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Mr. Clarke: I am not giving way because I want to be fair to the Secretary of State and give him time to respond to the debate.
I challenge the Government to do what the Opposition will do when we are in Government, which is to produce a plain person's guide to the various Acts relevant to disability and care in the community. That should not be too difficult; after all, shortly after the Secretary of State left his previous post at the Treasury last year, and after the disgraceful scenes in this House when the disability Bills were being debated, the Government found £1 million for their propaganda to persuade people that they were sympathetic to disability and care in the community issues. Of that £1 million, only a miserable £2,000 was spent on making their propaganda available to people with hearing impairments or unable to read, for whatever reason.
The money is there and I again challenge the Government to produce a plain person's guide. If they did it as well as the document dealing with young carers was done, it would be a welcome but considerable departure from the Department's approach to these important matters.
I also invite the Secretary of State to spend a little more time going around the country talking to organisations of and for disabled people and of and for carers. Above all, he should talk to those individuals and families for whom the Government's care in the community policy has been a disastrous failure. Within those groups he should talk to the young disabled people who leave school at 19. It is a traumatic time for them, their parents and their communities. Sadly, there is no Government strategy to deal with all those serious problems.
If there was a strategy for joint planning, such as that included in my 1986 Act, the people of England, Scotland and Wales would be far better served. The health authorities would be working with social services and social work departments and with patients and their advocates. Once again, people leaving hospitals on the basis of assessments would know that their future was secure and that they would not be sleeping on the streets.
The Minister dealing with disability matters a few months ago is now the Secretary of State for Wales. When I went to Wales I was appalled to be told that best practice is being discontinued to the point where one group of people with learning difficulties were told that they would be placed in homes in the community, but were then profoundly disappointed when they were simply put on a bus and sent elsewhere.
I want to conclude with the important issue of direct payments. We welcome the principle, but it must not go the way of community care. For the Government to raise the expectations of disabled people and then to disappoint them by failing to deliver was bad enough the first time-- to do so again would be inexcusable. If, as the chairman of the Conservative party has said, it is necessary to separate rhetoric from reality, that could not be more true than for this issue.
So far, the Government have said little about what the words in the Bill actually mean. It was published only at 7 o'clock this morning, when my hon. Friend the Member
for Peckham (Ms Harman) was already in the BBC studios. There are a number of areas of specific concern on which the Government have not yet told us their thinking.
First, the then Secretary of State for Health said last year that direct payments would be limited to those able and willing to manage their care. What does that mean?
Why is that not made clear in the Bill? The Government have become fond of putting as little as possible in a Bill, keeping back most of the important details and producing them from behind closed doors as regulations. Is the Bill another example of that? It is not a trivial matter. If the Government intend to make a distinction between those disabled people who are willing and able to manage their care and those who are not, we need to know how that distinction is to be drawn. I hope that we are not about to consider a measure that will introduce a new form of discrimination between one group of disabled people and another. It would seem that provision will be made for disabled people only if they can show a lesser degree of disability.
I have in mind the large group of people with learning disabilities. Those who attended the Mencap conference at Blackpool last week would as well. In drafting the Bill and defining who will be eligible to receive direct payments, let us have an assurance from the Government that the concept of able and willing will not be so defined as to exclude all those with learning disabilities. If Ministers intend to draft regulations in a way that discriminates against those people, let me remind them that many of the beneficiaries of independent living funds that are made available from central Government resources are people with learning disabilities.
Secondly, what of access to direct payments for frail elderly people? There is concern among those consulted by Ministers that it is intended to make direct payments available only to those aged under 65. In February, a Law Commission report on mental incapacity strongly recommended that there should be a presumption against lack of capacity. In other words, it recommended that people should be presumed capable unless shown otherwise on the available evidence. That approach should apply across the board. If direct payments are to liberate those with disabilities, there should be no blanket presumption of incapacity discrimination based on type of disability or on age. It should be open to all those people who believe that they are able or willing to manage their own care to seek direct payments to allow them to do so. There should be no presumption against them in advance of their applications being made.
Thirdly, let us consider the discretionary nature of what is being proposed. I hope that Ministers will reflect on the anomaly that will arise if direct payments are available to a disabled person in one area but not in another. We need to know that direct payments will be provided fairly and with adequate support. It is equally important that disabled people are not denied the right to choose not to receive direct payments and instead to continue to use services provided by local authorities if they wish to do so. Direct payments must not be allowed to justify the withdrawal of services now provided for disabled people. Many disabled people would be appalled if it transpired that all the fine words about choice and control were only rhetoric to disguise the usual Tory agenda of privatisation, cuts and closures.
The Secretary of State for Social Security (Mr. Peter Lilley):
The debate was opened with a powerful speech by my right hon. Friend the Secretary of State for Health, who effectively demolished the Opposition spokesman and made a well-reasoned case for what the Government are doing and intend to go on doing for the rest of this Parliament and into the next.
We heard interesting contributions from a number of my hon. Friends and from a number of Opposition Members. My right hon. Friend the Member for Brent, North (Sir R. Boyson) made a number of interesting and important points, not least about the value of assisted places, which, he said, involve taking pupils from poor homes to send them to the best schools, as a result of which 90 per cent. go on to university. That, believe it or not, is opposed by the Opposition.
Unfortunately, I missed my hon. Friend the Member for Chipping Barnet (Sir S. Chapman) making his return visit after his period in captivity, which usually takes place at this time of the year. We are delighted to have his contributions.
My hon. Friend the Member for Finchley (Mr. Booth) asked me to pay particular attention to the importance of autism and the treatment of it. I entirely endorse what he had to say. He will be glad to know that there are now double the number of speech and language therapists working than there were 10 years ago. The amount spent on the problem has trebled since 1979.
My hon. Friend the Member for Hendon, South (Mr. Marshall) endorsed the reforms that we are making in housing benefit. He was right to emphasise the impact that the present system has on driving up rents, and the importance of making the changes that we are making.
My hon. Friend the Member for Shoreham (Mr. Stephen) pointed out the nonsense and absurdity of the Opposition's policy in suggesting that one can manage a health service without any management.
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