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We come now to one cf the most important issues raised by the Bill. The Amendment would have the effect of putting all those who require constant attendance as a result of a disability on the same basis as blind persons who, under the Bill, receive a special scale of allowances as well as the 9s addition if they have been in receipt of an allowance for at least two years or are over pensionable age.
None of us would wish to underestimate the terrible handicaps and difficulties stemming from the loss of sight, and all of us are glad that this Bill makes suitable provision for the blind. In the light of what we now know about the effect of other forms of disablement, I regret, as I think all hon. Members must regret, that the opportunity has not been taken to bring similar help to all who suffer such grievous impairment of functions that they need constant attendance.
There are historic reasons for the preference given to the blind. Unlike a good many forms of disability, blindness is immediately obvious, and that is why it has always excited compassion. I remember as a child being deeply impressed, almost terrified, by the words of Milton. I do not think that anyone afflicted by a physical disability has ever described it in such a despairing and moving fashion:
Oh dark, dark, dark, amid the blaze of noon,
Irrecoverably dark, total eclipse
Without all hope of day;
It has always seemed that those words express most vividly the way in which normally sighted people feel about the loss of sight. I should say in passing how astonishing, inspiring and humbling it is to see how blind persons overcome their disabilities and enjoy a happy and fruitful family life. It is not surprising that against this background that sympathy was aroused and much pioneer work done for the blind long before the idea of a Welfare Slate was accepted.
Until the National Assistance Act, 1948, the blind were the only handicapped adults for whose social care there was statutory provision. It was not until 1951 that local authorities were authorised to produce schemes to help other classes of handi- capped persons. Whatever the reasons for this difference of approach to the disabled, I am going to suggest to the Committee that it cannot be defended any longer. I recognise that one cannot equate forms of disability. To those with normal sight blindness is terrible, but is not total deafness as isolating, if not more so? How crippling is the sudden loss of a limb, but is not the slow but relentless advance of multiple sclerosis still more terrifying? How can one compare the person, deaf or blind from birth, with one who has enjoyed a normal life before being gravely disabled by disease or injury?
The point was put very clearly by Penelope Hall in her book which has become a classic, "The Social Services of Modern England". In this she quotes a hospital almoner as saying:
There are no such people as the handicapped, there are handicapped individuals, all of them different, each with his own psychological and social problem to meet as well as his own particular physical disability to overcome.
What matters in each case is not the source of the disability but its extent.
We all welcome the scale provision that the Bill makes for the blind, but we know that there are degrees of incapacity due to blindness and that the definition of blindness includes not only those who are totally incapacitated but those who are partially sighted. We know that there is quite a large number of blind persons, otherwise fit, who are better equipped to cope with life and its problems than sufferers from the advanced stages of diseases such as epilepsy, bronchitis, muscular dystrophy, sclerosis, paralysis or the multiple handicaps, who are utterly and completely dependent upon others for their simplest needs.
How many seriously disabled persons are there? The trouble is no one really knows. Registration with the local authority is voluntary and the advantages of being on the register, as I said earlier, are not at all obvious. The number registered in England and Wales last year was only 176,000, and this is only a small percentage of the total. Let me take the situation in my own county, because this is something about which I know. I am proud to say that Essex enjoys the reputation of being one of the finest welfare authorities in the land. There are about 3,600 persons permanently and substantially handicapped—I am using the words of the Act now registered with the authority as being in need of help. Most are living in their own homes.
The county welfare officer tells me that probably 25 per cent. to 30 per cent. of them are so badly disabled as to need constant attendance. Certainly a great many of them are vastly more disabled than some of the blind who are entitled to the enhanced rates. Where is the equity and social justice in this? Surely it is time that we did something about this? Surely we ought to recommend, here and now, that it is people and their needs in contemporary society, not in theory, not precedent, that should determine the shape of the social services.
It is true that a good many of our disabled citizens, especially war disabled, are better treated in Britain than almost anywhere else. Broadly speaking this is true, especially so in the case of war disabled. But the levels of allowance that we provide, unlike those in certain countries, are determined by the source of the disability rather than by the extent to which it causes loss of faculty, and so it is that the war disabled, by general consent, obtain preference over the industrially disabled and men injured at work get preference over those injured at home.
So it is that only the war disabled and industrially disabled needing constant attendance get the £2 15s. a week allowance. Why should there not be a realistic allowance for all who are so gravely disabled that they require constant attendance?
Consider the case of the Yorkshire wife mentioned in a moving article, which hon. Members must have read, in last Friday's Daily Mail. She had the incurable and paralysing disease, multiple sclerosis, for 17 years. The article says:
At first her husband went on National Assistance to look after her. They couldn't manage so he went back to work and she went reluctantly into hospital. She was breaking her heart. Her husband brought her home. But he could not afford the £3 a week home help, so she went hack into hospital.
Now, at the age of 45, with a lively mind, she is in a geriatric ward. Her nearest neighbour is 99 years old.
The article goes on to say that she no longer reads so that her only contact with life is conversation, and she gets that once a day for an hour when her husband visits her. He is quoted as saying:
She is praying to die. She cries nearly every night that she has no reason to live. She says if she could come back home to me she could go on living.
And the article says:
Imagine what a disability income could do for her.
Consider another case, that of the truly remarkable woman we were privileged to meet earlier this week through the good offices of my hon. Friend the Member for Newbury (Mr. John Astor), who takes a great practical interest in the seriously disabled. I refer to Mrs. Page, a journalist, who works under the name of Ann Armstrong. She is a mother of two young children and has been suffering from respiratory polio for 12 years and is permanently anchored to a respiratory machine. The only movement she has is in her head and toes, with which she manipulates a dictating machine. I understand that she was in hospital for two years and that when she came out she could not, and nine years later she still cannot, be left alone in her home. I understand that she has about 15 hours help a week, some home help and some which she employs. It costs her about £5 a week and is nowhere near enough. Her husband takes over the minute he gets home. The disability income which I would propose would enable her to employ a regular amount of help, and in the article she is quoted as saying:
Financially it is a horrible struggle. It will always be a struggle. If we had extra money and extra help my husband might be able to get some sleep at night.
Lastly, I take an example from my own part of South-East Essex. It is of a man in his middle 40's who is living with his widowed mother whose income is only slightly above National Assistance standards. He has spondylitis. His condition has deteriorated and he can be moved only in a wheel chair. His aged mother finds it increasingly difficult to push him about. A higher scale would enable them to pay children to run errands or to pay a person to accompany him on little outings in the town.
Otherwise, he is almost permanently confined at home.
I have quoted these cases because it is impossible to measure the suffering and strain caused by a system which either keeps people permanently in hospital, or, if they are at home, makes it difficult for their families to make ends meet and cope with the financial burden. I think that the case for a constant attendance allowance on the grounds of social justice alone is unanswerable.
However, humanitarian considerations aside, I am convinced that such an allowance would save money. For one thing, we know from regional hospital board studies that one in three of the chronic sick could leave hospital if someone was at home to look after them. For another, we can see for ourselves in the Ministry of Health hospital costing returns that the net cost of keeping a long-stay or chronic patient in hospital ranges from £15 9s. 5d. a week to more than £22 a week, dependent, of course, on the type of hospital. I stress that this is the net cost which excludes all elements of capital expenditure. In these circumstances, it begins to make economic as well as social sense to provide a reasonable allowance for all these disabled persons who medically could be allowed home—and that does not apply to all of them—when their families are willing and suitable help can be secured.
In the past it has always been suggested that the main difficulty about extending the special allowance for the blind to other classes of handicapped persons has been the problem of deciding who should benefit. The Committee will observe that the Amendment does not specify types of disability. I am sure that to list types of disabling diseases would be quite wrong. We are anxious to focus attention on the fact that it is the degree of impairment and not its source which should govern our thinking and command our priorities, and I see no reason why the well-tried system of the tribunals which assesses the extent of the disabilities of war pensioners should not be extended to other handicapped persons who need constant attendance.
So far, I have been arguing the case for a constant attendance allowance for the seriously disabled to put them on a par with the blind. The second Amend- ment seeks to encourage the provision of constant attendance allowance from other sources. If it were accepted, the Amendment would impose no great financial burden on the community at large, but it would provide a boon to the unfortunate people whom it is designed to help.
The effect would be that a person who was so seriously disabled that he required constant attendance and who had a trust income of up to £2 a week, when obviously the capital could not be touched, which is modest enough—very much so in these days—or from, say, an annuity, a friendly society, or from trade union sick pay, or some charitable organisation, would have that sum totally disregarded in an assessment of his entitlement to benefit.
This proposal would considerably help in those cases where money is specifically provided for constant attendance either by a charity, or by other members of the family. We all know—and some of us have had experience of this within our own family circles—of married children of disabled parents who are not able wholly to look after the mother or father all the time but who are willing to contribute something towards the cost of constant attendance. I am sure that this proposal would encourage help of that kind.
It is arguable that as the cost of constant attendance is bound to rise—it is rising all the time—there may be a strong case for an even larger disregard, but our purpose in putting forward this proposal is to ensure that the principle underlying it is discussed and accepted.
I know that the National Assistance Board is particularly concerned with cases of this kind. There is one case in South-East Essex which perhaps I ought to mention. A widow in her late fifties who is almost immoveable because of rheumatoid arthritis—she cannot move out at all—prefers to go on living in her own home and has a married daughter who lives quite near and who comes in whenever possible. A home help is available for only a short time each week. This lady has a small income from a trust fund left by her father.
At present there is no statutory disregard and, as the Bill is drafted, there is no provision for a disregard. In line with the generally flexible and humane attitude which it has taken down the years, the Board has disregarded 15s. of that trust income under its discretionary powers. The full 40s. disregard which I suggest would enable her to pay for extra attention and comforts in the long periods when she is left on her own. Now that the Board has come under the new Ministry, surely it is right that the general discretionary power which the Board has used under Regulation 3 of the 1948 Regulations should be replaced by a specific provision for that disregard in the Schedule.
Here are two proposals designed to bring much-needed relief to people whose sufferings in many instances are such as to move the stoniest heart to compassion. I hope that what I have said will command the right hon. Lady's sympathy. I know that she cares very deeply about these matters and I hope that she will be able to accept both Amendments.