First, may I offer some sympathy to the Minister for his being kept here at this rather late hour. However, I am sure he will acknowledge that the subject of our short debate is worthy of our concern and attention.
I know that the Minister views the constant attendance allowance and the difficult individual problems which it is designed to tackle as being of serious and urgent importance.
I was pleased, therefore, to read the statement from the Department in a letter which I received on 5th November, 1971, that the present arrangement is seen as only a first step. However, I am sure that the Minister will agree that once the first step is taken the second and succeeding steps ought not to be long delayed. The momentum of community concern should be maintained.
The first of the two constituents to whom I wish to draw attention seems not to have had the favourable consideration which I am quite sure he deserves. A couple of weeks ago the Minister informed me that 65 per cent. of applications have been approved so far. This is very commendable. That being so, I believe that the first application of my constituent, Mr. Hubert Roberts, let alone his subsequent review, should have been successful.
I know that the Minister is aware of the details of Mr. Roberts' case. I trust that he will not mind my repeating some of them, since not merely is it necessary in presenting Mr. Roberts' case, but to do so is inevitably to pay tribute to a man who unquestionably merits it.
Mr. Roberts is in his early sixties. Before his premature retirement he was a mineworker at a local colliery, New Stubbin. He worked there for a long time until his diabetic condition compelled him to cease work. His condition deteriorated, and in 1966 one leg, and then in 1968 the other, had to be amputated. Both were removed above the knee. That has been a dreadfully heavy and harsh blow for him. In addition, Mr. Roberts remains a victim of severe diabetes so that physical infirmities, apart from the amputations, apply. Indeed, the other conditions can be quite harsh enough without the painful and extreme disability from which he suffers.
It should be said that throughout his years of ordeal Mr. Roberts has borne himself admirably. Only three or four days ago Councillor Carr, one of Mr. Roberts' representatives on the Raw-marsh Urban District Council, told me that everyone in Mr. Roberts' area both knew and respected him. His cheerfulness and fortitude are an example to all. Those who know most about him feel strongly that the application should be granted. It is felt that if he had in any way, and understandably, lost his moral strength—and had not been sustained by those close to him—then an allowance might have been more readily obtained.
I spoke to Mr. Roberts' own doctor. Dr. Jockel, a wise and experienced family physician, who knows the family well. Dr. Jockel has permitted me to say that he strongly supports Mr. Roberts' case, and he believes that Mr. Roberts deserves assistance. He spoke very highly of my constituent.
Mr. Roberts' local council supports the case, and it is hoping to offer a house specially designed for the disabled. It appreciates the needs of the family. The councillors certainly believe that he needs support. However, even if this house is provided, Mrs. Roberts will not find that the heavy demands upon her will noticeably reduce. The need for continued and constant care will persist. The attention she gives is needed, and it is available, as it must be, both day and night. I believe that it is sufficiently needed and available throughout all the hours that an attendance allowance is amply justified.
But it has been refused. I have looked at the papers, and it seems to me that the main reason for the refusal is that Mr. Roberts sleeps soundly. The point must be made that when he sleeps soundly it is because it takes tablets to enable him to do so. However, such good sleep is not really possible for Mrs. Roberts who has to remain able to act with an alert response to the needs which may well arise. There is the continuing danger, I am told, of insulin reaction. Nor could Mr. Roberts receive any attention without Mrs. Roberts being at hand and easily awake.
I believe that Mrs. Roberts' condition is one requiring the constant devotion which he needs and which has sustained him. He needs the supervision and repeated attention, and those are the conditions required for qualifications for the constant attendance allowance.
The second case is different. However, it illustrates a general problem which is most relevant in any consideration of extensions to the present system of assistance. If public recognition of the needs of the disabled is to increase, as it should, then the problems of the mentally handicapped need to be treated with increasing generosity.
James Snook, of Brinsworth, near Rotherham, is severely handicapped. He is a mongol, now in his twenties. All his life he has received the devoted care of his parents, who have built a sacrifice of so much of their lives. The Minister will know of similar instances and will be aware of the great demands made upon the families involved.
Let me give one rather topical example. It is fashionable in the first weeks of the British new year for those who can afford it—and perhaps many who cannot—to spend much of their time planning the summer holiday. The choice for the Snooks is inevitably rather limited. Caravan holidays have been usual. This means that Mrs. Snook, perhaps the most deserving member of the family since she is most frequently at home, because of the nature of the holiday has the least benefit of the change.
The Snooks have lived with this problem now for a very long time. From their experience and the wisdom that they have gained in so close an association with the problem, Mr. Snook has been able to play a part in local organisations which are doing so much today in caring for the mentally handicapped. However, Mr. Snook, an employee of British Railways in a responsible position, is drawing near to retirement, and Mrs. Snook's health is not what it was.
As they grow older, James, still a young man, remains strong. Sometimes, as his father said to me, he needs a little cajoling. His responses are not always normal. He can shiver for a long time with an unreasoning fright, and he sometimes needs to spend long hours in the toilet. It is true that he is able and fortunate enough to attend the occupation centre at Maltby in my constituency. This provision is splendid and commendable, but the hours of attendance are relatively short. They cannot match the long hours of care during the day and night which are required of the parents, and which the Snooks hope to go on giving for a very long time.
Some people may say that the burden is too great for the parents to bear, but it is a burden which they have accepted with that grace, compassion and parental feeling which can be counted among the best attributes of humanity. I would not say that their duties should be laid down while they have any capacity to bear them, but I believe that society should show more generously that it is prepared to offer more of a token of its willingness to recognise the burden which is borne.
It should be realised that, if the Snooks had not accepted this continuing responsibility, the cost to the community of James' institutionalisation would have been infinitely greater than the cost of the constant attendance allowance. The Minister may say that this could open the door to considerable expenditure. So it might, but one of the alternatives—probably in most cases, the eventual alternative—is much more expense. Indeed, the extension of this allowance to cases like that of James Snook could well encourage other people to feel able to follow the example of parents like the Snooks.
Therefore, I hope that the Minister will feel able, at the very least, to offer a little encouragement, comfort or hope to the Snooks. I trust that both these cases will be treated with more and early generosity.
Perhaps I should have said earlier that Mr. Roberts' steadfast years as a miner were broken by war service. Much of this was given in the Far East, where he was in the Chindit forces. The demanding nature of his industrial work was not lightly relieved at that time. The Chindits were part of the 14th Army, which I understand was nicknamed, not unjustifiably, as the Forgotten Army. Neither the Conservative Party nor my own is prepared in 1972 to see the disabled treated as a forgotten army. This all-party support is welcome, and it will uphold the present arrangements and concessions, but I hope that the Government and all people will agree on the need to accept quickly that current arrangements should be steadily improved.
Therefore, I hope that the very real disappointment which the refusal of the allowance has caused in both these cases will soon be removed so that neither the Roberts family nor the Snook family will feel bitter enough to believe any longer that the label "forgotten" might apply in their case.
I am grateful to the hon. Member for Rother Valley (Mr. Hardy) for having raised these two cases. It gives me the opportunity to say something about them and to try to set them against the background of what we are trying to achieve in the allowance as it now is and the hopes that we have for it in the future.
I join in the hon. Member's tribute to Mr. and Mrs. Roberts and to Mr. and Mrs. Snook for the work that they are doing, the devoted care and attention which they are giving to the badly disabled members of their families. We all want to give practical help to this type of family in the burdens which they bear.
We have made a start, with the new attendance allowance at the rate of £4.80 per week, and we have started with the most severely disabled of all. This is a small beginning, and it was necessary to start in this way because inevitably an allowance of this kind, which is new, requires working in. Equally, an allowance of this kind requires careful medical assessment, which means medical manpower being used, with all the time and so on that that involves. For this reason we deliberately started with the most severely disabled of all, but we are anxious, as is the hon. Gentleman, to extend the arrangements as soon as we possibly can.
The hon. Gentleman will realise that it would not be proper for me to go into the merits of the two cases to which he referred. The Act puts this duty on the independent Attendance Allowance Board, and it is for it to judge the medical merits within the terms of the Act. However, perhaps I can comment briefly on these two cases.
The application of Mr. Roberts was turned down. He applied for a review through the hon. Gentleman and the review procedure took place, which meant that the case was looked at twice. The Attendance Allowance Board found that Mr. Roberts did not ordinarily require attention at night, and this is the reason why he does not fall within the terms of the Act as it stands. However, in this case, if Mr. Roberts should unhappily get worse and thinks that he might qualify, it is always open to him to ask for a further review.
There would be no point in him doing so if his condition remained unchanged or as long as the allowance remains as it is. Thus, the two points for Mr. Roberts to bear in mind are, first, that should his condition unhappily become worse, then that might bring him within the present regulations, or secondly, that lie should look out for the extension which we hope to achieve before long, and that might bring him within them.
The case of Mr. Snook is in a slightly different category in that the Attendance Allowance Board is now reviewing the case and no decision has yet been given. I therefore cannot anticipate what its decision will be. If it goes in his favour, he will receive the allowance. If it does not, then the same points will apply to him as I mentioned in connection with Mr. Roberts.
I only wish that I could say more about these two cases because we are all extremely sympathetic. However, perhaps the hon. Gentleman will allow me to give a progress report, as it were, on how the allowance is working out.
We estimated at the beginning that about 50,000 people would qualify in the present stage one. In fact, by 25th January over 64,000 awards had been made and claims are still coming in at the rate of several thousand a week. The successful awards are over 60 per cent. of the claims actually made, and in the case of children the percentage is somewhat higher. There have been 12,000 applications for reviews, of which 74 per cent. have been successful.
I remind the hon. Gentleman of what the qualification conditions now are. They are essentially that the person concerned needs care both by day and by night. The intention is specifically reflected in the first medical requirement for the allowance:
A person must be so severely disabled physically or mentally that he requires from another person, in connection with his bodily functions, frequent attention throughout the day and prolonged or repeated attention during the night.
There is also an alternative requirement mainly for the mentally disabled that a person must be
so severely disabled physically or mentally that he requires continual supervision from another person in order to avoid substantial danger to himself or others.
These requirements in the 1970 Act are the same as those in the Bill of the previous Government, which fell when the last Parliament was dissolved.
The hon. Gentleman rightly said that we must maintain the momentum, having started on this road and having seen the very bad disabled cases who do not yet fall within the criteria. He rightly said that we are all anxious to move along this road as fast as we can. While the allowance as it is now will help more severely disabled people than we expected, we appreciate, as we have always appreciated, that it will by no means meet the needs of all severely disabled people but only those of the most severely disabled members of the community, those who need a great deal of help from another person both day and night.
The present stage has always been regarded as only a start, which it is hoped to extend in the light of experience gained in introducing the allowance, when the administrative and financial implications allow. If it is decided to develop the scheme to include further categories, for example, those who need a lot of help by day but little or none at night, much larger numbers of claimants would be involved and legislation would be required. I cannot give the hon. Gentleman a date for any such extension tonight.
The 1970 Act provides for questions relating to the medical requirements for the allowance to be decided by the Attendance Allowance Board, which is an independent body set up under the Act. Because the board cannot cope with all the claims it is empowered by the Act to delegate its function in individual cases to medical practitioners. The Board has nominated as its delegates various medical officers of the Department, otherwise employed on social security work, and medical practitioners from outside the Department experienced in war pensions and industrial injuries work.
On the subject of the review procedure, the Board may review a decision on any ground within three months. It may also review at any time if in making its original or previous decision it was ignorant of or mistaken as to a material fact, or if there has since been a relevant change of circumstance, for example, if the need for attention has increased. Following a decision on review, the claimant has a right to apply to a National Insurance Commissioner for leave to appeal on a question of law. There is no appeal on questions of medical fact or opinion.
Having appointed to the Attendance Allowance Board those best qualified to deal with such questions, it was considered not possible to set up a higher tribunal, and the unusually wide right to apply for a review on any ground within three months replaces the normal appeal right. There has been some misunderstanding on this, but it is clear, from the figures I have given as to the way in which the review procedure is working, that it is a very much wider and more effective appeal procedure than the normal appeal mechanism which we have in the national insurance regulations.
I am very sorry, therefore, that I cannot give better news to the hon. Gentleman about the two cases he mentioned tonight. I hope he will understand the reason for that. But, equally, I hope it will not be too long before it will be possible to extend the allowance so that other badly disabled members of the community who are not at present within its scope will be able to come within it.