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Baroness David: I thought that it was rather a clever response from the Minister to say that the amendment was going against the principle of the Bill. However, he went on to be a little more sympathetic. There really are problems. I have another example involving an 18 year-old who had to change a course. She was partially blind and there was not the support at one college. She had to move to a college a little further away. The local authority would not pay travel costs

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because it was not the nearest college. Local authorities probably differ a little in their responses to cases of need. I am grateful to the Minister for saying that he will consider giving a little more guidance. That would be helpful. I am grateful, too, that if we have individual cases for consideration, he will consider them or send them to the Department for Education. I am sure that we should all like to read what he said and hope that he will deal with the guidance problem. Granted that, for the moment I beg leave to withdraw the amendment. Amendment, by leave, withdrawn.

Lord Ashley of Stoke moved Amendment No. 59:

Page 9, line 10, at end insert:
("( ) the provision of services includes the provision of services to a disabled person representing another person in their capacity of parent, guardian or carer;").

The noble Lord said: I am well aware that the Government seek to confine the Bill to disabled people. However, the amendment seeks to extend the duty of service providers to provide access to goods, facilities and services to parents and carers.

There will be, and have been, cases where an able-bodied person needs the assistance of parents or a carer. A perfect example is of a normal hearing young boy in a court of law, needing the assistance of his totally deaf parents. Because those parents did not have any interpretation, they were unable to help the boy, so we required help for the parents in order to help the boy. It is clear that, if we do not get help for people in that situation or in hospitals, then justice fails to be done. If parents have to give their consent or otherwise to an operation which may be necessary in a short time, then we are in trouble.

The same principle applies to carers. There is a precedent for them because Section 3 of the 1986 Act on disabled persons—a section which was never implemented by the Government—provides that a disabled person has a right to communication support. Section 8 of the Act—also not implemented—extended that right to carers. It is all too easy for us in this House and another place, enjoying the debates and clashes of opinions and views, to be carried away with our words, phrases, speeches, theories, amendments and subsections and forget the realities. The reality behind the amendment is shown from the number of examples produced by the RNIB. The examples deny the pleasant advertising picture of carers being chubby, happy middle-aged ladies, getting a coffee for a smiling disabled person and patting the pillow. I will quote only one of the examples, because of lack of time. A man, Mr. M, is blind and is caring for his wife, who has multiple sclerosis. Imagine that kind of situation: he finds it difficult to obtain information about services for her in a form which is accessible to him.

There are other examples which I have no time to read. They are special cases which require special provision. I know that special pleading is not popular in the House, but such people are in great need of help

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under the Bill. I hope that the Minister will be able to give a sympathetic hearing to the amendment. I beg to move.

6.30 p.m.

Lord Mackay of Ardbrecknish: I have given a sympathetic hearing to the points made by the noble Lord and hope that I can allay his anxieties by trying to deal with the general point that he makes.

First, the Bill will prevent discrimination against all disabled people to whom a service is being provided. It will not matter in what capacity a disabled person is acting when an alleged act of discrimination takes place. I will check because it is a serious point and I am trying to make almost a legal interpretation of what is in the Bill. I believe that the example quoted of the blind husband seeking information pertains more to the wife with multiple sclerosis. That would be encompassed by the sentence which I have just read from the brief.

Where a service would normally be provided, for example, to a disabled parent, that service will have to be made accessible. We are content that, where a doctor is treating a young child, he not only provides a service to the child but to his parents as well. That would include such things as the provision of information about the child's illness and facilities for the parent to accompany the child.

The Bill will therefore cover many of the situations with which the amendment is concerned, although I am conscious, from the previous remarks of the noble Lord, that he is concerned about education and the provision by schools to disabled parents of information about their children. It may be parents who are deaf and whose children go to school. The noble Lord wishes to be sure that the schools will be sympathetic to that case.

All education is excluded from the general right of access provisions. However, I am pleased to be able to say that the Department for Education will be consulting on this important issue. Following the outcome, it proposes to revise existing regulations to provide for schools to make information available to parents in accessible formats.

With those assurances and that clarification of what the Bill means, I hope that the position is acceptable to the noble Lord. Perhaps I may go one step further in order to clarify the matter. If we consider carers, if information is made available to other carers, then it must be available in an accessible format for disabled carers. That confirms what I said about the example that the noble Lord gave of the blind husband looking after the wife who has multiple sclerosis. If information is available to a husband who is totally healthy and normal—using that word, I hope, in a positive sense—then the blind husband also should be able to obtain it under the Bill. I hope that those explanations are helpful to the noble Lord and that he will not only be able to withdraw his amendment but will feel comfortable in doing so.

Lord Ashley of Stoke: That explanation is helpful and much appreciated. Although it does not completely meet the points, it is constructive and I am happy to withdraw the amendment.

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Amendment, by leave, withdrawn.

Lord Carter moved Amendment No. 59A:

Page 9, line 10, at end insert:
("( ) the provision of services includes the provision of health care services.").

The noble Lord said: In moving Amendment No. 59A, I wish to speak also to Amendment No. 64, which deals with much the same point. The purpose of the two amendments is to try to get the position clear regarding possible discrimination in providing health care. The duty of a doctor is clear. Helpfully, the BMA has spelt it out in a letter stating that the BMA's policy—and I hope that this will be the professional opinion—regarding access to medical care is as follows:

    "Doctors owe a duty of care to all their patients, and each patient must be assessed individually and share in decisions about treatment options. Treatment offered must be based on clinical judgement and sound scientific evidence of likely benefit. It is unethical to refuse an available treatment to any patient who might benefit from it and who is willing to have it".

That is clear, although many of us have anxieties about the attitude of GP fundholders. We expressed that anxiety on proceedings on the National Health Service and Community Care Act 1990. I spoke from the Dispatch Box at that time about our concern that GP fundholders might start to discriminate between patients on the basis of their likely cost. At least the BMA has spelt out clearly that a doctor should not be able to discriminate against disabled patients.

However, there are other areas of care: community care, nursing homes, residential homes, the whole area of healthcare and community care. We wish to be clear about whether all healthcare services, of whatever kind, are caught by the Bill. The BMA states that its interpretation is that those services are caught by Clause 12(3) (h):

    "the services of any profession or trade, or any local or other public authority".

Amendment No. 64 covers the problem in a different place but it has the same intent. It is based on the fact that healthcare seems to be specifically excluded from the examples which are given in Clause 12(3). Is that exclusion deliberate or an oversight? Is the exclusion acceptable, since our concern is covered in another place in the Bill? The object of the two amendments is to clarify the position regarding possible discrimination in providing healthcare and to ensure that all healthcare services, of whatever kind, are included in the Bill. I beg to move.

Lord Robertson of Oakridge: It is my intention to move Amendment No. 64, which aims to alert all who are concerned with health care and the provision of medical services to the changed situation that will result from the passing of this Bill into law. My amendment, based on wording suggested by MENCAP, underlines that what is now largely a matter of medical ethics and codes of practice will come under a law that will make it an offence to discriminate against disabled people. Incidentally, I saw the amendment tabled by the noble Lord, Lord Carter, only this afternoon. It seems to me to be a perfectly possible alternative to my amendment. However, I do not wish to comment on it any further at this stage.

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One has to comb the Bill very closely to find any references to these subjects. However, Clause 12(3) (h) mentions,

    "the services of any profession or trade, or any local or other public authority".

The Minister of State advised me in a letter that this provision extends to include health care and medical treatment. I believe, however, that this is such an important area that there should be an explicit reference to it on the face of the Bill, putting the matter beyond any possible doubt. That is what my amendment is designed to achieve. In order to inform myself, I wrote to about two dozen leading disability organisations, voluntary and professional bodies. The reactions I received ranged from that of the BMA, which felt that there were no problems of discrimination and was happy with the Bill as it stood, to that of RADAR, which felt that the issue was so big that a separate Bill might be necessary. The director general of one organisation wrote:

    "If you can, through the Disability Discrimination Bill, prevent medical practitioners discriminating merely on the grounds of disability as to whether they treat disabled people or not, you will have achieved a great deal and we applaud your initiative".

It is not my intention to make a judgment on the medical profession, nor am I qualified to do so. However, I should like to mention areas of concern that have been drawn to my attention. The first is medical treatment itself. Under the Bill—and this will be absolutely clear if my amendment is accepted—it will be unlawful for a medical practitioner to provide medical treatment to a disabled person other than in accordance with best medical practice solely because that person is disabled. I have had some examples drawn to my attention of instances of disabled people having difficulty in receiving the same quality of medical treatment as others in society. There seems to be a particularly difficult problem in the case of Down's syndrome children. I have heard of several cases where there has apparently been a reluctance to give them the same treatment as other patients. ASBAH mentioned a young girl client with hydrocephalus and some learning difficulties who complained for some 18 months of pain in her shoulder but whose complaints went unheeded. The neurosurgeon who treated her said that there was nothing wrong. However, with ASBAH's assistance, another specialist identified a tumour in the shoulder which was then successfully removed. This story supports the concern of MENCAP that disabled people with lesser medical problems unrelated to their disability can have them ignored or played down by medical practitioners. ASBAH also mentioned problems that were experienced by pregnant disabled women who had been denied access to a similar level of service and choice to that obtained by other pregnant women. Other groups, such as John Grooms and MENCAP, emphasise the difficulties of getting sufficient support for disabled people following medical treatment. It would not be surprising if discrimination were to creep into the provision of health care. We are all prone to devalue disabled people, especially the elderly disabled.

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Moreover, there are times when it is perfectly proper for disabled people to be given different treatment tailored to their needs. But, as MENCAP put it to me in a letter,

    "doctors cannot justify denying treatment or offering treatment poorer in quality as well as different in kind from that offered to people in like state without disability".

In a nutshell, it is right to question the value of the treatment for the patient, but not right to question the value of the patient to receive the treatment. That is a complicated sentence. It reads like the old joke: whisky when you are well makes you ill; whisky makes you well when you are ill. If you try to say that quickly, you soon get into a muddle. I shall just say the sentence again. In a nutshell, it is right to question the value of the treatment for the patient but not right to question the value of the patient to receive the treatment. My amendment would put that beyond doubt. My second area of concern is the availability of nursing care and services. To meet the requirements of the Bill, reinforced by my amendment, there will need to be an improvement in the provision of suitable equipment to meet the needs of disabled people. Examples are pressure relief mattresses, inaccessibility of breast screening apparatus and the lack of hoists in outpatients departments. It would give considerable encouragement to disabled people if the Government were to give a lead by ensuring that hospitals and surgeries were constructively encouraged to provide accessible lavatories, clear direction signs, including signs in Braille for the blind and partially sighted, and induction loops for people with hearing impairment. My third area of concern is access to GP services. Three organisations mentioned problems that have recently emerged of GP fundholding practices not wishing to accept disabled people as patients because of the potential cost of their care and treatment. This Bill—and again my amendment clarifies this point—will make discrimination in this area unlawful. However, that will not necessarily make the problem go away. I hope that a way can be found to help GPs who are under this kind of pressure. I hope that these observations are helpful to the Committee. While the problems may not be widespread at present, there is a real possibility that, as the number of elderly disabled people grows and medical science allows disabled people to live longer, the examples I have raised will become more prevalent. Although the amendment raises no new issues of principle, mentioning the matter explicitly on the face of the Bill would provide a clear marker for the future. I shall be interested to hear what other noble Lords and the Minister have to say in response.

6.45 p.m.

Lord Swinfen: I very much support the idea behind these amendments. The noble Lord, Lord Robertson of Oakridge, mentioned John Grooms association for disabled people, for which I work. Our experience suggests that discrimination can occur in relation to all services provided by the National Health Service, including general practitioners and therapists. When we opened a number of new homes in the Southend area, one large one and three quite small ones—they were opened, I may say, over a number of years and spread quite widely

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over the Southend area—we had considerable difficulty in finding general medical practitioners who were willing to have the disabled people in our care on their lists. That appeared to be because they were under the misapprehension that because someone has a physical disability, he or she was likely to be ill more often and therefore to be a greater expense on the practice. Residents in our Edgeware estate have also been denied community physiotherapy services and equipment, apparently because they live in a residential home. I understand that the local services claim that their budgets are insufficient to meet the costs of providing these services. Talks with other organisations indicate that this occurs in other homes as well. It thus appears to us that there is double discrimination: a disabled person is forced to live in a residential home while at the same time being denied the medical services that able-bodied people could easily obtain. I support the ideas behind these amendments. Whether the wording of either is exactly correct for the Bill, I am not qualified to say, but I believe that we should have, if not one of these amendments, then something similar on the face of the Bill.

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