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The Parliamentary Under-Secretary of State for Social Security (Miss Ann Widdecombe) : I must congratulate my hon. Friend the Membefor Lancashire, West (Mr. Hind) on having this subject accepted for an Adjournment debate. I understand that this is the first time that he has been in this situation, and it is certainly a first time here for me tonight.
The Government are fully committed to giving as much support as they can to helping severely disabled people.
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However, merely to have a disease of whatever sort is not in itself a passport to benefits or to attendance allowance. As my hon. Friend so rightly said, what is relevant is the satisfactory answer to the question whether the effects of the disease are such as to justify supervision.The benefit that my hon. Friend raised tonight, and which therefore most concerns us, is attendance allowance. It may help if I remind the House of the background to the allowance. It was introduced in 1971 as a single, flat-rate benefit for people who need a lot of attention or supervision both by day and by night. A separate, lower rate was introduced two years later for those who satisfy the conditions only either by day or by night.
Decisions on whether the medical criteria are satisfied are made by the Attendance Allowance Board or, more commonly, by delegated medical practitioners--generally referred to as DMPs--acting on its behalf. In reaching their decision, DMPs have regard to a full report of the claimant's condition and attendance needs which has been completed by another doctor who has visited the claimant for that purpose. The claimant is invited to have a carer present at this visit and any relevant points made by the claimant or by the carer are included in the report.
In some cases, the DMP finds it necessary to obtain further medical evidence from a specialist who has dealt with the case or from the claimant's own general practitioner. The claimant can also submit any other evidence that he or she thinks may be relevant. The DMPs follow published comprehensive guidance issued by the Attendance Allowance Board. The board consists of experts in different areas of medicine and others who have a professional interest in people with disabilities.
Attendance allowance is a benefit aimed at helping people to meet the extra costs generally associated with severe disabilities. Its purpose is to provide a broad level of support, as of right, to many disabled people-- almost 800,000 at present. It is not related to any particular costs or disablement, but focuses on the care needs arising from the claimant's condition.
This is an essential principle on which the structure of the benefit is based. It is also the element which enables attendance allowance to be applied quickly to new conditions and illnesses, whatever their nature, as they are identified. To attempt to regulate for every type of disablement or medical condition which might give rise to entitlement to attendance allowance would be bound to lead to a very complex scheme. It would also be bound to lead to delays such as the delay that my hon. Friend has rightly deplored. For that reason, I am convinced that it would not be appropriate simply to make narcolepsy in itself a sufficient condition for attendance allowance.
I can understand the sentiments which clearly underlie my hon. Friend's concern to ensure that specific illnesses should passport people into attendance allowance. However, under the present rules, people suffering from any condition have to establish their entitlement to attendance allowance if they have sufficient care needs as a result of that condition. The effects of different conditions vary enormously and it does not always follow that a particular one will generate the same level of care needs. Narcolepsy is a generic term which covers, as my hon. Friend rightly said, narcolepsy, catalepsy and sleep
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paralysis. While they can be very alarming to the person concerned and to others with them, those conditions in themselves do not put the life of the person concerned in danger. That must be taken into account in determining the need for supervision.People suffering from narcolepsy may fall asleep in monotonous conditions, in conditions of extreme warmth, when they are watching television, when they are naturally tired, when they have had a heavy meal or in any one of the conditions in which people would normally feel the desire to sleep. However, most people do not suddenly suffer from an overwhelming compulsion to sleep when engaged in a positive activity such as walking downstairs or filling a teapot with hot water. The necessity of establishing that a narcoleptic is a danger to himself or herself is therefore an essential ingredient in trying to obtain attendance allowance. It is not sufficient simply to suffer from a low resistance to sleep, which is the essence of the condition of narcolepsy.
I understand that it is very rare for persons with narcolepsy to sustain serious injury as a result of an attack or to harm others. People who are prone to abrupt sleep attacks should obviously consider whether it is wise to drive or to pursue monotonous occupations which put them at risk. However, they would be unlikely to qualify for attendance allowance which requires round-the-clock supervision on those grounds alone. They would need to show that the particular manifestations of their form of narcolepsy created danger.
My hon. Friend was right to state that narcolepsy is not a well-publicised condition. He was right also to state that it is estimated that about 20,000 people in the population suffer from it. Symptoms usually begin in adolescence and there is no question of children getting into difficulties because they are unaware of their low resistance to sleep. For most sufferers the symptoms are not extreme, and to exempt all those suffering from narcolepsy from the need to satisfy the attendance allowance criteria would be costly and also inequitable for people with other conditions, because many narcoleptics are unlikely to have supervision or care needs sufficient to justify payment of the allowance.
Where to draw the line on eligibility is always one of our most difficult issues in social security. I am convinced that our present approach is right, especially as in representations that we have received disabled people have consistently said that we should concentrate on the effects that a disability has on a claimant's life rather than on the medical aspects of the disability.
My hon. Friend mentioned a particular constituent of his who has narcolepsy. One cannot help but sympathise with that constituent and with the anxiety that her husband and family have suffered. That constituent has been refused attendance allowance at either rate on the ground that the medical criteria are not met. As I have explained, decisions on attendance allowance are for the Attendance Allowance Board and its delegates. Neither I nor my right hon. Friend the Secretary of State can intervene. However, the lady concerned has exercised her right of appeal to the social security commissioner on a point of law rather then a medical point, and my hon. Friend was right to state that the commissioner has recently remitted the case back to the board to examine it afresh. That is the correct way in which the constituent's dissatisfaction should be considered. I suspect that what I have said will not necessarily have satisfied my hon. Friend. Nevertheless, I am sure that he
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will be able to appreciate the reasons for not giving automatic entitlement to attendance allowance to people with specific medical conditions. Even very serious medical conditions do not lead to automatic qualification for attendance allowance. Each individual case must show that the effects are such that supervision is necessary, either all the time or for part of the time.The Government have made continued improvements in social security benefits for disabled people over the past 11 years. I welcome the presence in the Chamber of the hon. Member for Birkenhead (Mr. Field). In his former incarnation as Chairman of the Select Committee on Health and Social Security he paid tribute on many occasions, albeit en passant in various reports, to the measures taken by the Government over the past 11 years to try to make life better for the disabled.
In 1979, 265,000 people received attendance allowance. Today, as I said earlier, nearly 800,000 receive it. It is estimated that by 1993-94 more than 1.1 million people will receive either the care component of the disability living allowance or attendance allowance. Overall, we have more than doubled expenditure on benefits for disabled people during the past 11 years. That is a record of our commitment and one about which we are, and have reason to be, justifiably proud.
Inevitably, when new diseases are identified, it takes time for the medical profession fully to recognise the
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effects. I do not doubt that some of the rather harsh words that my hon. Friend has spoken about medical practitioners are probably justified. It takes time for information to be disseminated. However, even if all those medical practitioners were to diagnose correctly all those coming to them for recommendations for allowances or for help with the condition and for prescriptions, having narcolepsy would not necessarily justify allowances and benefits for those patients. The slowness of some members of the medical profession to catch up with this is not having an effect on the rights of patients claiming attendance allowance. Even if severe narcolepsy were diagnosed, it would still be necessary for the sufferer to show that supervision would materially alleviate or prevent danger occurring as a result of those severe symptoms.If we are to use wisely the money that we are rightly spending on the disabled, we have to consider each case on its merits. Sympathetic as I am towards those who suffer from narcolepsy, which I recognise is a somewhat under-recognised condition, the system should be left alone. There is no such thing as an automatic passport to these allowances and that is how things should continue, as disabled people themselves agree.
Question put and agreed to.
Adjourned accordingly at twenty-one minutes past Eleven o'clock.
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