreadful disease, but the story had a very pleasant twist. My hon. Friend the Joint Under-Secretary of State, being a medical man, will appreciate this. My constituent paid one of his periodic visits to his doctor, something which he will have to do for the rest of his life. When the examination was over he turned to the doctor and said, "I do not want a medical

  1885
  certificate, thank you very much." The doctor said, "But you must have one." He said, "No. I am now paying income tax on the earnings I have got by being given a telephone."
  This is the simple end of the strata. I turn now to the only case that I have seen published on the economics of rehabilitation. This concerns a man who broke his leg, had an amputation, and the cost of rehabilitation came to about £260. He could either accept rehabilitation treatment and its effects or not. If he accepted, it cost the State £260. That man is 40 years of age with a chance of working for a further 25 years. As a result of the expenditure of £260, the State gains £579 per year for the rest of this man's life.
  It is a rather remarkable reflection that, when talking about the Bill, anxiety has been expressed about the tremendous cost and the overwhelming burden on the State. I submit that we should take a cool look at this to find out whether we can afford not to do it. Every time that we manage to get a disabled person back into the work force, it is bound to represent a net gain to society and to add something further to the gross national income. This is what the battle is about—to improve the gross national product.
  Over and over again, from the lightly disabled to the most severely disabled, we come across this business of them making a contribution to society. I have in the past referred to the case of a man who got polio in Malaya in 1954. He is know as the horizontal man. He will not mind if I disclose his name. He is Paul Bates, and he is in a permanently horizontal position. He is now able to use advanced Possum equipment. He uses the equipment which has already provide itself. I am not talking of the year 2,000; I am talking about now. This equipment exists. If Paul Bates had been looked after by a compassionate society for the past 15 years—his disability was such that he required intensive care because he was unable to breathe without an artificial respirator—it is estimated that it would have cost the country £100 per week. Over 15 years that amounts to £78,000. To me, on a Member of Parliament's salary, £78,000 is a considerable sum of money.
  1886
  Paul Bates is now paying income tax because somebody had the sense to apply the appropriate technology to him.
  I could go on with case after case. These cases rest somewhere in the archives and annals of the Ministry. There is no point in saying that it cannot do a cost benefit analysis, because the information is available. If these people do not get this treatment they will use our scarce resources—doctors, nurses and hospital beds—from now until they die. We must give them a chance to gain their independence now.
  But my plea does not end with those who are young enough and able to continue work, even though severely disabled. I must now move into the category—I am sorry to say that I feel, with my grey hairs, I am about to enter it—of the sere and yellow stage which will come to all of us in time. We will all get old and be unable to do those things that we could do in the past. But there is no reason why old age cannot be helped. There is no reason why we should have to banish people to old people's homes long before they want to go.
  Basically, the problem is one of communication. We must give people the means of controlling their own environment. We will save ourselves millions of £s in the long run if we have the courage and the guts to face the challenge. We are not talking about some time in the future; we are talking about now. The equipment exists. I should not like anyone outside to think that I am talking about cures for diseases. I am not. I am talking about devices which assist the disabled to overcome the severe disabilities that they face.
  I should like to quote one more case in illustration of my point. It is a tragic case and a sad ending, I suppose, but at least it is a happier ending for the man than he thought possible. I use this case to highlight why the Bill is so important. It concerns a surgeon in my constituency who served his community well, but, 18 years ago, realised that he had multiple sclerosis. He operated as a surgeon for ten further years. But he got no remission. For the last eight years he has served as a pediatrician in the hospitals in my constituency and has

  1887
  served the children well. Then remission stopped. He was paralysed and confined to a wheelchair.
  This man is now on a Possum unit and at least able to control his own environment. He thought that he would not have this chance. He can now operate his television, radio, heat and light, telephone—I will come to telephones in a moment—tape recorder, and I hope, in the long run, a typewriter. He is now writing books at home when he thought that he would be coming, as it were, to the end of his useful life. He did not know about the equipment, but he, if anybody, ought to have known about it.
  The Clause in the Bill which insists that people should be told about these things is vitally important. Medical assessments can be made afterwards, but, for heaven's sake, let us not keep people in the dark about the benefits of our society. We hear enough of the evils. Let us hear a little more about the benefits that are available. Therefore, this is one of the most important Clauses in the Bill.
  But let me come to the other side of the coin. My constituent was completely dependent for all his personal requirements and needs upon his wife. That meant that his wife was tied. All too often, as a society, we fail to pay the tribute that we should to those who look after severely disabled people in their own homes. But this man's wife has been released by this equipment. If she had given up and my constituent had gone into hospital, that would have been another £70 to £80 a week to nurse and to keep him alive. But both he and his wife have now got independence. She is free to go out knowing that he can control his own environment.
  I now turn to the problem of the aged within their own homes and in hospital. If we can find simple technical devices to assist disabled people to survive, either at home or in hospital, and control that small environment which they have left. so much the better for everyone both in the moral and economic sense.
  In my view, the young chronic sick, the disabled—whether disabled by disease or by industrial accident—and the old can all be given a greater degree of independence if this Bill becomes law, as I
  1888
  pray that it will. But, apart from this, the dependants of those people will also be released from their long drudgery of work, no matter how much they may love the persons they are serving. Finally, we can make better use of our doctors and nurses for future occasions.
  When my hon. Friend replies, I hope he will indicate what are the greatest worries for the Department from the financial point of view. What evidence has been gathered that the chronically sick if they were adequately looked after would be a burden on the State? Would it not be better to have a long look at those who have overcome their disabilities in order to find out what contribution they have made to our society.
  I am proud to be associated with my hon. Friend the Member for Manchester, Wythenshawe in this Bill. I sincerely hope that it becomes law because, in doing so, not only will it do this House good because it is supported by both sides, but it will be of immeasurable value to countless thousands outside.
  1.2 p.m.
  Mr. J. M. L. Prior: The hon. Member for Eccles (Mr. Carter-Jones) made an eloquent speech, particularly when he talked about the economics of the case. I join in congratulating the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris) on having the luck to have drawn first place in the Ballot and chosen this Bill. I also congratulate him on making certain that the Leader of the House was here to listen to his speech and, I presume, as well to give this Bill a fair passage through the House because it should, perhaps with some modifications, be put on the Statute Book.
  We can all take encouragement from the fact that the momentum to helping the disabled is being continued and that this is the second major debate which has taken place within nine months on the subject of a new deal and a fresh charter for the disabled. As has been pointed out, it is to enable the disabled to lead a fuller life within the community that we are trying to make changes. That is what is important. The mention that has been made of Megan du Boisson and Miss Mary Greaves is all the more important now when we learn so often that people who have helped themselves at the early stages, having perhaps been

  1889
  given help by their parents and enabled to train to do useful jobs, in turn help the country and perhaps their parents later on.
  Miss Greaves told me recently that if her parents had not made immense sacrifices when she was a child to enable her to be trained for a job and to have the equipment with which to get around, she would not now be able to keep her mother, and her mother would have become a burden on the State. So in many respects, as the hon. Member for Beccles said, this can be money well spent.
  What has happened about the social survey? Where have we got to on this question? It is disappointing that it is taking so long. In the debate last February, we were hoping that, by the summer at any rate, we would know more about it. Without wishing to be critical, I hope that the Government are pushing on with the survey because, until we really know what the problem is, it is difficult to know how to deal with it. One feels that the time scale has been allowed to drag out much too long. I hope that we shall hear more definite news today.
  Clause 4 deals with housing and the need for houses to be built or altered so that the disabled can get about in them. I hope we shall not hear this time that the Government do not think that some action is necessary, because it so obviously is necessary to have some powers over the local authorities to make them adapt or build a number of houses specially equipped with the wider doors, the ramps and other things which the disabled need. This can be done much more easily when houses are being built than later on. I do not believe that enough is being done even now after all the publicity there has been.
  The same applies to Clause 6, dealing with access to public buildings. Here, again, an immense amount of work remains to be done and I hope that the Clause will be allowed to stand.
  Clause 26 deals with research and development. I hope that research and development can go much wider than the mechanical aids for the disabled. I hope that it will go wide enough so that much more research can be done into such items as clothing and how to deal with incontinency, particularly among the mentally subnormal and in mental
  1890
  hospitals, where this sort of thing presents a major problem. Often, when going round mental hospitals or talking to people, I have been told that some problems of incontinency could be got over if only the patients could get to the toilet and get their clothing down more quickly. This may seem a rather small thing, but a little more research into the problem of incontinency generally and how to deal with the beds, and so on, would help a great deal.
  Clause 30 deals with the earnings rule. It is a very important Clause, perhaps almost the most important in this important Bill. Last year, I drew attention to the fact, as many others have, that if the wife of a disabled man on sickness benefit went out to work and earned more than £2 16s.— it may have gone up in the recent changes—she lost any help at all from social security. It was not until she earned £5 12s. that she was in any way better off than by just staying at home and earning nothing. This is very wrong. I am certain that we ought to get rid of the earnings rule. To do so could be immensely helpful in relieving the poverty in some disabled homes, and there is real poverty. The disabled are one of the few categories where there is real poverty.
  I want finally to discuss a topic which is not mentioned in the Bill, but which goes to the heart of the matter. This is a good Bill and it will help considerably, but it will not help with the problem of money. Sooner or later we have to face the fact that the one way in which we can enable disabled people to lead reasonable lives, to go about their business and lead the sort of lives that ordinary people can lead, bearing in mind that the expenses of disablement are very great and place a burden on a person or family about which we ordinary people can know nothing, is to introduce some form of disability pension.
  Since my Bill earlier in the year, I have thought much about this and I have talked about it a great deal. Perhaps I tried to go much too wide when I tried to redefine disability and the degree of disability which one might take into consideration. I am now convinced that what we should go for is to start on a narrow front of 100 per cent. disablement. With the 100 per

  1891
  cent. disabled, we could use the criteria which are now applied under the Industrial Injuries Scheme. We could deal with this category of people first and they are the worst cases anyhow. They will not be covered by the constant attendance allowance, which covers very few, but a large section would be covered by the 100 per cent. disability allowance.
  I agree that this would raise problems with those who are 70, 80, or 90 per cent. disabled, but if we made a start with the narrow band of 100 per cent. disabled, we could define that man and that disability clearly and help those whose need was greatest. This should be a straight pension, not subject to a means test or selectivity in any way, because it would give to these people the additional cash which they require because of disablement. They could then go out and earn their salary, but they will always have greater burdens than the rest of the community. This is the category with which we could start. I want to know how far we have got with the social survey and whether the Parliamentary Secretary is now in a position to tell us how many he thinks would fall into this category.
  I welcome the Bill and I congratulate the hon. Member, but I still think that, when everything else has been said and done, we shall sooner or later have to face up to the paying of a disability pension. I hope that the Parliamentary Secretary will tell us that this problem and its size and scale are now receiving from the Government the attention that hon. Members on both sides of the House wish to be given to it and which it is only right that the country should now support.
  1.15 p.m.
  Mr. Fred Evans: It was my countryman, Aneurin Bevan, who, talking about the health scheme, of which he was the main architect, once said that it could never succeed without a continual returning to what he called the deep well of human kindness. Aneurin Bevan would be as congratulatory of my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) as the rest of the House has been today, because the Bill will be a significant milestone along the same
  1892
  kind of road towards that Socialist concept of a society for which Bevan stood all his life. Many of us on both sides of the House are very conscious of the difficulties created in the past through too much permissive legislation vis-à-vis local authorities, and I am extremely pleased that the Bill adopts a mandatory pose.
  To illustrate what can be done, I should like to outline a few of the things which have been accomplished even under existing legislation, even with insufficient grant aid, by local authorities who have adopted an enlightened attitude to the problem of the disabled and the chronic sick. The county concerned is my own county of Glamorgan, which in 1950 began to publicise its proposals for compiling registers of disabled people. Today, more than 3,000 blind and partially sighted people are on the register, nearly 6,000 physically handicapped and 376 deaf and hard of hearing, a total of more than 9,000 people whose names have been entered on the registers, a total exceeded by only two other counties with much larger populations. In addition, with insufficient grant aid the expenditure per 1,000 of the population last year was £99 7s., which is twice the national average.
  I list some of the things which may be done with this kind of expenditure. There is a home visiting service staffed by qualified officers, some of whom have a certificate for social work, while others have been trained internally in well-devised county training schemes, a programme supplemented by staff development schemes.
  A network of social handicraft centres has been established in each locality for all classes of disabled persons and there are now more than 50 such centres. These provide for the necessity for social contacts as well as the ability to get some physical therapy in the development of crafts and so on. The authority provides the materials and tools free of charge in the first instance and at very small charges subsequently.
  Handicapped people are assisted to dispose of their products according to their wishes and the centres themselves are self-governing through their elected committees. They use the profits from the sale of their products for further

  1893
  supplementing social contacts and so on.
  It is extremely important—and this is something the Bill provides for—to bring the home-bound handicapped out of their home surroundings whenever possible so that they can enjoy the amenities of centres such as those I have mentioned. For this purpose, my hon. Friend will be interested to know, this local authority has produced a fleet of purpose-designed vehicles each equipped with a hydraulic lift and capable of carrying approximately 18 very severely handicapped people in order that they may enjoy outings and social contacts throughout the whole of the area in which they live.
  These purpose-built centres are a joint exercise with the lower tier authorities, the district councils, in the county in order to involve the whole of local government in the exercise.
  At urban council level we have meals on wheels, handicrafts and social facilities for retired people, linked to this scheme. The authority makes provision for homes for the disabled, including the replacement of steps with ramps, hand-rails, widening of doors, improving road surfaces, bathroom and toilet facilities, and many other things. With district council housing the county authority provides a subsidy to effect these modifications. As part of a policy of diversifying the type of residential homes for severely disabled people, the authority has developed a special home for younger, physically handicapped people. This is a purpose-built house incorporating up-to-date facilities and amenities, catering for 37 severely handicapped residents in need of care and attention which they cannot receive anywhere else.
  These are a few of the things that local authorities can do even under existing circumstances if the will is there. Unfortunately we all know that under permissive legislation there are vast inequalities of service between one area and another. We can no longer live with a situation in which someone who carries the tragedy of physical or mental disablement is further penalised because of an accident of geography or because of the laziness or uncaring attitude of some local authorities. If this Bill goes into Committee I hope that
  1894
  there will be no weakening over these Clauses dealing with local government.
  I turn to a point raised about the difficulty of compiling the register. I have been anxious to try to see something of the Government's social survey. The size of the problem can be indicated through the local authority I have quoted, where, in spite of this great effort to secure an up-to-date register and to provide facilities, the total number of registered cases as I gave them, is 1·3 per cent. of the total population. In the Denmark exercise it was found that approximately 6 per cent. of the population was likely to be composed of disabled people. Tower Hamlets is a very good authority, which discovered for itself that the disablement figure was likely to be about 1·3 per cent. of its population. Yet an investigation by the Council of Social Services showed that it was more likely to be 4·4 per cent. This is a huge problem and we must not disregard its size when looking at the Bill and giving it our support.
  In my area we have a particular problem with disabled people, as has every mining area. The extent of the problem can be seen from some returns given by the South Wales National Union of Mineworkers in April, 1968. In the South Wales coalfield, out of the total of men employed, 3,000 were registered disabled under the voluntary registration system and there were a further 3,400 disabled but not registered. Over 4,000 of these men were suffering from pneumoconiosis and for whom travel to any of the new factories was impossible. Many of them cannot even travel short distances. A recent survey by the N.C.B. revealed that in West Wales 22 per cent. of the labour force was either elderly or disabled. A further examination showed that in 21 out of 34 pits 20 per cent. of the men were disabled.
  The South Wales N.U.M., and I am speaking almost in a semi-official capacity for it now, gives a welcome to my hon. Friend's Bill, but it is concerned about certain aspects of it. For example, it is concerned that the 3 per cent. of obligatory intake of disabled people by firms employing more than 20 persons has now become an absolute farce. It is just not honoured. Fewer than 50 per cent. of the firms in the country are taking up their quota. The

  1895
  kind of representations which my hon. Friend is likely to have made to him can be judged from the contents of a letter I have received from the South Wales N.U.M. in which it is said that not only should the 3 per cent. quota of disabled people to be employed be considerably increased but an obligation should be placed upon employers to provide for disabled people and partly disabled people when an accident has occurred to an employee in the process of producing a profit for his employer. The obligation should be placed upon employers to make contributions to the schemes evolved by local authorities or other organisations.
  The mining industry probably contains the biggest number of disabled people in a specialist occupation. This is particularly so in South Wales where it is not only pneumoconiosis, emphysema or silicosis. By the very nature of the industry bronchitic complaints of all kinds are extremely prevalent. Looking at many of the death certificates of South Wales miners it will be seen that the first cause of death is bronchitis, the second pneumoconiosis and so on. They are all linked chest diseases which immobilise people.
  The South Wales miners have asked me to make serious representations about the provision of vehicles, because these people can work. We have had plenty today about the psychological rehabilitation of the disabled. These men can work but cannot travel very far, or even travel on public transport sometimes. We have already had one interesting case history and I would like to give another typical illustration.
  It is about a man who was severely injured in a pit accident, who was Herculean above the waist, but whose legs had been completely paralysed through a spinal injury in a roof fall. He became completely immobilised in his home. He could not walk 15 yards without a pair of sticks. He became a very bitter, cynical and tyrannical person with whom his own family could hardly live. When the invalid carriages began to be provided we succeeded in getting him one. Over a couple of years this man's personality changed completely. He blossomed again, found work, became a very good officer worker
  1896
  earning a high salary. His disposition and his home life completely changed. When he died about two years ago in retirement, he had had at least 15 years of very happy employment in a remunerative job. He had repaid what had been spent on his invalid carriage probably several times over. I therefore hope that if the Bill goes to Committee my hon. Friend will make representations along some of these specialist lines.
  I should like to deal with a matter which arises under Clau5e 31. Just as my hon. Friend the Member for Wythen-shawe finished his speech, a letter was handed to me. My hon. Friend has asked me to read it. It is a letter from the National Society for Autistic Children, which reads:
  "Autistic persons are a group who are frequently disabled for life and for whom there is little in the way of specialised provision. Because of this lack of provision an autistic child may have to enter a mental subnormality hospital and remain there for life, though this is in the worst interest of the child. At present it is almost inevitable that this will be the fate of the older autistic person when his parents are too old to care for him even if he is capable of working at a simple job, as there is no 'halfway' provision such as sheltered workshops and hostel accommodation. Autistic children and adults regress seriously in hospital owing to lack of communication and individual attention. The prevalence of autism is four per 10,000 school age children. This means that there are over 3,000 autistic children in England and Wales between the ages of 5 and 14. In some places, notably in London and the London area and also in the North-West of England, specialised schools and units have been provided. At the most, 250 of the 3,000 children are in these units, most of which accept children up to the age of 11 only".
  That letter speaks for itself.
  As an educationist, I regard it as very important that the House should show, particularly to the younger people, that the virtues of compassion, generosity and humanity are still alive and that their idealism should be harnessed to working in the service of people who are more deprived than they are. I wish the Bill every success, and I hope that my hon. Friend the Member for Wythenshawe will have the pleasure of seeing it enacted in the not too distant future.
  1.34 p.m.
  Mr. Tim Fortescue: From this somewhat, but I am sure temporary, isolated position, I add

  1897
  my congratulations to the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris) on his Bill and wish him well with its succeeding stages.
  I should like to say what a pleasure it is for me to follow in debate the hon. Member for Caerphilly (Mr. Fred Evans), with his obviously great knowledge of what is happening in his County of Glamorgan, and to add my voice to his and that of the hon. Member for Eccles (Mr. Carter-Jones) in pointing out that when a sick, disabled or even unemployed person receives benefit from the State he is an expense to the State in three entirely different ways: there is the benefit which he receives; there is the productivity of the nation to which he is not contributing; and there is the income tax which he is not paying. It must always be to the benefit of the State to ensure that as many such people as possible are enabled to take up productive employment. Talk of it being too expensive is not valid, as hon. Members opposite have eloquently pointed out. It is never too expensive to bring people back into the firing line.
  I wish to concentrate on Clause 17, which seeks to amend Section 33 of the Health Services and Public Health Act, 1968, which dealt with vehicles for the disabled. I played a part in the discussions in the House and in Committee on that Measure. The three additions to it proposed in the Bill exactly reflect what many of us on the Committee of last year's Bill were trying to achieve.
  The answers which we received then in the House and in Committee will, I am sure, be repeated by the Parliamentary Secretary today. There is a certain amount of persuasion about them. We were then told that, although it is freely admitted by the Government that four-wheeled vehicles are more acceptable to and more suitable for large numbers of disabled people—they prefer them, they are happier in them and they are able to have company in them—it would not be possible to provide them for all categories of disabled people because it would be far too expensive. The reason is not that an adapted mini-car is all that much more expensive than a three-wheeled vehicle—it is a little more expensive, but it comes off the production line and the servicing of it can be much cheaper—but that the three-wheeled
  1898
  vehicle is not acceptable to such a very large proportion of disabled people that the cost of providing it for them is limited. But it is felt by the Government that if four-wheeled vehicles were made available to all categories of the disabled instead of very restricted categories, as at present, the rush for vehicles would be so enormous that the cost would be very high indeed.
  That seems to me a form of Treasury puritanism which it is very difficult to accept. What the Treasury is saying is that it deliberately provides an unsuitable vehicle for the disabled because if it provided a suitable vehicle too many disabled people would want it. I see the Parliamentary Secretary shaking his head. I very much hope that I am wrong. But this is the gist of what was said to us last year.
  There is another reason—and this is another form of puritanism, whether on the part of the Treasury or the Department of Health and Social Security I am not sure—and that is that if a four-wheeled car were supplied to the disabled it could be abused. It could be driven by people other than the disabled for purposes not connected with the disability. If a disabled man had a 21-year old daughter, as I have, she might want to borrow it in the evenings when he was not using it for purposes entirely unconnected with the disability. This is one reason why the Department has set its face against providing more attractive vehicles to the disabled. That difficulty could be easily overcome by insisting that a vehicle supplied to a disabled man or woman should be so clearly and indelibly identified by some mark or badge that it would be obvious at once if it were used by other than disabled people. This is not an insuperable difficulty.
  I should like the Parliamentary Secretary to tell me whether these two reasons are behind the difficulty in providing four-wheeled vehicles for the disabled and whether, as a result of the great support for the Bill, he believes that these difficulties, which are not such that they cannot be overcome, could be considered very seriously in order to fall into line with what is proposed in the Bill.
  I apologise, Mr. Deputy Speaker, that I shall not be here for all the rest of the debate as I must go to my constituency

  1899
  almost immediately. Once again, I congratulate the hon. Member for Wythenshawe on producing the Bill and wish him every success with it.
  1.39 p.m.
  Mr. W. E. Garrett: I, too, would like to add my thanks to my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) and his colleagues for introducing the Bill. I am sure that those of us who participate in this debate must have been impressed by the thoughtful and kind considerations which have been expressed in the speeches of hon. Members.
  I welcome the Bill. It is long overdue. There is no doubt that it will be widely acclaimed in the North-East as a Bill containing extremely realistic proposals to cater for some essential needs of many unfortunate members of society. Because of the long history of industrial and economic factors particular to the North-East, it is reasonable to state that that region has a far greater proportion per head of the population who will fall into this category than other regions. A great many of the chronically sick are victims of the industrial depression of the 1930s and its consequent effects of large-scale malnutrition, while others are the victims of the toll incurred by the need to produce coal, ships and other heavy engineering products. Many of these people, I regret to tell the House, are not elderly but are very often middle-aged. It is true that they manage to maintain a better standard of living than hitherto and that the industrial injury and social security payments which the State provides ensure that they are not denied any basic fundamental financial assistance.
  The unpleasant fact remains, however, that our welfare society has no sound provisions for ascertaining the other needs of these citizens. That is a defect which the Bill seeks to remedy. Clearly, I suggest, it is not the primary duty of the Department of Health and Social Security to look after the needs that are dealt with in the provisions of the Bill. Rather should it be the duty of society as a whole to face its responsibilities.
  Attempts have been made by some local authorities to tackle the problem,
  1900
  with varying degrees of success. This has been referred to by my hon. Friend the Member for Caerphilly (Mr. Fred Evans) and my hon. Friend the Member for Eccles (Mr. Carter-Jones). I know of one council which for two years employed an officer and, with a limited degree of voluntary help, was able to commence a scheme embodying most of the proposals contained in Clause 2 of the Bill. Unfortunately, the scheme faded away because of lack of financial support. The hon. Member for Lowestoft (Mr. Prior) referred to the essential need to ensure adequate financial support.
  Therefore, I, too, would like to see more positive financial provisions incorporated in the Bill. Unless assistance is given to local authorities from Government funds, it follows that the areas which are heavily industrialised must bear a larger share of the cost than other areas. I would like an assurance from my hon. Friend the Joint Under-Secretary of State that this apparent anomaly will be given serious consideration at the appropriate time.
  I also welcome Clause 4 as it is a regrettable fact that some housing authorities have paid no attention to his vital aspect of the needs of the disabled. There are, however, those who have made some efforts and the House should commend them for their initiative. I have seen some first-class innovations to help the disabled introduced in council houses. Those innovations have been of immense value to the disabled and I see no reason why they should not be extended to help those who live in private property.
  I am sure that the House will also agree to the extension of travel concessions to include people who suffer from varying degrees of blindness, but I do not think that this provision goes far enough. Why not, for example, include those who have chest and respiratory diseases, because they, too, face great strain when having to walk a long distance.
  I know that this travel concession extension will be most acceptable and welcomed in the North-East, where again, because of so many environmental factors, there are probably more than the average number of people who suffer from these distressing chest and respiratory illnesses. I am equally sure that the new Tyneside Passenger Transport Authority will accept with good grace the

  1901
  extensions proposed in the Bill to the Travel Concessions Acts, 1955 and 1964. Again, in Committee, possibly much further thought will be given to this important matter.
  I suggest that mobility is most important to the people whom the Bill seeks to benefit. Clause 18 contains a vital provision, which will be welcomed by many hon. Members who have campaigned relentlessly for the elimination of the single-seater invalid car. It is a long overdue concession to those who have been unable to travel without their marriage partner or personal friend.
  Representing as I do a large industrial constituency, and coming into close contact with so many people who will benefit from the positive and long-overdue proposals of the Bill, I am sure that my hon. Friend the Member for Wythenshawe and his colleagues will accept my thanks on behalf of all these people for introducing what I consider to be a most humane and necessary Bill.
  1.46 p.m.
  Dr. Shirley Summerskill: I believe that the Bill could also be called by a different title—that is, a charter for the disabled and the chronically sick. Its many provisions are long overdue, but they are also things for which this section of the community has been pressing for many years.
  The provisions of the Bill acknowledge the fact that the disabled and chronically sick people require much more than merely extra money to jingle in their pockets. They need two other essential things to give what is their new way of life meaning and purpose. Those two things are mobility and the need to feel useful.
  The Press and television have made the public far more aware than ever before of the needs of this section of the community and have given people a greater understanding of disability and chronic sickness. They are no longer nervous or afraid when they meet people of this kind. This is also a tribute to the various pressure groups which exist on their behalf.
  One of the most important features of the Bill is that there will now be a legal obligation on local authorities, not only to identify their sick and disabled, but to assist them in specific ways. Many local
  1902
  authorities have been doing this for years and have done a great deal, but others could do a great deal more, whereas others still are not meeting the requirements of these people because they do not know who or where they are.
  Thus, the existing permissive legislation is being converted into compulsory legislation, putting the onus on local authorities. It is not unimportant that some local authorities have registered from 6 to 10 times as many disabled people as have other local authorities, which means that there must be thousands of chronically sick and disabled people in Britain who are lacking the help that they require.
  In my constituency, the local authority is helped enormously in its efforts by voluntary organisations. We have in Halifax, fortunately, separate organisations which help the multiple sclerosis patients, the deaf, the blind, the mentally ill, the spastics and those with spina bifida and hydrocephalus. I do not think that all towns can boast of these advantages. Those organisations are run by dedicated people who are giving their time and effort to give these patients the knowledge and help that they require, but it is wrong that any town should rely on these people for this service.
  With regard to the housebound, I welcome the Clause which deals with housing. Often the housing that disabled and chronic sick people need is very similar to that which old or retired people need, that is to say, with access to the interiors planned to suit limited movement, especially in the bathroom and the kitchen, but many of the local authorities are slow to operate home working schemes to help the housebound in this way. I welcome all the Clauses in the Bill which help domestically and with personal help those who cannot get out, because if there is one thing which afflicts the disabled person or person with chronic sickness it is that feeling of loneliness and isolation which is in conflict with the fact that they rely entirely on other people to help them, and they are completely dependent upon outside help.
  We have all seen, for those who can get out of their houses, signs outside public buildings which sometimes say, "No dogs. No prams or wheelchairs." That is what meets the disabled person

  1903
  when he does eventually manage to get out. The other thing which the chronically sick or disabled person does need is the feeling that he is useful to the community.
  That is another reason why he should be encouraged to work part time or full time if he possibly can. There is a great deal more that should be done in this respect. I would confirm what another hon. Member earlier pointed out, that 50 per cent. of British firms do not take up their 3 per cent. quota of disabled workers. These firms are exerting a prejudice and a discrimination against the disabled because they are different, similar to the race and sex discrimination in employment which can be seen to exist in some areas. This situation is inexcusable, because there are known to be 55,000 people who are anxious to work and remain unemployed although classified as capable of working when they are chronically sick or disabled.
  Another form of exploitation which exists is that the labour of the disabled is often grossly abused, with wage rates averaging 3s. an hour, and this loss of earning power to a disabled person is an additional handicap which he has to bear. Remploy offers a magnificent example of what can be done to employ severely disabled people, and the range of jobs which they are able to do, and I think that far more of the less severely disabled people could be employed, with a little imagination and common sense and time taken to do it. There should be more factories to employ the totally disabled labour force, operating machinery which is adapted to the disabled.
  I welcome the provision for wireless and television licences. If there is one thing which, I believe, the housebound disabled person requires, it is television and wireless. It can assist, whatever disability he has, to give him a view of the outside world, which is the one thing that he is denied. I do not agree with the hon. Member who said that the solution is that they should be able to earn more in some jobs. That is an unrealistic view, because these people by their very disability or sickness are confined to the house and are incapable of earning.
  1904
  We have all heard of the invaluable rôle played by the wives of these patients, and therefore I welcome this change in the earnings rule so that a wife can make a fuller contribution outside the home in order to help support the person who is in fact her dependant.
  I would draw to the attention of my hon. Friend who is to close the debate something I am sure he is already aware of, the definition of "chronic sick". We had this discussion, if I can put it in that mild way, over prescription charges. It is very difficult, as my hon. Friend well knows, to define chronic sick. Most G.P.s would be extremely hard put to it to know when a patient stops being chronic sick, and when they can decide that he is well. The list of so-called chronic sick, to qualify for free prescriptions, is, in my view, grossly inadequate. That is why the whole concept of defining these people I believed at that time to be quite wrong. Similarly with the phrase used in the Bill, "long term treatment". How long is long term? But these are things which will be clarified before this Bill can come into force.
  I would end by pointing out that the Bill is primarily concerned with making this section of the community as independent as possible. Those of us who are healthy only appreciate our independence when we are deprived of it when we are ill. It is estimated that 3 per cent. of the people in this country are now disabled or chronic sick. By 1970 one person in every six will be physically disabled through disease, accident, or the onset of old age. This Bill provides the opportunity for positive effort to be made by those who are fit to appreciate the needs and the limitations of those who are not, but we must also appreciate their great potentialities. They do not want our sympathy, as has been pointed out, but they want our understanding and our help, and it is the way that we behave to one another that establishes the quality of the society.
  1.56 p.m.
  Mr. Paul Dean: I should like from this Dispatch Box to join in the congratulations to the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris) upon introducing this Bill. Success in the Ballot is always

  1905
  a fortunate thing, but, in my view, there is no Bill I should more like to see first in the Ballot than a Bill on this subject. We from this side of the House wish it well. I am very glad that it is supported by hon. Members in all parts of the House, and, indeed, supported by an Early Day Motion signed by a very large number of hon. Members.
  I know that my hon. Friend the Member for Farnham (Mr. Maurice Macmillan) hoped to be here today, but, owing to indisposition, it has not been possible, but he expects to be able to take an active part at the later stages of the Bill.
  These Bills help to focus attention on the problem of disability, to get people thinking increasingly about disability in all its various forms. It is not a question of trying to single out the disabled as a special category. That is certainly the last thing they want, and the last thing we want to do. It is a question of ensuring in everything that is done that their special needs are not lost sight of, so that they can be put in a position where they can lead lives as independent as possible and take their rightful place within the community.
  In any debate of this kind one is always struck by the many-sided aspects of the problem. I was very struck, as, I am sure, we all were, by the speech of the hon. Member for Stoke-on-Trent, South (Mr. Ashley), in particular by the reference he made to deafness, which he described as a great challenge to the imagination because it is invisible. A very interesting point, that, because so many aspects of disability are visible; they are obvious. This is one which is not, and who better to draw our attention to that than he?
  We welcome this Bill in principle, and we very much hope that it will go forward to Committee where it can be considered in detail. This is the third Friday this year which has been devoted to the problems of the disabled. The Disablement Commission Bill was introduced by my hon. Friend the Member for Moray and Nairn (Mr. Gordon Campbell) on 28th March, and the Disabled Persons Pensions and Miscellaneous Provisions Bill was introduced by my hon. Friend the Member for Lowestoft (Mr. Prior) on 21st February. I had the privilege of taking part in
  1906
  both those debates, and the principles of those Bills were warmly welcomed on both sides of the House, although, unhappily, the Government did not feel able to accept them, and they were voted down on Second Reading. I very much hope that history will not repeat itself on this occasion.
  We have also had a debate on autism and the problems of the education of autistic children, which was referred to by the hon. Member for Caerphilly (Mr. Fred Evans). All this shows that the attention of the House is rightly being increasingly concentrated on the problems of the disabled and what we, with many others, should be doing to assist people in this category. May I mention four specific points in the Bill briefly before making one or two general comments.
  The first concerns the Clauses dealing with mobility. We are all pleased that Mr. Speaker is one of the vice-presidents of the Disabled Drivers' Association, and that there is such a close connection between the House and the association, which does so much valuable work for the mobility of the disabled. This work is becoming increasingly important with the advances of medical science and with the improvements in vehicles so that more disabled people can leave their own homes, lead a more independent life, do their shopping and go out to work. This involves access to buildings, which is dealt with in Clauses 17 and 18. I reinforce the plea made by my hon. Friend the Member for Banbury (Mr. Marten) with regard to haemophiliacs and hope that the Parliamentary Secretary will be able to say some encouraging words on this.
  The 1968 Act, which Clause 17 seeks to amend, fairly substantially extends the categories of persons who can be provided with vehicles of various kinds, and I hope the Parliamentary Secretary will tell us what progress is being made in providing vehicles to the wider categories of people included in the 1968 Act. The Bill also deals with the equally important matter of mobility in the home.
  My second point concerns the constant attendance allowances, and Clause II suggests the setting up of an advisory council. Will the Parliamentary Secretary tell us about the timing of the Government's proposals for constant attendance allowances for the severely disabled? This is an aspect which is warmly welcomed on

  1907
  both sides of the House, and we all hope that the introduction of allowances will not have to wait until 1972 or the date on which the proposed major reform of National Insurance comes into operation.
  The Bill does not deal with disability pensions, and I appreciate why the hon. Member for Wythenshawe felt that it was not appropriate to deal with them on this occasion. My hon. Friend the Member for Lowestoft suggested that a start could be made with a disability pension, as opposed to a constant attendance allowance, by taking the 100 per cent. disabled who are comparatively easy to define and dealing with them in much the same way as under the Industrial Injuries Scheme.
  My third point concerns Clause 30. I am delighted that Clause 30 deals with the earnings rule for the wife of a sick man. This again has been raised in the House on many occasions. At present the wife who goes out to work to try to keep the home together is allowed to earn only £3 2s. a week before losing all her allowance. Surely, we want to encourage such a wife to support her family and to be able to look after the home.
  Fourthly, I do not know what the Minister will feel about the details of Clause 20, but there have been recent cases, which have received publicity, of younger chronically sick being placed in accommodation which is intended for geriatrics. This is something we all want to see put right, and I hope the Clause will commend itself as a step in that direction.
  May I now refer to one or two general points? The first concerns our lack of knowledge on disability. We do not know who are the disabled, where they live, or the extent of their disability. There is not even an acceptable definition of disability or of chronic sickness on which to base our proposals. We do not know whether they should be based on loss of earning power, whether they should include mental as well as physical handicaps, whether they should cover the widest categories—the war disabled and the industrial injuries, which are fairly well defined—or whether they should concentrate primarily on the civilian disabled, whom we now realise have not received sufficient attention in our general welfare arrangements.
  1908
  For example, a disabled housewife may receive no cash help either through the insurance scheme or through the supplementary benefits scheme. One cannot separate the need for cash from the need for care, as the disabled wife cannot remain at home unless she has money to enable her to do so. If she had to go to hospital, the cost to society and to her family would be far greater. As the hon. Member for Wythenshawe said, we should think less of the actual cost and much more of the net cost of what the Bill proposes. I think he will accept that definitions will be required. He does attempt a definition of the younger chronically sick, but it will be difficult for the local authority to carry out the statutory obligations he is putting on them unless there are clearer definitions of disability and of chronic sickness.
  There is also the question of the Government social survey. I hope that the Minister will be able to tell us when this survey is to be published. I well remember in our earliest debates, in either February or March, that the Minister who replied then said that the survey was expected in the spring. We have now reached winter and there is still no sign of it. It is immensely important particularly for the Committee stage of the Bill, that we should have this information as soon as it is available. After all, estimates vary from 1 million to perhaps 3 million, depending on definition. The information we hope this survey will produce is the sort of essential background information against which we can judge this legislation or any other.
  The register proposed in Clause 1 will help to some extent, but it will inevitably take some time before a complete register, even in each local authority area, can be produced. Even then that will not provide us with the information we need on a national level, which we hope the Government survey will give us. Local authorities have registers of the disabled but registration is voluntary and many, especially those suffering from the disabilities of age, probably do not register.
  I was interested to see that a recent study by the Council of Social Service in Tower Hamlets, called "Physical Disability and Community Care", showed

  1909
  that the rate of disability in the population was 4·4 per cent. This compared with a total of registered handicapped people in the borough of 0·96 per cent. of the population. The survey found that the needs of these people were very inadequately met, despite a comparatively good system of health and welfare services available in the area. Some 31 per cent. of the 200 handicapped people interviewed were getting a home help but a further 29 per cent. wanted them; 12 per cent. were receiving chiropody treatment and another 11 per cent. said that they required it; 25 per cent. complained about their accommodation, because of difficult stairs, dampness or other inadequate facilities.
  Special appliances and aids were supplied only to the registered handicapped so that about 80 per cent. of the disabled were not receiving them. About 75 per cent. had not heard about clubs in the area run by voluntary services. This survey is but one example of many which can be quoted showing that there is still an enormous area of un-met need which would come to light if the extent of the disability were properly known. It is only when it is fully known that we shall be able to decide how best to allocate priorities, how to ensure that we can use the resources available to the very best effect. One thing is quite certain, that this is one of the biggest challenges facing Governments, local authorities, voluntary bodies and society, and will remain so for a long time to come.
  I turn to the question of co-ordination. At present, there are as many as seven different departments which may be involved in dealing with the disabled, even with one disabled person, in such spheres as education, medical needs, work, welfare and transport, to mention a few of the main points. There is inevitably some overlapping and lack of coordination. We should consider a central co-ordinating body which would advise the organisations involved, ensuring that the needs of the disabled are met in the most efficient way. I am glad that this Bill suggests that on the various committees and councils there should be at least one person with experience of work among the chronic sick and disabled and with knowledge of their needs.
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  Should we not go a step further? Do we not really need some sort of Disablement Commission, which we have debated before, covering the whole area, able to focus attention on the needs of the disabled wherever they arise? It seems right that the services for the individual should be tailored to meet his needs as best they can. This is an appropriate moment for going a little further along the road the hon. Gentleman is suggesting in his Bill.
  So many of the services which the disabled want are in a state of flux. We have the Seebohm Report, not yet in statutory form, but with which local authorities are experimenting, as to the best way of co-ordinating various social services at local level. Surely advice from a body which can see the overall problems of the disabled would be of great value in deciding the best way of putting the Seebohm concept into operation at local level? Then we have the proposed reorganisation of the National Health Service, the suggestion that instead of having the administration split in three ways, between the family doctor service, the hospital service and the local health services, they should be brought together under one administration. Here too, the needs of the disabled must be taken into account. Then there is the Maud Report on the reform of local government which is immensely relevant. I suggest to the hon. Gentleman that this may be the right time to take this concept of co-ordinating advice a stage further.
  In some respects this can be described as an ambitious Bill, because it deals with a large number of subjects showing the many ways in which we can and should be assisting the disabled to live effective and independent lives. It is also ambitious when one considers the obligations that are being placed on local authorities. In other respects it is modest in that it does not deal with the difficult question, what can be a much more costly one, of a disability pension. Whether it is described as modest or ambitious, I am sure that proposals on these lines are a step in the right direction. We on this side of the House warmly welcome the Bill and hope that, without too many Amendments in Commtitee, it will speedily reach the Statute Book and be put into operation.
  2.17 p.m.
  The Joint Under-Secretary of State for Health and Social Security (Dr. John Dunwoody): It may be of assistance to the House if I intervene at this stage to indicate the 'Government's attitude to this Bill. I welcome any opportunity of dealing with the problems of the chronically sick and the disabled and I should like to thank my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) for providing us with such a first-class opportunity. This present occasion is the more welcome since it enables the House to review a large number of aspects connected with these problems at a single time, and to see the problem as a whole. We have had so far a debate of a very high standard. I have heard every speech and not one has fallen below that standard. The fact that we are able to debate this issue in this way is a credit to the House.
  It would be invidious to pick out any hon. Member who has contributed so far, and I know that other hon. Members wish to contribute later, but I should say a word about two of my hon. Friends, the Member for Stoke-on-Trent, South (Mr. Ashley) and the Member for Willesden, West (Mr. Pavitt), both of whom have handicaps that in political life are severe in nature. I want to congratulate them not just on overcoming their handicaps, but on their first-class contributions to the debate—an indication of the way in which each one, in his own way, is an effective, participating Member of Parliament.
  A very large number of points have been raised in this debate. There are over 30 Clauses in the Bill, and points have been put to me on virtually every one of them. They do not involve only my Department. At the latest count, there are nine Departments involved in dealing with the Bill. However, i can assure hon. Members that every point put to me today which I may not be able to cover in this speech will be given serious consideration. Many of them are primarily Committee points and probably will be best resolved there if and when the Bill goes into Committee.
  I want to congratulate my hon. Friend the Member for Manchester, Wythenshawe not just on the content but on the compassion of his speech in introducing
  1912
  his Bill. I also congratulate him on the speed with which he has come to grips with this cast and difficult subject. The advantage of drawing first place in the ballot is a dubious one, in that it leaves very little time in which to get one's ideas into a finite form. However, he has shown remarkable energy in solving the problem, and I am deeply impressed with way in which he has brought a complicated Private Member's Bill before the House.
  I hope very much that the House will wish to give the Bill a Second Reading. I welcome it wholeheartedly. There will be a need for careful reflection on each of its many Clauses. This is a complex and intricate subject, and it may turn out that some of its provisions duplicate powers which we have already.
  Perhaps it may serve the House best if I outline some of the more general and crucial considerations to enable us to take full advantage of the opportunity that the Bill gives us to take a real step forward in the coherent and co-ordinated provision of assistance to the chronic sick and severely disabled.
  Before I do that, one specific point has come out in a number of speeches from hon. Members on both sides of the House, and it concerns invalid vehicles. I have been asked a number of specific questions about them, and there are two points that I wish to make. The first is perhaps in answer to the hon. Member for Banbury (Mr. Marten), who asked about investigations into the number and the costs of extensions to the service. I know the interest that the hon. Gentleman has had in this problem for many years. This is a difficult subject, and very many varying estimates have been made in the past of the possible costs of expanding this vehicle service. There is a real difficulty in ensuring accuracy, but I have given instructions within my Department in the last few weeks for the preparation of up-to-date estimates based on reliable figures.
  On the more general point of invalid vehicles, we all want to see an improved service. There is no difference between us on that. But let us remind ourselves that we in this country do far more in providing free transport for the disabled than any other country. We have a remarkable record. Over20,000 invalid

  1913
  three-wheelers have been provided, and over 7,000 cars. In the five years to 1968–69, we have doubled our expenditure on the service to more than £4½ million. That is not a record of which to be ashamed. Of course, we are not doing as much as we would like or intend to do in the future. But this steady progress and committing ourselves to a further substantial improvement by introducing the new and greatly improved three-wheeler at a time when every penny of extra expenditure has to be justified to the hilt, shows that we attach great importance to giving disabled people mobility. That point came out time and time again in many speeches.
  Turning to the more general considerations, one is the major change already taking place in the organisation of many of the services which we have been discussing. This will soon gather momentum. The Gracious Speech indicated the Government's intention to introduce legislation on the basis of the Seebohm Report. In the near future, there is to be a further Government green paper on the organisation of the National Health Service. Hon. Members will know that, recently, an important report on housing management policy has been published, and my right hon. Friend the Minister of Housing and Local Government has promised that its implications will be discussed with local authorities and departments. It deals, among other matters, with the weight to be attached to the claims of the sick and handicapped to housing. Beyond doubt, that is a vitally important factor in their living and well being.
  I draw attention also to a valuable report on voluntary service recently published on behalf of the National Council of Social Service and the National Institute of Social Work Training. The importance of this is that structural improvements are to be introduced throughout these services. These will result in a concentration of the resources to better effect. The health services will provide comprehensive services in hospitals and health centres and in the home according to the need for service and not a category of illness.
  The "Seebohm services", including the welfare services for the handicapped, were also obviously meant by the Committee to take an overall view of family
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  services in much the same way. The fact that a certain age group or disability was represented in a family would alter the social worker's view of the family; it would not necessarily suggest a special and collective attitude to the age or disability category. Similarly, judgments about the recommendations in the housing report must be made in a general context of housing need, for young families and for the elderly just as much.
  There may be arguments for and against this view, although I notice that comment on Seebohm's general approach has almost all been favourable. If it is right, the House will wish to be careful not to obstruct it by putting statutory labels on a group of people and conferring statutory advantages unless they can be fully justified.
  I am sure that we should all think more of these people as people with normal hopes and aspirations who face obstacles that we do not, rather than as different and abnormal and thus risk the danger of thinking of them as inferior in one way or another.
  Another important consideration is social security. The National Superannuation Bill has almost been completed and will be introduced shortly. Those Clauses in this Private Member's Bill which deal with social security benefit will most likely have to be reconsidered in the light of the Government's Bill when it is introduced. This House may think that some of the Clauses in the present Bill are superfluous or that they should be changed, and that public general legislation is the most convenient place for them.
  I will offer only general views on the Clauses which deal with advisory machinery. I hope that they will be debated. However, there is something of a dilemma here. Every Minister will wish to see that his advisory bodies have relevant competence and experience. It is understandable that special interests should seek permanent representation on advisory bodies. Whether it is necessarily always right that the advisory bodies should be rigidly compelled by law to include representatives from particular groups is perhaps sometimes debatable.
  In many ways, a decisive consideration is the problem of resources. Hon. Members need no telling of the Government's

  1915
  determination to get our economy right and keep it right. As part of this job, inevitably there are strict limits on the growth of public expenditure, both centrally and locally. Though the local health and welfare authorities are no less likely than the Government to continue saying, that the social services must command priority, the financial resources cannot be stretched indefinitely. If more is spent in one direction, there may be less to spend in another.
  Mr. Carter-Jones: My hon. Friend is the most appropriate person that I can think of to answer this query. When we decide who shall be on committees, does he not agree that where there is a disease which the medical authorities have not yet been able to cure but which technologists have found a way of alleviating, it is desirable to have technologists on an equal footing with medical men on such committees?
  Dr. Dunwoody: I know of my hon. Friend's great interest in the application of technology to the problems of the disabled.
  I agree that people skilled in this field have something real and worth while to contribute and have a real place on many of these advisory committees. I would say, however, that I would not necessarily want there to be a statutory obligation. I am not suggesting they do not have a real place, but we must seriously consider whether we shall make statutory obligations for a large number of people. One must take special areas, and my hon. Friend indicated a good example of such an area. There are opportunities in those areas for the application of technology to the disabled and we want to see those who are experienced in these matters on advisory committees of one sort or another.
  An even greater constraint may be lack of qualified manpower. The task of approaching the family—let us remember that the disabled and the chronic sick are part of a family and are not merely individuals in the community— assessing and discussing its needs, helping it to decisions about them, seeking the best form of help, whether in the social or in the medical field, are demanding tasks for skilled persons.
  1916
  Indiscriminate provision of services may be wasteful and can be unhelpful and sometimes even dangerous, especially if not adequately supported by professional and skilled staff. Our problem is that in the social work and in some other domiciliary fields there are not yet enough trained people to do all the things we want to do. We must bear this in mind. Simply having more money would not solve the problem overnight.
  Mr. Prior: If the hon. Gentleman is now leaving the financial side, could he give some indication of the Government's attitude to Clause 30, which deals with the earnings rule for wives of sick men?
  Dr. Dunwoody: I am leaving the more general financial provisions and the financial side of the Bill. So far as Clause 30 is concerned, I want to be careful not to go into detail which can be gone into in Committee. There are 32 different Clauses in addition to this one. This is one of the Clauses which, as it deals with the earnings rule for wives of sick men, it would be wisest for us to leave until we know more definitely what is to come before the House in the new national superannuation legislation, which should be before the House in a very short time.
  The hon. Member for Lowestoft (Mr. Prior) asked me a specific point related to the provision of information, particularly in regard to the Government's Social Survey which has been taking place. The Government, with my Department taking a lead, have commissioned a large survey of the adult chronically sick and handicapped living at home. This survey has been carried out by the Government's Social Survey Department. The field work and the tabulation is complete on what is almost a unique piece of work.
  The survey has been looking primarily at those who are prevented by handicap from doing, or doing without difficulty, the ordinary daily living activities which most people take easily in their stride. The survey looked at handicap, housing circumstances, financial matters, access to the various health and welfare services. The process of analysis has now begun, and because of the size of the project this is an involved and long process. We can now correlate and co-ordinate the information obtained. This huge task will not be completed until the middle of next

  1917
  year. Some general information is already becoming available.
  We are grateful to the Government Social Survey Department for its great efforts to contribute information about the severely handicapped in time for decisions about benefits for them. But we must exercise patience until the whole exercise is more clearly comprehensible.
  In my judgment, it would not be in the interests of the services or of the sick and handicapped themselves to rush into premature conclusions based on partial results. There will be more work to do in this and other directions, but next year we shall have a large body of information which no previous British Government, and few Governments elsewhere, have ever had. We can then see for the first time just who and how many we are talking about. We shall know how many are getting service, how many who need it are not, and what is the most effective line of advance. In other words, we can get our priorities right for this group and balance these against wider priorities for the first time.
  Amongst other things, the survey should help us with the problems of definition. No doubt hon. Members have been struck, as I have been, with the difficulties which the absence of definition raises in this Bill. Who are the chronic sick and the handicapped? Like the elephant, they are easy to recognise but hard to describe. We may be confident that the survey will show that a high proportion are elderly. But what is the significance of age? How "chronic" is chronic? How "disabled" is disabled?
  It is obvious that for some purposes "disabled" does not mean always the same thing, and the problem arises in this Bill.
  Two men with the same handicap may not be disabled to the same extent in relation to their occupation. A handicap that is disastrous for a manual worker may not be such for a non-manual worker. A chronic bronchitic does not pose the same daily problems as a paraplegic. For many purposes, this does not matter. If a man needs help, he should get it. One should not split hairs. But when a statutory duty is imposed on an authority to separate out different groups for special treatment, some definition is unavoidable, indeed essential.
  1918
  A definition is no less needed when a specific individual right is created. It may well be an invidious business to operate a definition when the line between the ins and outs is as shadowy as it often will be here. Many Clauses in the Bill would need to be examined from this point of view.
  My hon. Friend has covered a wide variety of questions about people for whom hon. Members in all parts of the House will have the greatest sympathy. He is to be congratulated on that. No doubt the House will want to have these matters further examined to achieve a practical result, and will I hope give the Bill a Second Reading today.
  What seems to me to be needed is a penetrating look at the real purpose that each Clause or group of Clauses seeks to serve. I hope my hon. Friend will feel that this is the proper course so that at Committee stage a well-informed discussion can take place. We must avoid, if we can, imposing duties which cannot be carried out. We must avoid unnecessarily complicating the function of the new bodies that are to be created. My Department will be eager to advise and its help for these purposes and I am certain that other Departments concerned will do the same.
  2.38 p.m.
  Sir Brandon Rhys Williams: I am delighted to have the opportunity of adding my personal congratulations to the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris) for his excellent endeavours in bringing this Bill before the House. He has covered himself with credit and has produced a Measure of far-reaching importance.
  I do not wish to introduce a note of acrimony or controversy when I say that it is wrong that it should be left to a Private Member to introduce a Bill of this importance. I hope the Government will take note of the warmth of welcome given to the Bill in all parts of the House and that it will encourage them to modify their own priorities in social security matters. I hope they will take note of the feeling of the House that they are not doing enough for the disabled.
  This is a big Bill. It is like a shop window with a number of attractive things in it. My inclination is to say,

  1919
  "Yes, we can afford them all, and we must have them". But it is not in every case a question of affording what the hon. Member is suggesting, but a question of whether we have the manpower, and especially the skilled manpower, in the right places to carry out the instructions in full, particularly to local authorities. It must be right to encourage the worst to bring themselves up to the standard of the best even if we have had to be patient and realise that the objects of the Bill are not possible of attainment overnight.
  Besides what is suggested should be done by local authorities, there are some things which it is suggested should be done by the central government, and I welcome in particular Clause 26 which requires the Minister of Technology to lay before Parliament an annual report showing what research and development programmes have been undertaken. There is nothing which will focus the Government's attention more continuously and more fully on the need to help the disabled than an obligation written into the Statute Book to produce an annual report on what they have done. This is certainly a useful provision which I hope will survive the Committee Stage. The hon. Member for Wythenshawe has obviously paid a great deal of attention to the setting up of advisory committees which will have the same purpose in that they will have statutory authority to bring pressure on the Government to keep disability in the front of their plans, and this is an excellent idea.
  On the subject of the cash relationship between the disabled and the community, I feel that there are anomalies in the Bill which correspond to inconsistencies in the way that we think about the entire cash relationship between the individual and the State. For instance, in Clause 8 the means tests applied by local authority officials shall take reasonable account of the additional expenses which may be incurred by disabled people or their families by reason of their disability. Of course this is right and necessary, but we have to remember that in dealing with the disabled we are dealing with people whose self-respect is very easily damaged, and that perhaps the greatest thing that we can confer on them is the gift of self-respect. One must therefore go very gingerly in dealing with
  1920
  the whole question of the means test as we apply it to the disabled and their families. Although I welcome the Clause, I am left a feeling of uneasiness that we ought to find a long-term solution which will take the disabled out of this area where they are likely to be exposed to means testing continually by local authorities.
  Clause 9 is, in some ways, not a very large provision for cash assistance in dealing with travel concessions. My preference here is for the disabled to have a sufficient income for them not to have to be treated as special people. Although I should not in the circumstances of today be opposed to them being given travel concessions, the ultimate goal must be that they should be able to afford to get about like the rest of us.
  In Clause 16 we see the opposite principle being applied, in that for chiropody services the local health authority may apply a means test with a view to obtaining payment from the beneficiary of those services. This is a means test being applied in a very controversial sense, and I rather think that the Minister has views on this subject about which we may hear more in due course.
  Clause 28 deals with the special cash concession for telephones. Here one is dealing with equipment which I am told is extremely costly. I do not think that one can envisage a disablement income being provided as of right which would be large enough for disabled people to be able to afford this type of telephone equipment for themselves out of their own resources. I think that it would be too ambitious to suggest that their income should be sufficient to cover the costly apparatus which has been devised to help people who are unable to use telephones in the normal way.
  In Clause 29, which deals with television and wireless licences, the principle which applies is the same as that which applies to travel concessions. We are not talking about large sums of money. Although it is a useful concession, and one which I hope will remain in the Bill, it is not something which we ought to contemplate as a long-term provision in our legislation for the disabled.
  Clause 30 takes us an important step forward in our thinking about disabled

  1921
  people and their families helping themselves. I am sure that this question of the self-respect of the disabled requires that they should be able to establish themselves as viable members of the community. One therefore welcomes the idea that the earnings rule should be relaxed. We on these benches do not like the earnings rule, because it stands in the way of people who are endeavouring to look after themselves. I commend this Clause to the Government, and I hope that they will not obstruct it by any excuse that their other provisions for superannuation might supersede it, or in some way conflict with it.
  Clause 22, which deals with the deaf, has the same objective in that it prevents employers from discriminating against deaf people, and therefore we hope that those suffering from this disability will be able to find employment more easily.
  There is one Clause which I had hoped to find in the Bill, and which I know the hon. Member for Wythenshawe would have liked to have included if it would not have made the Bill too unwieldy. This is in the context of self-help where, by voluntary effort, people raise money to assist the disabled. I have had the honour of serving the Spastics Society in connection with its fund raising activities. I know how important it is to the society that the law should be clear, and not hostile to its endeavours. The Spastics Society takes a substantial burden off the Government by its fund raising activities, which involve millions of people making a weekly contribution to spastics. Lately this society has been harried and caused great anxiety by the approaches which have been made by the tax collector. I hope that the Government will recognise that they should be merciful in the way in which they apply the regulations governing the fund raising activities of charities. I hope, too, that in Committee I shall be able to introduce a Clause which will be helpful in clarifying the law in that respect.
  I do not want to deal further in detail with the Bill which I am certain will be thoroughly aired and examined in Committee. I should like, however, to tell the hon. Member for Wythenshawe once again how much I commend his endeavours, and how I wish them every possible success.
  2.47 p.m.
  Mr. A. H. Macdonald: The Bill has been described by many hon. Members as an ambitious one, and certainly there is a good deal in it, but I do not see that that is in any sense a criticism, and I should like to add my congratulations to those which have been offered to my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris).
  One thing which appears to me to be a criticism of the Bill is the fact that throughout its length there is no reference to money. I understand why that is so, but it is, nonetheless, a little unfortunate. It is particularly unfortunate when I notice that the Clauses which refer to local authorities are in the main mandatory and impose a duty, whereas, inevitably, the Clauses which refer to Government Departments merely seek to give a power to the various Ministers concerned. I understand the reason why that is so, but I think that it is a little unfortunate.
  Here I rather differ from my hon. Friend the Member for Caerphilly (Mr. Fred Evans) who welcomed the mandatory nature of the Clauses referring to local authorities. It is a little unfortunate that we are contemplating a Bill which merely confers powers on Government Departments without any definite instructions that they may use them, and at the same time imposes on local authorities a mandatory duty involving the expenditure of an unknown amount of money.
  Because I am enthusiastic about the principle behind the Bill, I feel a little apprehensive. I was once a member of a local authority, so I can guess what they will feel. When local authorities come to look at the Bill they may be a little less enthusiastic about it than I should like them to be. I feel that this may bring some measure of discredit upon the concept.
  I have a couple more detailed and lesser criticisms of the Bill. These refer to Clauses 28 and 29, to which I cannot give the same welcome that I give to the rest of the Bill. I am inclined to agree with the criticism expressed by the hon. Member for Newbury (Mr. Astor) and the hon. Member for Kensington, South (Sir B. Rhys Williams).

  1923
  It is not that I want to insist that disabled persons shall, out of their own resources, bear the full cost for telephones or for television licences. I think that it is preferable, from an accounting point of view, in addition to the arguments put forward by previous speakers, that if public money is to be spent in some way to provide this kind of concession, it is better to have it spent out of the Vote of the Department of Health and Social Security or, alternatively, by the health and welfare departments of local authorities, rather than try to conceal, in the accounts of the Post Office or the B.B.C, the fact that disabled people are being assisted in this way. I am not suggesting that disabled people should pay the full cost of these special telephones. I suggest that if we are to provide assistance we should come forward openly and say clearly in appropriate cases where the assistance is to be provided.
  I particularly wish to refer to that part of the Bill which deals with the facilities that are to be provided by local authorities. In general, apart from the criticism that I mentioned earlier, I am glad to see this. I am also pleased to say that my own local authority is quite good in many of the respects enumerated in these Clauses. I hope—and I think I detect it in the Clauses—that the result will be a fairly fruitful partnership between local authorities and the voluntary services which can be brought in under these Clauses.
  I mention that, because I think it desirable that voluntary bodies should become involved in the process of providing assistance and facilities to the disabled in order that individual members of the public may be associated with this work and not leave it all to the statutory bodies or to local authorities.
  There is no significant difference in the facilities provided. It is not true, as it is sometimes said, that facilities provided by councils are efficient but cold, whereas facilities provided by voluntary bodies are a bit muddle-headed but warm-hearted. None the less, it is important that individuals and voluntary bodies should be associated in this work.
  1924
  I should like to take an example from my constituency. Other hon. Members have done this, so I do not see why I should not. In Chislehurst there are two clubs for the disabled run by the Red Cross. These clubs are assisted by the local authority which gives them the use of a special van for the collection of disabled people to transport them to the clubs. But the van alone is not enough. It is necessary to rely on private individuals to provide transport. Both clubs, when I have visited them, have made the same complaint to me: that they know of more disabled people in the area whom they would be able to accommodate if only they could be got there. Yet, to their regret and mine, it appears that there are not enough people in this area who are willing to give up one afternoon a fortnight to transport disabled people to and from these clubs.
  I am sorry that this is so. If the provisions of the Bill were to impose more duties on local authorities to the total exclusion of assistance by voluntary societies and individuals, I fear that this indifference by individuals—this is a hard word, but it is indifference—would increase rather than diminish, and that would be unfortunate.
  This afternoon has been a salutory experience for me. I find myself on a bench where I do not normally sit. This is because my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) asked me to assist him in making notes of the speeches made before his own contribution so that he might know what had been said. I have known my hon. Friend for some years—even before we were both elected to this House—and I know that he will not take offence at what I am about to say. It was a pleasure and a privilege to assist him in this way, but at the same time it would be impossible to deny that I found it something of a chore. Usually this work is carried out by his wife. I understand that she does it a great deal better than I did on this occasion. It is a pity that the rules of the House do not permit my hon. Friend's wife to sit close to him so that she can carry out this work during debates. But I made notes of the speeches for his assistance when he came to make his speech, and I found it a chore.
  Mr. Sydney Bidwell: My hon. Friend will probably get better with practice.
  Mr. Macdonald: Possibly so, but I only had to do it for an hour or so. My hon. Friend's wife has to do it all the time. I am sure that it is a pleasure and a pride to her to assist my hon. Friend in this way, but none the less it must be a burden upon her. How much more of a burden must it be to those wives and members of the families of those who are physically disabled in some particularly grievous way who are full time engaged in giving such assistance. Therefore, it is all the more important that we avoid all possible danger of increasing public indifference which unfortunately exists in this sphere.
  Still on indifference, I should like to refer back to the fact that, for reasons which I well understand, no financial provision does or can appear in the Bill. I think that lack may even increase public indifference to this matter.
  I am sure that I am not the only hon. Member who gets a large number of letters from constituents urging additional expenditure on this or another aspect of social welfare. Nor am I the only one to receive letters from constituents urging reduction in taxation. I do not object to people expressing either view. They are entitled to do so. But I do chafe a little when I receive a letter expressing both views on the same page. Some people do not understand the connection between raising revenue and spending on social services.
  I could not find myself in complete agreement with my hon. Friend the Member for Eccles (Mr. Carter-Jones) when he seemed to suggest that expenditure on the disabled might be fully recouped by increasing their earning power. I concede that it will be so in some cases, but I can hardly credit that this doctrine will apply in all cases. Certainly there will be cases where we should provide assistance but where there can be no possibility that the recipients will be able to increase their earning power, if any, to a point where they could reimburse the State by their work for the assistance it provided.
  I hope that, in making it clear that we are in favour of the principle underlying the Bill—that of providing assistance for the chronically sick and disabled—we
  1926
  shall make it unambiguously plain that there is bound to be a charge on public funds, whether local or national, to carry out this work. We must make it clear that the work is nevertheless so important that the charge has to be accepted and the money found. If we make that clear, we shall go forward with confidence and, I believe, with added dignity to the people who receive that assistance.
  3.0 p.m.
  Mr. John Golding (Newcastle-under-Lyne): I welcome the Bill and congratulate my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris). The great problem for many disabled persons is that of loneliness in their isolation. To be confined to bed month after month or year after year is a very great hardship. In these circumstances, television and the telephone can make a very great contribution to their welfare. I support Clause 29 very strongly. The problem is growing in my constituency that persons living in homes or in warden attended communities are receiving subsidised television whereas the old and the disabled who are not lucky enough to be in a home or to have places in warden attended communities have to pay the full price for their licence.
  The opinion is growing amongst ordinary people that those who are housebound ought to receive some rebate on their television licence and that this could well be financed by the Post Office getting the money which the licence dodgers are failing to pay.
  The provision of telephones to those who are housebound is also very important. I support Clause 28, but I do not believe that it goes far enough. Of course there should not be charges for special appliances needed by the disabled. The Post Office Corporation is making a profit of about £40 million a year and it would be a ripple on the ocean for it to waive the charges on special equipment for the disabled.
  In addition to this, I believe that the rentals ought to be waived by the Post Office on telephones for those are old or disabled and housebound. A few years ago, in about 1964 or 1965, the Post Office Engineering Union put to the Post Office a proposal. We said that our members would be prepared to install and

  1927
  maintain telephones free of charge for the disabled and elderly who were housebound if the Post Office was prepared to provide the equipment.
  The Post Office was not prepared to accept the offer but it did experiment in Manchester with some form of communications system. We do not think it went far enough, but the Post Office did go on to sponsor a study of isolation, which is taking place in the University of Sussex. We await the results of the survey with great interest. For the person confined to his home the telephone is very useful. It can keep him in contact with all of his old friends and his family, in a very simple way. It is particularly useful to those confined to bed, because it can be installed by the bedside and can relieve the loneliness and isolation to which I have referred.
  I should like to see Clause 28 extended so that the disabled and housebound could have free telephones. I do not accept the argument that we have to wait until people receive sufficient income before they can have a television set or a telephone. There are arguments which can be deployed to the effect that there are times of the day when a free telephone service could be provided without any great economic loss to the community.
  I want to deal now with another aspect of isolation, and I refer to invalid cars. The proposals in the Bill to make it possible for one class of person to have a car do not go far enough. I was disturbed recently to come across a case of a man who was in bed suffering from exposure which had occurred when his invalid carriage had broken down. As he was on his own he was unable to summon help and was left unattended for many hours until the police arrived. The argument put very strongly by his wife and accepted by me was that this could not have happened had there been a second seat, which she could have occupied, in the invalid carriage.
  It is wrong to send a man out in a mechanical appliance which can go wrong, knowing that if it does break down the man can do nothing for himself to get it started again. There is a strong case for two-seater cars for all invalided men. The point was also put to me that the one-seater invalid carriage can be the
  1928
  cause of a break-up in a home. It is not very satisfactory if the man has always to go out on his own, if he cannot take his wife with him, if the family must always be separated when they go out. This week I received a letter from a man saying that he had heard from the Department that he would have to wait 18 months for an invalid carriage because his disability required him to have automatic transmission. The Department ought to provide all sorts of invalid carriages as quickly as possible.
  In my constituency housing for the disabled causes me great concern, particularly among the mining community. It is a mystery to me why National Coal Board estates seem always to be built on hills and why it is that Coal Board houses always seem to be unsuitable for miners as soon as they contract pneumoconiosis, emphysema, or bronchitis. Some of the most difficult problems I have seen concern families when the breadwinner suffers emphysema, bronchitis or pneumoconiosis and the house is unsuitable for him to live in. This also applies to council houses. It often seems difficult to arrange transfers for people who have become sick and disabled and for whom a house is no longer suitable.
  Clause 3 refers to holidays for the chronic sick. This year, there was a proposal by a committee of Staffordshire County Council to close down the holiday home, Tan-y-bryn, for mentally handicapped children, but there has been a reprieve for one year. During the discussions of that closure it clearly emerged that holidays were most needed not by the mentally handicapped children but by their parents.
  Much attention has to be paid to the welfare of those who attend the chronic sick, either by way of provision of holidays, or by superior provision of family health so that those who prefer to have members of their families at home rather than in hospital when they are chronically sick can from time to time have a break from the great burden which they so willingly carry.
  Those are the points I want to make in welcoming the Bill.
  3.13 p.m.
  Mr. John Page: I must apologise to you, Mr. Speaker, and the House for having only just arrived to take

  1929
  part in this important debate. I have been to a funeral which I felt I ought to attend. I have not, therefore, had the opportunity of hearing any of the speeches, but I shall not detain the House for more than a moment.
  One of the privileges of being a Member of Parliament is to visit one's disabled constituents and to realise the immense courage which they show in their homes in trying to keep the family together and not to be burden on their spouses and their families. Not only is it a financial relief for local authorities and others when disabled people are encouraged to stay in their own homes, but it is a tremendous personal advantage to them and to their families that they should be allowed to do so.
  So often disability comes gradually and the individuals and families grow accustomed to it. It is only when it becomes really deep that outside help is needed and when the encouragement of the Government and local authorities is most necessary. That is why in general I welcome and heartily support the Bill.
  Clause 3 mentions the provision of assistance for disabled people in their homes. We in Harrow have examples of homes which have been designed or changed in order to make the difficulties of living in a wheelchair minimal. Clause 3 will go a long way to giving local authorities the power to spend money to make the homes of the disabled easier for them to live in.
  An aspect which I do not believe is covered in Clause 3 is this. Special consideration should be given to the question of the children, in particular of disabled mothers to obtain boarding accommodation. When the children come home early or have to spend weekends at home the disabled mother perhaps finds the burden intolerable. However, if the burden must be borne only for the holidays from boarding school it will be easier to bear.
  I hope that under Clause 3(3) a realistic attitude will be taken by local authorities to the use of the home particularly of a disabled man for business purposes. I have heard of difficulties of disabled people who are unable to run such things as a small printing business or duplicating business from their homes which are in the middle of residential areas. I cannot conceive that the residents locally would
  1930
  not wish such individuals to have the opportunity of earning and, by contributing to the household income, to fulfil their functions as a member of the family.
  On Clause 6, I wonder whether as soon as planning permission for alterations is required by a theatre, cinema, shop or similar public place it can be made incumbent on the applicant to provide special lavatory facilities which people with wheelchairs are able to use. Perhaps this is a Committee point. Friends of mine with wheelchairs say that half an inch makes it impossible for them to open the doors of lavatories in public places. Therefore, they often cannot go shopping or to the cinema and elsewhere.
  I have an intense interest in the activities of the Disabled Drivers' Association. Therefore, I commend Clause 18. If a disabled person is living at home and he is unable to drive, it will be of great advantage if he can get somebody to drive him. It will make life so much easier and happier for those who live with disabled people.
  I heartily commend the spirit behind the Bill and congratulate those who have taken this opportunity of introducing it.
  3.20 p.m.
  Mr. Hugh Jenkins: I was going to apologise to the House for having been present only since lunchtime, but I had the opportunity of hearing the speeches from the two Front Benches and, possibly, my apology need hardly be made, since the hon. Member for Harrow, West (Mr. John Page) has felt able to make a speech without hearing any of the debate at all.
  Mr. Speaker: Order. The apology is nevertheless still welcome.
  Mr. Jenkins: At one stage in the hon. Member's remarks, which I none the less welcomed, I began to wonder whether he had even read the Bill.
  Without further ado, I should like to make three short points. First, a constituent of mine wrote an article in the Guardian, in December 1966, which drew a great deal of public attention to this problem. I think that the consideration in particular of the young chronic sick and the growth of public concern dated from about that time.
  That article performed a very considerable service. My constituent who

  1931
  wrote it had been in a geriatric ward for a considerable time—in fact, since the age of 16. At the end of the article, she said:
  "I have revived painful memories that I would rather forget. But so long as there are young people normal in their minds and feelings lying imprisoned in crippled bodies, in geriatric wards, helpless and hopeless, one must remember so that the general public are not allowed to forget."
  That is an important statement and I am glad to be able to say that owing very largely, I think, to the efforts of the National Campaign for the Young Chronic Sick, my constituent is now in her own home in my constituency. She says, indeed:
  "Thanks to the work done on my behalf by the Campaign for the Young Chronic Sick I have left the geriatric hospital behind me and am now living in my own home."
  The reason that my constituent is now in that happier position was due to chance reading of an article in the New Statesman by Mr. Marsh Dickson. The first two Clauses of the Bill, which I congratulate my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) on introducing, provide in one case for registration and in the second case for the provision of information. These are two extremely important Clauses, because they identify and they inform. In future, therefore, when the Bill becomes law, people will automatically get to know what facilities and possibilities are available to them and will no longer have to rely purely on chance.
  I would like to say a word about Clause 6 and access to public buildings. It is most important that there should be legislation about this. Many organisations try to draw the attention of responsible bodies to the need to provide for the disabled in public buildings, but the circulars which are sent out are filed. For example, one body, of which I am vice-chairman—the standing advisory committee of local authorities on the theatre—circulated local authorities drawing attention to the needs of the disabled, but the circular gets put on one side and when a building is being designed it is not there. Therefore, unless legislation is passed requiring authorities to do these things, many with the best will in the world will not do them. Clause 6 is therefore extremely important.
  1932
  I hope that my hon. Friend the Joint Under Secretary of State will not attempt to emasculate the Bill too much in Committee. It is welcome to hear that it is accepted by the Government in general principle. I hope that it will not be found desirable to suggest that too many of the Clauses should not go on to the Statute Book. Indeed, in some respects the Bill could do with strengthening.
  It has been suggested by my hon. Friend the Member for Chislehurst (Mr. Macdonald) that there is something wrong in a public body making special provision for the disabled or for special needs. That is a view which I would like to dispel. At a time when we are asking private employers to consider their social responsibilities, to regard themselves as part of the community and to make provision for special needs, it seems to me to be entirely wrong that we should take the view that, for some reason, public bodies are not required to do these things. It is perfectly proper that they should. When I asked my right hon. Friend the Minister for Posts and Telecommunications the other day to provide the disabled with special telephone equipment, he gave me the answer that it was not an appropriate thing for a public body to do and that the money should be found by some other organ of the State. I do not accept this proposition. I think it is a false one. It seems to me that just as private employers have social responsibilities, so also public employers have social responsibilities, and the Post Office, out of its substantial profits——
  Mr. Eric S. Heffer: Even more so.
  Mr. Jenkins: —even more so, as my hon. Friend rightly points out—out of its substantial profits should be prepared not only to be a sympathetic and good employer but also a good collective member of the community and to see that, in addition to the provision of its own facilities, it has the responsibility to act towards the disabled and the handicaped sections of the community in a manner which meets their special needs. So I hope that the Clause which provides for that will be accepted, and that no shelter will be taken behind the proposition, which I believe to be entirely fallacious, that it is not proper for a public authority to act in this way.

  1933
  Those are the few words I wished to add to this debate, to which I have listened with very considerable interest. I want to congratulate my hon. Friend for bringing the Bill forward. I hope that the Government will accept it and I have every confidence that, when it goes on the Statute Book, in the full and strengthened Measure in which I hope it will, it will provide a very great and most valuable service for a section of the community who need that service very much.
  3.27 p.m.
  Mr. Sydney Bidwell: I hope that it will not be thought that I have any disrespect for the sick and disabled if my few remarks are very brief. It is only out of respect to the Chair.
  I want particularly to welcome Clause 16, which refers to chiropody services, and to thank my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) very warmly for including a provision of this kind. Whereas it does not provide for chiropodists all that I sought to provide in the Measure which I presented under the Ten-Minute Rule Bill right at the end of last Session, at least it does take them a stage further in tackling their justifiable professional anxieties, and it will also serve those who need chiropody and need to be encouraged to go for such treatment in time. I am sure my hon. Friend on the Front Bench will share these views.
  The second point I wish to make is that the main proposition before the House in this debate is not whether we all care about the disabled, or the degree in which we care, or how we want to help them, but to bring them into the sphere of normal activity as much as possible. I was particularly moved by the speech of my hon. Friend the Member for Eccles (Mr. Carter-Jones), who spoke of the challenge to the House by the presentation of this Measure. And about time, too, I would say. The challenge is that we now address the mind of Parliament to the whole subject, rather than leave
  1934
  it to the good will, or, sometimes, the not so good will, of local authorities, or to a degree of private or individual interest or blurb or whatever one may call it. I found in my local authority experience considerable anxiety to do these sorts of things. What we say in the Bill is, that they shall do these things, and by this Bill we are imposing upon the Secretary of State a new duty. It is an overdue new duty, I feel.
  3.30 p.m.
  Mr. John Horner: I want to express my warm support for the Bill and my congratulations to my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris).
  I am aware of an hon. Member of this House who has during the last 12 months been obliged to find his way through the intricacies of the various services that are available to people who are stricken down with paralysis, and who are obliged to find a new way of life for themselves. That Member of Parliament has nothing but the highest praise for the hospital services and for the extraordinary quality of medical service that can be obtained at the spinal unit in Stoke Mandeville Hospital, which is of world-wide renown, but he was, perforce, obliged to seek help for himself, and for others, when he left the manifold facilities available at the hospital and tried to find a way of living at home, and he has been most disturbed at the difficulty of obtaining the necessary information.
  The provision in the Bill which obliges local authorities to see that that information is readily available to all such persons commands my warmest support, and may God speed the Bill through the House.
  Question put and agreed to.
  Bill accordingly read a Second time.
  Bill committed to a Standing Commit tee pursuant to Standing Order No. 40 (Committal of Bills).

  LAW REFORM (MISCELLANEOUS PROVISIONS) BILL
  Order for Second Reading read.
  3.32 p.m.
  Mr. David Ensor: I beg to move, That the Bill be now read a Second time.
  May I add my congratulations to the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris) for his courage and compassion in bringing forward his Bill.
  I am not left with a great deal of time, but the Bill to which I am asking the House to give a Second Reading, although of some importance, is quite short. It will be agreed by both sides of the House that, for hundreds of years we have had in this country a great and remarkable system of justice. On the other hand, not until 1925 did the late Lord Birkenhead start to improve and reform the law of property.
  During the course of this Parliament and the previous one, the Lord Chancellor set up a Law Commission to report on reforming the law on a variety of subjects, and the Bill is the outcome of three small matters. The Bill consists of three Clauses which embody recommendations contained in the Reports of the Law Commission laid before the House on 24th July, 1969, and 14th October, 1969.
  Clause 1 makes an agreement to marry unenforceable at law, and provides that no action shall lie for breach of such agreement. This, in fact, abolishes actions for breach of promise. Such actions in the 17th century were entirely in the hands of the ecclesiastical courts but, as with divorce matters, they came into the civil courts.
  The Law Commission's Report on breach of promise of marriage laid before this House on 14th October, 1969, said in paragraph 1 of the introduction:
  "Under the heading of 'miscellaneous matters involving anomalies, obsolescent principles or archaic procedures' … we singled out a number of matters for examination on the ground that they seemed to rest upon social assumptions which are no longer valid. Among these are included an action for breach of promise of marriage."
  It then proceeds to go into the history. Those who, like myself, have practised
  1936
  in the law for many years have always felt that this was, and I use the word advisedly, a ridiculous form of action.
  Unfortunately it was frequently used to blackmail young men who got themselves into some problems, and I entirely agree with Mr. Justice Scarman and the Law Commission that this action should no longer be enforceable in law.
  Clauses 2 and 3 are incidental because they merely tie up the loose ends arising from the abolition of that form of action. Clause 2 deals with the problem of the Married Women's Property Act, 1882, and Clause 3 provides that:
  "A party to an agreement to marry who makes a gift of property to the other party to the agreement on the condition … that it shall be returned if the agreement is terminated shall not be prevented from recovering the property by reason only of his having terminated the agreement."
  I would suggest that that is a perfectly reasonable proposition. If we do not have the action for breach of promise and an engagement is broken off, we must obviously have some clear provision for the return of presents and so on. Clause 5— — ——
  Mr. John Page: I am an amateur at this. May I ask the hon. Gentleman's help? Is the return of an engagement present incumbent on the individual, whether or not he has broken off the engagement? One can refer to them as the breaker or the breakee. If Mr. Smith gives Miss Brown a ring and Mr. Smith breaks off the engagement— I am getting muddled—I would have thought that whoever breaks it off, if there is not a breach of promise action, then the other party should be entitled to retain the gift.
  Mr. Ensor: This is a matter of opinion. The hon. Gentleman will see that the Clause says quite clearly:
  "Where an agreement to marry is terminated, any rule of law relating to the rights of husbands and wives in relation to property in which either or both has or have a beneficial interest shall apply …".
  Obviously the intention is there. I hope that the House will give this Bill an opportunity to go into Committee when we can deal with such points in more detail.
  Clause 5 abolishes the right to claim damages for enticement, seduction and harbouring of spouse or child. This

  1937
  again is a recommendation of the Law Commission on 24th July, 1969. It is obvious that this sort of action, although it does not technically and legally come within the divorce laws, is bound up with this sort of situation. In its wisdom the Law Commission felt—and I agree with it—that if we were to abandon actions for breach of promise of marriage, we ought to get rid of actions for Enticement, because they are really quite out of date.
  We are getting to a situation nowadays where the sexes are becoming nearly equal. There are to be proposals for equal pay. A new divorce law is to come into operation very soon in which there is provision for divorce by mutual consent after three years and for a different situation to apply after five years. Actions of the kind to which I have referred are now completely out of date, and we ought to get rid of them.
  I have left Clause 4 to last. It is on a slightly different basis, and it refers to claims for damages arising out of adultery. Under the new divorce law which is to come into operation shortly, it is clear that there is an entirely different situation. Paragraph 99 of Report No. 25 of the Law Commission which was laid before Parliament on 24th July, 1969, says:
  "Under Section 41 of the Matrimonial Causes Act 1965 the husband, on a petition for divorce or judicial separation or for damages only, may be awarded damages against any person with whom the wife has committed adultery."
  Of the three main Clauses in the Bill, this is probably the one about which there may be some argument. I have had an opportunity to talk to right hon. and hon. Members about the Bill. There does not seem to be any difference of opinion about the first two Clauses, but there is doubt about this one. I accept that entirely, but I am asking this House to give my Bill a Second Reading so that we may have an opportunity to discuss this matter in Committee.
  Ever since Lord Birkenhead's reform of the law of property in 1925, we have been trying to make further improvements in our law and bring it up to date. We are all aware of the problems facing us generally in the administration of justice, not only in criminal matters but in civil matters. In the circumstances, I
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  hope that the House will approve of my Bill and give it a Second Reading.
  The Joint Under-Secretary of State for Health and Social Security (Dr. John Dunwoody): It may be of assistance to the House if I intervene at this stage to indicate the Government's attitude to the Bill.
  I regret very much that my right hon. and learned Friend the Attorney-General has been prevented through illness from attending the debate. Had he been present, I know that he would have been very willing to assist the House on any legal technicalities which might arise. I am sure that the House will appreciate that, in his absence, I must decline to give such assistance. However, we are fortunate in having in the person of my hon. Friend the hon. Member for Bury and Radcliffe (Mr. Ensor) a promoter who has great experience of dealing with legal problems.
  The Government see no objection to the Bill. Its proposals are among those of the Law Commision. If it is the wish of the House, the Government are prepared to see that the Bill makes progress and becomes law. It is for hon. Members to decide on the arguments that they have heard whether the Bill should receive a Second Reading.
  Question put and agreed to.
  Bill accordingly read a Second time.
  Bill committed to a Standing Committee pursuant to Standing Order No. 40 (Committal of Bills).

  LOCAL GOVERNMENT (FOOTPATHS AND OPEN SPACES) (SCOTLAND) BILL
  Order for Second Reading read.
  3.45 p.m.
  Mr. Tom McMillan: I beg to move, That the Bill be now read a Second time.
  I understand that the Scottish Minister concerned is not on the Front Bench, but before he left he assured me that he supported this Bill.
  This is a small but nonetheless important Bill. It attempts to remedy the problem faced by local authorities in Scotland regarding the provision and

  1939
  maintenance of footpaths and the preservation of open spaces for private housing developments.
  It is now accepted as desirable that in urban areas vehicular traffic should be separated from pedestrian traffic, and in modern planning layouts are often designed to this end. This means that there are footpaths which run from one part of the development to the other and do not run alongside a road.
  When a town or a county council carries out this type of development no problem arises over the construction or maintenance of the footpaths. On the other hand, if a private developer carries out development in the landward area of a county, which can be either housing or commercial or a mixture of both, the county council has no power to assume responsibility for the future maintenance of footpaths. In that case the private developer has to maintain them and this can create problems. The private developer may have moved on or he may even have gone bankrupt, or the responsibility may have been placed on the individual frontager and this can be quite a burden. In this context private developers include such bodies as new town development corporations and the Scottish Special Housing Association.
  There is also doubt about whether the powers available to town councils are adequate to enable them to take over the responsibility for these footpaths. Local authorities in England and Wales already have power to provide and take over footpaths. This is a Scottish problem. It is becoming more acute because of the increase in private house building and the practice of local planning authorities of ensuring that modern standards of pedestrian and traffic segregation are carried out in the private housing layouts. The problem can cause friction between local authorities on the one hand and private developers on the other. It is also hampering the Government in their efforts to expand private house building.
  Local authorities have raised with the Secretary of State for Scotland the need for powers to enable them to take over footpaths of this kind, and I am sure they will welcome the Bill. The Bill also fills a gap in their powers by empowering them to construct footpaths as well as maintain them.
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  The Bill also deals with open spaces in housing developments. Local planning authorities usually insist on open spaces as part of landscaping of the area, but these also cause problems. County councils do not appear to have powers to enable them to take over the responsibility for open spaces of this kind and it is doubtful if the powers of town councils or district councils are adequate for the purpose. Thus, once a developer has provided them he may have to go on maintaining them indefinitely. Therefore it would be useful to give local authorities power to take over these open spaces as well.
  The purposes of the Bill are obviously useful and local authorities would be glad of the powers in it. I do not think there will be any objection to these provisions, and I hope that the House will give the Bill a Second Reading.
  Question put and agreed to.
  Bill accordingly read a Second time.
  Bill committed to a Standing Committee pursuant to Standing Order No. 40 (Committal of Bills).

  LOCAL GOVERNMENT (FOOTPATHS AND OPEN SPACES) (SCOTLAND) BILL

    FOOD AND DRUGS (MILK) BILL
    Read a Second time.
    Bill committed to a Standing Committee pursuant to Standing Order No 40 (Committal of Bills).

  CAERPHILLY MINERS' HOSPITAL
  Motion made, and Question proposed, That this House do now adjourn.—[Mr. Boston.]
  3.50 p.m.
  Mr. Fred Evans: I wish to raise the question of the change of function of the Caerphilly Miners' Hospital. The town of Caerphilly lies in the Rhymney Valley, which covers the constituency of Caerphilly, and large areas of the Bedwellty and Ebbw Vale constituencies. It is a thriving and populous town which has succeeded in attracting to itself a considerable and diversified industrial complex which has been accompanied by an expanding population. To the north

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  of the town is an area which still has coal mining as its main industry. It is separated from the City of Cardiff by a high mountainous area with inadequate road systems. The roads of the Rhymney Valley are narrow and winding, and frequently become difficult or impassable in winter conditions, and this is particularly true of the hill road to Cardiff.
  South Wales produced many ancestors to the present National Health Service, both in Aneurin Bevan's home town of Tredegar and in the Rhymney Valley, one of these being at Caerphilly. There, in 1923, the miners, tired of seeing their comrades injured in their dangerous industry having to be taken by train to Cardiff, often with delays which produced serious consequences, set up their own hospital, which has done outstanding work, and was always completely self-supporting prior to being absorbed into the National Health Service.
  Since 1945, £½ million has been spent on it. It has developed a fine maternity wing, and a nurses' training school which has the distinction of having secured 100 per cent. passes in final examinations since 1948. The hospital has become an important and much-loved institution in the Rhymney Valley, a position which it thoroughly deserves in view of its history of success.
  With the building of a new teaching hospital at Cardiff, the Welsh Hospital Board proposes to remove the surgical wing from Caerphilly and to limit the hospital to maternity and geriatric cases. This will remove the only surgical facilities from a hospital which has 80,000 people, likely to become 100,000 in the next 15 years, in its catchment area, where coal mining is still the most important industry.
  Time and again attempts were made to secure information, by myself in this House, by the Caerphilly Urban District Council from the Welsh Hospital Board of Health, and subsequently from the Welsh Office when it assumed responsibility for the health services in Wales. All inquiries were fobbed off with evasive Civil Service answers. Eventually the Chairman of the Welsh Hospital Board agreed to discuss the future of the hospital with the committee fighting to preserve and expand its facilities.
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  He assured the committee that the forthcoming proposals, since published at the beginning of last November, would be proposals only, and that full discussions would take place and alternative plans considered before final decisions were arrived at. I subsequently received the same assurance from my right hon. Friend the Secretary of State for Wales. To this date no offer of consultation has been made, and one can only conclude that the so-called proposals are, in reality, firm plans.
  It is obvious that certain areas of the social services such as health and education are very sensitive areas because they impinge on people so directly. It was obviously for this reason that my right hon. Friend the Secretary of State for the Social Services laid down new procedures for examining the opinions of local communities leading to community involvements, and for examining the opinion of local doctors at a very early stage when plans are made which may close hospitals or change their functions.
  Notice of the new procedures was issued by the Welsh Office at the beginning of this December, but by 2nd December the Chairman of the Welsh Hospital Board had been reported in the Press as saying that the new procedure would apply to other parts of Wales but not to the Cardiff area proposals, in which Caerphilly is involved, because, he says, consultations for that area have already begun under the older administrative machinery. The people of Caerphilly have never been consulted, and they will regard this statement with bitterness and cynicism.
  Caerphilly is in a populous area with a dangerous industry and an expanding complex of light industry. Industrialists who asked what hospital facilities there were in the areas before they decided to come are now being robbed of a surgical and accident unit, and people will have to travel in very difficult circumstances to a new teaching hospital at Cardiff.
  The people of Caerphilly believe that they have not only a sound social case for the retention and expansion of this hospital, but also that there is an overwhelming medical case for its preservation. We have, for example, thoroughly examined the transport problems in this valley of narrow winding roads, particularly at peak traffic times when some

  1943
  700 vehicles an hour pass through to Cardiff, without the added complication of having ambulances trying to negotiate these roads. The winter conditions, which I have mentioned, are such that they can isolate this valley very easily and this, indeed, could lead to serious consequences for patients.
  We have consulted industrialists and we are aware of their needs for a local casualty unit. They are backing the claim by the people of Caerphilly for the retention of this hospital. We claim that we need a casualty unit, backed up by specialist services, and with facilities for detaining casualties overnight when necessary. We suggest that the present casualty unit be enlarged to cope with a possible future increase in the number of industrial and road accidents arising in the surrounding area, and we draw attention to a statement made five years ago that the accident unit at this hospital would indeed be preserved.
  We are also concerned about bed availability in the new hospital at Cardiff. The Welsh Hospital Board has decided to close a further four hospitals in this same valley. These total 120 beds, in addition to those which will have to be found for general cases. If we add to this figure about 150 to cover the cases normally dealt with in the Caerphilly Miners' Hospital, we reach a total of 300 beds. Therefore, we find it impossible to visualise how the new teaching hospital at Cardiff will be able to cope adequately with this load when it will have only 630 beds available for general patients.
  We are also concerned about waiting lists for simple surgical operations— appendicitis, hernia, tonsillectomy and so on—which constitute the bulk of surgical operations. In the Caerphilly area the waiting list at the moment runs to about two years, and the waiting time is continually getting longer. We cannot see that the transfer of such cases to a hospital at Cardiff will reduce the waiting lists. We envisage rather that they will lengthen. The more complicated cases can, admittedly, be best dealt with in larger hospitals, but at least 70 per cent. of the work load of most surgical units concerns operations which can be carried out, and have been carried out,
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  efficiently and effectively, in the local hospital in this town.
  We would say that if only in the interests of national economy, which suffers as a result of absenteeism, there is a case for a miners' hospital of this calibre extending its present facilities and dealing efficiently with these common cases which can so often result in patients having to remain away from work until an operation can be performed. We have in this area a rising population. We expect that, in the fairly near future, the figure of 100,000 will be reached. Apparently, the Department of Health and Social Security regards a population of 100,000 as the point at which a district hospital should be provided.
  It being Four o'clock, the Motion for the Adjournment of the House lapsed, without Question put.
  Motion made, and Question proposed, That this House do now adjourn.—[Mr. Boston.]
  Mr. Evans: We claim, therefore, that the entitlement of this area for a district hospital has been soundly made. We do not wish in addition to go through a period of limbo where services are likely to be run down. Indeed, we are deeply suspicious that the taking away of consultants from the hospital and their replacement by a locum consultant means that, already, a decision has been made, although we have been told that these are only proposals.
  Attached to the hospital is a very fine maternity wing, and we claim that this should be backed by specialist services, including at least one consultant gynaecologist, as at present. We cannot expect general practitioners to deal with difficult cases and one cannot always foresee difficulties arising. Forming an unsupported general practitioner unit would, in our view, be a retrograde step and would throw additional burdens on general practitioners.
  We are interested, too, in the running costs. Apparently a hospital bed in the new hospital at Cardiff would cost £70 to £75 a week. In Caerphilly Hospital, the cost is in the region of £45 per week.
  We have consulted the local medical people, both general practitioners and

  1945
  consultants, and they are firmly behind the claim for the retention and expansion of the hospital. We are very concerned that my right hon. Friend the Secretary of State for Social Services should be speaking in one set of terms in this House about community involvement whilst, in Wales, a separate voice in the Welsh Hospital Board is claiming that the new procedures for consultation shall not apply to this hospital.
  We have written to my right hon. Friend the Secretary of State for Wales requesting an interview. We have not been granted one and we still do not know whether any consultation at all will take place. Yet, many months ago, two part-time consultant surgeons in this hospital were replaced by one full-time surgeon employed on a locum basis. It is now even more surprising to see, from the Western Mail of 2nd December, that the plans for the Cardiff area are too advanced to be affected by the recent statement made by my right hon. Friend the Secretary of State for Social Services.
  It is never too late to start afresh from a false position and we say that this is what must be done. There is still time for planning to start from scratch and everyone concerned with Caerphilly Miners' Hospital is more than ready and willing to co-operate.
  In addition, my right hon. Friend referred to community hospitals being used for common or routine operations, such as hernia, varicose veins, etc., in the Sunday Express of 30th November, thus highlighting the need to keep hospitals like Caerphilly fully open and indeed expanding. We therefore claim that the Welsh Hospital Board and my right hon. Friend the Secretary of State for Wales should enter into consultations with the people of Caerphilly, including the general practitioners and specialists, in order to examine this problem fully. We are satisfied that it has not been examined as yet in its full implications.
  I have received documents from my friends in the medical world who make all these points. They have produced a document which is a resume of all the sound medical arguments for the retention of this important hospital. These will be submitted, as other documents have been submitted, both to the Welsh Hospital Board and my right hon. Friend the Secretary of State for Wales.
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  Many more strong arguments could be put forward by my constituents who feel extremely passionately on this issue. There is not time in this Adjournment debate, if the Minister is to be allowed adequate time to reply, to go more deeply into the medical arguments, but I appeal to my right hon. Friend the Secretary of State for Wales to have second thoughts about what we consider to be an extremely powerful argument and to meet the committee which is fighting to preserve this hospital, and to enter discussions with it.
  I ask him to reject these proposals out of hand and to begin from scratch to examine a serious problem which may influence generations to come. If we feel that a mistake has been made, let us have the honesty and integrity to say so and to discard plans which are wrong and to start afresh and produce something which is intelligent and worthy of a community like the Caerphilly constituency.
  4.7 p.m.
  The Minister of State, Welsh Office (Mrs. Eirene White): I am sure that everyone will have the greatest sympathy with my hon. Friend the Member for Caerphilly (Mr. Fred Evans) in his concern about the local miners' hospital in his constituency and the other associated hospitals. I am glad that he has taken the opportunity of his good fortune with the Adjournment to raise the subject in the House.
  In the Welsh Office we are well aware that there are strong local feelings about this matter, but I hope that my hon. Friend will take every opportunity in his constituency after this debate to try to clarify what must be some misapprehension about the procedure for discussion of the reorganisation of hospitals, particularly those in the catchment area of the new group of hospitals at The Heath.
  We fully understand that the prospect of drastically altering the function of any hospital which has given good service naturally disturbs the community it serves, particularly those whose life work it has been to give service to the hospital. I should like to take the opportunity of paying the warmest possible tribute to the medical staff, the

  1947
  nursing staff, and all other concerned with the Caerphilly Miners' Hospital. We know its history and those of us who, like myself, have connections with that part of the country fully understand the feeling of the local community, because it was its effort and its initiative in the first place which brought the hospital into being. We are in no way lacking in sympathy or understanding with local feelings and local sentiment.
  Nevertheless, it is the duty of the Secretary of State in these matters always to put the well-being of patients first. It is for him ultimately to decide how best he feels the welfare of patients in this area can be most adequately and fully served, and how to ensure that they receive the most modem medical treatment which science can provide. I was distressed by some of the observations of my hon. Friend, because even he seems to be under a serious misapprehension about the proper procedure.
  Before I embark on that, I would like to emphasise that where one has the pressure of increasing demand for increasingly expensive and sophisticated medical services, one has to take into account the total pattern in the area of a new modern hospital. We find that the expenditure on the hospital programme under the present Government, which has greatly increased in momentum, has increased the capital costs of new hospitals, which are high. We also find by experience that these new hospitals are much more expensive to run than the older ones. This is self-evident when one is undertaking very much more sophisticated treatment.
  It is therefore essential, in establishing a large new hospital, to ensure that there is no unnecessary duplication or waste of services within its catchment area by continuing to use older hospitals which are less suitable for a particular type of treatment. The new buildings which are being provided must clearly to some extent be regarded not as net additions but as replacements at a higher standard of facilities which may have been provided elsewhere. Unless this basic fact is grasped, and unless we can organise matters in such a way that certain economies can be achieved, we will find that we may have a fine new hospital but
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  that we shall have neither the revenue nor the skilled doctors and nurses available to run it.
  We have to look at the peripheral hospitals in such a situation. It is for this reason that public discussions have now been started about the future pattern of hospital services in the Cardiff Management area which includes Caerphilly. It is the Welsh Hospital Board and the Board of Governors of the United Cardiff Hospitals who have the responsibility for looking at any possible new pattern and it is they who prepare plans for reorganising the services in the Cardiff area. The Boards appreciate that any pattern of reorganisation which is proposed may not meet the wishes of all members of the community and they have therefore indicated not only their own preference but alternative ways in which the service might be provided although they do not recommend these alternative forms of development.
  They have put forward choices, fairly, as the basis of discussion and I am sure my hon. Friend recognises this. The Boards have prepared three alternative suggestions for consideration. Two of these suggest a different allocation of beds at the Miners' Hospital although throughout it is proposed that the annexe, what is called the Van annexe, should not be kept open, and I do not think that my hon. Friend has brought that into consideration. It is not for me to go into the merits or demerits of any of these proposals now.
  I must make the position of the Secretary of State clear in this matter. At present, no proposals have been approved by the Secretary of State. He is not in any way committed and he does not have before him any firm proposals about the Caerphilly Hospital or any other hospital in the area under discussion. He must wait until the hospital boards have received all the representations which may be made about these proposals. When the Boards have considered them, and in the light of them it is for them to make firm recommendation to the Secretary of State. It is only at that point that he takes cognisance of the proposals of the hospital boards, and in due course, having considered the evidence himself, reaches a conclusion. Therefore, although my hon. Friend brought forward a number of interesting,

  1949
  important and valid points today, he will appreciate that I cannot comment on them, and it is not possible at this stage for the Secretary of State to do so. They will naturally be taken into account by the Board, together with the other evidence.
  I take issue with my hon. Friend on some of his references to the procedure for consultation. He knows that the booklet issued by the United Cardiff Hospital Board and the Welsh Hospital Board in November this year is the basis for these consultations with the local interests in the area. It was unfortunate that he should have said that the local people were fobbed off with evasive answers. He must appreciate that until the Board had been able fully and in detail to study the possible alternatives —and I assure him that there are very many alternatives in this jigsaw of the Cardiff hospital area—it could not responsibly embark on discussions with the local interests because it had first to satisfy itself of the possible alternatives which might reasonably be considered.
  My hon. Friend said that no offer of consultation had been made and that it must be assumed that the proposals are firm plans. Neither of those points is valid. I should have thought that a plain invitation was issued by the hospital board in the foreword to the booklet issued in November. It asked that any comments, criticisms or alternative suggestions should be submitted by 31st January next. It said that if further information or clarification of any point was required they should be contacted. Speakers would be provided for any organisation interested in a further discussion and requests for officers and officials of the Board and Board of Governors to meet deputations from public authorities and professional interests would be considered sympathetically. I should have thought that all concerned would have taken up this invitation if they wished to do so. I know that the chairman of the hospital board and others are entirely at people's disposal for the fullest possible discussions and for weighing up the pros and cons of various possibilities.
  There has been, understandably, some concern about the new procedure which my right hon. Friends have communicated to hon. Members within the last ten
  1950
  days or so. My hon. Friend the Member for Caerphilly seemed concerned that the chairman of the hospital board is reported to have said that this new procedure will not apply to the Cardiff and district proposals now before us. He seemed to regard that as unjust. But there is some misunderstanding. We cannot start entirely from scratch in this instance because the hospital at The Heath has been built physically. Because of the difficulties which have arisen in building these new very large hospitals, my right hon. Friends have indicated that when such large hospitals are contemplated in future and it is clear that there will be consequential effects on other hospitals in their neighbourhood there should be much earlier discussion, for example, about the precise location of the new large district hospital. One might then have arguments at that point in time, before any brick or stone is laid, as to the precise place which would be of optimum advantage to the whole service for that hospital.
  We had certain discussions in various parts of Wales as to whether certain large new hospitals might with advantage have been sited elsewhere. That situation, however, as I am sure my hon. Friend appreciates, does not arise in Cardiff because the hospital is being built.
  Mr. Evans: Surely, it is because the new hospital at Cardiff was planned without consultations that we are now in the position that we are told we cannot have consultations because we were not consulted before.
  Mrs. White: There cannot be consultations as to where The Heath Hospital will be; that is plainly ruled out. This, after all, is the kernel of the proposed new procedure that in future, where a hospital which is bound to have such widespread effects on other hospitals is to be planned, there should be much fuller consultation about its location and its relationships with other hospitals before it is begun.
  I assure my hon. Friend that he should not see more in what has been said than was actually there. The simple fact is that one cannot start absolutely ab initio when the hospital is already being built. That does not mean that the discussions and consultations on what is,

  1951
  given that one central fact, the best disposition or reorganisation of the other hospitals are not real and open, because they are. There are various possible patterns for the use of the peripheral hospitals of all kinds, of which the Caerphilly Hospital is certainly one of the most important. All I am saying is that the new procedure means that one starts ab initio, from scratch. One cannot do that because one main factor in this set of circumstances is already given.
  I therefore hope very much that my hon. Friend will appreciate that the proposals for consultation are absolutely genuine. There are various permutations and combinations which are possible within the Cardiff hospital catchment area. It is important that these should be fully discussed and I hope that they will be discussed calmly and with good sense.
  I know that these matters arouse acute emotions, but we are all anxious to try to find the best solution in the circumstances. I can repeat only that my right hon. Friend the Secretary of State has reached no conclusions whatever on any of these proposals, that he will await the results of the consultations which have been invited with the two hospital boards and that he hopes that everyone in the locality will try to look at the whole problem as a problem which we are all concerned to solve in the best interests of the community and if possible, not simply as an emotional campaign.
  There are all kinds of considerations which we must try to reconcile so that we get the best possible care for different types of patient. One of the most important things to keep in mind is that certain hospitals in the peripheral system could well be used for different sorts of patients. One must take social as well as
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  medical considerations into account. The Welsh Office is very much alive to this and would wish to take into account considerations not only of the purely medical aspects of the hospital service, but also of the patients' families, visitors, and so on, and their own convenience.
  Before I conclude, I should refer to the suggestion made in a circular letter which, I think, we have all received and to which my hon. Friend referred. It suggests—I am sorry that these rather emotive suggestions should be made— that there has been some policy of deliberately running down hospitals prior to any firm decisions being taken. I received this letter only today, but I made it my business to make immediate inquiries. There is certainly no question of any deliberate policy of the sort, and I am told that there is no evidence of any drifting away of staff at the hospital. There have been one or two difficulties about consultants at the moment, but this has nothing particularly to do necessarily with the situation at Caerphilly. I am also advised that, so far as orthopaedic surgery and gynaecology are concerned, arrangements have very recently been made for even more sessions to be provided at Caerphilly than in the past. It is true, of course, that in the present position no new capital works are likely to be undertaken at any hospital in the area, but I think this is understandable; till their future functions have been decided, I think that that is very reasonable.
  I hope that, with these explanations, my hon. Friend and his constituents in Caerphilly will feel that their views on the matter will have a very fair hearing, and that, to use a famous phrase, the options are still open.
  Question put and agreed to.
  Adjourned accordingly at twenty-six minutes past Four o'clock.

AGRICULTURE, FISHERIES AND FOOD
  Rabbit Clearance Societies
  Rabbit Clearance Societies
  Frozen Fish Fillets (E.F.T.A. Exports)
  Frozen Fish Fillets (E.F.T.A. Exports)
  DEPARTMENT OF SOCIAL SECURITY (PUBLICATION OF INFORMATION)
  DEPARTMENT OF SOCIAL SECURITY (PUBLICATION OF INFORMATION)
DEFENCE
  Chatham Dockyard
  Chatham Dockyard
  Malaysia (S.A.S. Squadron)
  Malaysia (S.A.S. Squadron)
EDUCATION AND SCIENCE
  International Cybernetic Foundation
  International Cybernetic Foundation
  Special Schools (Strike)
  Special Schools (Strike)
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  Organochlorine Pesticides
EMPLOYMENT AND PRODUCTIVITY
  Prices and Incomes (Reports)
  Prices and Incomes (Reports)
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  Bus Strike (Central Scotland)
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  Professional and Executive Register
FOREIGN AND COMMONWEALTH AFFAIRS
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HOUSING AND LOCAL GOVERNMENT
  Derelict Areas, Gateshead (Clearance)
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  Stainless Steel Products (Fixed Price Contracts)
LOCAL GOVERNMENT AND REGIONAL PLANNING
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  Piped Television
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  Local Radio Station (Mid and North Wales)
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  Television Licence Fee
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  Stereophonic Radio Transmissions
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SCOTLAND
  School Pupils (Per Capita Expenditure)
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  Café Royal, Edinburgh
  Café Royal, Edinburgh
TECHNOLOGY
  Gelatine and Glue Research Association (Grant)
  Gelatine and Glue Research Association (Grant)
  Timber
  Timber
  Nickel Supplies
  Nickel Supplies
  Motor Industry
  Motor Industry
  Export Promotion
  Export Promotion
  Steel Rods
  Steel Rods
SOCIAL SERVICES
  Rent (Supplementary Benefits)
  Rent (Supplementary Benefits)
BOARD OF TRADE
  Lifeboatmen and Coast Guards (Pay)
  Lifeboatmen and Coast Guards (Pay)
  Japan
  Japan
  Wood Pigeons
  Wood Pigeons
  Teesside Airport (Charges)
  Teesside Airport (Charges)
TRANSPORT
  Hovercraft Service (Great Britain—Northern Ireland)
  Hovercraft Service (Great Britain—Northern Ireland)
  Motorways (Landscaping and Tree Planting)
  Motorways (Landscaping and Tree Planting)
NATIONAL FINANCE
  Post-war Credits
  Post-war Credits
  Sales of Land and Assignment of Leases (Tax)
  Sales of Land and Assignment of Leases (Tax)
  Balance of Payments
  Balance of Payments
  Roads (Expenditure)
  Roads (Expenditure)