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Mr. Kirkwood: That is helpful to know. That will help us to estimate the number of people who may or may not be affected. We can make some informed guesses about Scotland. The provisions for Scotland in terms of the Social Work (Scotland) Act 1968 will have to be given special consideration in Committee.
I emphasise the importance of effective support services. The hon. Member for Mid-Kent said that people with disabilities are, by and large, perfectly able to look after themselves and that that is right and proper. However, requiring some of them to pick their way through their liabilities and duties as employers without back-up and assistance is something else. The work of the Disablement Income Group is essential to make the Bill work properly.
Even if it cost a little bit of money in pump priming to set up the pilot schemes, to get best practice and to disseminate the results, it would be money well spent. The right hon. Member for Chelsea said--I am sure that he is right--that the Policy Studies Institute survey shows that the scheme, if operated properly, could save money in the long run, but it will take time to get there and it will take money to set it up properly.
Mr. Rowe:
The hon. Gentleman is on an important point. Does he agree that any money that is available, whether it is from savings made as a result of the local authority providing direct payments rather than services directly, or whether it is extra money, should be most profitably used by disability organisations rather than by local authorities?
Mr. Kirkwood:
I agree with that. I hope that we shall return to that point in substance and at length in Committee.
I am puzzled as to why the Bill--in clause 1(2),I believe--introduces liabilities for local authorities to examine financial circumstances. It puzzles me that the National Health Service and Community Care Act 1990--in section 47, I believe--treated the liabilities for local authorities to examine people's financial circumstances differently from this Bill. I do not understand why we are introducing new provisions that were not deemed necessary in 1990. The provisions, which of course give discretion to local authorities, have been working reasonably well. There is an argument about charging and the difficulties that it is creating, but I am puzzled as to why there should be a difference in approach between the 1990 Act and the Bill. There might be a perfectly obvious answer--
Mr. Kirkwood:
Perhaps one is about to come in my direction.
Mr. Bowis:
I do not know whether it is obvious, but the simple answer is that it is merely trying to put on a level playing field those who receive services and those who receive direct payments. The discretionary charge applies to both.
Mr. Kirkwood:
I am nervous about that, but I do not want to pursue the point further, as we may have further opportunities to do that. I suspected that that was the answer, but we have to be careful about the way in which it works in practice.
I return to a point that the Minister may not have picked up in my earlier intervention. I am still slightly nervous about this aspect. In Scotland, under the Social Work (Scotland) Act 1968, there are schemes which already permit direct payments. There is still concern there--from anecdotal evidence by people who know more about the detail than I do--that some schemes might fall foul of the regulations.
I listened carefully to the helpful intervention earlier from the Minister, who said, if I understood correctly, that nothing in the Bill will prohibit any legal schemes which currently exist. If that is also true for Scotland, I am content; if it is not, I am worried.
Mr. Bowis:
I can make the hon. Gentleman content: the schemes to which he refers--cash payments in emergencies--are not affected by the Bill.
Mr. Kirkwood:
In that case, I am happy to sit down. Before doing so, however, I congratulate the Government and hon. Members who have been fighting the good fight. It is a start. I hope that the prediction of the right hon. Member for Chelsea that this is something on which we can build will be borne out in fact.
Sir Andrew Bowden (Brighton, Kemptown):
It was indeed sad news when the House heard that Lord Jay had died. It was my privilege to have known him in my younger days. I know that he gave great service to the House and to the nation. He will also be missed as a member of the House of Lords chess team. Invariably, when I played him, representing the Commons, I lost. He will be missed.
We heard a steady speech, as always, from the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood). I find it difficult to disagree with much of what he said, except on one point, on which I must correct him. I can assure him that my hon. Friend the Member for Mid-Kent (Mr. Rowe) will have a substantial majority at the next election. If he did not, I would be very concerned about my own seat.
Attitudes to the disabled have changed fundamentally during the 25 years that it has been my privilege to serve in the House. The Government deserve considerable credit for the progress they have made in helping to act as a catalyst to bring about those changes. The Bill is another substantial step forward in the right direction.I know that, initially, and perhaps for too long, the Government had reservations, but they have now overcome them, and we can make yet another step forward for the disabled.
It is a fundamental right of disabled people in our country to be able to control their lives in their own way to a maximum degree, as individuals and through their recognised organisations. The House will be interested to know that, in Brighton, there is an influential group known as the Brighton Association of Tenants with Disabilities. It is a strong, effective body, led by a determined and courageous chairman, Max Vaughan.It has fought for many years for disabled people's rights, against anybody who it feels has not been helping and co-operating. I have no doubt that it will greatly welcome and recognise the strengths of the Bill, which will increase choice and increase disabled people's rights.
As hon. Members on both sides of the House have said, the Government must clarify, and quickly, the question of eligibility. It is unacceptable to the great majority of hon. Members to restrict the eligibility criteria on the grounds of age or type of disability. A high percentage of disabled people are older people. There must be no age discrimination.
People whose disabilities begin after 65 already feel discriminated against. They are unable to obtain any benefits towards the cost of mobility. They are not able to make claims for financial support from the independent living fund. Many older people who receive community care services find that their local authorities offer less support--either in fewer services, or services to a lower
value--for those over 65 than for those under 65. These distinctions are made purely on the basis of age, and that is wrong.
If age discrimination is not eliminated from the Bill, or if the Government do not make a very clear and positive statement before the Bill comes back to the House, I shall find it very difficult, if not impossible, to support it on Third Reading. I hope that the matter can be clarified when the Bill goes into Committee.
I now come to two other important points. I am delighted that my hon. Friend the Minister made it clear that the Government will support and help in every way to establish schemes to advise, assist and help direct payment recipients to buy services. That will be vital for the local authorities that have had no experience of operating such schemes.
That will also be vital for a large number of individuals who will have the basic common sense and experience of life to handle their own finances but who will need detailed help. That is where local authorities will have a very important role to play. I do not ask my hon. Friend to deal with that in great detail in his winding-up speech, because I have no doubt that he will give further details of the scheme in Committee.
I should be grateful if my hon. Friend would clarify a point relating to direct payments. Surely there is no question of such payments being considered capital or income; that would be fundamentally unfair.
Mr. Bowis:
I am happy to confirm that, but, if clarification is needed, it will be provided.
Sir Andrew Bowden:
I thank my hon. Friend.
Mr. Gerry Steinberg (City of Durham):
I, too, welcome the Bill--as, I am sure, do most disabled people.
In 1994-95, statistics issued by Scope showed that72 per cent. of disabled people wanted more independence, and 59 per cent. wanted more control over their everyday lives. Most local authority social services departments also welcome the Bill: most are committed to the principles of empowering users and carers, and offering them maximum flexibility and real choice in respect of the services that they receive. That view has the full support of disabled people, many of whom find dealing with social services a nightmare. That has been particularly true over the past few years, when resources have been scarce, to say the least.
One of my constituents has cared for her severely disabled daughter for more than 30 years. Virtually everything has to be done for the disabled girl: caring for her has been more than a full-time job for her parents. The mother wrote to the social services department in April 1994:
I only hope that the Bill will prevent the repetition of problems such as the one experienced by that frustrated mother.
Paying disabled people money directly, so that they can purchase services themselves, is the ideal way of empowering them. In the past, many social services departments have examined ways of skirting round existing legislation--for instance, voucher or brokerage schemes. As has already been pointed out, at least60 direct payment schemes are already working successfully in some areas. The Bill, however, will end the legal anomaly that prevents local authorities from making any payment to a third party in connection with the provision of community care.
Although I support the discretion being given to local authorities to decide whether to offer direct payments, and the ability of people to decide whether to manage their own care, I firmly believe that the Government are making a huge error in allowing the Secretary of State to make regulations excluding whole categories of disabled people. In limiting the option of direct payments to those with physical disabilities aged between 18 and 65, the Bill itself becomes discriminatory: it discriminates against those aged 65 and over, and against those with learning difficulties.
As a former headmaster of a school for children with special educational needs and, in particular, learning difficulties, I find it extremely distasteful that the Government appear to be discriminating against an entire section of the community, regardless of individual circumstances. People with learning difficulties should not be excluded automatically; they should be allowed to exercise the direct payment option, if they are able to do so, and should be given all the support they need.
I also think it absurd that people who may need care in the community as much as any other group--those over 65, especially the disabled--are to be disqualified by the regulations. I conclude that the disqualification is based on the fact not that those people cannot understand or decide on their needs, but that such care would cost more money. As always, well-intentioned legislation has been ruined by the Government's failure to provide the necessary funds.
Some schemes that are running successfully now will not be within the terms of the new regulations--for example, schemes that include people over 65 and/or people with learning difficulties. Will such schemes be allowed to continue? I was not sure of the answer earlier in the debate. I am delighted to see that the Minister is nodding, but I hope that that will be made clear in the Bill; it certainly is not clear now.
It would be nonsense not to include such groups, especially as, under the proposed new regulations, local authorities already have discretion to award payments to those who are "able and willing". That in itself gives
enough discretion to authorities, and will ensure that all who can and want to participate will be able to do so. If the Government are not prepared to include those groups in the Bill immediately, as they should, the least they should do is agree to a review of the initial scheme once it is up and running, with the aim of adding other groups as quickly as possible.
I am pleased to learn that individuals may receive a mix of direct payments and services. That will allow increased flexibility in the design of care packages, and may also be important in ensuring that the developing community care market is not destabilised. I fear, however, that the legislation could become a charter for unscrupulous providers. We have seen such developments in some of the private nursing homes that have been set up over the past few years. When an agency or commercial provider is used, it should be one that has been approved or accredited in some way.
A rigid inspection service should also be introduced, either by local authorities or by the Government, to ensure that a high-quality service is provided. I have no doubt that some people will seek to exploit the new system, seeing it as a way of making easy money. The last thing we want is the exploitation of disabled people. Most people in receipt of community care have limited resources, and must be given value for money; monitoring will be necessary to ensure that that money is spent properly. Once money had been spent, it would be almost impossible to recover if it had been spent improperly. Local authorities need the power to keep an eye on things.
I agree in principle that close relatives should not be paid to provide a service. I firmly believe that we all have family responsibilities and obligations, but regulations should allow recipients to purchase services to provide some respite for informal carers, and allow them to recompense neighbours, friends and, in some instances, relatives who provide regular and substantial assistance.
I should like to quote a letter to Crossroads from the same lady whom I quoted earlier. It shows her frustration and difficulties in obtaining respite care for her daughter.It states:
I hope that that moving letter to Crossroads will end the frustration that people such as that lady feel in failing to obtain proper respite care.
Local authorities should be allowed the discretion to decide bona fide arrangements. They should be allowed the discretion to decide any period of temporary residential or respite care that is needed. To fix a specific number of weeks in one year is inflexible, and does not cover for the unexpected.
My understanding of the Bill is that, if a disabled person wished to use direct payments to employ someone as a care assistant, they would have to take on all an employer's responsibilities. For example, they would have to understand the workings of tax deductions, national insurance, employer liability insurance, and sick pay and holiday pay. That is a formidable task, and could put many disabled people off the scheme.
If my assumptions are correct, surely those people should not have those responsibilities, and a system should be devised to avoid it. If that is not possible, however, it is obvious that a huge amount of support will be needed for someone who has never had to hire or fire before. The Government should make it clear in the regulations how that support will be organised and provided.
As I said, if there is not adequate support, many people may be put off from using the scheme. Consequently, direct payments would be likely to reach only a limited number of people, which is the last thing that we want. Over the years, the Government have produced some reasonable reforms in the special needs sector--I admit that, and have congratulated them on it. I think in particular of special educational needs.
The Government have always failed, however, in that they have never provided the resources to ensure that those reforms were successful. What disturbs me about these proposals is that, unless adequate resources are made available for community care--clearly, they are not at present--the new system could become a cheap and easy option for some local authorities, or lead some to cut services.
Equally, the Bill must not become a means in some sectors of passing responsibility for an underfunded, failing community care system to disabled persons. Inadequate funding could fail the system and do the opposite of what the Bill hopes to achieve. It could threaten disabled people's independence.
6.53 pm
"Dear Mr. Brookes
It gives me no pleasure at all to write to you about this matter.
I remember the first meeting I went to at the Abbey Day Centre on care in the community and for the first time in Karen's life I felt like the future was looking better for carers like myself. After
6 Mar 1996 : Column 398reading carers magazine and hearing that families like mine will have assessments made, I decided to phone for an assessment. All I asked for was that if there was a problem here, I could ask Social Services to provide extra care for Karen from Crossroads . . . Since the third visit from the Social worker Crossroads said they would help me to have a week's holiday so I asked if Social Services would pay so much towards the extra care.
I cannot understand how money appears to be available for services I do not want, but it seems so difficult for a service I do want. I would rather have 2 hours of care that I do want than 10 hours of care that I do not want."
"Dear Ros,
Ref. to your visit regarding assessment of Karen, I cannot go on holiday without writing this letter.
Monday's visit was different and after Tuesday's phone call; when I had time to think about what you had said, when I said I did not want a new lady coming to visit here, you said that if I was hoping for respite care and hoping to have a weekend away for eg., then I would have to see this lady because you could not see the time when Crossroads could provide this care. I hope you realise that at St. Nicholas Church Hall recently when someone told Mr. P. Brookes that caring for someone at home was made more complicated by the system of offering care which consisted of a bit of help here eg. District Nurse, a bit there Dom. Care, a bit from ILF, a bit from Crossroads, and now you say a bit from this lady you know . . . The cost of care for Karen while we are on holiday is a lot of money but 4 years ago I know it was costing £600 a week for someone like Karen to live in a home for the severely disabled. Also this is the first time in her 32 years that help has been given to us so that we can have a holiday knowing Karen is being properly cared for in her own home.
As for what you have offered, forget it, Karen has to have such personal things done to her just to keep her going, she wants continuity in her care, not anybody or everybody."
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