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Mr. Bowis: The purpose of that provision is to preclude payment for services along the lines mentioned by the hon. Member for Monklands, West (Mr. Clarke), not to preclude people receiving payments on behalf of the individual, if that is what the individual wishes.
Sir Nicholas Scott: We shall need to look carefully at the regulations when they come out, to ensure that they cover that point.
The last point that I should like to make is that the payments of cash to disabled people should, when calculated, provide not only for the actual cost of the provision of care, but for matters such as national insurance, statutory sick pay and insurance, which are necessary for a comprehensive and effective package.
Mr. Alfred Morris (Manchester, Wythenshawe):
I want, first, to thank the Minister for his clearly heartfelt words, which could not have been more felicitously chosen, about the life and passing today of Douglas Jay. For many years, Douglas was my close colleague in this House, and I kept in touch with him after he departed for another place. There are still some right hon. and hon. Members who will remember just how closely at times I worked with him. They will know how very moved I am by his death. I loved his humour and benefited much both from his learning and parliamentary skills. I mourn his passing and will ever cherish his memory.
It is, of course, a pleasure for me to follow my hon. Friend the Member for Monklands, West (Mr. Clarke) in this debate, and I pay warm tribute to the depth of his concern to improve the Bill in ways that disability
organisations want to achieve. At the same time, I am delighted to see by his side on the Front Bench ourgood and hon. Friend the Member for Paisley, South(Mr. McMaster), in pursuance of his abiding commitment to the cause of extending choice and enhancing the freedom and independence of disabled people.
The intensity and extent of interest in the Bill among disability organisations is demonstrated in all the helpful briefing we have had from them. There should be a word of gratitude also today for organisations which, while they may not have lobbied the House in recent days, were very much involved in the earliest campaigning for direct payments like, for example, the Association of Disabled Professionals, who, five years ago, on 21 March 1991, met the then Secretary of State for Health to press for a nationwide scheme of direct payments. Their concern then, like mine in this debate, was to quicken the pace of progress from paternalism to partnership in addressing the problems and needs of disabled people.
Five years ago, direct payments were being made to disabled people only by a few pioneering local authorities. The fear that they were acting illegally prevented other councils from following suit: in their areas disabled people had to rely for help with personal and domestic tasks on whoever the local authority sent and, as the right hon. Member for Chelsea (Sir N. Scott) said, at times that best suited the council. The people sent to help would only do what they had been trained to do in the way that they had been trained. Often this did not meet the real needs of the disabled person and was not, therefore, to her or his liking. But it was Hobson's choice. Either they docilely accepted what was organised for them or they were shunted into residential care.
With direct payments the few disabled people who received them were able to employ helpers of their choice at times that suited them and in a way that they wanted. In short, direct payments helped disabled people to regain some control over their own lives. That is why the Community Care (Direct Payments) Bill, which has its origins in that meeting five years ago, has been so widely welcomed by disabled people. Welcome though it is, however, there are three areas in which I hope it will be improved.
First, there is the Government's proposal initially to allow only physically disabled people below the age of 65, including those with sensory impairments, to receive direct payments. That is wrong and I hope the House will insist that people with learning difficulties should be included from the outset. Only to include people with learning difficulties if they also have a physical or sensory impairment, as the Government propose, is hardly logical and will be difficult to justify in practice when dealing with real people in their homes. To distinguish between physically and sensorily disabled people on the one hand and people with learning difficulties on the other means singling out one group for special treatment thus creating a class of favoured disabilities, which is as distasteful to most disabled people as I am sure it will prove unacceptable to this House.
I turn now briefly to the proposed age bar. To exclude people from direct payments if they are over retirement age smacks, some might say reeks, of unfair discrimination. It presumes that chronological age is the main determinant in measuring need; but that is demonstrably untrue. Of course, the truth is that discriminating against elderly disabled
people by excluding them from direct payments is about keeping costs down. It has nothing whatever to do with logic or fairness.
Ideally direct payments should be payable to all adults who are able and willing to manage them, with some help if necessary and without age limit. I believe that local authority staff with direct contact with individual disabled people are in the best position to decide who to include in the scheme. Under the terms of the Bill, local authorities are to be allowed to refuse direct payments to any individual providing they act responsibly and reasonably in doing so. But why not let them act responsibly and reasonably in deciding who to include?
The second area for improvement to the Bill relates to the direct payment itself. Two issues arise here. One is that of ensuring that direct payments will in fact buy what the disabled person has been assessed as needing. Leaving aside the question of a contribution from the recipient, the direct payment should cover in full the real cost of securing the agreed service. In the case of an agency providing the service, the payment should allow the agency's staff terms of employment similar to those available to local authority staff. If the payment is used directly to employ a helper, the payment should allow the recipient to fulfil all her or his duties as a good employer.
In assessing how much a service provided by a local authority costs, the authority should ensure that its total cost is calculated. This should include all overheads and supervisory and administrative staff costs. Otherwise the comparison between direct payments and in-house costs relating to individual clients could result in direct payments becoming a means of cheapening the cost and reducing the quality of providing essential services. It is extremely important to safeguard the disabled person against that happening. Also very important is the Government's proposal for local authorities to allow individuals to supplement whatever they receive as a direct payment from their own resources. In all such cases, however, local authorities should not be allowed to reassess what the individual can afford and then demand an increased contribution.
As Ministers know, there is already widespread concern about the failure of some local authorities to understand their legal duties to provide services for disabledpeople, about which I questioned the Health Secretary on 29 February. My parliamentary question asked him
to which the Minister's reply was:
That reply was not well received by disability organisations that have been in touch with me since last Thursday and I hope that it will be urgently reviewed by the Secretary of State. Very clearly there is need now for clear further guidance to be issued.
The other issue relating to direct payments is that of means testing. It seems generally accepted by the Government and organisations of disabled people that it
will be essential to ensure that local authorities apply the same test of means for direct payments as they would apply for their own services. Allowing different means tests to be applied would enable a local authority to sway the decision of a client, either towards their services or towards a direct payment depending on their political proclivities. This would be manifestly wrong, but I believe it could happen unless, in addition to the guidance which the Government propose under section 7, the Bill's wording in relation to the assessment of a contribution is identical to the wording used in connection with the assessment of a contribution towards local authority services in section 17 of the Health and Social Services and Social Security Adjudications Act 1983, ("reasonably practical for him to pay").
Finally, the third area for improvement of the Bill relates to who a disabled person can pay to provide the help that she or he needs. At present, the Government want to limit those that can be paid. The idea is to avoid what they describe somewhat euphemistically as creating pressure for informal care to be put on a formal contractual basis--as Baroness Cumberlege expressed it in another place on 15 January. To achieve this the Government intend to exclude all so-called relatives living in the same household.
But I have serious worries concerning lodgers and others and the wording the Government use in referring to people in the same household. As paragraph 24 of the consultation document explained, such people are not to be paid
they
This would preclude a person who has someone other than a close relative living in the household--for example, a lodger or friend--from arranging with that person to become her or his helper. The wording suggests that they would have to be hired as a helper and then given accommodation. This is far too restrictive. It would also rule out direct payments to people who take in lodgers whom they subsequently decide to hire as helpers. There would be nothing improper in that and in my view it should be allowed.
In passing I want here to urge that care be taken in deciding who can be classified as a partner. Are gay and lesbian couples to be included? How will disabled people be protected from a local authority that is over-officious or intrusive in determining whether a partner is a partner properly so called? In regard to people not living in the same household, the Government intend to exclude so-called close relatives. The problem with their list is that it includes some who, in the real world, cannot really be termed close. The surviving partner of a stepson is an example. Thus I suggest that the list of "close relatives" should be re-examined and reduced.
It might seem reasonable to exclude anyone who is already providing assistance to a disabled person and for whom extra help is sought from the local authority. But this could exclude people receiving the invalid care allowance and would not be appropriate in all cases.It also raises the issue of how the invalid care allowance will be treated in relation to direct payments, about which so far there has been an ominous silence.
To avoid the difficulty the Government describe as creating pressure for informal care to be put on a formal contractual basis, while also avoiding a hard list of excluded relatives, it might be possible to put the onus of proof on the local authority to show that the person the disabled person sought to pay would provide the requisite care informally. In my view it should be possible, without treating it as an exceptional case as the consultation document proposed, to employ a close relative who is--and will remain--in residence elsewhere. This is particularly important in relation to emergencies. The consultation document sets down in paragraph 3 that disabled people will be expected to make sensible arrangements so that they have adequate cover in an emergency, for example if one of their usual assistants is taken ill.
"if he has now considered the implications to local authorities of the High Court's decision in relation to Gloucestershire county council's refusal to restore care services to over 1,000 disabled people in the county; and if he plans to issue further guidance to local authorities on the effect of section 2 of the Chronically Sick and Disabled Persons Act 1970 following the High Court's decision",
"I have no current plans to issue further guidance on this matter."--[Official Report, 29 February 1996; Vol. 272, c. 695.]
"unless"
"are people who have been specifically recruited to be live-in personal assistants."
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