House of Commons Hansard Debates for 21 May 1991

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Orders of the Day

Disability Living Allowance and Disability Working Allowance Bill

Lords amendments considered.

Clause 1

Introduction of disability living allowance

Lords amendment : No. 1, in page 1, line 12, at end insert "a community care supplement"

4.12 pm

The Minister for Social Security and Disabled People (Mr. Nicholas Scott) : I beg to move, That this House doth disagree with the Lordsin the said amendment.

Mr. Speaker : With this, it will be convenient to consider the following Lords amendments : No. 2, in page 3, line 6, at end insert ", to any one of which may be added a community care supplement payable out of the National Insurance Fund."

The Government's motion to disagree with the amendment. No. 3, in page 3, line 36, at end insert--

"(5A) The weekly rate of the community care supplement shall depend on the individual circumstances of a severely disabled person. In particular it shall depend on the extent to which he is severely restricted in his ability to perform normal personal care and domestic tasks because of his disablement, on the extent of his need for help, attention or supervision from another person, on the cost of securing the required help, attention or supervision, and on such other factors as the Secretary of State may prescribe.

(5B) For the purposes of subsection (3) above--

(a) a community care supplement shall not be payable in addition to a payment from the Independent Living Fund ;

(b) providing his circumstances qualify him for a payment from the Independent Living Fund, a community care supplement shall be payable to a severely disabled person in lieu of such a payment when the payment ceases on the expiry of the life of the Independent Living Fund Trust on or before 8 June 1993 ; and

(c) payment of the community care supplement shall be disregarded for the purposes of assessing housing benefit and community charge benefit."

Amendment (a) to Lords amendment No. 3, in line 8, after supervision', insert

on the need for a special diet'.

The Government's motion to disagree with the amendment.

Mr. Scott : I am conscious, in moving the motion, that the amendments bring us to an issue to which both sides of the House attach much importance--the position of the most severely disabled members of our community. I have considered, and in most cases listened with much care, to speeches made in debates in the House and in another place. I am sure that the House will want me to concentrate on the substance of the issues rather than to raise detailed objections to the amendments.

I do not intend to detain the House by focusing on details, other than to make two points : first, the Lords amendments for the creation of a community care supplement within disability living allowance are, as I shall seek to convince the House, unworkable in practice.

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Secondly, it must be perverse to provide, as one amendment does, for the community care supplement to be paid from the national insurance fund, when the rest of the benefit, of which it is supposed to be a part, is paid from general taxation. I well understand that that was used as a device to raise the subject properly for debate and I am happy that it gives me an opportunity to explain where the Government stand.

I do not think that I am oversimplifying matters by saying that at each stage in our discussions of this issue during the Bill's passage two main points have been made. First, there was some pressure on the Government to devise a regulatory statutory replacement for the independent living fund from 1993. Secondly, there has been genuine concern that we should take the opportunity to clarify as soon as possible what the arrangements will be for people who are already getting support from the independent living fund. I very much understand that concern and I shall come back to it in a moment. However, let me deal first with the desire to see a regulated benefits system replace the independent living fund. I have to say to right hon. and hon. Opposition Members who take a close interest in such matters that I do not believe that even the best legal skills that I could deploy to draft a set of regulations would come close to delivering the pattern of help provided now by the independent living fund. To "tack on" a community care supplement to a benefit on which we expect to have to make about 20,000 decisions a week would be a recipe for abandoning any serious attempt to go into the needs of individual disabled people in depth in order to arrive at a package that meets those needs.

I know that Opposition Members who have been urging the introduction of a regulated system do so with the best of intentions and motives, but we must recognise that the independent living fund has been more effective in delivering help where it is needed than was the system that it replaced. We must bear it in mind that that system was regulated statutory help with the costs of domestic assistance. At the risk of labouring the point, it clearly did not get to as many people, or as effectively, as those who are now getting help from the independent living fund.

I reiterate the point that I made in Committee and on Report--benefits that are supposedly designed to cater for every contingency end up not being understood let alone claimed by many of those at whom they are aimed. I can do no better than to quote Sir Roy Griffiths' report on community care in which he said : "Our social security system is essentially designed to provide a standard range of benefits for large numbers of people against objective tests of entitlement. It is not an appropriate system for the direct provision of individually tailored packages of support, within a finite community care programme."

Sir Roy also rightly argued that if we were to make a successful reality of our aim, which I am sure is shared in all quarters, of enabling people to live in the community, we need to give primary responsibility for the assessment of need and for the planning and delivery of care packages to a single authority.

I remain convinced that our community care strategy is the right approach to meeting the needs of all disabled people, including the most severely disabled. Local social services authorities are now drawing up plans for April 1993. The organisations that represent disabled people now have the opportunity to ensure that local services match local needs.

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Mr. Tom Clarke (Monklands, West) : The Minister refers to a strategy for community care, but has he consulted the organisations of or for people with disabilities, such as the Royal Association for Disability and Rehabilitation, Mencap and others? Has he taken their views on board and, if so, how does he respond to their worries about cash limits?

Mr. Scott : The hon. Gentleman knows that ministerial responsibility for the introduction in due course of community care belongs to my right hon. and hon. Friends in the Department of Health. We have received a number of representations about the arrangements that will succeed the independent living fund, but local authorities are already working on their plans for the introduction of community care. They have a responsibility to put their plans to my right hon. and hon. Friends in the Department. There is no better time for organisations of or for disabled people to begin to make clear their views about the type of packages that will be necessary in their individual localities or, more generally, across the country than when the local authorities are working out their plans. Disabled people, their carers and the organisations with which they are involved should play a major part in the designing of the services that will need to be delivered to disabled people after the introduction of community care in 1993.

The independent living fund has done a splendid job since its inception. I pay the warmest possible tribute to the trustees, the director and the staff who have been involved in all its activities. Their workload and the way in which they have tackled it have been far in excess of what was envisaged when the independent living fund was set up. It is right that not only I as the Minister, but the whole House should pay the warmest tribute to the trustees, the director and the staff for the way in which they have responded to the demands that have been placed on them.

A centrally run organisation such as the ILF could not hope in the long run to help all the severely disabled people who seek help to enable them to live independently in the community. The ILF has successfully primed the pump. It has fulfilled an invaluable role in proving that, with the right support and assistance, even severely disabled people can be enabled to live with independence and dignity in the community. From April 1993, it is right that the baton should pass to local authorities and that they should carry on and extend the good work of designing and providing packages of care for many more people than a central fund could ever hope to maintain. The scale of the work involved brings me to the second main concern that has been raised in our recent discussions. The point has been made--I freely acknowledge its force--that some local authorities, given what else they have on their plates, will find it genuinely difficult to take on "at a stroke", to coin a phrase, from the ILF the several thousand people for whom it has worked out individually tailored care packages.

My hon. Friend the Member for Exeter (Mr. Hannam) and other hon. Members whose expertise on these matters is well known made the case especially effectively on Report. My hon. Friend the Member for Exeter said that uncertainty about future payments from the fund was already causing disruption because disabled people could not make long-term care arrangements when they did not

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know whether their payments would continue. The point is well made and I hope that the House will agree that it has been well taken. Several hon. Members of all parties in both Houses have expressed the view that it was a question not solely of ensuring that the transitional arrangements met the needs of the people whom the ILF helps, but of ensuring that those people are reassured early about their future. I recognise that it is important that we should now end any further uncertainty.

Mr. Robert G. Hughes (Harrow, West) : On a point of order, Mr. Speaker. I seek to raise a point of order further to the points of order raised at 3.30 pm. It was alleged that after the recess it would no longer be possible for questions to be tabled about national trust hospitals. I have checked with the office of the Leader of the House and I have it on its authority that that is not the case, that normal rules apply and that national trust hospitals will be the subject of questions. Such questions can be tabled. Was not the allegation just another fabrication by the Labour party on the subject?

Mr. Speaker : I do not know about that. If the hon. Gentleman was here, he will know that the points of order, which took place some time ago, were hypothetical. Unlike the hon. Gentleman, I have not had the advantage of leaving the Chamber to find out about the matter. If what he has said is true, I welcome it. We do not need to hear any more about it now.

Mr. Scott : This must be the first occasion for a long time on which a Minister has been interrupted by a Parliamentary Private Secretary in the course of a debate. However, I recognise the importance of the point.

It is important that we should now end any further uncertainty. I hope that right hon. and hon. Members of all parties will welcome the proposals that I am about to announce.

I have concluded that the best way in which to give reassurance to existing beneficiaries of the independent living fund is to retain quite separate arrangements for that group. We shall not, therefore, expect local authorities to take over the role of providing for people who are receiving money from the ILF at the time at which the wider community care arrangements are introduced. Incidentally, even Opposition Members may recall that the life of the trust under which the ILF was established expires in June 1993--a few weeks after the planned introduction of the Government's community care proposals. We will instead put in place a successor body to the ILF which will take on all existing beneficiaries and make cash payments

Dame Elaine Kellett-Bowman (Lancaster) : I am sorry to interrupt my hon. Friend, but I wish to thank him for bringing our anxieties to an end so swiftly. We have had many representations on this and we are most grateful to him.

Mr. Tom Clarke : Will the Minister clarify what he meant by "a few weeks" ? I understand that the Government's proposals for the community care section of their Act are to be introduced at the beginning of April 1993. If not, the present situation would continue until

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June and we would be talking about three months, not a few weeks. Have the Government changed their plans for the implementation of their Act ?

Mr. Scott : We can query whether it will be a couple of months or a few weeks, but the hon. Gentleman has the facts exactly right. The terms of the trust expire in June 1993 and the arrangements for community care come into effect at the beginning of April 1993. Let me reiterate and put clearly on the record the arrangements, then I shall give way to any hon. Member who wishes to question me. We intend to put in place a successor body to the ILF which will take on all existing beneficiaries and make cash payments to them in the same way as the ILF does now. The details of that body will have to be worked out during the coming months, but the principles are clear--the successor body will function in the same way as the ILF. It will be able to look in depth at the circumstances and needs of the people whom it will inherit from the ILF and to judge the most appropriate way of meeting those needs. The presumption at the outset will be that the new body will usually pay the same cash amounts to people as they had been getting the week before, but it will be possible for people whose circumstances then become worse to obtain more money to enable them to carry on living in the community. I hope that that will come as welcome news to the more than 7,700 people who currently obtain help from the ILF. Hon. Members who follow these matters with care and, I hope with sympathy will know that in each year of the ILF's life to date we have given substantial extra sums so that new claimants could be helped. Funding in 1991-92 is more than 10 times the level at which it was when we set out in 1988-89 and more than 20 times the amount that the old supplementary benefit system domestic system addition ever provided. That commitment will continue during the 1992-93 financial year so that there will be room in the ILF's budget not only to continue helping all existing beneficiaries but to carry on admitting new people during the year.

Mr. Dafydd Wigley (Caernarfon) : I have been following the Minister carefully. Am I right to understand that from 1993 onwards there will be a twin-track situation with one group of people benefiting under the successor body and obtaining increased levels of support, whereas people with identical needs and circumstances will not be able to obtain any benefit under that body because those circumstances arose after mid-1993? Is not that a formula for uncertainty and misunderstanding? Will not some people be looking over their shoulders at friends and neighbours who will be obtaining assistance on which they are missing out? Surely that cannot be a stable formula for the future.

Mr. Scott : I shall not reiterate the argument that I have already deployed because I understand that the hon. Gentleman wishes to challenge it. As the hon. Gentleman knows quite well, in April 1993 it is planned to move to a wholly new arrangement for care in the community which will apply to residential care in nursing homes and to decisions made about care packages in different localities. He will recall that when Sir Roy Griffiths studied these matters he came to the conclusion that I have already outlined, that local authorities should look at the individual needs of not just disabled people but elderly people to decide what care package was most relevant to

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their needs, whether that involved institutional care or care in the community, and to devise appropriate arrangements.

That applies, too, to those who have been helped by the independent living fund but, appropriate though I think those new arrangements are and much though I support what Sir Roy Griffiths concluded, we came to the conclusion, after having studied the matter, that to ask local authorities to take on whatever the existing case load of the independent living fund is in April 1993, at the same time as they will be introducing the other more general arrangements for community care, would be too much and that it made sense--not least to meet the point of my hon. Friend the Member for Exeter--in order to put at rest the minds of those who are receiving help from the independent living fund to say that this successor body would continue the payments that are now being made and that it would also, where conditions had deteriorated but people could still live in the community, meet any additional costs that may arise.

I hope that, on reflection, the hon. Member for Caernarfon (Mr. Wigley) will see that point. His views on community care may differ from those of the Government, but that will be the Government's policy in April 1993. I have sought to find the most satisfactory arrangements to meet the needs of those who will be the beneficiaries of the independent living fund then and to make an early announcement about what the arrangements might be so that any uncertainties can be removed.

4.30 pm

Sir Michael McNair Wilson (Newbury) : Can my right hon. Friend say from which budget the successor body will draw its finance?

Mr. Scott : These matters will be discussed by the Government, but I envisage that it will be part of the Department of Social Security's budget. We shall seek funds to ensure the position of the successor body to the independent living fund after April 1993. My response today means that we shall be spending more next year than this and that we shall be ensuring that all those who currently receive cash help from the independent living fund will carry on receiving cash help after 1993. I hope that the measures that I have announced today will meet the concerns in a far better way than the amendments that we are considering today. On that basis, I urge the House to reject the amendments.

Mr. Alfred Morris (Manchester, Wythenshawe) : It says in the press that this debate was delayed until today so that the Minister could attend a preview of the Chelsea flower show. That was a contest he won. If it is also true, as some people think, that he battled with the Treasury to avoid having to make the speech we have just heard, that was a contest he lost, and he must be ashamed of having been made to oppose the Lords amendments.

Miss Emma Nicholson (Torridge and Devon, West) rose

Mr. Morris : I hope that the hon. Lady will allow me at least to start my speech. I know that other hon. Members want to intervene in the debate but, as I continue my speech, I shall seek to give way. This debate is crucially about choice for disabled people and achieving full control for them over their own lives.

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The amendments will vouchsafe for people with disabilities the freedom of choice and independence they crave and which thousands of them now enjoy with help from the independent living fund. The right hon. Gentleman is said to take pride in the creation of the ILF. If it was his baby, he is now clothing himself, like Herod, in the ignominy of infanticide.

His commitments to existing recipients are simply not good enough. Thanks to this Government, we now see more bands of second-class disabled people than in "Son of Poll Tax". Can the right hon. Gentleman say how many people in the last 12 years have enjoyed some form of transitional protection which has disguised a creeping cut for them alongside massive cuts for others in identical situations? The Minister has argued that, under the new community care arrangements, the ILF's role is best undertaken by local authorities. But unfortunately the new era of community care exists solely in the imagination of Ministers. Their disgraceful decision not to implement sections 1, 2 and 3 of the Disabled Persons (Services, Consultation and Representation) Act 1986, thus tearing the heart out of that important Act, shows the Government in their true colours. The Minister for Health claims that the community care arrangements "reflect and amplify" sections 1, 2 and 3 of the 1986 Act. This is a good description of these so-called "arrangements" : they are son et lumiere without substance. They are a fantasy for which Tory Ministers know that they will not be called to account since, by 1 April 1993, they will have been swept from office.

Anyone who saw Margaret Tebbit talking to Terry Wogan will have admired her courage in building a new life after her terrible injuries. Her triumph over severe disability is an inspiring example of personal bravery. Perhaps Mrs. Tebbit's most significant statement, in terms of this debate, was that the independence she now prizes depends on two young New Zealanders who provide the personal assistance she needs. This level of support can be essential if the most severely disabled people are to lead normal lives. To some, but by no means all, it is provided by the ILF. These amendments enshrine the assistance it gives as a statutory right. That is what severely disabled people want. They need and ask the House for a statutory right to the assistance that they need.

I have some sympathy with the view that assessment should be locally based ; but it is essential that the right to support must be made enforceable nationally. As all hon. Members know, the statutory rights provided by the Chronically Sick and Disabled Persons Act 1970 ultimately have to be enforced nationally if they are not to be infringed. The hon. Member for Hornsey and Wood Green (Sir H. Rossi), when he was Minister of State for Social Security and the Disabled, recognised this truth in his laudable decision to enforce the provision of telephones for housebound disabled people in Wandsworth under section 2(1)(h) of the Act. We want to see the same uniformity across the country in the provision of personal assistance services as in the administration of cash benefits for disabled people. One of the ILF's key features is that the money it provides is paid direct to the disabled person, so that she or he has the power to hire the assistance she or he wants and arrange the work to suit her or his needs. This is the

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formula which works so successfully in Denmark, Sweden and Finland ; and the ILF has shown that it works equally well here.

The right hon. Gentleman will know that the issue of direct payments by local authorities was raised during the passage of the National Health Service and Community Care Bill. Despite expressing warm sympathy and even visiting local projects, health Ministers rejected Opposition amendments ; but they promised further consideration before the Act came into force. This seems to have been an empty promise. In a reply to me on 10 May, the Minister for Health said that the Government had decided not to change the law "because of the difficulties in determining which clients would be eligible for direct payments and in controlling costs."

This is crazy. If the ILF can make satisfactory arrangements, why not local authorities? They have a legal duty to decide who needs help and for the Government, with their fetish for privatising local authority services, to say that it would be more difficult for councils to control costs is a rich argument indeed.

The reply of 10 May continued :

"However, our guidance stresses the need for disabled people to be fully involved in decisions about the care which they need and points out that there is no reason why a disabled person who wants to have day-to-day management of his or her carers should not do so."--[ Official Report, 10 May 1991 ; Vol.190, c. 608.]

The hon. Member for Mid-Kent (Mr. Rowe) put it very well in a letter to The Times on 9 May, when he said that, because, where help is financed by the ILF, disabled people are the employers, they are able to hire staff in whom they feel confidence. He went on to say that they

"can arrange the sort of day-to-day flexibility which suits both parties and, therefore, create for themselves the sort of life which, for example, allows for an unexpected whole-day visit to the Department of Health to lobby for the continuation of such arrangements."

The hon. Member saw the problem as one of machinery ; I see it simply as a psychological block on the part of health Ministers, which, if it is not removed, will turn all the right hon. Gentleman's promises for 1993 into hot air.

My hon. Friends and I have tabled an amendment to draw attention to a particular group of people, many of whom are now terminally ill, whose problems Ministers in both Houses have been determined to sweep under the carpet. We have done this in order to warn the Government that they will not succeed in doing so, and because the daunting problems of the people of whom I shall speak exemplify those of countless other victims of the Government's so-called social security reforms of April 1988. I refer to people with AIDS, who, as I told Ministers from this Dispatch Box yesterday, are in many cases now literally dying for want of financial help from the Department of Social Security for the special diets that they so vitally need. If the right hon. Gentleman ever finds time to talk to colleagues in the other half of Richmond house, he will learn of their growing concern about the increase of HIV infection among the heterosexual population. Their PR offensive on this issue last Friday prompts one to ask why, if they are so concerned to limit the future death toll, they show such total unconcern about deaths that are happening now because of inability to afford special diets.

In Committee, I tried to make sense of the figure in the reports of the Office of Population Censuses and Surveys

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on people who need special diets, but I received very little assistance from the right hon. Gentleman. Indeed, I had to complain to the Chairman that Ministers were apparently concealing vital information from the Committee. When totally out-argued, they developed a habit of referring to detailed secondary analysis from the OPCS reports. But even when I tabled a parliamentary question specifically asking for the data to be placed in the Library my request was ignored. The written answer is to be found at column 419 of the Official Report of 11 March.

I was referring to the secret data that had been mentioned in Committee. These secret data from the OPCS tapes will feature in the next debate on the amendments relating to mobility allowance, where Ministers have been floundering for years. In relation to people who need special diets, we start with the clear statement in the OPCS reports that the highest additional expenditure was associated with digestion disabilities. On the other hand, extra expenditure on food varied little between the severity categories. This last fact supports the assertion of the right hon. Gentleman that many people who need a special diet will receive DLA. Of course they will, but it will be insufficient for their needs ; and many others will not receive the allowance.

I think that it is worth recalling today some of the figures in various other parliamentary replies. On 21 January, I was told that "a quarter of those expected to qualify for the lower rate of the self-care component-- some 60,000 people in all--need a special diet".--[ Official Report , 21 January 1991 ; Vol. 184, c. 61 .]

A later answer, on 20 March, revealed that, of the total of 240,000 eligible for the lower care component, only 140,000 were expected to receive that help. This shortfall of 40 per cent. is not something the right hon. Gentleman has greatly publicised. The figure of 60,000 will fall in practice to 35,000.

Also on 20 March, the right hon. Gentleman told me that "Something under 500,000 people below the age of 65 said that they needed a special diet"

and that

"nearly 200,000 of the people in this group would be in receipt of at least one of the rates of the new benefit."--[ Official Report, 20 March 1991 ; Vol. 188, c. 124. ]

He attempted to justify the exclusion of the 300,000 by asserting that their problems were not, strictly speaking, disabilities. This is just playing with words. Their costs are just as great, and if they cannot afford the correct diets they may well soon become seriously disabled and die prematurely.

4.45 pm

This brings me back specifically to the situation of people with AIDS. I will pass over briefly the letter I quoted on Report from Mrs. Anita MacDonald, which blew out of the water all the figures Ministers had been quoting for the last two years on the cost of diets recommended to people with this condition. What it is essential to know now is how effective the social security system is in meeting their needs. The OPCS conducted its postal screening for the adult survey in March-May 1985. The Minister for Health told me on 28 March that in 1985 there were only 205 people alive with AIDS. The chances of one being included in the data were thus remote. Even one such person may well have died before interview. The OPCS data can therefore tell us nothing about the social security problem of people with AIDS in 1985-86--when

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additions of £30 for the cost of diets were available on supplementary benefit--let alone today, when they may qualify for nothing.

So it was an additional disappointment when, on the same day--28 March--the right hon. Gentleman dismissed out of hand the suggestion that he should conduct research into the effectiveness of the social security system in meeting the financial needs of people with AIDS. He clearly just wants to bury his head in the sand. I will stress, in case he gives the same misleading reply as he gave on Report, that I am talking not just about people who will die within six months, but about people with AIDS who are determined to live, and who need the money to buy the right kind of food to enable them to do so. Our amendment, like those from the House of Lords, is thus extremely important.

I implore the right hon. Gentleman to recognise the validity of the amendments as a whole and, even at this late stage, to reconsider his position. Caroline Glendinning, in her deeply well-informed article in the current issue of Disability, Handicap and Society, says that, despite ministerial

"rhetoric of protecting' the most deserving', vulnerable' or needy', much of this protection' has been illusory."

She states that the Government's economic and social policies have done much to damage the quality of life for disabled people, and she concludes :

"The last ten years have, in policy terms, been disastrous for disabled people, involving threats to opportunities, living standards, independence and choice. Yet in response the growing strength and articulated demands of disabled people and their organisations give hope for the future."

The right hon. Gentleman knows that all the organisations of and for disabled people are united in very strong criticism of the Bill's inadequacies. To look for any exception to that truth is about as worthwhile as looking for the Kohinoor diamond in a box of Smarties. I ask him to recognise the force of disabled people's criticisms and now to respond more constructively to them.

Mr. John Hannam (Exeter) : First, I thank my right hon. Friend the Minister for Social Security and Disabled People for the sympathetic hearing that he has given to the arguments advanced by Members of both Houses during meetings with the all-party disablement group and throughout our debates on the independent living fund. My right hon. Friend today confirmed the importance of the fund's role and acknowledged it in his announcement of a successor body.

There is no doubt that the ILF is recognised by everyone, including Ministers, as an important cog in the wheel of provision for severely disabled people. As my right hon. Friend the Minister said in Committee, the fund is a great success not least because it has identified a real need in the community and gives disabled people the chance to exercise control over the provision made for them. The fund filled a worrying gap which became evident in 1986, and it has proved extremely successful in enabling severely disabled people to buy in their own personal care and assistance services. For many such people, the ILF is central to independent living, and disabled people want it to be made statutory. That has been the whole gist of the argument throughout our debates.

The ILF has been administered largely by disabled people, such as the eminent Peter Large, and at present it helps more than 7,000 severely disabled people to live in

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the community. The average payment is about £70 per week, and the highest £400 per week. That gives some idea of the wide range of assistance that the ILF gives, and I express my thanks to all the members of the trust for their tremendous work for the ILF. Looking to the future, we must ask ourselves to what extent social services departments, with all the diverse calls upon their funds, will be prepared to provide such levels of payment and assessment. On Monday, during health questions, I asked my hon. Friend the Minister for Health why local authorities were now being prevented from making individual cash payments in lieu of personal assistance. I asked that question because that problem is connected with the question of the ILF ; the two are linked. If we do not have ring-fenced funding for community care and the ability to pay cash amounts, how can new severely disabled people be assured of help after 1993?

During the debate on a new clause that I tabled on Report, I said :

"I cannot realistically envisage that one day in April 1993 all local authorities will suddenly, magically, assess and provide individually tailored packages of care for severely disabled people in the way that payments from the ILF do."--[ Official Report, 7 February 1991 ; Vol. 185, c. 435.]

Many feel that community care funding for local authorities is not yet adequate, and dread a future in which they may be forced back into institutionalised residential care after having enjoyed the basic human right of independent living. It is in that context that I warmly welcome my right hon. Friend's announcement that the Government propose to continue to maintain payments to existing recipients of funds from the ILF. I am especially pleased that the new body will be able to increase the amounts if the needs of those severely disabled people increase. That is different from the principle applied in respect of the replacement social security benefit system in respect of special allowances. In that case, the allowances remained static and account was not taken of inflation. In this case, the arrangements are more flexible ; allowance is being made for the possible deterioration in the condition of severely disabled people and for a consequent increase in their needs. I remain concerned that those who become severely disabled after 1993 will be at the mercy of local authorities with varying levels of performance, and I continue to argue the case for ring-fenced funding to take account of the problem. Having said that, I am sure that my right hon. Friend the Secretary of State for Health will ensure that proper levels of provision are given through the care in the community system, and that will remain our main concern for the future.

I am grateful to my right hon. Friend the Minister for his announcement today. I regard it as an achievement on the part of all those in both Houses who have campaigned on this issue and who have expressed deep concern about the sudden break that will occur when the ILF ceases to exist. We shall continue to monitor the situation carefully, but I am grateful to my right hon. Friend for listening to the arguments and for providing a solution today.

Mr. Jack Ashley (Stoke-on-Trent, South) : This is a remarkable debate. We have heard the Minister eulogising the independent living fund and his supporters saying how marvellous it is, yet the Government intend to kill the ILF stone dead. How on earth can any Government operate like that ? If the ILF is as good as the Government make out, it is absolutely crazy to kill it, and the Minister knows

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full well that the reasons that he advanced for doing so were pathetically inadequate. The decision has been dictated by the political fact that the Minister cannot get sufficient money to continue the ILF. That is the basic truth about this debate. The Minister made one of the worst speeches that I have heard from him. He boasted about how wonderfully well the ILF had done. That is fine ; we accept that. But if the disabled people of the present are entitled to the kind of consideration that they receive from the ILF, the disabled people of the future should be entitled to precisely the same consideration. Why should they be second-class citizens ? The Minister talked about the ILF passing on the baton to local authorities. How can he use such euphemisms ? What if local authorities drop the baton because they are butterfingered? Many local authorities are hamfisted and will drop the baton and, as a consequence, disabled people will suffer. With a great fanfare of trumpets, the Minister says, "Local authorities are preparing their plans". That sounds marvellous. They are preparing their plans, we gather, for community care for disabled people. That is wonderful. There is just one thing wrong with the statement. I have been in the House for 25 years--some would say that that is far too long, but never mind--and I remember hearing the same refrain in respect of the Chronically Sick and Disabled Persons Act 1970. Ministers said, "Local authorities are preparing their plans." We all know what happened. Countless local authorities neglected their

responsibilities under the Act, implementation was patchy and after 21 years it has still not been fully implemented. There is absolutely no point in the Minister telling us that local authorities are preparing their plans because we are not convinced--and we are not convinced that they will take the baton that is passed to them by the ILF either.

The hon. Member for Exeter (Mr. Hannam) works closely with me. I am the chairman of the all-party disablement group and he is its secretary. He works very hard. Having said that, I think that he was a trifle too diplomatic today. I suspect that the fact that the Minister praised the hon. Gentleman and mentioned the efforts of other Conservative Members while failing to refer to those of the Opposition is a sign of the impending general election. The Minister was just a trifle selective, although I do not complain about that because I know that Opposition Members are marvellous, too. My hon. Friend the Member for Oldham, West (Mr. Meacher) will tear the Government to shreds, as the Minister knows, and my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) has already made a fine speech. However, I want to avoid party politics.

When the hon. Member for Exeter said that many people were afraid that the funding of community care was "inadequate", he was taking diplomacy to its extremes. He knows quite well that it is not merely inadequate but pathetically inadequate. Community care is neglected by local authorities, and there is no point in the Minister saying that authorities will do the kind of job currently being done by the independent living fund.

I have 5,000 points to make, but I will sit down now because many hon. Members wish to speak and I see my

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hon. Friend the Member for Ashfield (Mr. Haynes), the Opposition Whip, glaring at me from the end of the Front Bench.

I believe that the Minister is making a very serious mistake in ditching the ILF and handing responsibility to local authorities. He will be there this evening, with a wad of banknotes in his pocket like a gambler, with a majority of 100 in the Division Lobby. At the end of the debate, he will have lost the argument, but he will win the vote. He is presenting us with a fait accompli.

I ask the Minister this : if, as is certain, he wins the vote and gets this killing of the ILF through, will he seek legislation to enable local authorities to make cash payments? I think that the all-party disablement group would support him very strongly on that. If the local authorities can have those powers, it will go a very short way towards ameliorating--not condoning, but ameliorating--the crime that he is about to commit by killing the ILF.

5 pm

Sir Michael McNair-Wilson : I welcome what my right hon. Friend said about the successor to the independent living allowance for those 7,000 people benefiting from it. It will be reassuring to them, even if it brings a shadow of a doubt into my mind as to why the Government are not entirely confident that the National Health Service and Community Care Act 1990 will not be able to provide for these cases from 1 April 1993. I shall be interested to hear my right hon. Friend's explanation.

The disability living allowance, which is central to the Bill, seems on the face of it to be a sensible amalgamation of attendance and mobility allowances. Where there were two benefits there will now be just one. Fewer and simpler allowances always have much to commend them, especially if they make it easier for disabled people to know what is on offer. But that gain is negatived if administrative neatness detracts from the help that was originally available, or if the funding arrangements are varied and left with a margin of doubt about their payment.

To that extent, I understand and sympathise with those organisations representing the disabled which are concerned about what will happen when the independent living fund is phased out in 1993. I know that the fund is discretionary. I know that the Government have given assurances that the local authorities will take on responsibilities for the costs of domestic assistance within their new community care duties, as set out in the National Health Service and Community Care Act. But, leaving aside the 7,000 people to whom I have already referred, who are covered by the successor structure which my right hon. Friend outlined, for the newer claimant that must depend on the funds available and the sensitivities of local authorities to what is being asked for.

As I think the House knows, I am the president of the National Federation of Kidney Patients Associations. The federation has expressed to me its concern about what will happen when the independent living fund goes. It shares my worries about how local authorities will react.

Kidney patients on dialysis at home have the cost of paying for a carer to help them with their machine and to be available while dialysis is taking place. As I have told the House before, any suggestion that the attendance allowance at the lower rate for the cost of the carer is very

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