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into the discussion about care packages, how can such secrecy be part of the deal? The Minister may want to shake his head again. I hope that, in conjunction with his colleagues from another Department, he will be able to tell us that social service authorities are not being cash-limited in that way. If they are, there can be no effective and honest partnership between those needing care and the care providers, which means that the objectives will not be fulfilled in practice.Hon. Members on both sides of the House have expressed concern about the £500 limit. If we are to judge community care partly by the extent of its impact on people in the greatest need, the question of the £500 cash limit, which will inhibit proper community care, is crucial. I hope that the Minister will say something clear and reassuring about his willingness to consider amendments in Committee. I understand that, at present, fewer than 1 per cent. of those benefiting from ILF money will be affected. I take that point. Nevertheless, that represents a significant number of individuals. Moreover, I think--and I shall be happy to be corrected--that, in practice, the £500 is a larger sum than is implied because, under the old ILF scheme, one could also get support from social services. If that is now being costed at up to £200, more than 1 per cent. may be caught by the care trap. I seek clarification on that.
Whether we are talking about one or two people or several dozens or more, the crucial question must be what will happen in practice. What happens if the care package that is devised costs £600 or £700, as it may well do in the most extreme cases? Will that person have to go into institutional care? Some say that they will have to be dragged screaming and kicking if that is the case. Again, the Minister shakes his head.
What happens if the social services department cannot afford to spend any more under the cash limit, given that the ILF regulations specify that the figure must be no more than £500? I am told that we are talking here about some of the most serious cases of paralysis--people who have broken their neck in a road accident and those suffering from multiple sclerosis or are in the more advanced stages of motor neurone disease.
To those listening to the debate, £500 may seem a great deal of money- -and it is a great deal of money--but a great deal of money is needed if someone who requires round-the-clock care is to be cared for in the community rather than in residential care, which is the principle to which we all aspire.
As has been said, there is, in any case, no sense in asking a person to move into residential care if that will cost more than a package that could be devised. The individuals affected may be few : it would be nice to have some estimates. In any case, what happens to them will be a key test of the Bill, and we need to consider that both today and in Committee.
I am worried that what should be a new dawn for community care is fast becoming a debate about residential care not only as regards the ILF and its cash limit per person but in different ways. Certainly, all the initial controversy following all fools' day will be about residential care--about whether people are having their costs paid and about the concerns of home owners.
I have another fear. As a result of the Government's ideology and dogmatism, social service authorities will have to spend 85 per cent. of the new money on the so-called independent sector, which is predominantly,
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although not exclusively, the private sector. The private sector is mainly--again, not exclusively--in the business of institutional care, so that will pull the money towards institutional rather than community care. If, as we have said today, the £500 limit stays and we cannot shift the Government on it--I hope that we can--some critical cases, who, despite terrible disabilities, live in the community and often thrive in and contribute to it, may be moved into institutional care.Moreover, there must surely still be many people suffering from terrible conditions who are in institutional care but who, in the right circumstances and given the right opportunities, cash and care--and, of course, the choice--could come back into the community and live more fully than they do at present. Let us not forget that group. We need to think how we can enable them to come back into the community if they want to. Can they do that with a package of care costing £500? Some will need more, and that is an important point. The theme of cash or care and the association between the two Government Departments may be a more fundamental theme for the future than this small but important measure concerning the ILF suggests. Our society is faced with important questions about the costs of disability and aging. We know that the Bill does not cater for those over 65, but we have to consider the costs of disability and aging and who should meet them.
In future, in some of our mainstream debates about social security, and not least about pensions, we should ask about both the private sector-- occupational pension schemes--and the public sector--the national insurance fund--and determine whether the risks against which we should insure ourselves include the risk of the need for intensive care as well as pensions. If we discuss pensions on one day and community care on another, we start to make great mistakes about the risks facing us in our later life and the different ways in which we should insure against them.
7.56 pm
Mr. Charles Hendry (High Peak) : I am grateful for the opportunity to contribute to the debate. I am glad that the Government have found time for it in their programme. At a time when many of our attentions seem to be diverted overseas, it is nice to find time to consider matters rather closer to home which have a direct bearing on many of our constituents' daily lives.
The Government's priorities for disabled people can be categorised in three ways : first, a desire to enable people to live as independently as possible ; secondly, a commitment to target more resources on people who are disabled in a way that recognises their particular needs ; and, thirdly, a commitment to look at their wider entitlement and interests to enable them to play as full a role as possible in society. The Bill addresses all three.
Hon. Members have referred to a number of the ways in which the independent living fund has grown over the years. It has grown from £1 million in 1989 to £100 million today and is now helping 21,000 people, or more-- this is one of the rare occasions when the Labour party is saying that we are helping more people than we say we are helping. The Opposition's support and encouragement on that are welcome. The House should be reminded that the introduction of the ILF was criticised and questioned by
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the Labour party. In listening to the Opposition's concerns today, we should bear in mind the fact that they have not always been fulsome in their support.We should also bear in mind the fact that the fund has helped far more people than were being helped under the old supplementary benefit system. Before 1988, 6,000 people were being helped to the tune of some £30 per week. Today, 21,000 are being helped with a weekly average of over £110 per week. That shows clearly the Government's ongoing commitment.
That takes us to where we should go next. There can be no doubt about the success and popularity of the ILF. We must accept, however, that the benefit was introduced initially to help the most severely disabled people. All of us have had constituents come to us and say, "My friend down the road has been given support from the independent living fund. Why can't I, since my condition is similar?" Inevitably in such cases, the boundaries become frayed and, in time, they are enlarged and more people benefit. It is very good that we can claim to be supporting more people than we ever envisaged supporting. However, we must also remember that the intention is to help the most severely disabled. The proposals will enable that intention to be maintained.
We must also consider areas where there is clear consistency, not just in name, but in the way in which the fund will operate in future. Through care in the community, it is the intention that care should be tailored to meet the individual needs of disabled people and that the structure of the support should be flexible to allow that to happen.
Also, and this is paramount, individual disabled people must be involved in determining how best their care needs can be met. We must stress, and the Government have made it clear, that the needs and wishes of disabled people should come first.
Mr. Bradley : If the package designed by the local authority conflicts with the wishes of the individual, would the hon. Gentleman support the right of an appeal system within the proposals?
Mr. Hendry : Any new system develops over time. We do not set a principle in cast iron and then, 20, 30 or 40 years later, say that it should not be changed. We must consider how the system operates and identify the difficulties. If flexibility or alterations are required in time, that can be achieved. To suggest that we are simply casting something in stone does not reflect historical precedents accurately.
Mr. Bernard Jenkin (Colchester, North) : In the care in the community programme, we are dealing with local authorites which are ultimately governed by elected councillors and subject to the pressures of the normal lobbying process, not least the letter to the Member of Parliament asking him to intervene on behalf of the client concerned. Does my hon. Friend agree that the idea that we are creating a system in which there is no appeal procedure, redress or comeback is entirely false?
Mr. Hendry : I agree with my hon. Friend. Many of us have received letters from our constituents about the independent living fund. We have raised cases on their
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behalf and have been able to ensure that those cases were reviewed properly and effectively. Members of Parliament can and do properly play that role.I would also like to consider the fact that we recognise a need for change, but are also trying to establish a principle on a secure and long-term footing. On several occasions in my constituency, parents who are inevitably getting older have expressed their fears about their severely disabled children who may now be in their teens or twenties. They want to know how their children will be supported when they have died. That is an immensely responsible attitude. From the conversations that I have had with such parents, and having seen their sincerity, I have no doubt that they would like their disabled children to be looked after as much as possible in the home where they were brought up within the community. Parents recognise that in familiar surroundings it will be easier for their children to face the pressures.
Several comments have been made about the role of the disability living allowance. Introducing something as large as that in one go has caused teething problems. I commend the Government for being willing to introduce something on a scale which will help more than 250,000 people. I commend them for introducing it in one go instead of phasing it in over four years, as the Labour Government did with mobility allowance ; that helped only about 5,000 people. The Government took a brave and important step.
There will inevitably be a rush of cases and a huge administrative caseload to be handled. However, I congratulate the Government on the way in which they have reacted to that and I congratulate the people working in the benefits offices on the way that they have dealt with those problems. As a result of their efforts, 60 per cent. of claims are cleared within a month and older people are being targeted as priorities.
I am aware of cases in my constituency where people have felt that their cases have been delayed unduly. However, in relation to the vast number of cases that have already been handled, I have no doubt that the majority are being handled efficiently and effectively. There is now a system in place which is trying to push matters forward.
Mr. Bradley : What does the hon. Gentleman think about a situation in which the application of one of his constituents may have been delayed and missed the cut-off point? That person may have been awarded DLA, but would not have been able to apply to the ILF. Should such a person be compensated because he or she was unable to receive help from the ILF?
Mr. Hendry : One of the difficulties in implementing change is that there must be a cut-off date. We cannot get away from that. If after the cut-off date we say that anyone close to the cut-off date will receive special remedial treatment to ensure that that person does not receive less money than he might otherwise have received, we completely undermine the principle of change. If we are to make changes and tough and sometimes brave decisions, we must accept that there will be difficulties.
It is easy for the Opposition. They are not trying to raise taxes to pay for the support. They are not responsible for Government decisions. It is easy for Opposition Members to say time after time, "Let's throw more money at it." As it is not the Opposition's money, they can spend it as if it is going out of fashion. That has always been the
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Opposition's tendency. However, if the Opposition ever want to be taken seriously as credible politicians, they must accept some of the financial facts of life.Mr. Thurnham : My hon. Friend has just referred to the Labour party as the "Opposition". In a number of town halls around the country, the Labour party is charged with and is responsible for the delivery of services. From my experience and from the reports from constituents, I have noticed that many restrictions are placed on home helps--or, as they are now called, home carers--which include trade union restrictions and limits on whether they can work at weekends. I have heard that carers have been told that they must not work at weekends and they have had to do that work in secret. Opposition Members have said that they want more openness when such extraordinary arrangements are taking place. Does not that show that, when the Labour party is in power locally, things are very far from perfect?
Mr. Hendry : As is so often the case, my hon. Friend is absolutely right. I would like to pay tribute to the incredible amount of work that he has carried out on behalf of disabled people through his involvement in charitable work and in pushing their case in the House.
I need no lectures or advice from my hon. Friend the Member for Bolton, North-East (Mr. Thurnham) about the difficulties involved in living with a Labour local authority. My constituency is in Derbyshire and we have one or two problems with our county council, not least in that area. It consistently refuses to charge for home helps. To suggest to people who, in many cases, have significant resources and would be happy and keen to pay towards the costs of home helps that they may not do that is absurd. Ultimately fewer people will receive home helps because there is no way of getting the additional resources from the people who would be happy and willing to pay towards that provision.
Mr. Jenkin : It is important that we do not tar all Labour councils with the same brush. I draw my hon. Friend's attention to Strathclyde regional council, with which I became familiar when I contested a Labour stronghold in Glasgow, Central in the 1987 general election. That council made a very bold move, probably unconsciously, realising that it was privatising its social services, when it made its social workers self employed. The council employed people on piece-work contracts which effectively made the work force much more flexible so that they could provide a much more flexible service to clients. I would not always criticise Labour local authorities in the way that my hon. Friend has just done, although there is always justification for doing that in certain cases.
Mr. Deputy Speaker (Mr. Geoffrey Lofthouse) : Order. The debate is now ranging rather widely. If hon. Members will keep their comments within the boundaries of the debate, we shall be able to discuss the Bill thoroughly.
Mr. Hendry : I am grateful for your guidance, Mr. Deputy Speaker. I shall come directly to another aspect of the Bill that is worth our attention--Motability. All hon. Members will welcome the enormous growth in the provision of cars for disabled people under the Motability scheme. Since 1977, Motability has had a tremendous record for supplying cars. It hardly seems possible that in November 1991 Her Majesty the Queen presented the
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250,000th car, yet less than two years later the Prime Minister will be handing over the keys for the 350,000th car. If we look at the number of cars that were provided last year, it presents an astonishingly good picture of an organisation that works effectively. In 1992, there were 75,195 applications for a car under the scheme, of which 63,745 were granted. That is an amazingly high figure and is a testimony to the way in which the Government have backed Motability by contributing to not only its running costs but its capital costs. The Government have worked in conjunction with the private sector, car manufacturers and those who convert cars to provide a real benefit to many members of the community.I became aware recently of the case of a multiple sclerosis sufferer whose family had not taken a holiday together because of his inability to travel around the country. With little support from me, Motability moved fast to provide and convert a car, and as a result he and his young family enjoyed a holiday. I pay tribute to its work and the way in which it has helped countless thousands of others. More than 140,000 people have cars under the Motability scheme. We should be grateful for the increased quality of cars. Not many years ago, we lived in mortal fear not of the quality of driving but of the fact that dangerous little three-wheelers were scurrying around the streets, posing a threat to many others. Disabled people can now have not only the dignity but the comfort of a standard car under the scheme, which is a tribute to the scheme and what it has been able to achieve.
Dr. Liam Fox (Woodspring) : I hope that my hon. Friend will give credit to car manufacturers and banks for the help that they give to the scheme. Many hon. Members often attack the clearing banks for their behaviour in some sectors, but this is one area where they are contributing much to helping disabled people.
Mr. Hendry : I willingly do so. I paid tribute to the way in which car manufacturers have helped. I extend the warmth of my congratulations to the banks.
The significant increase in resources allocated to the independent living fund has demonstrated the Government's record of support for disabled people. When the Government took office in 1979, 360,000 disabled people were receiving help with the costs of their care and mobility but the figure has now increased to 2 million, which shows how vastly increased our commitment to disabled people has been in the past 14 years.
This year, £14.9 billion will be spent on the long-term sick and disabled, which represents an increase of £9.9 billion in the past 14 years. Any Conservative Member who suggests that the Government lack commitment in looking after the needs of disabled people need only look at those figures to realise how substantial our record of support has been.
The Bill deals with disabled people as whole ; real people rather than simply statistics and numbers. I will not rehearse a range of arguments across education, transport and other matters but will consider a couple of aspects, the first of which is the right of disabled people to employment. I was very pleased and honoured recently to open a conference in my constituency on behalf of the
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placing, assessment and counselling team in Derbyshire, which considers how employers can better take account of disabled people. One of the things that struck me most during that seminar was the way in which the scales fell from the eyes of local employers who believed that there may be problems in hiring disabled people but who gradually realised that they should look beyond the disability at disabled people as whole people and hire them on the basis of their strengths and skills. One small element in that concept was the way in which the Government changed the title of my right hon. Friend from the Minister for the Disabled to the Minister for Disabled People. The Government recognised that they are disabled people and not an analogous lump. The more that employers do so, the better it will be not only for disabled people but for companies and employers.I pay tribute to companies in my constituency that have gone way beyond their quota in hiring people who have disabilities. One firm, Otter Controls in Buxton, has made it a policy to take on people with disabilities. Despite the difficulties of the recession, from which it is now recovering, it has done all that it can to ensure that it continues to be a major employer of disabled people.
Mr. Alfred Morris : The hon. Member referred to the right of disabled people to employment. He will know that there is very strong feeling in all the organisations of and for disabled people in Derbyshire, in particular, about the importance of the Civil Rights (Disabled Persons) Bill. May I take it that the Bill has his support? I know of the hon. Gentleman's interest in this field. He will know how strongly the Bill is supported by the organisations of and for disabled people in Derbyshire.
Mr. Hendry : I have told the organisations in Derbyshire that have made representations to me that I feel that the position taken by my right hon. Friend the Minister is correct. The Government wish to proceed through voluntary measures, and if that does not prove sufficient my right hon. Friend will reconsider legislation. I am instinctively opposed to unnecessary legislation. The rights of disabled people are immensely important, but it is much better to use voluntary procedures than to introduce legislation and the difficulties that go with it. As the legislation on equal opportunities for women and race relations have shown, there are inevitably difficulties when enshrining sufficient rights in law. The final matter that I wish to consider is access for disabled people. I commend a young lady in my constituency who is significantly disabled and who recently was pushed around the town of Buxton in her wheelchair by a disabled colleague. She took her video camera to try to highlight for the benefit of people such as myself who are blessed in not suffering from the disabilities that she has the day-to-day problems that disabled people experience in trying to live their lives as normal people. A lot of Buxton was designed by the Georgians, who believed in pillars and lots of steps, so it is not easy for a disabled person to move around in a wheelchair. The town was built on many slopes and hills, which makes life more difficult. My constituent's work has done much to bring to the attention of the county council and myself the difficulties that disabled people face.
The Bill gives us the opportunity to look more generally at the needs of disabled people but particularly at the way
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in which we look after and service the needs of the most severely disabled people in our society. I commend the Bill and recommend that the House gives it a Second Reading.8.18 pm
Mr. Bernard Jenkin (Colchester, North) : My hon. Friend the Member for High Peak (Mr. Hendry) has given us an able assessment of the benefits of the Bill. Indeed, throughout the debate hon. Members have successfully explored its benefits for severely disabled people. I should like to comment on the contribution by the right hon. Member for Manchester, Wythenshawe (Mr. Morris) before he leaves the Chamber, and in due course on the speech by my hon. Friend the Member for Havant (Mr. Willetts).
In a debate on a motion relating to the Bill of the right hon. Member for Wythenshawe--
Mr. Alfred Morris : The Civil Rights (Disabled Persons) Bill.
Mr. Jenkin : I am grateful. In that debate I thought that we explored extremely well the subject of disabled people and civil rights. It opened my eyes to some of the disadvantages of the current set-up.
I remain unconvinced, however, that civil rights legislation in this area would solve the problem that it seeks to solve. There has been a gradual increase in the number of disabled people in employment and the disabled working allowance is proving of benefit, providing encouragement and incentive, not compulsion. That seems a better course.
Mr. Alfred Morris : The hon. Gentleman has referred to the debate in the House on my Civil Rights (Disabled Persons) Bill on 26 February. He will know that the issue was debated for five hours on that day and that the motion was carried by the House after the Minister had spoken. I hope that he shares my pleasure in that decision by the House of Commons on that day. It is certainly shared by all the organisations of and for disabled people.
Mr. Jenkin : I certainly take note of the House's decision that day, although of course there was not a large number of hon. Members present to vote. I take note of the view expressed by the House in the early-day motion on the subject. I pay tribute to the right hon. Gentleman for the campaign that he has waged--no one in the House has contributed as much to the debate on disabled people. I am sure that that debate will continue and that we will all continue to listen to the points that the right hon. Gentleman makes. The debate is by no means over.
I want to concentrate, first, on the purpose of the Bill ; secondly, on the funding provided to enable it to be put into effect ; and, thirdly, and perhaps most importantly, on the principles of assessment that will be used to apply the benefits of the Bill. I should begin, however, by discussing the background and the financial restrictions under which the Government are working.
We have a huge budget deficit. I am impressed that this debate should be taking place not to moan about the quantities of funding available, but, in a constructive spirit, to discuss how best the limited funds available should be allocated. That is a tribute to both sides of the House.
This Bill, as my hon. Friend the Member for Havant pointed out, fulfils a manifesto pledge that we made at the
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general election. Its purpose is to help with financial support for the most severely disabled people. It unashamedly builds on the success of the independent living fund. I do not regard it as a step backwards from that fund ; I regard it as an extension of the work of the fund, although we are delegating much of the responsibility for that to local authorities.The Bill establishes the extension fund, supplementing the independent living fund, and the 1993 fund for new applicants, but it is the partnership with local councils that will represent an advance in the provision of care for the disabled--it is not a step backwards.
Secondly, the funding provided for the implementation of community care includes £26 million in the ring-fenced total of £565 million. The £26 million is for the severely disabled and that represents an overall improvement. Overall funding of community care has been generously increased for the forthcoming year. I refer to what was said by the incoming president of the Association of Directors of Social Services, quoted in The Independent on 3 October 1992 : "We recognised that the public spending round would be difficult and we think that in the context of the present economic climate Mrs. Bottomley has done well to get this money and to give us specific funds for the second and third year of implementation."
That is not a cheapskate formula ; the overall provision for the disabled, within overall community care budgets, is generous indeed. If we remember that the total provided for the disabled from the DSS budget is about £15 billion--a threefold real terms increase--it can hardly be accused of being cheapskate. The Government have clearly demonstrated their continuing commitment to the disabled. My third point concerns the principle of assessment and the interesting discussion that we seem to be having about cash payments as opposed to direct provision. I have great sympathy with the points made by the hon. Member for Birkenhead (Mr. Field) in this regard. It is important to understand, however, how the local authority will fulfil the role of care adviser in the provision of care for the disabled under the care in the community proposals. First, the local authority will identify people who appear to be in need of care services ; then it will assess what support or help they need. It will then share those assessments with the people concerned--the most important aspect of this method of empowerment. It is important to involve the client in decisions about the type of provision, and that is expressly provided for under the care in the community proposals. Clients' wishes and preferences must be discussed with them so that their needs are reflected from a material point of view and so that they are involved in decisions about their care.
Finally, the local authority will decide what services should be arranged in response to the assessment. Such services may be provided by the local authority, but increasingly a greater proportion will be purchased under contract from organisations in the independent--the non-local authority-- sector. That, too, is important, because there is a danger in the arrangements for community care that the services will be producer dominated. By specifying a limit on the quantity of services that can be directly provided by the local authority, a separation between purchaser and provider is created, and that will improve the authority's advocacy on behalf of the people who require the care.
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If someone appears to need health services or help with housing, the authority has a duty to get in touch with the relevant people. This system will replace the system of special higher rate income support payments, currently available to the less well off people who enter residential and nursing homes, to help meet the costs of their care. The current system has a bias in favour of residential care, regardless of what is best for the people concerned. The reforms remove that bias, offering users genuine flexibility and choice in how they are looked after.My hon. Friend the Member for Havant drew our attention to the excellent work done by the Rowntree trust. I wish to draw attention to the developing ideas that we have for care advocacy and further separation of the role of the client and the care advocate, and that of the financier and provider. In particular, I draw attention to a case that I share with my neighbour, my hon. Friend the Member for Colchester, South and Maldon (Mr. Whittingdale). It involves a family whose child is mentally handicapped and which recently lost control of the child. The simple reason is the easily imagined one. When a severely handicapped child is born, the parents naturally say that they will look after the child, but things become more difficult as the child gets older. Looking after a severely mentally handicapped teenager is a demanding operation.
In that case, the strain on the marriage and on family life and finances proved too much for the parents, and they finally accepted that the child would have to enter an institution. Imagine their shock when they realised how much that would cost. Let me emphasise that the health services had offered the child high-quality care, but it was institutional care, not family care or care in the home. For the lack of anything between £2,000 or £8,000 for the additional help that they needed in the home to enable them to continue looking after their child, the health service is now picking up a bill for about £35,000 a year.
That is where the argument for service advocacy or brokerage comes into play. We could not only make resources stretch much further, but involve the families of disabled or mentally handicapped people or the clients themselves where they are capable of making the decision. The money could be allocated to them, instead of to the health authority or the local authority to invest in plant--that is, a residential home or residential care of one sort or another. The Rowntree trust draws attention to stories involving people in the work that it does. For example, Patrick, who had spent almost all his life in residential care until he moved into a home of his own at the age of 27, said, "It means exercising choice and control and having the right to choose who gets me up and who puts me to bed." In another case, 40-year-old Maria explained : "It means I can get up in the morning when I want to, I can go to bed in the evening when I want to, go out when I want to."
Extremely good though institutions may be, the present arrangements of institutionalised care often fail to enable disadvantaged people to lead their own lives, or to lead their lives with their families.
Mr. Thurnham : My hon. Friend quoted what seems a high figure for the cost of the care of a constituent's child, at I think £37,000 a year. Does he agree that there are differences in how well organisations can manage their
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budgets? Voluntary organisations can also call on charitable causes for their capital costs if not for a contribution to their running costs.My son is now at an establishment called Brookvale, near the constituency of my hon. Friend the Under-Secretary--in Bury, South--where costs for care are only £15,000 a year, but the standard of care is very high. That compares to the cost of £30,000 a year for neighbourhood network homes in my constituency, run by the local authority, where I do not believe that, in all cases, the care is as good as it is at Brookvale.
Mr. Jenkin : My hon. Friend highlights the point that I am making, which is that different types of provision, provided at different standards, are available. We want the client and the families of the client to be involved in the choice of the provision. A purchaser-provider approach often means that the price of such provision is not as expensive as it is when it is provided by a top-down approach.
As we are debating service brokerage and carer advocacy, I shall say something about the ambiguity in the attitude of the Opposition. What we have successfully achieved in the independent living fund seems to have converted a substantial part of the Opposition to the idea of service brokerage. However, as my hon. Friend the Member for Havant pointed out, that does not seem to extend to the social fund. I feel that it should extend to general practitioner fund holding because that is a form of service brokerage where the purchasing power is put in the hands of a care adviser--a general practitioner. He or she then decides, on behalf of the client, how best to allocate resources on behalf of the patient. It means that the community care proposals that are to be implemented at the beginning of April are an interim step on the long road to more responsive care in the community, in its generic meaning, of all kinds. It is artificial to have a care advisory or brokerage system simply for the disabled and not involve the health services and all the other relevant services. The ultimate social services system of the future must ensure that, where moneys for health and social services for those acute cases are all held under one fund, and a single broker advises the client or the client's family on the services that are required, they are purchased from the local authority, the private sector providers, the health service and all the other institutions, bodies and charities that are involved in acute care. That interesting and exciting challenge lies before us as we develop social services and health care in the 1990s. I commend the Bill to the House.
8.37 pm
Mr. Peter Luff (Worcester) : It is a tribute to the House that, for the second time in a little over a fortnight, we have been afforded an opportunity to have a serious debate about the needs of disabled people. It has been a privilege to hear some of the speeches made on both sides of the House on that important matter.
I was, however, a little disappointed at the ribaldry among Opposition Members when my hon. Friend the Member for Bolton, North-East (Mr. Thurnham) praised the hard work done by the civil servants in the disability living allowance unit and elsewhere to assist disabled
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people. I pay tribute to those officials, with whom my constituency office works closely to achieve satisfactory outcomes.Mr. Thurnham : My hon. Friend spoke of Opposition Members. Is it not right to point out that, during almost all the debate, there have been twice as many hon. Members on the Government Benches as there have been on the Opposition Benches? Even now, there are 10 Members on these Benches and only five on the Opposition Benches.
Mr. Luff : My hon. Friend makes his own point, which will be noted by everyone outside the House.
I hope that it will be in order, when paying tribute to those staff, also to pay tribute to the House of Commons staff who work closely with them to achieve satisfactory outcomes for disabled people in our constituencies. The Benefits Agency staff and the DLA staff are always anxious to do all that they can to promote the needs and interests of those in genuine need. In particular, I should like to praise the staff of the Benefits Agency office in Worcester, who work so hard and consistently for disabled people.
The original independent living fund was a bold partnership. It was not without controversy when it was introduced but it has become a central part of the Government's commitment to disabled people. Perhaps it is not surprising that within two years of the fund's introduction the Select Committee on Social Services was writing : "On 9 February 1990 the Minister for Disabled People issued a press release headed : Independence is the key to better lives for Disabled People'. The help provided by the Independent Living Fund cannot be appropriate for all disabled people. We believe however that the Independent Living Fund has given meaning to the Minister's phrase for many disabled people. Our concern is that the Government has not fully appreciated the innovatory nature of the ILF in giving some disabled people and their families the resources to build up their own packages of care. We recommend that the ILF should continue to exist not only for an interim period, but also after the implementation of community care legislation, and should be provided with sufficient resources to meet the claims of those who meet the present criteria to help from the Fund, and whose needs have not been met through the eventual implementation of community care policy." I was delighted to find that the Conservative party's manifesto, to which I still attach great importance, contained a strong commitment to maintaining a fund to support the most severely disabled people. Slightly more than two weeks ago we debated the Civil Rights (Disabled Persons) Bill. I am sure that hon. Members on both sides of the House accept that there is no more fundamental civil right for a disabled person than the opportunity to decide how he or she will live his or her own life. In that context, the ability of the individual to remain in his own home is of central importance. It is important also to emphasise the mobility aspects of this civil right and to welcome especially the features of the Bill that relate to Motability.
The Bill widens the legislative powers that govern the Government grant that is paid to Motability. It will enable the Government to ensure that they can continue to fund the organisation in future. I am glad to say that Motability commands genuine cross-party support in the House. It helps disabled people to obtain a car or a powered wheelchair on favourable terms, thus increasing their independence.
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The people most often helped by the charity are the severely disabled, who are unable, or virtually unable, to walk. They include people with cerebral palsy, spina bifida, muscular atrophy and many other crippling conditions. We have heard unusual tributes from hon. Members to the role of the clearing banks in helping to fund Motability, and it should be recognised that it is a partnership. It is a registered charity that is assisted by the Department of Social Security, clearing banks, motor manufacturers and dealers and insurance companies. I am sure that we all have constituents who benefit from the operation of the scheme.The Government pay significant sums to Motability and about 140,000 people are now being helped. Since the scheme's inception, about 330, 000 vehicles have been supplied. It is worth bearing in mind that the scheme has helped the environment, apart from the disabled, through its pioneering role in pushing the case for lead-free petrol. Reference to the mobility features of the Bill enable me to correct an omission from my speech--
Mr. Alfred Morris : The hon. Gentleman has referred to motor manufacturers and dealers, clearing banks, insurance companies and other interests that were brought together to create Motability. Speaking as a patron of Motability, may I say that I hope that he will appreciate that it has always relied as well on a great deal of voluntary effort. Many people give of their time to ensure the success of this very important organisation, and have done so continuously since it was started by the memorandum of 1977.
Mr. Luff : The right hon. Gentleman's intervention is a timely one. I intended to move on to emphasise that aspect of Motability's work and to link it with the work of another scheme for disabled people, shop mobility, which makes an enormous contribution to the mobility of disabled people. It enables them to make their purchases in ordinary shops in shopping centres, for example. I was privileged to see in great detail the work of shop mobility at Worcester when I drew its Christmas raffle some months ago. The role of the voluntary sector--individuals--in helping the disabled to achieve independence in their lifestyle must never be overlooked.
The Government should be proud of their record in responding to the needs of disabled people. The increase in spending has been phenomenal, and that is spending of which the ILF is a part. Spending has trebled in real terms since 1978-79, and is now £14.9 billion. We have seen the introduction of the disability living allowance. It has not been without its problems, but already there have been nearly a third of a million successful claims. I especially welcome the disability working allowance, which provides a top -up for the earnings of disabled people.
I attach enormous importance to giving independence to disabled people and their ability to choose their own lifestyle in the context of the role of carers. Expenditure on the invalid care allowance has increased significantly from only £4 million when the Government came to power to about £366 million today. The number of beneficiaries has increased from 5,000 to 195,000.
It is entirely appropriate that one of the key objectives to the Government's proposals for community care is to ensure that service providers give practicial support for carers a higher priority. That is recognised in the Government's White Paper, "Caring for People". There is
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clear recognition in that document that helping carers to maintain their valuable contribution is right and a sound investment. Local authorities and health authorities will be expected to continue to develop services for carers in advance of the introduction of assessments in April.It is not going too far to say that carers are perhaps the most long- established voluntary sector that looks after the disabled. I am concerned that their work should not be over-professionalised. It is work that often goes unsung, and even more often it is unnoticed. I am sure that the entire House would wish to offer thanks and gratitude to those who are doing so much to promote the interests of disabled people.
Dame Elaine Kellett-Bowman : My hon. Friend is far too young to remember that the process started with the work of the Council for the Single Woman and her Dependants. It has continued for many years since then.
Mr. Luff : My hon. Friend makes an important point. Many of us are accustomed to seeing carers in that context. There are so many relationships that relieve the state of a financial burden and enhance the quality of life of the individuals who receive care. I welcome the role of local authorities. The Government are often criticised for diminishing their role, but that is not our objective. It is often our objective to take powers to others, and I have in mind grant-maintained schools. They represent an attempt to give power to parents, not to take power from local authorities. The Bill will do exactly the opposite of what our critics sometimes accuse us of doing because it will significantly enhance the role of local authorities. The ILF and its successors provide help on the basis of a care plan that is agreed between the fund, the disabled person and the local authority. As a result of assessment, the authority will provide a specified level of service, which the fund will then supplement by a cash payment to the client.
If the system is to work properly, it is essential that local authorities have full confidence in their ability to live with their side of the care- in-the-community bargain. I know that a year or so ago, when care in the community had still not been fully implemented, nursing homes in my constituency and in the area covered by the county council were worried that they would not be in a position to take on that responsibility. I made vigorous representations to the Government, as a result of which, I believe, the Government have responded appropriately to ensure that local authorities can play their full role in delivering care in the community. I welcome particularly the generous funding that the Government have made available to local authorities to enable them to do that. If there were not the confidence that the necessary funding was in place, I do not think that there would be the same confidence in the value of the ILF and its successors.
Local authorities have been allocated significant additional funds to support their new responsibilities for community care. The ring-fenced grant of £565 million for England, specifically and exclusively for community care next year, is very welcome. That sum includes some £399 million that would otherwise have been spent through the DSS ; £140 million to facilitate the introduction of the changes ; and £26 million to help meet the needs of severely disabled people.
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