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7.9 p.m.

Baroness Hollis of Heigham: My Lords, like other noble Lords, I sincerely thank the noble Lord, Lord Campbell of Croy, for initiating the debate which allows all of us to recognise and affirm the individual nature of disability and the distinctiveness of a disabled person's

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experience. My noble friend Lord Ashley of Stoke reminded us of invisible disability. The noble Lord, Lord Rix, reminded us of learning disabilities. The noble Earl, Lord Haig, spoke about the war injured. The noble Lords, Lord Selsdon and Lord Quirk, and the noble Baroness, Lady Masham, referred to those needing specialist medical and orthopaedic help.

As the noble Lord, Lord Campbell of Croy, said, the word "disability" brings to mind the image of the guide dog or the wheelchair. However, as the noble Lord, Lord Addington, rightly pointed out, tonight we are talking about the differences. It is worth reminding ourselves that, for every 1,000 people, three of us will have severe learning difficulties; another 20 will have some impairing degree of learning disability; six of us will have a significant loss of hearing since childhood and over 100 of us will be wearing hearing aids; 10 of us will be in wheelchairs and 10 of us will have dementia—namely, Alzheimer's; 17 of us will be blind or partially sighted and 100—that is, one in 10—will have mental health needs, to say nothing of those with asthma, angina or arthritis. Our needs—their needs—are different. Our abilities—their abilities and their disabilities—are different. Their aspirations are different and the demands that they may make on services and carers will be different.

The Disability Income Group has shown what that means for two real-life families. Jennifer is a five year-old child with severe cerebral palsy. Her parents already face heavy laundry bills and heavy costs because of extra clothing and bedding, fitments for the wheelchair, as well as heating costs and the like. They amount to some £60 per week. If Jennifer had a lightwriter, which would allow her to communicate by blinking, that would cost £2,400. A special chair with adaptations for her parent's car would cost between £6,000 and £7,000.

The DIG also cites the case of James from another real-life family. He is 57 and brain-damaged as a result of an accident. His sight, speech and hearing are worsening. He is sometimes violent. He is often dizzy and spends his time playing expensive computer games. His wife cares for him around the clock. She tells DIG that she has to have domestic help at £21 per week, that he needs private physiotherapy at £20 per week and that their laundry, clothing, bedding and hygiene costs amount to £50 per week. Almost £1,000 has been spent replacing furniture that has been damaged, to say nothing of the computer games.

As my noble friend Lord Ashley reminded us, someone with hearing difficulties may need amplifiers or interpreters. Those with loss of vision may need anything from a magnifying glass to a talking calculator. Someone who has broken his or her back in an accident and is now in a wheelchair but who has the capacity and the will to seek work may well need to employ a team of carers throughout the day and night.

As each and every one of us has said tonight, the abilities and disabilities are different, yet what disabled people have in common perhaps outweighs the differences between them. What they have in common is not so much their disability, but their poverty and the poverty of their carers. Two-thirds of the nearly 7

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million disabled people in this country live in or on the margins of poverty. It is poverty that reduces their quality of life, disables them and excludes them from mainstream society.

Three out of four disabled people live on social security benefits. They are three times more likely to be unemployed and, if in work, they are likely to earn much less than non-disabled people. Yet, with lower incomes, disabled people and their carers face higher costs. Being disabled is extremely expensive because of taxi fares, home adaptations, special diets, extra laundry, additional heating, personal care and special equipment. Disabled people have lower incomes but higher costs and an inadequate and incomplete benefits system to bridge the two.

What is wrong with the current benefits system? First, it is horrendously complex. I tried to count the benefits. It appears that there are something like 30 different disability benefits to which a disabled person or carer may be entitled. It is a full-time job being disabled.

Secondly, the actual level of benefit for both disabled people and their carers is woefully low. If he or she is fortunate, the average carer will get an invalidity care allowance of some £35 per week if caring for someone full time for more than 35 hours per week. However, if the carer cares for two people for 20 hours each a week, the carer will get nothing at all. Therefore, the carer's income depends in turn on the type of benefit which the disabled person is entitled to claim, thus affecting all sorts of relationships.

Thirdly, the way in which and the place where someone becomes disabled, where they have worked, their age and their national insurance contributions determine what they get. So two people who are equally disabled may find a difference in their benefit of over £200 per week. What is needed is a benefit that reflects not how or why people became disabled or where they incurred their disability—or even how disabled they are—but a benefit that reflects what is necessary financially in order to provide that person with an acceptable quality of life.

Fourthly, although the level of benefits is determined nationally, the cost and quality of care in the community is locally determined, as the right reverend Prelate the Bishop of Worcester said. Whether local authorities do or do not charge for home helps, day centres or personal care is up to them, and whether they do or do not charge makes a tremendous difference to the disposable income that is available to a disabled person for heating, laundry, diet and taxi costs. Referring again to figures from DIG, Hertfordshire charges a minimum of £18 per week for three hours' care. That is about half of the entire DLA care component. In Doncaster, which has privatised its non-medical care services, clients—disabled people—are being charged over £5 per night and nearly £5 per day for care. Some authorities are even considering asking people on income support—the most minimum level of income—to pay for care services. Why? Not because local authorities are nasty, but because the Government have required local authorities to recoup 9 per cent. of their costs through charges. How are they to be met? By charging disabled

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people. From where do the Government expect disabled people to find that money apart from top-slicing it off their benefit, which is what they will have to do?

Fifthly and finally, I should welcome a comment from the Minister on what appears to be an emerging problem in the benefits system for disabled and partly disabled people. It looks as though people are going to be signed off what is now invalidity benefit and what will become incapacity benefit on the ground that they are fit to do some light work. Already, however, the NACAB is finding that one-third of the people who are referred to it are having difficulty being regarded as fit and available for work and so do not qualify for unemployment benefit and may not in future qualify for the jobseekers allowance. So, people are being disqualified from one benefit but are failing thereby to qualify for another. What are they to live on?

Few disabled people can survive on their benefits or on so-called "care in the community". Instead they are subsidised. By whom? Their carers. Those carers spend their own money on diet, heating, laundry and transport for the disabled person. In the process, the carers exhaust their own savings and too often go into debt. Indeed, they are often dependent on benefits themselves. When their caring responsibility ceases—I hope that the Minister will tell me that I am wrong on this—they will apparently not be eligible for benefit because a disqualification from unemployment benefit will be carried over to the JSA if they relinquish a caring responsibility and, as a result, have fallen short in terms of their national insurance contributions. So they are poor. They are often in poor health. The result of being a carer means that they in turn become so socially isolated that they lose the opportunity of being cared for in their turn when they need it.

The Alzheimer's Society has told us that half of all its carers spend more than 80 hours a week employed in care: two-thirds of them are stressed or tired; a third are lonely; and a third are in poor health themselves. That is why I hope—again I should welcome the Minister's comment on this—that the Government will look sympathetically at the Bill being promoted by the Carers National Association —the Carers (Recognition and Services) Bill—that my honourable friend Malcolm Wicks is introducing in the other place this afternoon which would require local authorities to assess the needs of carers and to be responsible for providing services such as respite care to carers.

As we all know, many disabled people do not want, and rightly do not want, to be dependent upon a carer to be cared for. They are able to care for themselves if they have the income to do so. That is why direct payment—we welcome the Government's proposed initiative on that—may become important to empower a disabled person to make the choices that all of us here take for granted each and every day. For other disabled people, especially those with learning difficulties, dementia, a fluctuating condition, chronic illness or who are in pain, their carers are their lifeline.

The relationship between a disabled person and his carer is not always easy. It is sometimes reluctant; it is sometimes conflictual; but care is usually offered with

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tenderness and generosity, and usually accepted with courage and grace. Let us be in no doubt that the most appropriate way in which the community can respond to disability is by ensuring that disability no longer means poverty; that carers' needs are assessed and met; and that disabled people enjoy the rights, opportunities and choices that only a proper civil rights Bill will guarantee.

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