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Mr. Salmond : The hon. Gentleman may be interested to know that the Under-Secretary of State was also billed to appear for the debate at St. Andrews, and that he mysteriously failed to turn up.

Mr. Marshall : Obviously my hon. Friend felt that it was his duty to be in this place.

Mr. Bill Walker : My hon. Friend will be interested to know as well that St. Andrews asked me to attend the debate. I made it clear that it was my duty to be in the House.

Mr. Marshall : That is the sort of devotion to duty that we would expect from my hon. Friend.

It is unfortunate that the University of St. Andrews, which is well renowned historically as being a centre of compassion, voted against the community charge. We know that 80 per cent. of single pensioners will be better off under the community charge than under the rating system. I must apologise to the people of Scotland that my former university has become so heartless as to vote against the community charge.

11.44 pm

Mr. Sam Galbraith (Strathkelvin and Bearsden) : The contribution from the hon. Member for Hendon, South (Mr. Marshall) was one of the most disgraceful contributions to the debate. He is not just an hon. Member of this House, he is also a Euro Member for north London and he collects two salaries.

Mr. John Marshall : That is not true. Does the hon. Gentleman accept that I do not take any salary as a Euro Member? I do not know whether his Labour colleagues can boast the same.

Mr. Galbraith : I withdraw that and rephrase it. The hon. Gentleman collects two lots of expenses. We do not require any tutorials from him about hardship and

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pensioners. He also made a great play about talking to local authorities. He should speak to his local authority and to the chief officer who is bitterly opposed to the poll tax before he talks to us about that.

Mr. Marshall : Will the hon. Gentleman give way?

Mr. Galbraith : No. Sit down. The hon. Gentleman is not interested in what we have to say, so he should not bother boring the House with his comments.

I rise at the Dispatch Box briefly once again to challenge the Government's medical advice on the regulations. I did that in the House last week and I want to do so again now. I have taken extensive advice since last week from my colleagues who are experienced in these matters and who might have expected to have been consulted, but were not. They are at one with me in the belief that the Government's medical advice in relation to Alzheimer's sufferers is wrong. I do not expect the Minister to give me any specific answers tonight. I accept that because I am going to make some technical points and it would be unfair of me to ask the Minister to respond to specifically medical matters. I expect the Minister to reconsider my remarks and return to the House to say that he will stop treating Alzheimer sufferers differently from other patients with dementia.

When considering patients with Alzheimer's it is important that we distinguish between a diagnosis and a clinical picture because often those two factors are confused. The diagnosis is Alzheimer's disease while the clinical picture is a separate presentation. The latter is the way in which the patient behaves and his relationship to surroundings, relatives and the environment. Alzheimer's disease is a diagnosis and I accept that it is not necessarily the same thing as severe mental handicap. Essentially, for those patients the diagnosis is irrelevant. We must decide whether patients can lead an independent existence and whether they have severe impairment of social and intellectual functions.

When we consider diagnosis and presentation, we must also consider acquired dementia. I have referred to severe mental handicap which may be due to dementia. The hon. Member for Orkney and Shetland (Mr. Wallace) was right. Between 90,000 and 100,000 people in Scotland suffer from that form of dementia. The majority of those people have Alzheimer's disease, the figure being about 80 per cent.

If I use slightly technical terms it is not for the Minister's benefit, but for the benefit of his friends and colleagues who will consider this later. Ten per cent. of those dementia sufferers have what is known as a multi- infarct syndrome. It is impossible to distinguish between a patient presenting with Alzheimers's disease and multi-infarct syndrome based on the presentation. That is clinically impossible. Alcoholism is another cause of dementia and the clinical picture can be the same as Alzheimer's disease. Parkinson's disease is another cause of dementia and its clinical picture can be the same as Alzheimer's. Similarly Huntington's chorea is another form cause of dementia.

The clinical presentation and everything that the Minister has said about Alzheimer's disease--that it is progressive and

intermittent--applies to all those causes of dementia. However, the only cause that the Minister is excluding is Alzheimer's disease. Will the Minister explain why that is so? Alzheimer's clinical presentation is exactly

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the same, as is the nature and cause of the disease. Why is it that those suffering from Alzheimer's disease are discriminated against? What is the difference between a patient suffering from Alzheimer's disease and one suffering from multi-infarct syndrome?

In a letter to my hon. Friend the Member for Cunninghame, North (Mr. Wilson), the Minister wrote :

"Parliament recognised that considerable difficulties and some potential for unfairness would be involved in assessing precisely when a person with a degenerative condition, such as Huntington's Chorea, reaches the point during the progress of the condition where intelligence and social functioning are severely impaired." I accept that, and I do not dispute that it can be difficult to decide when that point is reached--but the same applies to every other form of dementia, even congenital dementia. Will the Minister explain what difference the diagnosis makes?

In a letter to my hon. Friend the Member for Glasgow, Garscadden (Mr. Dewar), the Secretary of State for Scotland wrote :

"People with degenerative brain disorders, such as Alzheimer's disease, have a very gradual onset of their condition and may continue for a period of some years to carry on a normal life". So may a patient suffering from multi-infarct syndrome, from alcoholism, from dementia caused by a head injury, or from Parkinson's disease. Why do the Government persist in discriminating against patients suffering from Alzheimer's disease? That is the question I ask the Minister to answer tonight.

The Minister may give the easy answer that people in residential care will be exempt. He surely does not suggest that the way to exempt a loved one from the poll tax is to place him or her into care. I quote again from the Minister's letter to my hon. Friend the Member for Cunninghame, North :

"I do not therefore believe that the community charge arrangements offer any financial discouragement to caring for people in the community."

In truth, they do just that. Instead of being able to look after a loved one at home--albeit that they may have no relationship with those around them or with their surroundings--it is suggested that they be placed in residential care and in that way be exempt from the poll tax.

It is not the diagnosis that should concern us but the clinical picture. The regulations refer to "severe mental handicap", which makes the actual diagnosis irrelevant. Everything that the Minister and his right hon. and hon. Friends have said in relation to Alzheimer's disease applies to every other cause of dementia, be it congenital or acquired. The diagnosis remains irrelevant. I put it to the Minister again that the medical advice which the Government have been given is wrong. By accepting it, the Minister penalises those who wish to look after their loved ones at home. For all those reasons, we shall certainly be voting against the regulations. 11.52 pm

Mr. Lang : With the leave of the House, Mr. Deputy Speaker, may I reply? Nobody can say that this evening's debate has been a particularly uplifting affair. As was said by the hon. Member for Banff and Buchan (Mr. Salmond), the debate has shifted to Scotland, where we all eagerly await the arrival of the army of 100,000 protesters that the hon. Gentleman promises will descend upon us at some unspecified time.

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Perhaps I should first concentrate on the constituency of the hon. Member for Angus, East (Mr. Welsh), where the Scottish Nationalist council is implementing the community charge so efficiently.

Mr. Salmond : I hope that the Minister will answer the substantive points made in the debate, but perhaps he noted that the thousandth non- payer has been signed up in the constituency of his right hon. and learned Friend the Secretary of State for Scotland.

Mr. Lang : It will be interesting to see what happens about that army of 100,000 people who "Can pay, won't pay". I think that it will be more a case of "Can't find, won't find".

Alzheimer's disease is a serious subject, and it is one that I am content to address. However, it was significant that when my hon. Friend the Member for Hendon, South (Mr. Marshall) asked what was done by the Labour party to exempt Alzheimer's diseases sufferers when they had the opportunity to do so, there was no answer. The hon. Member for Edinburgh, South (Mr. Griffiths) suggested that the House should reverse last week's decision. The fact remains that, after two years' debate, only now do the Opposition begin to show any concern for those suffering from conditions such as Alzheimer's disease. The debate concerns a serious and sensitive issue. Many of us know people who suffer from Alzheimer's disease, and we all recognise that it is a tragic condition, but when the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) says that we are discriminating against those with Alzheimer's disease he misunderstands the position, which is that diagnosis is difficult : his comments underlined that. We are not discriminating against Alzheimer's. We are taking exactly the same attitude to all degenerative brain disorders.

Mr. Galbraith rose --

Mr. Lang : I am sorry, but I should like to reply to the points that the hon. Gentleman made.

Considerable serious research is going on, some of it promising, but an indication of how much there is still to learn about diseases such as Alzheimer's can be found in the most recent edition of the Lancet . In an article headed

"Senile Dementia of Alzheimer's Type : Normal Ageing or Disease?" it states :

"The clinical diagnosis of dementia is very inaccurate in general practice, and the same applies to senile dementia of Alzheimer's type in hospital practice, with a preponderance of false positives when checked against the post mortem findings."

In the Lancet of 4 March, an article headed

"Senile Dementia or Alzheimer's Disease"

states :

"The existence of senile dementia of Alzheimer's type as a disease entity has lately been questioned. Is it instead part of the normal process of ageing?"

In the Lancet of 29 October, another article asks :

"Do general practitioners miss dementia in elderly patients?" It continues :

"How accurate are general practitioners in recognising dementia in their elderly patients? In a frequently cited study by Williamson and colleagues, 200 patients in three Scottish general practices were assessed by a geriatrician and a psychiatrist. Later their diagnoses were compared with information taken from the general practitioners' medical records and from interviews with them about each of their

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patients. The general practitioners were said to be aware of only seven of the 48 cases of dementia identified by the investigation team."

I could give a number of other quotations from articles in the Lancet . They prove that diagnosis is extremely difficult, and that is the underlying problem that we face in finding any method of assessment whereby we can decide on a dividing line making it appropriate to exempt sufferers from degenerative brain disorders.

Mr. Galbraith : The Minister continues to make the mistake of confusing clinical diagnosis with clinical picture. The regulations apply to the clinical picture--severe mental handicap and severe impairment of social and intellectual function. The diagnosis is not at issue here.

Mr. Lang : The difficulty is of assessing when it would be proper and fair to grant an exemption without creating more anomalies than it would remove. That has governed the balanced medical advice that we have received.

The hon. Member for Orkney and Shetland (Mr. Wallace) asked whether the maximum rebate of 50p was a national rule or one local to his area. The answer is that regulation 51 of the Housing Benefit (Community Charge Rebates) (Scotland) Regulations 1988 provides that housing benefit shall not be payable in respect of any claim where the weekly amount awarded would be less than 50p.

The hon. Member for Londonderry, East (Mr. Ross) asked about the community charge in Northern Ireland. It is not, of course, for me to say anything about the Government's intentions in the Province, but, as I am sure he will acknowledge, the structure of local government, the level of its funding and the area of its responsibilities are very different there from in the rest of the United Kingdom. For students from Northern Ireland to come to the rest of the United Kingdom and pay the community charge at 20 per cent., although their parents are paying rates in Northern Ireland, seems entirely acceptable to me, and I do not believe that it will reduce the enthusiasm of students from Northern Ireland to come to Scottish universities.

My hon. Friend the Member for Tayside, North (Mr. Walker) asked when students would start to pay. The answer is, when they enrol for the start of their courses, as regulation 3(c)(i) of the student regulations shows.

This evening we have again witnessed the now familiar sight of the Opposition striving to find anything cogent to say in response to the new community charge arrangements. It is clear that they have nothing of substance to contribute, which is why they are reduced to scavenging for peripheral titbits. Even then they are finding nothing of worth.

The measures to introduce the community charge system have proceeded steadily towards implementation on our planned timetable, as we have always maintained that they would. This is possibly why the Opposition have run out of substance for their arguments. This debate marks another, and near final, step forward in the process of removing the totally discredited domestic rating system. The Opposition's usual, tired criticisms of the regulations and of the community charge pale into insignificance when they are contrasted with the huge, and entirely justified, weight of criticism which, over the years, has been directed against the domestic rating system. It is

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a source of great satisfaction to me and to millions of ratepayers in Scotland that we are now within a few weeks of ending the domestic rating system there.

Question put :

The House divided : Ayes 197, Noes. 207.

Division No. 117] [12 midnight


Abbott, Ms Diane

Allen, Graham

Archer, Rt Hon Peter

Armstrong, Hilary

Ashton, Joe

Barnes, Harry (Derbyshire NE)

Barron, Kevin

Battle, John

Beckett, Margaret

Bell, Stuart

Benn, Rt Hon Tony

Bidwell, Sydney

Blair, Tony

Blunkett, David

Boateng, Paul

Boyes, Roland

Bradley, Keith

Bray, Dr Jeremy

Brown, Gordon (D'mline E)

Brown, Nicholas (Newcastle E)

Brown, Ron (Edinburgh Leith)

Bruce, Malcolm (Gordon)

Buchan, Norman

Buckley, George J.

Caborn, Richard

Callaghan, Jim

Campbell, Menzies (Fife NE)

Campbell, Ron (Blyth Valley)

Campbell-Savours, D. N.

Clark, Dr David (S Shields)

Clarke, Tom (Monklands W)

Clay, Bob

Clelland, David

Cohen, Harry

Coleman, Donald

Cook, Frank (Stockton N)

Cook, Robin (Livingston)

Corbett, Robin

Corbyn, Jeremy

Cousins, Jim

Crowther, Stan

Cryer, Bob

Cummings, John

Cunliffe, Lawrence

Cunningham, Dr John

Dalyell, Tam

Darling, Alistair

Davies, Rt Hon Denzil (Llanelli)

Davies, Ron (Caerphilly)

Davis, Terry (B'ham Hodge H'l)

Dewar, Donald

Dixon, Don

Dobson, Frank

Doran, Frank

Douglas, Dick

Duffy, A. E. P.

Dunnachie, Jimmy

Dunwoody, Hon Mrs Gwyneth

Eadie, Alexander

Eastham, Ken

Evans, John (St Helens N)

Ewing, Harry (Falkirk E)

Ewing, Mrs Margaret (Moray)

Fatchett, Derek

Field, Frank (Birkenhead)

Fields, Terry (L'pool B G'n)

Fisher, Mark

Flannery, Martin

Foot, Rt Hon Michael

Foster, Derek

Foulkes, George

Fraser, John

Fyfe, Maria

Galbraith, Sam

Galloway, George

Garrett, John (Norwich South)

George, Bruce

Gilbert, Rt Hon Dr John

Golding, Mrs Llin

Gordon, Mildred

Gould, Bryan

Grant, Bernie (Tottenham)

Griffiths, Nigel (Edinburgh S)

Griffiths, Win (Bridgend)

Grocott, Bruce

Hardy, Peter

Harman, Ms Harriet

Healey, Rt Hon Denis

Heffer, Eric S.

Henderson, Doug

Hinchliffe, David

Hogg, N. (C'nauld & Kilsyth)

Holland, Stuart

Home Robertson, John

Hood, Jimmy

Howarth, George (Knowsley N)

Howell, Rt Hon D. (S'heath)

Howells, Kim (Pontypridd)

Hughes, John (Coventry NE)

Hughes, Robert (Aberdeen N)

Hughes, Roy (Newport E)

Hughes, Sean (Knowsley S)

Illsley, Eric

Ingram, Adam

Janner, Greville

Jones, Martyn (Clwyd S W)

Kaufman, Rt Hon Gerald

Kennedy, Charles

Kirkwood, Archy

Lamond, James

Leadbitter, Ted

Lewis, Terry

Litherland, Robert

Livsey, Richard

Lloyd, Tony (Stretford)

Lofthouse, Geoffrey

McAllion, John

McAvoy, Thomas

McCartney, Ian

Macdonald, Calum A.

McFall, John

McKay, Allen (Barnsley West)

McKelvey, William

McLeish, Henry

Maclennan, Robert

McNamara, Kevin

McTaggart, Bob

McWilliam, John

Madden, Max

Mahon, Mrs Alice

Marshall, David (Shettleston)

Marshall, Jim (Leicester S)

Martin, Michael J. (Springburn)

Martlew, Eric

Maxton, John

Meacher, Michael

Meale, Alan

Michael, Alun

Michie, Bill (Sheffield Heeley)

Mitchell, Austin (G't Grimsby)

Moonie, Dr Lewis

Morgan, Rhodri

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