On a point of order, Mr. Deputy Speaker. The hon. Member for the Isle of Ely (Mr. Freud) has abandoned a very important debate on the mentally handicapped. My hon. Friend the Member for Thornaby (Mr. Wrigglesworth) has taken advantage of the same subject. However, the hon. Member for Isle of Ely gave no indication—
The hon. Member did come to me during the night to tell me that he had an important engagement at St. Andrew's University. He was quite happy that the debate would go on nevertheless. He was most apologetic about missing it. so it is unfair to criticise him on that score.
I can understand the feelings of my hon. Friend the Member for Keighley (Mr. Cryer) because he had the Adjournment for Friday and he would have welcomed the opportunity to be in my position now. Had I known earlier, I could have approached him, but I hope that he will have the opportunity to raise his subject in the near future.
It is an unexpected pleasure for me to have this opportunity to address the House on the plight of handicapped children. It is an unexpected pleasure because it gives me an opportunity to relieve the pent-up frustration I felt throughout the night as I sat on the Bench as a PPS at the Home Office unable to say anything, despite feeling many times that I should like to do so.
This is a very important issue and we do not have the opportunity to discuss it much in the House. I felt that it was too important a subject to let it go by default. I do not wish to appear carping in any of the things I say, because the Government have a very good record on handicapped children. Indeed, their record is good in the whole of provision of services for the disabled.
We have on the Front Bench the first Minister with a responsibility for the disabled in the history of this country. My hon. Friend the Under-Secretary of State is a member of the co-operative movement and he has done a tremendous amount of work for the disabled. The Co-operative Parliamentary Group is proud of the work he has done.
We know that new cash benefits have been introduced and that other benefits have been increased at an unprecedented rate. We have attendance allowances, mobility allowances and non-contributory invalidity pensions. A sum of £12 million has been given to us from the Rowntree Trust in connection with family projects. These are all policies for the disabled of which we can all be rightly proud.
My own interest in this subject stems to a large degree from my experience with the Teesside Disablement Group and with the Advisory Body for the Chronically Sick and Disabled in Cleveland County. Some 18 months ago, when the Minister came to open the Blenheim House Home for the Handicapped, we had fruitful discussions with the advisory body as a result of which I have raised a number of these matters in the House. The advisory body represents a number of groups, such as multiple sclerosis, spina bifida and others. There are 72,000 handicapped people in the county and their interests are constantly being cared for.
There is very little warning given to a family that suddenly finds itself with a handicapped child in its midst. It is an enormous blow to the family concerned. That family needs help in adjusting itself to the situation of coping with a handicapped child.
I have experience of a family in my constituency of Thornaby who came to see me at one of my surgeries. That family and its example gave me back my faith in human nature. Its example underlines the capacity of parents and families to hold together against great hardship. This brings out the best in people in facing up to the difficulties of family life in extremely difficult circumstances.
The one area in which help can be given to families is where early diagnosis can be made. I hope that the Minister will be able to say what action the Government have been able to take in helping to assist the medical and other services, and indeed families, in identifying children in these categories so that immediate provision can be made to give them assistance.
One of the ways in which a handicapped child can be helped is by the provision of early assistance once the handicap has been identified through the social services. The health services can be brought in immediately to give assistance. If that assistance is not provided at an early stage, a family will not be able to make all the advances necessary to be able to resign itself to the situation. Opportunities must not be lost, because ground once lost is difficult to regain.
I hope that the Minister will be able to give us the Government's views and to say what action can be taken to give early assistance to handicapped children and their families. It is very important that we stop the child and the family from being isolated from the community by the enormous amount of time and effort which has to be put into caring for a handicapped child.
I will not go into the recommendations of the Warnock Committee on Special Education. My view tends to be in favour of integration with the community, with community groups and with the school service, and not to isolate handicapped children and their families from those groups. I want to see them integrated as much as they possibly can be. I should like the Minister to say in what ways the Government can help in this and what views they have on the recommendations of the Warnock Committee, and on other provisions for helping the handicapped child and the family to be more closely integrated with the society around them.
Next, I should like the Minister to say a few words, if he can, about the take-up rate of the benefits, some of which I have mentioned. It has been made clear to me by the advisory body in Cleveland that there is a need for action here, because some handicapped children and their families are not aware of the benefits available to them.
Indeed, the advisory body wrote to me a little while ago and asked me to take action with the Minister in order to make available a supply of leaflets, so that they themselves, through all the different age groups, could make them available, and so that people could find out about the provisions available to them. The Minister, happily, was able to do that, and I know that was much appreciated.
One of the other features the group pointed out—this is the fifth point on which I hope the Minister will comment—was the need for a better co-ordination of services and provisions for handicapped children and their families and, indeed, for other handicapped people. In particular, there is a need for better coordination between the social and health services and the Department of Employment which provides a whole range of facilities for handicapped people.
As my hon. Friend knows, I wrote to my right hon. Friend the Member for Huyton (Sir H. Wilson) about this. He replied:
I know you will understand that I am not unsympathetic to the points that have been raised with you.
That is by the advisory body.
There is, I am sure, need for more effective co-ordination of services and I hope that I have indicated some of the ways in which I believe we can expect to see improvement.
That letter was written to me by the former Prime Minister some little time
ago. I should be grateful for any progress report the Minister can give to me about the steps that he has taken and that the Government have been able to take to help in the better co-ordination of services.
One further matter which I have raised with the Minister previously, on which he might like to comment, is the work done by the Voluntary Council for Handicapped Children. My hon. Friend might remember that I tabled some Questions to him last year about the work of this council. He stressed in his reply to me that the Department had agreed to provide both financial help and advice and to maintain close contact with the council. I believe that my hon. Friend addressed the council and discussed with it ways in which the Government could give assistance. Again, I should be grateful if my hon. Friend could comment on progress in that respect.
I have raised a number of issues which are, I think, of crucial importance to the welfare of handicapped children in the community and the families of handicapped children in the community. I look forward to hearing the Minister's comments on these points.
As I know you will appreciate, Mr. Deputy Speaker, with all your concern for the subject, I was very glad when I heard last week that the hon. Member for Isle of Ely (Mr. Freud) had won an Adjournment debate to discuss the welfare of handicapped children. I know that he and his wife take a keen personal interest in the problems of handicapped children and have done so over many years.
The hon. Gentleman has had to leave the House in order to meet an engagement in Dundee. He informed me of his difficulties, and I am grateful to him for having taken so much trouble to explain why he could not be here for his debate. I know that the hon. Member will be as happy as I was to learn that the debate has been "saved" by my hon. Friend the Member for Thornaby (Mr. Wrigglesworth) having successfully submitted the same subject to Mr. Speaker earlier this morning.
My hon. Friend also takes a keen personal interest in the welfare of handicapped children. His speech was one of deep understanding of their problems, and I warmly congratulate him on the remarkable spontaneity of his advocacy in opening the debate. He does superb work for his disabled constituents and their families in Thornaby, and, indeed, for the disabled all over the county of Cleveland. He made a kindly reference to my visit to his constituency to open Blenheim House last year. I was delighted to be with my hon. Friend because I know that his concern for disabled children and their families is very deep and sincere.
Before I proceed to reply to my hon. Friend the Member for Thornaby I must emphasise that I shall be pleased to consider any point which the hon. Member for Isle of Ely may wish to pursue with me. My reply to my hon. Friend will cover many of the points that I know the hon. Member for Isle of Ely wished to raise. I shall be pleased to consider them further and write to the hon. Gentleman if he would like me to do so. My right hon. Friend the Secretary of State for Education and Science would also be happy to give personal consideration to any points affecting handicapped children within his responsibility which the hon. Gentlemen may wish to pursue.
I turn to the subject of the debate. To have a handicapped child can impose severe strains on a family. I should like first, therefore, to say something about what I have been attempting to do as Minister responsible for the disabled to help these families.
Special cash provision for handicapped children is comparatively new but increasingly important. The attendance allowance was the first cash benefit to become payable. Today the allowance is being paid to the families of some 40,000 severely handicapped children. Our new mobility allowance will also soon become payable to handicapped children. Indeed, they will be the next age group to benefit and will receive the mobility allowance just as soon as we can phase them into the scheme.
We estimate that around 30,000 handicapped children aged under 16 will receive the mobility allowance. What is more, all of these children will be receiving outdoor mobility help for the very first time. This is an important breakthrough in helping handicapped children not only in this country but internationally.
Mobility allowance and attendance allowance beneficiaries will overlap to some extent in that some handicapped children will receive both allowances. This means that, at the maximum, the families concerned will receive, at November 1976 rates of benefit £17·20 a week. This compares with nothing at all only six years ago. From the age of 16, the handicapped child can now also receive our new non-contributory invalidity pension which provides an additional £9.20 a week without any means test.
Money is not the answer to all the problems faced by disabled children and their families. It is clearly right, however, that we should seek to relieve the additional handicap of poverty which so often hits families with a severely handicapped child.
The Family Fund, which is administered for my Department by the Rowntree Trust, continues to provide another important source of help for families with severely disabled children. In its first three years the fund has helped over 23,000 such families, and already some of the needs highlighted by the Family Fund are beginning to be provided for by the new cash benefits and statute-based services. Yet the fund has so far assisted only half of the total number of families whom it believes to be eligible for and to need help. It has recently given fresh publicity to its rôle, aimed at families which are eligible for help but slow to apply. If hon. and right hon. Members feel able to help in publicising the availability of help from the fund, especially in areas of low take-up, I know that its administrators will be deeply appreciative.
The Family Fund is, of course, careful not to duplicate provision that can be made available to handicapped children and their families under the provisions of the Chronically Sick and Disabled Persons Act 1970 and other legislation.
Anyone who goes among the families of handicapped children, as I very often do, knows how highly they value not only the new cash benefits but also the aid that is given by local authorities under Section 2 of the 1970 Act. My hon. Friend the Member for Thornaby referred to services, as well as cash benefits, and to the importance of both. There are many outstanding examples of children now being enabled to live with their families, instead of being hospitalised or otherwise institutionalised, by virtue of housing adaptations and other forms of help given by local authorities under the Act. So our new services are no less important than our new cash benefits to handicapped children and their families. Moreover, we must never underestimate the importance of getting right the balance of provision as between services and cash.
Looking to the future, my hon. Friend may be aware of the recent Sunningdale conference on the disabled. The purpose of the conference was not only to review existing provision but also to consider policy developments in this field. The conference was attended by Ministers and Members of Parliament, representatives of local authorities and voluntary bodies, academics, civil servants and others, including disabled people. It was an important and unique occasion. It was certainly the first occasion of its kind in this country, and. I suspect, in any country.
A number of significant proposals emerged from Sunningdale which directly affect handicapped children. I should like to refer to one or two. First, it was agreed that it is essential to find a way of ensuring that families with handicapped children know exactly what is available from statutory and voluntary agencies alike. This is a field in which my hon. Friend has taken a particular and sustained interest.
It was also suggested at Sunningdale that there should be more and better information from the centre. I think it was Oscar Wilde who said, returning from the first night of one of his plays, that while the play was a great success the audience was a failure. We must never overlook the importance of trying to see what we do from the standpoint of those whom we are seeking to inform and to help. Thus I regard the suggestion about improving information from the centre as one of very considerable importance. I am now considering how best to implement the suggestion.
Turning from the centre to the localities, I am glad to note that one local authority has already appointed a disabled person to provide information about all the help and helping agencies available to the disabled. His telephone number—and nothing else—is widely advertised, for example, in doctors' waiting rooms. The precise part that anyone filling this rôle should play is still very much open for discussion. Should he be able to take up the cudgels on a disabled person's behalf, or should this be a job for others? However such questions may be settled, it is already clear that the experiment in one locality is improving take-up both of services and of cash benefits. My hon. Friend referred to the take-up of benefits. Naturally, I am keen to ensure that there is maximum take-up of all the new benefits for which we have been able to legislate.
Another question we discussed at Sunningdale was that of co-ordination between all the agencies that can help. How often do we hear of parents who are quite overwhelmed and bewildered by the complexities of the welfare "machine" and not know which way to turn? This is not in any way an indictment of the advice and help given by statutory organisations or by the voluntary sector, but simply a reflection of the highly complex range of needs of the handicapped child and his family. One of the big and intractable problems of our time is how to make the "machine" accessible and understandable to people who are in a distressing situation which is new to them. What they need is a "single door" approach to make the face even of the largest institutions seem more human. This approach can help to reduce the fears which so often afflict the parents of a handicapped child.
I am, therefore, most grateful to the National Children's Bureau for its initiative in recently establishing the Voluntary Council for Handicapped Children. One of the main aims of the new council is to provide the "single door" approach to the very wide range of help which is now available from so many different agencies. I am much impressed with the council's work so far and by the quality of its first pamphlet "Help Starts Here", which I understand will be followed by other publications. I am also very interested in the seminars and "workshops" which the council has mounted.
The membership of the council represents a great deal of talent and expertise covering all the interests of handicapped children. I am naturally very glad to have been able to authorise payment from my Department of a grant to the council of £30,000 over the next three years. This example of voluntary organisations working together is one which might well be followed by other organisations in the voluntary sector. I commend the National Children's Bureau's initiative to them.
Another suggestion made at Sunning-dale was that much greater use should be made of the experience and expertise of parents with older handicapped children in helping new parents of children with similar handicaps. The National Deaf Children's Society has a successful scheme of this kind to provide help and advice for younger parents of deaf children. I should like to see the principle of that scheme applied much more widely in the service of handicapped children, and I shall be seeking the advice of the volunteer centre to this end. There is an increasing tendency to encourage the day foster care of handicapped children, and of children from other households under stress, within families so that in a familiar local environment the child can establish close and continuing relationships.
My Department has this year published a "Guide to Foster Care Practice", which is the report of a working party chaired by Mrs. Janie Thomas of the London School of Economics. The report specifically deals with ways of meeting the needs of handicapped children and will influence practice in this field. I should also like to refer to the new organisation, Parents for Children, which is taking a particular interest in placing for adoption children with special needs including handicapped children. This is another voluntary organisation that my Department has been able to help financially.
The most effective action which the Health Service can take in regard to mental and physical handicap is to try to prevent its occurrence wherever this is possible. In my view, there is much more scope for preventive action in improving services during pregnancy and childbirth.
My Department is keen to ensure that all health care activities that have a preventive purpose in this area are coordinated so as to provide a comprehensive service. The sole aim is to reduce the incidence of handicap. Before conception, the service would ensure rubella vaccination, the availability of family planning advice and the provision of genetic counselling for those at risk of certain inherited conditions. During pregnancy a high standard of ante-natal care is required with pre-natal diagnostic facilities where necessary.
I am especially concerned that older women should be offered tests to detect Down's Syndrome, and I am hopeful that services for the detection of neural tube defects can be expanded in the near future. It is important also that birth should take place in well-equipped hospitals where the full range of modern obstetric and paediatric techniques is available, and that there should be a prompt clinical examination of the newborn. My hon. Friend referred to the great importance of prevention. I share his viewpoint about the importance of this area. By encouraging continued development in the areas I have mentioned, we hope that over the years ahead we shall see a real decline in the numbers of children born with severe handicapping conditions.
My hon. Friend will know that all babies are examined at birth for observable abnormality, including Down's Syndrome, and that arrangements are made for any care or treatment which might be needed. There is also special surveillance of all handicapped children to make sure that everything possible is done to minimise handicap. Between six and 14 days after birth all infants are tested for phenylketonuria, a disease resulting in mental handicap, so that appropriate dietary treatment can be instigated as soon as possible.
The birth of a child with a handicap which can be immediately diagnosed must be regarded as an acute emotional and social crisis for the parents. A booklet on care of the child with spina bifida, prepared in 1973 by the Standing Medical Advisory Committee, stressed the skill which is required in counselling the parents of a child with this condition. It suggested that, if at all possible, the mother should be allowed to see and handle the child shortly after birth, and that the father should be involved in discussions about care at an early stage.
Repeated opportunities for both parents to discuss their anxieties should be provided. Ideally one member of staff should assume particular responsibility for stimulating these discussions. The importance of repeated opportunities for such discussions, both in hospital and at home, cannot be over-emphasised. I think that this advice holds good for all types of handicap which are apparent at or soon after birth.
My hon. Friend, as the hon. Member for Isle of Ely intended to do, has referred to the need for better coordination of services for families with a handicapped child. As he will know, the Committee on the Child Health Services under the chairmanship of Professor Court is expected to report later this year and it would be wrong for me to anticipate its recommendations. Nevertheless, I can indicate what services are already provided.
The community health services for preschool children aim to identify, at the earliest possible stage, any defect or deviation from the normal requiring immediate or later treatment to prevent the development of a handicapping condition. Current advice to health authorities is that all children should be seen at a child health clinic for routine developmental screening and physical examination at specified ages during their first five years.
Developmental surveillance and specific screening tests are usually carried out by medical officers or health visitors at clinics run by area health authorities, or in the home by health visitors alone. General practitioners increasingly take part in screening programmes, either by working in child health clinics or by organizing "well baby" sessions for their own patients.
The importance of multi-disciplinary assessment for children with suspected handicap has been recognised for a number of years. It is referred to in Policy Circular HM(71)22 "Hospital Facilities for Children". Our Consultative Document on Priorities also recognises the importance of providing comprehensive assessment and follow-up services to help handicapped children to reach their full potential.
Comprehensive assessment services encourage the participation of parents, and provide them with support and advice in the management of the child. Many of these services arrange parents' discussion groups, toy libraries and supplies of appropriate literature, and will put parents in touch with appropriate voluntary organisations.
It was the intention of the hon. Member for Isle of Ely to mention the problem of confidentiality of information about handicapped children. The key to overcoming this problem lies in the involvement of the parents in making plans for the child.