| Previous Section | Index | Home Page |
7.51 pm
Mr. Alan Howarth (Stratford-on-Avon): The case for direct payments is supported by moral, practical and financial arguments, all of which point in the same direction. The moral argument, however, is the most important. The case for direct payments is most importantly expressed in terms of human dignity, personal freedom and civil rights.
Some hon. Members may have read the study published by Dr. Jenny Morris, entitled "Community Care or Independent Living?", in which in citing one of her case studies, she sets out the view of Maria, who talked to her about direct payments. She said:
There is an ambiguity in the term "care". We like to associate care with cherishing and loving people, and through that giving them the best support that we can. However, care has perhaps too often meant, in practical terms, something that is more akin to being taken care of and to being dealt with as a problem case.
Another of Jenny Morris's interviewees used the word "custodial" to describe the care that she had received.Too often, care has been somewhat too akin to institutionalisation within the community. It is not so with independent living. But if that is made possible through direct payments, services can be fitted to the needs of the individual disabled person rather than his or her needs being accommodated to the needs of the social services authority.
Direct payments are good for the disabled. With the best will in the world, social workers are unable to design packages of care that are as sensitive, flexible and precisely tailored to the needs of individual disabled persons as those that disabled people are able to create for themselves. Inevitably, social workers must juggle with the needs of a range of clients. They must work within the rigidities of bureaucratic life. I make no criticism of them for that. With direct payments, however, all concerned are released from such limitations.
Direct payments make it possible for the demands on families to be eased and for the stresses and burdens to be lightened. They are good for local authorities too, because they enable authorities to use the expensive time of skilled, professional staff to do the jobs that only they can do. It is absurd to have highly trained and qualified staff organising the lives of intelligent people who can do that perfectly well for themselves.
The financial argument reinforces the moral and practical ones. As the right hon. Member for Chelsea(Sir N. Scott) said, experience tells us that the cost of providing care that is organised by the disabled person personally with direct payments is about 30 to 40 per cent. less than the cost of providing local authority services, because administration overheads are avoided.
That is a great recommendation in itself for direct payments. I hope, however, that the Government will not be tempted to use that factor as an excuse for applying a further squeeze on the resources that are made available to social services departments.
It is emphasised in the 18th paragraph of the consultation document that a local authority shall not arbitrarily decide to make payments that are inadequate. What is sauce for the goose should be sauce for the gander. After all, year after year the Treasury makes arbitrary decisions that lead to the making of inadequate payments, allowing only inadequate resources to be made available to social services departments. If local authorities are admonished by the Government and told not to behave in that way, I hope that the Government will take that lesson to heart themselves. It is an experience that we speak about with strong feeling in Warwickshire, where many of my constituents have recently experienced drastic increases in charges because of the inadequacy of the resources that are available for social services.
The Bill has been a long time coming, but I congratulate the right hon. Member for Chelsea, who over a long period wanted policy to develop in the direction set in the Bill. The right hon. Gentleman was responsible, of course, for the introduction of the independent living fund in 1988, which was a giant step towards making direct payments available to a wider range of disabled people. I congratulate also the hon. Member for Mid-Kent (Mr. Rowe) on his determination to pursue such a policy through a private Member's Bill. I know that the Under-Secretary, the hon. Member for Battersea(Mr. Bowis), has for a long time been thoroughly sympathetic to the objective. I am sure that he is pleased to have been able to carry the day within the Department.
Perhaps it was implicit in the tone in which the Minister spoke earlier that he accepts that the Bill is somewhat restrictive. I believe that it is too restrictive. The consultation document tells us that direct payments are a "new and untested development". That is not so. About 60 local authorities are implementing direct payment schemes through third-party agencies. It is a few years since the directors of social services unanimously resolved that they would like to see legislation introduced to empower social services departments to make direct payments.
It is a shame, therefore, that people with learning difficulties, as it is proposed, should be excluded from the new freedom. That seems peculiarly unnecessary, given the experience of the independent living fund. After all, 18 per cent. of the ILF's clients are people with learning difficulties. They manage very well, provided that they have the advocacy, assistance and support services that the Government themselves envisage. If people with learning difficulties are to be excluded, will people with a history of mental illness be similarly excluded? I ask the Minister to comment on that now or later.
I share the regret that was expressed by several hon. Members, that people over 65 are to be excluded, at least initially. Some 37 per cent. of the beneficiaries of the
original independent living fund were people over the age of 65. The Royal National Institute for the Blind has pointed out that a high proportion of people who are visually impaired are over the age of 65. The blind and the partially sighted will feel that the existing inadequacies of community care are certain to be reinforced by this feature of the new policy. People over 65 are as likely to be fully capable of organising and managing their own budgets for personal care as are people under 25.
There is an irony in the consultation document. Section L states:
However, section B sets out the Government's proposals for discrimination--the exclusion of people with learning difficulties and people over the age of 65. Age Concern has termed that "blatant age discrimination". If the Government consider that Age Concern is biased, perhaps they will heed the Law Commission, which recommended:
The Government's timidity is misplaced. There is a great deal of experience around. I hope that they will reflect carefully on the injustice and the dashing of hopes that their policy, as they at present intend it, will cause.
The Government want to give local authorities discretion as to whether they should run direct payment schemes at all. The very existence of that discretion will result in discrimination, which I regret. If the Government are to give local authorities such discretion, surely they do not need to double-bank by taking a discretion unto themselves as well, through the regulation-making power. Surely we do not want to pursue a discriminatory policy. The creation of a double discrimination, through central Government regulations and the scope that will be provided for local authorities to restrict their schemes, is deeply regrettable.
I hope that when the Government have considered the responses to the consultation, including this debate, they will, after all, be willing to espouse option (f) in the consultation paper:
should be eligible to be included in the schemes.
If the Government should feel unable to go that far, it is essential that they make it clear, formally and explicitly, that local authorities should not unreasonably refuse to operate direct payment schemes where there is demand for them. Where local authorities operate them, it should also be insisted that they do so according to clearly expressed criteria, consistently, not capriciously, applied. Disabled people need to know where they stand.
Local authorities would welcome guidelines from the Government. While we want experimentation and local innovation, it is essential that minimum national standards should be stipulated. Pauline Thompson--who has been rightly praised by the right hon. Member for Chelsea and who has done so much wonderful work in this field, both as a trustee of the original independent living fund and as director of the Disablement Income Group--has called for a national code of good practice. I hope that the Government will be willing to respond positively to that. I commend the DIG for the handbook that it has produced in timely fashion, entitled, "Facilitating and Supporting
Independent Living". I also appreciate the support of the Joseph Rowntree Foundation for the British Council of Organisations of Disabled People, for the guidance that it has produced to support independent living schemes.
It goes almost without saying, yet needs to be said, that local authorities must have adequate funding. It is their duty to fund the needs that they assess, but it has been a duty too often honoured in the breach. They need to supply the resources to enable disabled people to be employers--and good employers. The costs that need to be met must include the costs of recruitment, PAYE, national insurance, sick pay, holiday pay, insurance costs such as employer's liability insurance, and, in certain instances, redundancy costs. Many people will need to pay the fees of domiciliary care agencies.
My hon. Friend the Member for Wakefield(Mr. Hinchliffe) said that we need to consider the status of domiciliary care agencies carefully. For one thing, the VAT position is anomalous. I understand that there is exemption from VAT where an element of medically qualified supervision is associated with a domiciliary care agency, but not otherwise. All agencies should be exempted from VAT, provided that they are registered in a national scheme, such as that proposed by my hon. Friend, and subject to proper inspection.
Among the other costs that will need to be supported by local authorities are those of training, advice and advocacy. Local authorities will do well to give their support to user-led voluntary organisations, which will be especially cost-effective, because they have crucial insight into the needs of disabled people. They make it possible for disabled people to share experience and expertise, and to pool overheads such as payroll costs.
I hope that local authorities will give support at a suitably early stage. Paragraph 6 of the consultation document states:
If we start to provide support only following an assessment, it will be too late. From the moment an assessment is contemplated, the question whether it would be appropriate for a disabled person to use direct payments should be under active consideration. I should not need to stress, but it may be worth so doing, that disabled people must be fully involved in the assessment of need, because nobody understands their needs better than they do.
I welcome the Government's proposal to permit direct payments to be used to pay for the costs of aids and adaptations. That is an encouraging flexibility, but disabled people need expert advice on that especially.It can involve much bafflement and the waste of a great deal of money. In everyone's interest, it is important that competent, expert advice should be available to disabled people locally. I ask the Minister to assure the House that the provision will not restrict the existing entitlement to aids and adaptations for which there is no charge.
I was puzzled that the consultation document proposes that direct payments should be usable for a maximum of only four weeks' respite care in a 12-month period. I do not understand the basis for that arbitrary figure. I think that judgments should be made case by case, as the amount of respite that may be needed will vary greatly between households. Respite care is an excellent investment: it enables people to remain in their own
homes or allows carers to continue to provide care for longer periods. That is highly desirable in itself, as well as cost-effective.
I hope that the Government will not give with one hand and take away with the other when it comes to charging. The charging regime across the country is riddled with inconsistencies and inequities. We must have some national guidance in order to establish a more acceptable pattern and achieve greater consistency and fairness in that field. I note that the Government intend to dock direct payments by removing charges before the payments reach disabled people. I believe that that is discriminatory and I hope that the Government will reconsider their decision. Why should the Government take from disabled people the resources that enable them to meet community care charges, rather than allowing them to act for themselves, as others do? In any case, disabled people should have the power to negotiate the appropriate level of charging. They may need to hold a valid discussion with social services authorities on the subject.
A number of hon. Members have mentioned the restrictions that are imposed on members of a disabled person's family who may qualify for payment through a direct payment scheme. It is impossible, as well as undesirable, for the state to shoulder responsibility for the vast effort that goes into informal care. There are some6 million carers in our society and the state should not intrude upon care that is willingly and lovingly given by relatives and friends. However, we take too much for granted that extensive devotion and care.
Very tight restrictions govern the invalid care allowance, and £32.25 per week is a meagre allocation. While the Government are considering policy in this field, I hope that they will examine support for carers. The principle that the state should, in appropriate circumstances, subsidise family members who care for a disabled person is already established through the existence of the invalid carers allowance.
The list of exclusions in the consultation document as to family members' eligibility to receive payment is strangely arbitrary--for example, a niece or a cousin is not precluded. The guidelines are too rigid--although the Government acknowledge that flexibility may be needed in rural areas, such as my constituency, where it is not easy to find people outside families who are available and capable of assuming a caring role. It would be very unfortunate to preclude payments to family members in areas such as south Warwickshire. I hope that the Government's intentions in that area will be interpreted much more generously.
The Government do not need to fear that there will be an enormous explosion in the amount that is spent supporting family members who are also carers. Many disabled people would love to be less dependent and to feel less of a burden upon their families. They often wish not to employ family members but, where they do, we must recognise that that can be extremely cost-effective.
The Government are proposing two different sets of rules. The consultation document sets out the limitations on the employment of family members under direct payment schemes. However, there is a rather more generous system with the independent living fund.I suggest that it would be sensible to have common
criteria for both schemes--not least because a not inconsiderable number of disabled people will receive funding from both sources. I hope that, in making a cost-benefit analysis of their proposals, the Government will recognise that, by supporting family carers, they may give disabled people the opportunity to work and to contribute to the economy.
"It means I can get up in the morning when I want to, go to bed in the evening when I want to, go out when I want to and lead the kind of life that I want to . . . to not be reliant on my family and friends . . . to keep all that separate (so that) to them I'm me rather than someone who needs help."
"suitability for direct payments should be considered in a non-discriminatory manner for all eligible people requesting them."
"There should be a presumption against lack of capacity".
"All adults who are able and willing to manage direct payments (with help if necessary), with no age limit"
"The Bill starts from the point where, following an assessment".
| Next Section
| Index | Home Page |