House of Commons Hansard Debates for 27 Apr 1993

Dame Elaine Kellett-Bowman : There is only one.

Mr. Henderson : Yes, there seems to be only one Liberal Member. I wish that they would stick to the business before us, not squabble over one election that will take place on 6 May. The country and the bns may be different from that given in one specific part of the country.

Question put and agreed to.

Resolved,

That, for the purposes of any Act resulting from the Non-Domestic Rating (No. 2) Bill, it is expedient to authorise the payment out of money provided by Parliament of any increase attributable to the Act in the sums so payable out of money so provided under any other Act.

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Disability (Grants) Bill

Not amended (in Standing Committee), considered.

[Mr. Michael Morris

in the Chair.]

Clause 1

Grants to certain organisations concerned with disabled persons

6.2 pm

Mr. Barry Sheerman (Huddersfield) : I beg to move amendment No. 1, in page 1, leave out line 13 and insert

to enable payments to be made to or for the benefit of people with disabilities for the purpose of promoting their independence and freedom of choice.'.

In Committee, we were disappointed that we were not successful in amending the Bill despite the debate that we had on Second Reading and the obvious shared concerns expressed in Committee. When it came to the crucial act of voting, the Government were not flexible. On a Bill that covers many aspects on caring for the severely disabled, we hoped for some compromise and flexibility from the Government. The key words in the amendment are

"independence and freedom of choice".

I note that the Minister for Social Security and Disabled People agrees with me. In the foreword of the Greenwich personal evaluation scheme, which was published recently, he said :

"This report on Personal Assistance schemes shows that as well as being cost-effective, some schemes offer disabled people a greater degree of independence."

The Minister will know that the amendment is designed to reintroduce into the debate the important change in the way in which disabled people view the sort of help and support that they need and receive, and the way in which they receive it. That merely scratches at the surface of a fundamental change that has taken place in the sphere of disability in recent years. The debate is continuing, not only in the form of the Bill that we are discussing, but in another place, where a different Bill was recently debated which was designed to address the same subject : how people receive the help necessary for them to continue to live lives that are full and give them the opportunity to use all their potential.

I do not wish to speak merely as the shadow Minister and say what I believe to be the main concerns of disabled people and those who support them. I prefer to act as a mouthpiece and tell the House the comments that have been made in favour of direct payments by the people affected by them. They have expressed their views far more eloquently than I could hope to do.

Two disabled people were quoted in Anne Kesselbaum's report, "Cash for Care". They said :

"It makes us feel in control of our lives ; gives us back the feeling of being people and not a pathetic handicappedfamily If you have a carer you feel safe with, you know your quality of life is better. It opens things up. Your personality changes, you laugh."

Some of those comments go to the heart of the subject.

Jane Campbell, a disabled person, said in conversation with Lord McColl :

"Employing your own personal care assistants places negotiations on a very different plane. You are not asking for favours or desperately attempting to change the (statutory)

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home carers rota so as to enjoy another hour at that party. Instead, you are setting your schedule for the day, which you know will be adhered to by your employee, with whom you have agreed a one to one contract of employment.

Whereas my traditional form of help gave me no privacy, and was often loaded with what people thought best for me', I now decide my own priorities, and I feel I have an equal say in how my home and my family life is run."

Those are moving words from disabled people who want the sort of care on which the amendment focuses. She concludes :

"This is, I believe, fundamental to one's dignity and sense of belonging and contributing."

A young lady, Maria, was interviewed by Jenny Morris for the Rowntree trust's report, "Community Care or Independent Living", and said :

"It means I can get up in the morning when I want to, go to bed in the evening when I want to, and lead the kind of life that I want to."

That is a true testimony of the power given to the disabled when they can receive money from the independent living fund. I should be out of order if I strayed too far, but that example shows the amount of power that is handed to disabled people when a local authority social services department can provide cash for disabled people to allow to make their own decisions and to draw up contracts of employment to meet their needs. In the same interview, Vicky, a disabled person, said :

"Independent living means that I employ people, and basically that they are here to do the physical things that I can't do, which allows me to have the lifestyle that I choose."

The important common factor running through all the quotations is that, given the money to employ their own care assistants, people with disabilities enter into a one-to-one, employer-employee relationship with their helper. They can specify exactly the sort of care that they want, and in what form they want it. They can specify the exact hours when they want that help. Last, but certainly not least, they can ensure that the person helping them, who spends much time in their house--and sometimes lives in it--and helps them to perform intimate functions, is someone with whom they feel happy and comfortable. Surely that is something that every hon. Member should want for the severely disabled people of our country.

I do not wish to delay this stage of the Bill. I give a final quotation which illustrates the sort of horror story that can occur when a disabled person does not have full control over the care contract and those who fulfil it :

"The home help came to me one day when my bed was wet and I asked her to change the sheets. She refused. She said, Today is not the day we change the bedlinen.' I asked if she expected me to go to sleep in a wet bed. She said, Well, I'm not changing it.' " Clearly, that is untypical. We appreciate that the vast majority of local authority carers are genuinely caring and compassionate people. I simply point out what can happen. When it happens, the disabled have fewer powers to seek redress and prevent the atrocity recurring than if they employ their own helpers.

In a recent Friday debate, my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) introduced a Bill that would have established a commission for disabled people to have their grievances inquired into and righted. That measure was voted down at the behest of the Government, so the disabled do not even have that avenue to pursue. When such a ghastly experience occurs and a disabled person is unable to have carried out by her carer the sort of basic task that I have

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described, it is regarded by many of us as a minor atrocity, because it combines physical discomfort with personal humiliation to a quite intolerable degree.

In his Second Reading speech, the Minister referred to local authorities being in the driving seat. As the Bill proceeded through its brief Committee stage--we did not prolong the proceedings ; it went through in two very civilised sessions--we got the impression that the Minister made a slip of the tongue or, if that was not the case, that he regretted what he said when he referred to the need for local authorities to be in the driving seat.

The thrust of our argument in Committee--unfortunately, we were not successful in getting it accepted--was that disabled people should be in the driving seat. The experiment conducted by the independent living fund showed that empowering people to make their own arrangements costs dramatically less than providing the service direct. In other words, when people can choose and draw up their own contracts with the people of their choice, the Exchequer can make a saving of between 20 and 50 per cent. of the cost. People make more sensible decisions than bureaucracy makes for them.

The Minister has seen the evidence. He saw much of it in the debate on cash payments in another place. Apart from the case made by the Minister in that debate, the view was unanimous, on the evidence before the other place, that cash payments are effective, are empowering and save money.

The argument adduced throughout our debates leads us to believe that, secretly, the Minister is on our side. Indeed, it is rumoured that some of his colleagues are on his side. Clearly, if they were not whipped, many Conservative Members would be with us--I have particularly in mind the all- party amendment that was voted down by the Government majority in Committee.

We are willing to believe that, but for some evil power lurking in the Treasury, many Ministers and Conservative Members would be with us. I give the Minister the benefit of the doubt on that issue. But if that is not the case, we deserve a thorough explanation today. If I am right, and it is the fault of the Treasury, we are left to wonder what sort of people are making decisions in the Treasury under Conservative rule. What kind of Treasury official or Minister would consider the research and the figures and say, "This is not permissible because it would save money"? Let us be clear : as I have explained, it would save money.

6.15 pm

I am talking of an innovation that is tried and tested. The independent living fund tried it for five years, and local authorities have tried it to good effect. Suddenly the Government realised that some local authorities were giving direct cash payments, and said that that was outside the letter of the law. What sort of Treasury official, in this day and age, could look at the facts, which clearly show a saving to the Government of 20 to 50 per cent., and still refuse to make a change in the law that would bring about such a saving?

Are we not, in the closing years of this century, enlightened enough to ask who the people are who are making such decisions behind the closed doors of the Treasury? Why are they allowed to be in the driving seat? This is not a question of local authorities or disabled

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people being in the driving seat. Treasury mandarins are in control. That is why we believe that they are the evil influence. They are stopping the acceptance of consensus for an obvious sensible way forward.

The amendment would give the Government at this late stage a chance to make a change. We hope that they will respond in a positive manner.

Mr. Alan Howarth (Stratford-on-Avon) : I apologise for arriving late for the debate, which started earlier than I had expected. Even so, I hope that I may crave the indulgence of hon. Members and make a contribution because it is an extremely important subject and I hope that, as a result of the consensus that undoubtedly exists across the Floor of the House, the Government will find it possible to concede the case for direct payments, and will respond positively. The case for the amendment is well rehearsed and familiar. The arguments for it are so solid and the case against it so insubstantial that it seems strange that it remains necessary to debate it, but we must do so. The moral case is too important to neglect and the case in terms of practical efficiency and good value for money alone should be recognised and accepted by the Government. The moral case should be restated, being the most important part of the argument. The principle at stake is the dignity of the individual. The argument essentially is that direct payments by local authorities to severely disabled people would enable them to enjoy as much as possible of the autonomy that able-bodied people assume as a right for themselves. The point was eloquently expressed by Lord McColl, Baroness O'Cathain, Lady Darcy de Knayth, Lady Masham and others in the debate last week in the other place on the Disabled Persons (Services) (No. 2) Bill.

The issue for us is whether we are to empower those of our fellow men and women who happen to suffer from severe physical disability to live as independently as they may and on terms as equal as possible with everyone else. What do we mean by policies of care? Is care merely to be an expression of an authoritarian and patronising attitude that says, "We who are in charge will take care of your problem. Indeed, we will take care of the problem that you are"? Or is care to be a manifestation of compassion, of a fellow feeling that impels us to act imaginatively to help someone who faces exceptional difficulties to meet his or her needs?

To give the simplest instance, are we to enable a physically disabled person to make his own decision about when he gets up in the morning and goes to bed at night? Or are we to decide that for him? Or for her? In an impressive and moving account of the transformation rendered to her life as a result of direct payments, Jane Campbell recently wrote :

"Almost overnight I gained full control over my physical and to some extent mental being. Can you imagine that until the age of 29 everything I wanted to do from getting out of bed to attending an important meeting had to be negotiated? ... . Employing your own personal care assistants places negotiation on a different plane. You are not asking for favours or desperately attempting to change the (statutory) home carers rota. Whereas my traditional form of help gave me no privacy and was often loaded with what people thought was best for me', I now decide my routines and I feel I have an equal say in how my home and my family life is run. This is, I believe, fundamental to one's dignity".

Ann Kestenbaum, in the case studies that she describes in "Cash for Care", quotes Mr. M's wife, aged 48, suffering

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from rheumatoid arthritis, heart condition and leg fractures as saying that having control of their own resources

"makes us feel in control of our lives. Gives us back the feeling of being people and not a pathetic handicapped family."

Ms K, who suffers from a spinal injury, says :

"Having the cash to pay for the things you need means you have standing."

Jenny Morris in "Community Care or Independent Living?" quotes Jack as saying :

"I am a husband, a father and a breadwinner. And 10 years ago I was in an institution where I could not even decide when I would go to the toilet. You know you can't really understand it if you haven't done it. Your whole life changes."

Jane Campbell endorses Jack's point impressively. She says : "Contributing, of course, is the biggest gift that direct payments has awarded me. I have been able to take up a demanding full-time job that is equal to my skills."

She works as a training director and she chairs the British Council of Organisations of Disabled People.

The moral, practical and financial arguments all reinforce each other. Jack and Jane contribute their skills to the betterment of society. They pay taxes. Jane attests that less stress as a result of less dependence on others and more control over her own body has had beneficial effects on her health.

Lord McColl, whose view on the point must carry particular weight, observed in last week's debate :

"a high morale directly enhances the body's defences against illnesses of all kinds. As a result, people have fewer illnesses and thereby save the National Health Service money."

The arguments in favour of independent living are familiar to the Government. My right hon. Friend the Minister for Social Security and Disabled People inaugurated the independent living fund, something of which he is proud, and justly so.

The Under-Secretary of State for Health, Baroness Cumberlege, replying to the debate in the other place last week was emphatic when she said :

"We fully support the aim of enabling disabled people to live independently and to exercise choice. We wish to give local authorities freedom and flexibility to meet those choices in innovative ways and to see disabled people placed at the centre of decision making."

That statement is consistent with numerous other ministerial utterances and, I believe, truly reflects the spirit in which Ministers have sought to establish care in the community. What, therefore, is puzzling and deeply unsatisfactory is that Ministers, who express enthusiasm for independent living and scepticism about bureaucratic procedures and solutions, continue to refuse to allow local authority social services departments to make direct cash payments to severely disabled people.

I shall examine the objections that Ministers have put forward to direct payments by local authorities. The speech by the Under-Secretary of State in another place last Wednesday was the fullest and latest rehearsal of those objections.

The Minister made the point that social services departments and the social security system have different roles. She said : "Social services departments arrange exactly that--services. The Benefits Agency provides cash benefits. It is the business of the social security system to provide cash to support individuals in need. It is not the business of local authorities."--[ Official Report, House of Lords, 21 April 1993 ; Vol. 544, c. 1663-64.]

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That seems to me a descriptive observation rather than an argument against change. Moreover, it is not entirely accurate as a description of the status quo. Local authorities make cash payments in certain instances and they do so under recent legislation--the Children Act 1989. Local authorities make payments to children leaving care. They make cash payments to foster parents. They also make cash payments to voluntary organisations. So, the Government cannot pray in aid as a principle of administration that local authorities should not make cash payments.

The Government have themselves legislated to enable local authorities to make payments to children and to able-bodied adults. I cannot imagine under what principle of administration disabled people alone should be excluded from receiving cash payments from local authorities.

In any case, even if the Minister's descriptive statement is broadly valid, that is not an argument for persisting slavishly with a fixed conception of the respective roles of different public service organisations. The Under- Secretary of State talked of the Government's fear of "imbalance", as if the existing bureaucratic structure were a thing of such beauty that its preservation had to be the paramount consideration, more important than finding better ways to help disabled people. Doubtless there were powerful reasons for that broad division of labour in the past, but society and its needs and our conception of how to meet them have moved on.

Throughout the 1980s my right hon. Friends have encouraged us to think of Government as enabler rather than provider and have encouraged those in the public service to think in terms of outputs and value for money rather than inputs.

Only yesterday, in an article in The Times, my right hon. Friend the Chancellor of the Duchy of Lancaster inveighed against the bureaucratic top -down model of governmental provision. He condemned the inadequacy of

"rule-bound, hierarchical, uncompetitive old style service providers".

He went on :

"Any organisation that governs its employees by detailed rule books in the end will promote only the best operator of rules, not the innovator or the creator. Any organisation that believes it is accountable only upwards, to those who set the rules, will treat its citizen customers as troublemakers".

My right hon. Friend is right. For corroborative evidence, he need only read "Squaring the Circle", a study of needs assessment by Kathryn Ellis of the university of Birmingham for the Rowntree Foundation. She demonstrates the procrustean approach of social services staff, fitting clients into rigid categories of need, defined by pre-existing bureaucratic structures and assessment categories. Disabled clients who did not fit in and who expressed views of their own were dismissed as "demanding", "fussy", and "manipulative".

My right hon. Friend the Chancellor of the Duchy of Lancaster went on to emphasise the need to delegate financial responsibility down and measure outcomes.

In The Times today, my right hon. Friend the Chief Secretary to the Treasury is reported as saying of the Government's review of the welfare state :

"We will consider all options which will have the purpose of meeting our objectives, one of which is to focus benefits increasingly on those in need we wqant to ensure people have greater control of their own resources".

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So Cabinet Ministers are actively repudiating the status quo which the Under-Secretary of State was briefed to pray in aid last week. The Under-Secretary of State went on to say that local authorities are providers, enablers and facilitators of care services. That is right and as it should be. But if local authorities are to be enablers and facilitators, the Under-Secretary of State undermined her own argument against them making direct payments to clients because enabling and facilitating is exactly what that process involves.

As the House knows, the Association of Directors of Social Services is unanimous in its support for direct payments by its departments. It passed a formal resolution to that effect last autumn. It is keen to move with the times.

I spoke yesterday to Mr. David Mason, director of social services for Warwickshire county council, who confirmed his urgent hope that the Government will change their mind on this subject. As he said to me,

"choice and empowerment come through purchasing power". The Under-Secretary of State raised, however, another objection, which the Government have advanced repeatedly. She said that it would be difficult for local authorities to define eligibility for direct payments. I find that a singularly unpersuasive argument in the context of the Government's policy of care in the community. The essence and great virtue of the policy is that local authority social services departments are to lead in assessing the needs of individual clients. Their daily duty and activity, enjoined on them by the Government, will be to assess need and, therefore, eligibility for help of one kind or another.

But the Government have another argument to show that it could not be done. The Minister said that it would be difficult for local authorities to manage a general system of cash payments. That is an Aunt Sally. We are not talking about a general system. We are talking about a strictly finite and relatively small number of cases. In "Cause for Concern", published in March, Pauline Thompson provides the number of clients of the previous independent living fund authority by authority.

The largest number was in Birmingham, where there are 424 ; in my county of Warwickshire, there are 79 ; the smallest number was in Barking and Dagenham, where there are nine. Nor need the Treasury fear any opening of the floodgates. Mercifully, there are not large numbers of severely disabled people in this country and, of them, only a limited proportion want to handle their own budgets and employ their own assistants. When Kingston-upon-Thames social services department made inquiries as to how many severely disabled people might wish to take advantage of such an option, 12 said that they would.

6.30 pm

The Treasury continues all the same to fear that costs would run out of control. Last week the Parliamentary Under-Secretary of State said the local authorities would find it difficult to carry out the necessary monitoring to keep control over public funds. Again, that is an odd assertion. It would be easier for local authorities to monitor and control individual budgets assigned to clients than it is for them to keep control over the costs of their own in-house services. There is no problem whatsoever in requiring clients to keep funds provided by social services

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departments and the ILF in a separate bank account and to be provided with regular statements, receipts and timesheets. If the Treasury did not spend its time inventing imaginary difficulties, it would see that direct payments enable a given level of care to be achieved at less cost than the cost of publicly provided services. Evidence for that has been impressively marshalled by Jenny Morris, Ann Kestenbaum and Victoria Phillips. I shall not elaborate that part of the argument except to make the obvious point that there is far greater flexibility in pay rates and job descriptions for people employed directly by clients than there is for local authority employees.

My right hon. Friend the Minister for Social Security and Disabled People, in his foreword to the "Evaluation of Personal Assistant Schemes" in Greenwich by Mike Oliver and Gerry Zarb, endorsed their cost-effectiveness. That report suggests that, for its £5 million-plus home help budget, Greenwich council could have purchased 665,912 hours of work ; for the same amount the personal assistant scheme could have brought 1,450,569 hours. Similarly, the personal assistant scheme could have bought twice the number of care attendant hours.

Under the scheme that the Government are now introducing, there will be an incentive for councils to inflate their costs, to bring the cost of care packages above the £200 threshold for a contribution from the ILF 1993 fund.

In the debate in another place, the Minister also raised as an objection to direct payments that they would be at odds with the idea of a flexible response to individual circumstances and that somehow they would entail the creation of a separate social security system within social services with its accompanying rigidity. That would seem to be a through-the-looking- glass argument. A wealth of evidence demonstrates that cash payments which enable clients to manage their own arrangements for assistance provide enhanced flexibility. It is one of the strongest arguments in favour of direct payments. Ann Kenstenbaum writes :

"Some of these arrangements are very flexible. Although the ILF award is assessed on the basis of regular hours of need, clients very often see their care needs in much less rigid terms. This is certainly true where care is essentially respite, allowing a family carer to have a break and get out of the house. It is also the case where a client's state of health and therefore care needs vary from one week to the next, or where a client leads a relatively active life engaging in different activities for which different hours of help are needed."

She goes on to describe the problems of rigidity in the provision of services by social services departments.

Mrs. B, with rheumatoid arthritis, is quoted as saying : "Home helps are bound by too many rules. You couldn't expect a home help to be so flexible because of the other people they have to see."

Mrs. J says :

"As a home help, she had to refuse to clean windows. Now (employed privately) if she is asked to do something, she just does it." Miss C sums up the problem of rigid practices among local authority employees :

"They canna do this, canna do that.".

Those complaints take us into the arguments against yet another objection by the Government. The Under-Secretary of State said that cash payments by the social services department would be unnecessary because the new

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scheme ensures that in future the two parts of the package, cash from the ILF and services from the local authority, will be brought together

"so that the client receives a coherent package of care agreed jointly by the disabled person, the local authority and the new fund."

But this could have been designed as a model of cumbersome, time-consuming and expensive bureaucracy. I do not believe that care packages can be most cost-effectively designed if they are made up of £200 of services and extra cash put in from the ILF.

The Minister went on to emphasise that she would expect the disabled person to have

"as great a say as possible as to who is to be employed to provide the care."

She added :

"There is no reason why a care assistant should not be personally chosen by the disabled person."

I find it hard to credit that disabled clients will actually decide who is to be employed by local authorities. But if they are to have a say, why not go the whole way to autonomy? Would it not be less costly, administratively simpler and morally better for disabled people to employ their assistants?

The argument to which the Minister appeared to attach the greatest weight was that, while

"in individual cases disabled people may be able to use money more effectively than certain authorities"--

a grudging but useful acknowledgement--there is a risk that they will

"adversely affect authorities' ability to match their resources to all local needs, not just those of people receiving direct payments."--[ Official Report, House of Lords, 21 April 1993 ; Vol. 544, c. 1664-65.]

That would be a powerful argument if it were true, but the Association of Directors of Social Services does not believe it to be valid. The truth is that many social serv1eOne of the most important and worrying findings in Pauline Thompson's recent survey is that only a minority of severely disabled people receive services from their local authority. The case for allowing severely disabled people who wish to do so to design and manage their own care arrangements becomes all the more powerful. To the extent that social services departments do not have to commit staff and time to detailed organisation of care for people with complex needs, so they will be able to address themselves more fully to the huge range of their other responsibilities.

The Minister's one other argument was that it would not be right to expand authorities' "already very full agendas" by asking them to take on responsibility for cash payments. Would that the Government had always been so concerned not to impose on local authorities. But they need not be fearful of doing so in this instance. They would be easing the enormous burden that they have laid on local authorities with care in the community.

I apologise for having dealt with these arguments somewhat laboriously. But it is an important issue, and they are the arguments that the Government have so far invited us to accept. I cannot accept them, because they disintegrate as one looks at them. I do not think that the Ministers who have advanced them believe in them either. Lady Cumberlege said that she was sad to have to reject the case made by every speaker in last week's debate. She

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