National Insurance Bill
Considered in Committee.
[Sir William Anstruther-Gray in the Chair] Clause 1.—(Higher contributions and benefits under National Insurance Act 1946.)
Mrs. Barbara Castle (Blackburn)
I beg to move, in page 2, line 19, at the end to insert:
(5) (a) The amount of sickness benefit shall be increased by such amount as is hereinafter mentioned if as a result of loss of faculty the beneficiary requires constant attendance at home.
(b) the amount by which sickness benefit is to be increased under this section shall be determined in accordance with regulations by reference to the extent and nature of the attendance required by the beneficiary.
I think that it would be convenient to the Committee to discuss, at the same time, the following two Amendments standing in the name of the hon. Member for Blackburn (Mrs. Castle):
In page 2, line 22, at end add:
(6) The weekly rate of sickness benefit shall be increased by such amounts as are set out [column 250]in Schedule 2 of this Act if, as a result of loss of faculty, the beneficiary is likely to remain permanently incapable of work.
In Schedule 2, page 12, line 32, at end insert:
9. Amounts by which weekly rates of sickness benefit are increased on account of permanent unemployability:
(a) for beneficiaries over 18 or with dependants, /67 6/;
(b) for beneficiaries under 18 without dependants /38 6/.
I had hoped that you might consider that we should discuss this group of Amendments together, Sir William, because they are all designed to recognise that people can be as seriously disabled and, in some cases, permanently disabled by natural causes as they can as a result of war injury or accidents at work. The purpose of the Amendments, therefore, is to try, where medically desirable, to keep these people out of hospital and to make financial provision of an amount which would enable them to stay at home instead.
At present, there is no financial provision at all, either under the National Health Service or the National Insurance Act—or even under the National Assistance Benefit Regulations—to meet the kind of situation which the Amendments are trying to meet. The absurdity of the present situation is obvious if one gives a little thought to the matter. Why should we force people to go into hospital when there is no medical reason why they should, when they would much prefer to stay at home and, not least, when it would be much cheaper to the taxpayer if they were to stay at home?
We are all aware of the growing financial cost of hospitalisation. I have with me some of the figures published by the Ministry of Health concerning the cost of keeping patients in hospital. It comes as a shock to some of us to realise the great disparity between the amount of money we pay for people when they go into hospital and the amount we pay them when they are dealing with their illnesses at home.
Moreover, the cost has been rising steadily in the past few years. It varies—and since these figures were published the cost may have risen still further—from £30 a week in a regional hospital for acute cases to no less than £42 9s. 4d., which was the cost in 1962 to keep a [column 251]patient for one week in a London training hospital. Clearly, in circumstances when we are seeking desirable economies, we should consider this matter most seriously.
The historical reasons for our making this provision in some cases and not in others are, I think, well known. After the war, when we came to recast the National Insurance system, we were all full of the needs of the war pensioners; the men who had served their country and had become seriously disabled in the process. We thought of all the humane ways by which we could add to the war disability pension additional payments which were necessary if the disabled persons were to lead tolerable lives.
So we introduced the constant attendance allowance for the person who needed waiting on at home and the unemployability supplement for someone who had permanently lost the capacity to work. At the same time, the Labour Government decided—and perfectly rightly—that it was difficult to justify, on any social or humane grounds, why similar payments should not be made to people who were disabled by an injury at work. So those payments were extended to industrial injury benefit recipients as well. However, they were never extended to people who might be permanently and drastically disabled by natural causes.
There are all sorts of cases one can think of where this can happen, but because it was a naturally caused catastrophe and not one caused by injury at work or by war, we have left that sort of person to be completely dependent on sickness benefits. There is no way under the National Health Service by which we can make any financial payments to patients who are trying to deal with their disability at home. Since that time—since the social insurance scheme was recast as a result of the Beveridge Report—we have learned a great deal about its inadequacies and our ideas about many aspects of social insurance have been undergoing a progressive change.
The Bill we are discussing today gives us a long needed opportunity to look at another of the gaps in our social insurance provisions. I first raised this matter on Second Reading because I had had brought to my notice that day a particular case which graphically illustrated the sort [column 252]of problem I had in mind. The case does not arise in my constituency, but has been brought to my attention by a friend who is working with and trying to help a young man totally and permanently crippled with polio.
The young man is still only 30 years of age. He is a young man of great intelligence, who is trying, with enormous courage and gallantry, to battle against a disability that would have defeated most other people; trying not to accept a fate of permanent invalidism and hospitalisation, but rather to build a new life for himself at home, where he can read and can write books and have around him all the things that make life tolerable.
Under our present provisions, he is having to do it on an income of £4 15s. from National Assistance. For various reasons—he had been working in Kenya—he does not qualify for sickness benefit, but that is broadly irrelevant, because even the increased benefit provided under the Bill would not be sufficient to enable him to maintain himself at home although he is a bachelor living in a modest council flat. This young man needs help. He needs permanently to be waited on. He needs normal domestic help and, if he is to do any kind of creative work, he needs additional assistance.
At the moment, he is getting that assistance simply because of the kind-heartedness and charity of friends. He lives under a shadow that is even more serious to him than that of his disability—the shadow of the fear that one day he will not be able to continue to cope any longer at home, that his friends may no longer be able to keep on helping him, and that he may have to give in and go into hospital. If he did that, under our Welfare State he would be maintained in hospital for the rest of his life at a cost ranging from £35 to £42 a week.
Is not that a ludicrous situation? He could live modestly, and much more fully, at home on an income of £12 to £14 a week. In that event, he could still pay for his help, still keep his little bungalow going and still have something like a human being's life—and, I repeat, he is only 30 years of age. But despite the efforts made by him and his friends to contact his own Member of Parliament and the Ministry of Health—and the fullest inquiries have been [column 253]made by all those responsible in this case; I do not accuse them in any way of not having done their best to help him—under the existing law, even with the National Assistance Board being brought in and the extent of any possible supplementation having already been dealt with, the maximum amount that he can receive is £4 15s. a week. Next May, when the new National Assistance scales come in, that sum will no doubt be increased to £5 1s. a week, but his most modest minimum expenses would amount to between £12 and £14 a week.
My friend who is trying to help this young man pointed out to me that if he had got this disability at work he would, under the new increases proposed in the Bill, have been entitled to the 100 per cent. disability pension of £5 15s. a week, supplemented by the maximum constant attendance allowance for the most seriously disabled cases of £5 a week, and also, presumably, by the unemployability supplement of £3 7s. 6d., giving him a weekly income of £14 2s. 6d. If he had that, he would think that all his worries were over, his life would take on a hope, a security and a fullness that it must, as things are, for ever lack.
I have quoted only this one case, but since I made that Second Reading speech I have received letters saying that I am right, and that there is not only this case, but dozens of other cases where people who will be ill for a long time as a result of incurable or chronic disease could be kept at home at much less cost to the community if only there were some way of getting a financial payment for those ready to wait on them. It must be remembered that very often those, who help in this way, and make their services available, do so at the cost of their own entitlement, either to a wage earned elsewhere or to any kind of unemployment benefit. They sacrifice all possible means of maintaining themselves in other ways.
The aim of the Amendments is broadly twofold. It is, first, that regulations should be introduced laying down the amounts of constant attendance allowance that would be payable, in addition to sickness benefit, according to the extent and nature of the attendance required. The aim, of [column 254]course, is to make constant attendance allowance payable in those cases where the sick person is being nursed at home. The Amendments do not specify the amount, but we could discuss on the Regulations what amounts would be appropriate and how they might be graduated in each case to meet the degree of attendance necessary. The second aim is to provide that an unemployability supplement should be paid on the same scale as is paid in the case of industrial injury where the beneficiary is likely to remain permanently incapable of work.
There could well be faults in the draftsmanship of the Amendments as they stand, but I hope that the Minister will not turn them down on that ground. At this stage, it is the principle that we seek to establish. If the wording needs to be altered, the Minister will have an opportunity of suggesting a better form of words.
In all sincerity, I ask that we should seize this opportunity to deal with what is clearly a glaring anomaly in our social insurance scheme and, in doing so, bring a touch of humanity into our administration and sunshine and hope into innumerable lives and, at the same time, and by no means least, save ourselves a good deal of money in the process.
Mrs. Harriet Slater (Stoke-on-Trent, North)
I want to reinforce the argument made by my hon. Friend the Member for Blackburn (Mrs. Castle) that by accepting the Amendment we would be extending to a class of people who, up to now, have been neglected some of the benefits they would have got had they been injured in war or industry.
I think, also, of the married man whose wife has to give up her job to look after him. I know that there are large numbers of the type of people to whom my hon. Friend has referred, but there are also those whose only hope of adding to their income is for the wife to go out to work and leave the man alone in the house for hours, hoping that someone will come in and look after him. The only alternative to that is for the woman to give up her job and seek National Assistance—something that she does not want to do and should [column 255]not need to do in such circumstances—because someone must be in constant attendance upon the sick person.
I think of those who suffer from sclerosis and who reach the stage where they are unable to feed themselves and cannot walk about. They have to get about in an invalid chair and somebody has to do practically everything for them. If there were a wife or someone else in attendance they could be sure of being cared for and could even go out to look at the wider spaces outside their home. There are also those who are badly crippled with arthritis, or who suffer from thrombosis or some other cardiac troubles and become almost incapable of getting around. Unless they have somebody with them, their lives become a constant misery. I ask that something be done for these people as well.
There are the people who are unable to manage on their money and who go short of the bare necessities as well as constant attendance. If these allowances were given to them in the way that they are given to the industrially injured or the war injured it would mean that they could have not day-to-day but hour-to-hour attendance, which they ought to have, and they could have the care and regular meals they need. These people who suffer the great tragedy of long-term illness should not be subjected to long hours of loneliness.
I should like to emphasise the cost to the State if we do not give these people a constant attendance allowance and they have to go into hospital. Even in the regional hospitals for chronic cases the lowest cost per case was £22 5s. 5d. This is amazing.
It is more than that now.
Yes, that was in 1960. It is now £26 5s. 10d. and, as my hon. Friend has said, it is in some cases £42 9s. 4d. a week. How much better it would be to make it possible for these people to be cared for at home rather than be subjected to long periods in hospital with the added expense that that brings not only to the State which has to provide the services but to members of their families who have to spend money on bus and train fares to visit them and buy gifts of food to bring some comfort to them. The cost per case can be as [column 256]high in the London teaching hospitals as £92 7s. 5d. The lowest figure now in the regional hospitals for acute cases is £55 15s. 11d.
The time has come to give some fresh thought to this old problem. We should look at these cases in the same way as we look at the industrially injured. There is also the question of unemployability. Nothing worse can happen to a relatively young person than to be unemployable because he is suffering from some disease. We might be told that there are Remploy and similar organisations to meet these cases, but these touch very few people who become unemployable.
Apart from anything else, it is a terrible psychological tragedy to these people when they realise that they are not only ill, but are likely to be for a long time, with very little possibility of their becoming employed. It needs a great deal of courage and change in mental outlook to alter one's whole form of livelihood and find some other job. Nearly always the people who are best able to do that are those who are artistically inclined. They can learn to use their artistic capabilities to do a new job. In a few cases, if they are lucky, they might find themselves doing a job which they have never thought they would be doing. In the great majority of ordinary cases, however, these people are forced to face the fact that they are not likely to be employed in the future.
I hope that the Ministerial reply will not be that because we did nothing in 1948 we must now carry on with the present arrangements. We have had a great deal of experience since 1948 of meeting these cases. There must be particulars of hundreds of them in the files at the Ministry. We have now reached the stage where we should take a completely new look at this problem in the light of the circumstances which have been put to the Ministry. We have the medical facilities to make sure who are the really long-term sick people.
I repeat that I hope we shall not be told that because nothing was done earlier we must not alter our view and that these people can apply for National Assistance. For goodness' sake, let us take these cases out of the hands of National Assistance and give these people justice and what should be their moral right.[column 257]
Mr. James Griffiths (Llanelly)
I hope that the Minister will give careful consideration to the Amendments in the name of my hon. Friend the Member for Blackburn (Mrs. Castle), which have been supported so ably by my hon. Friend the Member for Stoke-on-Trent, North (Mrs. Slater). I call as a witness my hon. Friend the Member for Mansfield (Mr. B. Taylor) in saying that this is one of the things which, if circumstances had been different, I should have liked to have amended in the National Insurance Act.
When we launched the Industrial Injuries Scheme the position was that the two kinds of benefits to which these Amendments refer—the constant attendance allowance and the unemployability supplement—began with war pensions. We changed considerably the method by which we assess compensation for industrial injury and we based it on loss of faculty rather than on loss of earnings.
It was found in practice, however, that if it had not been for our introducing a hardship allowance the whole scheme would have broken down. We introduced that element which was not in the world of the old war pensions. These provisions for constant attendance allowance and unemployability allowance were incorporated from the old pensions warrants into the new Industrial Injuries Scheme. On the whole, they worked well. To some extent they have not been so absolutely essential since 1948 as they were before, for the reason that sickness benefit has become payable at the same time as industrial injury benefit whereas hitherto they were mutually exclusive.
I believe that there is the strongest possible case for accepting these Amendments, particularly the first one providing for constant attendance allowance. Of all beneficiaries under our National Insurance legislation, the sick are the ones least able to have a pressuregroup to speak for them. As a trade unionist, I know very well that the industrial disabled can call upon the services of their organisations to work on their behalf. Indeed, it is part of our job in the miners' union to see to these things. I think that the Minister would have had very much more pressure about the Industrial Injuries Act were it not for the fact that coal mining is now nationalised and the National Coal [column 258]Board and the National Union of Mine-workers see to these matters. The organised workers are able to apply pressure to gain improvements.
The sick have no pressure group. Today, the old-age pensioners are organising, and, quite rightly, they make their influence felt both between and at elections. The sick have no one to speak for them. The most tragic of all beneficiaries under our National Insurance Scheme are the chronically sick whose sickness is long-term, but not attributable to their employment. It is for this reason that I have risen to say a few words in support particularly of the first Amendment. I support the Amendment which deals with unemployability supplement also, although I know that different arguments apply in that case.
We all have knowledge of the circumstances of those whose have been struck down by sickness and compelled to stay at home. What a tremendous burden is carried by the family. We know of women whose lives have been a terrifying burden for years as they have cared devotedly for husbands or sons, without any payment at all. Until 1948, there was nothing for the long-term sick but 10s. 6d. per week. Under the old scheme, the longer a person was unemployed the less he got. He received more sickness benefit during the first six months than he did afterwards. All he received, if he was sick for a long time, was 10s. 6d., unless he was fortunate enough to belong to one of the more prosperous approved societies which was able to add a few shillings.
At least, we have changed that and provided continuous sickness benefit at the standard rate, under certain conditions, and we do not reduce it at the end of six months. However, what happens now, if a person is sick for the rest of his life, is that he receives only the standard benefit plus whatever is given in supplementation.
There is here a provision which has worked admirably in respect of war pensioners and beneficiaries under the Industrial Injuries Act. It has served a purpose and met a need. It has been a welcome benefit which has brought relief to countless beneficiaries under the war pensions Warrant and the Industrial Injuries Act. Since it has proved to be of value in those [column 259]schemes, let us, at least, accept in principle that there is every reason to consider applying it under our National Insurance legislation to the long-term sick.
The financial burden will not be very great. There will not be a very large number of cases. Indeed, I should be interested to learn from the Minister—I am sure that he has the figures—what is the number of people under the Industrial Injuries Act at present receiving constant attendance allowance. I have the impression that the number is not large. I may be wrong, but I suspect that it may be many fewer than we suspected when we began to design the scheme way back in 1946. Therefore, I do not believe that the burden added by the first Amendment would be a heavy one. The cost can, I believe, be met.
I put it to the Minister in this way. To make the concession for which we ask—certainly, to accept the first Amendment providing for constant attendance allowance—the Minister need not say that he cannot do it without an increase in contributions. I think that it could be done within the existing resources of the Fund. Moreover, I myself would not be averse to saying that, if necessary, he need not be afraid to dip a little into the reserve, which is now well over £1,000 million, as he admitted to me the other day.
I ask the Committee to think of what it would mean to the long-term sick themselves, to the mothers, the wives——
—and daughters, too, who spend their lives looking after them. The whole home is affected. If we could incorporate the proposals now before the Committee, in particular, the constant attendance allowance, into the Bill, we should render a great service to people who, in the past, have been neglected and to whose needs we ought to pay more attention.
In adding my voice to that of my hon. Friends and pressing the Amendments on the Minister, I hope very much that he will give the most careful consideration to the matter. This is something which I should like to see done. I hope that he, too, would like to see it done. If we both agree, there is no reason why the Amendments should not be incorporated in the Bill.[column 260]
Mr. Tom Brown (Ince)
I support the Amendment because, if accepted, it would bring a little hope and cheer to those who have hitherto been left out of our insurance legislation. In any study of the insurance Measures which the House of Commons has passed to provide benefits for those in need of help, there stands out a large group of cases hitherto left by the wayside. These Amendments apply to that group.
I have heard many illustrations of how our proposals would bring joy and happiness to those for whom we are concerned, but there comes to my mind at this moment the photograph which appeared in one of the national papers last Saturday of a man who has been on his sickbed for 22 years and 8 months. I want the Minister to visualise that man's suffering—not for 22 weeks but for 22 years and 8 months. He has had to have constant attention all that time, and his unfortunate wife has had to look after his every need.
I will tell the Committee his name. He is Tom Lawton, and he lives at High Street, Alsager Bank, Stoke-on-Trent. I have permission to give those particulars publicly here. If anyone wants further evidence, he can get it by writing direct to the man himself. The last time I had a letter from him, he needed at least eight pillows to keep him in a comfortable position.
Now, in 1963, we are years away from the days of the great benefactor, Lloyd George, who introduced this type of legislation to us years ago. Yet, today, we have to put down Amendments to a National Insurance Bill in order to bring relief and happiness to those forced to suffer as a result of accidents in the pits.
I sometimes wonder—I say this with all respect—whether the senior officials of the Department, when amending legislation is being brought forward, collect evidence of the facts before they compile the Bill. This Amendment should not be necessary. The people with whom it deals should be covered by the Bill. My right hon. Friend the Member for Llanelly (Mr. J. Griffiths) said that these people had been left by the wayside. But after the Bill has passed through all its stages there will still be some people left outside its provisions. We want to cover as many [column 261]cases as we can, and the Amendment goes a long way to covering a number of people who have been left by the wayside.
The Minister cannot advance the argument about cost, because so few cases are concerned. But those few cases should have the attention of this Committee. I plead with the Minister not to say “No” to this Amendment, but to tell us that he will accept it and that he has the unfortunate man to whom I have referred, and many other unfortunate men, in mind. There are also unfortunate women who have a grave responsibility because they are called upon 24 hours a day, seven days a week and 52 weeks a year to give attention to the victims of sickness and injury.
I hope that the Minister will not advance the argument that the cost involved in this Amendment is too much. However much it may cost, these people stand, and have stood for years, in dire need of something which will at least bring them a little joy and happiness in the eventide of their lives. I strongly support the Amendment.
Mr. Bernard Taylor (Mansfield)
It would be remiss of me if I were not to say a few words in support of this admirable Amendment if for no other reason than that for some time, in many debates which have taken place on insurance matters, I have argued the claims of the long-term sick.
We could all quote, as my hon. Friend the Member for Ince (Mr. T. Brown) has done, individual cases, which I wish to do in a moment. I support what my right hon. Friend the Member for Llanelly (Mr. J. Griffiths) said about the constant attendance allowance and the distinction that there is between the Industrial Injuries Scheme and the National Insurance Scheme. I am sure that the Minister will say, “Why make a distinction?” My right hon. Friend has explained why. It is now about 17 years since the inception of these schemes, and it is time that the whole matter was considered again. If omissions were made in 1946, and if we are convinced that those omissions should be put right, there is no reason in the world why we should not do that.
The people with whom we are concerned are unorganised. They have no voice; they suffer in silence. It is we in [column 262]this Chamber who must continue to press the claims of people in circumstances so eloquently described by my hon. Friends the Members for Blackburn (Mrs. Castle) and Stoke-on-Trent, North (Mrs. Slater).
I wish to draw attention to two cases. The first concerns a man with whom I used to work in the mines many years ago and who fell sick in 1938, 25 years ago. He had a very severe chest condition. He could get neither a war pension for being gassed in the war nor an industrial injuries pension for pneumoconiosis because, it was said, he had emphysema and bronchitis. From 1938 until the day he died in 1962, he was constantly on sickness benefit and had to have constant domestic are and attention from his wife. The National Assistance Board was extremely good both to him and to his wife, but that was not what they wanted. It would have been very nice if he had had some supplement from the National Insurance Fund by right because of his very grave sickness disability.
A friend of this man had both arms off at about the time he fell sick in 1938, and his wife became entitled to the constant attendance allowance under the Industrial Injuries Act. Here we have two cases, one concerning a man permanently disabled by sickness who received no supplement and the other concerning a man permanently disabled by an accident at work whose wife received the constant attendance allowance. One can understand the feeling between the wives of these two men who would never work again and who were treated vastly differently from the financial point of view under the two schemes.
To talk about individual cases is perhaps more convincing than to deal with the general principle of the matter, because it brings before the Committee the hardship of the circumstances through which these people are passing. I know a young man in my constituency in his middle twenties who is suffering from multiple sclerosis. He is bedridden and will never work again. It is for cases like this that the Amendment seeks to make provision.
I hope that the Minister will listen to the pleas which have been made and that at long last there will be some recognition for these long-term sickness cases.[column 263]
Mr. Laurence Pavitt (Willesden, West)
I wish to add my voice to those of my hon. Friends. I approach the Amendment from a different point of view, but I arrive at precisely the same point. I approach the Amendment from the point of view of health rather than from that of pensions, but the Amendment of my hon. Friend the Member for Blackburn (Mrs. Castle) deals with that angle as well as with the pension angle, and I congratulate her on tabling it.
Perhaps the Committee is at its best when it has an Amendment of this kind before it, because the Minister has to deal with a wide range of categories involving millions of people, and it is only when we are able to concentrate on a small dispossessed area that we can be at our best in showing concern for people who happen to be in a much more unfortunate position than the rest of us and who may otherwise be left out.
I want to add to the remarks of my hon. Friends the Members for Mansfield (Mr. B. Taylor) and Stoke-on-Trent, North (Mrs. Slater) about multiple or disseminated sclerosis, not only from the point of view that they put forward but from the therapeutic point of view. If a person has the misfortune to contract multiple sclerosis, the greatest factor in the treatment of it is his attitude of mind.
The treatment depends on keeping them domiciliary as long as possible and on persuading them that theirs is not a hopeless case and that they can, by continuing to maximise their physical and mental output, not only control the disease and hold it but make inroads against it. This is a constant day-to-day, hour-by-hour, fight both for the person concerned and for those in the house taking care to ensure that that person is buttressed in the fight.
The point of defeat is the moment when one says, “You have to go to hospital” . Very often that point is reached, not because of physical causes, but because of financial causes which make it imperative when one can no longer manage to maintain the person affected in his home surroundings because of the social conditions and the fact that the income in the home is not sufficient. I should like to reinforce the case put forward by my hon. Friends, because it has a particular impact on the Amendment. [column 264]
From the health point of view, during the last five years we have watched a complete trend away from the institutional towards the domiciliary. We are seeking more and more to treat cases in their own surroundings rather than put them into hospital. The Minister will know of the great inroads which, thanks to the Mental Health Act, have been made to get people out of mental hospitals, to rehabilitate them and put them into the community. Very often, these are people who will need care and attention for the rest of their lives.
What we seek to do therapeutically is to rehabilitate those people and give them a greater amount of individuality to conquer their disabilities. We can often do that best if we surround them with their families and friends and put them, as far as possible, to doing useful work in the community. From that aspect, the Amendment would be a great help in the treatment of this section of the community.
The Committee will know that the Minister of Health has undertaken to close some thousands of beds in the mental hospitals before 1975. If those beds are to be closed and people are to be taken out of the hospitals, they must be cared for in their own homes, but they need sufficient money to be catered for in that way.
The points raised by my hon. Friend as to the cost of hospitalisation are pertinent. In terms of the taxpayer, as my right hon. Friend the Member for Llanelly (Mr. J. Griffiths) pointed out, the burden of carrying these Amendments would not be great, and the amount that the Minister of Health would save by not hospitalising some of these people would represent a net saving to the taxpayer.
The occupation of chronic beds is a constant headache to the National Health Service. To put into a hospital somebody like the man mentioned by my hon. Friend the Member for Ince (Mr. T. Brown), who has been ill for 22 years, immobilises a bed in hospital for all that time and puts that much of the Health Service out of commission. Therefore, from all points of view—not only cost, but the efficient running of the hospital service—the Amendment would enable us to free hospital beds and would enable the hospital service to [column 265]treat other people, thus having side effects of great benefit.
The average cost of £92 7s. 5d. quoted by my hon. Friend the Member for Stoke-on-Trent, North in connection with a London hospital is an average over all cases treated in London teaching hospitals. The kind of case to which the Amendment relates is the case with the highest cost, because it concerns the long-term people. A figure of £92 is infinitesimal in comparison with the case of the man quoted by my hon. Friend the Member for Ince, who is ill for 22 years or more.
The Minister could meet the wishes of the Committee and accept the Amendment without incurring a great deal of cost to the Exchequer. I sincerely hope that he listens at least to the views of this side of the Committee and accepts the Amendment.
Dame Irene Ward (Tynemouth)
I wish to add one or two points for consideration by my right hon. Friend. I have a shrewd suspicion that he will inform us that a great many of these most unfortunate and chronic sick cases can, and should, be dealt with by the home help service, the district nursing service and the general welfare services of the local authority. I submit one or two items for his consideration before he takes that line.
Part of the problem which confronts administration, and certainly confronts those who have to get involved in legislation, is the wide variation in the services emanating from local authorities. This is an important point. Some local authorities run a first-class home help service. Others have hardly yet scratched the ground towards providing a service. It is important to remember that in all the services a contribution comes from the Treasury. When there is a responsibility on the taxpayer, I fail to see why some people should get better service and some get less good service. The same applies to the district nursing services. In some areas, district nurses are in short supply. In other areas, there is a better service because more district nurses are available.
The welfare services of local authorities vary tremendously. Very often, the services provided by local authorities come from the crusading spirits of those [column 266]who serve as elected members of the local authorities. Some local authorities look to one side of their public responsibility and to some extent, perhaps, neglect the other side. What worries me about the whole problem of the chronic sick is that according to where one happens to live, one may be rendered a very good service or, possibly, a rather indifferent service.
I congratulate the hon. Lady the Member for Blackburn (Mrs. Castle) and the hon. Lady the Member for Stoke-on-Trent, North (Mrs. Slater) on putting down the Amendment, because I have an idea that this is probably the first time we have discussed the matter in this form and in this detail. It is a very good thing that the question has been raised.
I recognise that it takes a long time to win a battle in Parliament. Before reaching any decision, my right hon. Friend the Minister should have gone into all the points that I am raising about the variety of services that are available to the chronic sick. I should like to hear from him how far he has discussed the implications of the Amendment with my right hon. Friend the Minister of Health.
In matters of this kind, two Ministries are linked together. Nearly all hon. Members who have spoken have referred in great detail to certain aspects of the responsibilities of the Ministry of Health. Indeed, the hon. Member for Blackburn, like the hon. Lady the Member for Stoke-on-Trent, North, referred to the cost to the Health Service of people who permanently occupy hospital beds.
Before my right hon. Friend replies on the Amendment and before he commits himself to Government policy, whether for or against the Amendment, I want him to say in specific detail whether he has discussed the matter in detail at the appropriate level with the Ministry of Health. If so, I should be glad to know the answer they arrived at in their discussions.
I am quite certain, now that we have gone so far in providing welfare services, that we can really get down to bettering the general administration. Although I am certain that this particular battle will not be won today, I hope that my hon. Friend will give a sympathetic answer, for many people are interested in the chronic sick. Incidentally, I see [column 267]that it is reported that there are more mentally sick people in the South than in the North.
I hope that we shall get a sympathetic reply, and I very much appreciate this matter being raised. The position of the chronic sick has not had all the attention Parliament could have given to it.
Mr. Edwin Wainwright (Dearne Valley)
I am surprised that the Minister has not yet intervened in the Debate.
The Joint Parliamentary Secretary to the Ministry of Pensions and National Insurance (Mrs. Margaret Thatcher)
I have been waiting to give everyone a chance to speak before replying. I shall reply, and not my right hon. Friend.
I apologise to the hon. Lady, but I have been watching both her and her right hon. Friend in the hope of seeing a sign that they would give way on this point. Judging from their attitude so far, however, I am afraid that the answer will be “No” . I shall be surprised if it is not.
I do not know how anyone could withstand the case for this proposal, put forward so strongly by my hon. Friends the Members for Blackburn (Mrs. Castle) and Stoke-on-Trent, North (Mrs. Slater). For anyone to withstand that case must mean that his heart is not where it should be when we are discussing a subject of this kind. I cannot understand why, in this Parliament, we have not dealt with this issue before. I know that we have tried to do so from this side of the House time and again, but the Government have not accepted the principle.
Why should there be difference of treatment between people who are incapable of looking after themselves? It is not their fault that they are so sick. Let us take the example of multiple sclerosis. It is heart-breaking to see the victims of that disease. I know of the case of a man only in his forties who has to lie helpless. Whenever he wants to sit in a chair he must be lifted out of bed and into the chair, where his wife has to prop him up. He has to lie helpless, seeing his wife working so hard trying to maintain some kind of home life for [column 268]them both, and nursing him continuously. He knows well that the income of the house is insufficient and that she denies herself in trying to provide him with certain small delicacies to try and make his life a little easier.
Another case I know is that of a girl in her late twenties. Until recently, she had to be lifted on to the bus so that she could travel 30 miles to work. But she has now reached the stage when she can go no longer and must stay at home. Slowly but surely she will become one of those cases we are discussing. Her parents are to look after her. They will keep her at home, but without sufficient help from the Government.
We should look at these matters more humanely than before. We should do our best to help the chronic sick to stay at home with their families. I have every praise for our hospitals and their staffs, but I do not think that they can offer more comfort to a person than he can receive at home if it is possible for him to stay there, so that his dear ones can nurse him. It is necessary that we look at this problem from a more sympathetic point of view.
Home helps have been mentioned. They do tremendously good work, but is it their duty to lift a sick person out of bed into a chair and back again in order to change the sheets, or to do other things of that kind? I do not know. But I do think that there are plenty of other kinds of jobs which they could do for our sick and injured and aged people and that we should take over some responsibility for this work.
We should make it possible for a couple to engage someone to come in for an hour or so to help out. If we cannot afford that, then our present society stands condemned. What will posterity think when it sees how we treat people in this situation? We shall be condemned as heartless; and if we cannot deal with it better than we have been doing we shall deserve all the criticism levelled at our society.
In discussing why these people are not looked after, some of my hon. Friends have mentioned organisations. It is a criticism against us that we ignore individuals who are not organised. Selective cases can be found of individuals having to suffer because there is not a group of people to look after their interests. It is [column 269]the duty of Parliament to make sure that individuals are properly looked after. We should not sit back satisfied that we are doing our best for this section or that section of the community while leaving a small number of people out in the cold. It is bad enough for a person to be helpless and to have to depend on other people, but not to have sufficient money for a reasonable standard of living is even worse, and is something which must make such a person's mind more difficult to keep balanced.
Most homes in this country can afford television sets and nearly every home has a radio set. I wonder how many of these people cannot afford the rental for a television set and how many of them cannot afford to pay the £4 television licence.
This is another instance in which we can put pressure on the Government and hope that they will yield to it and make certain that these people have some kind of joy and happiness in the last few years of their lives. As they lie in bed, they have plenty of time to think. We have to try to ease their tremendous burdens. I hope that the hon. Lady will say that the Government will at least accept the principle of the Amendment so that we can be assured that these people will be looked after as are others who are similarly unfortunate.
When, in her Second Reading speech, the hon. Lady the Member for Blackburn (Mrs. Castle) raised a specific case, I naturally made inquiries about it. It was that case which stimulated her interest and which led her to propose the Amendment, but it would not be affected by the Amendment.
If the principle of supplementation of sickness benefit by constant attendance allowance were accepted by the Committee, the National Assistance Board would surely be capable of following that example and make similar supplementation available in similar cases.
The National Assistance Board already tailors its grants to individual needs. I understand that the man whose case was quoted by the hon. Lady could not claim sickness benefit either because he was not an insured [column 270]person, or because his contribution record did not have the requisite number of contributions. The Amendment is hinged to those who could claim sickness benefits and who are fully insured persons with full contribution records. I made inquiries about the case which the hon. Lady mentioned from our friends in the Assistance Board, to whom I pay great tribute in cases like this. The figures which the hon. Lady gave are not the whole story and I will write to her after having made further inquiries.
When she mentioned the figures, I was a little surprised that we appeared not to give more help to a person in such severe need, but I am sure that she would not expect me to pronounce a judgment or opinion until I have had an opportunity to look at all the facts. It is a valid point that the case which stimulated her interest would not be affected by the Amendment.
Surely the hon. Lady realises that I was using that case just as an illustration. I wanted to get the facts clear, so I made it plain that it was a case on National Assistance, but I went on to point out that that was irrelevant to my argument. As the man's friend who wrote to me pointed out, if he were on sickness benefit, even at the increased rate, and it were supplemented by National Assistance, he would still come up against this kind of National Assistance maximum. The hon. Lady's argument has nothing to do with the case I was making.
I would not agree with that at all. What I was trying to discuss was how far we could help severely disabled people within the framework of the National Insurance Scheme.
I would be grateful if I could get a word in edgeways, now that I have waited so long and listened to the arguments of others.
The hon. Lady knows full well that if the contribution record is complete, sickness benefit can be drawn for an indefinite period, plus cover for dependants, as was pointed out by the right hon. Member for Llanelly (Mr. J. Griffiths). If [column 271]a person is not insured, no sickness benefit is payable, this being an insurance scheme.
Comparisons have been drawn with the Industrial Injuries Scheme, which, as the right hon. Gentleman knows, is based on completely different principles. National Insurance is based entirely on benefit for incapacity to work, for loss of earnings, whereas the Industrial Injuries Scheme is based on benefit for loss of faculty.
Comparisons between the two schemes are constantly drawn, especially by those hon. Members who represent mining constituencies and who have been miners and who make certain that the Industrial Injuries Scheme always has a preferential rate over the National Insurance Scheme, for two very good and valid reasons—first, that many of the occupations are dangerous and, secondly, that the injuries are received while the person is working under someone else's orders. The Industrial Injuries Scheme is hinged from the start on benefit for loss of faculty, whereas the National Insurance Scheme is hinged from the start on benefit for incapacity for work and in no way compensation for disablement. This goes right to the very root of the problem and it is not easy as the result of an Amendment to graft an idea from one scheme on to another which depends on entirely different principles.
Mr. J. Griffiths
I follow the hon. Lady's argument quite clearly. While it is quite true that the two schemes are based on different principles, the constant attendance allowance is the one thing which should be applied to both. It is the one case in which, under the Industrial Injuries Scheme as under the War Pensions Warrants, the problem is whether a person who is living at home is so disabled that he or she needs constant attendance. If he or she does, then a supplement is paid. That can be applied to ordinary sickness as well as disablement without in any way interfering with the difference between the basic principles of the two schemes.
I get the point of the right hon. Gentleman's intervention. Constant attendance allowance is hinged on 100 per cent. disablement, which is loss of faculty, and the right hon. Gentleman [column 272]knows that it is not easy to assess 100 per cent. disablement even under the Industrial Injuries Scheme and that it is not easy to agree on what should be scheduled diseases.
Many bed-ridden cases would not be affected by the Amendment because the insurance principle would not apply to them. I have listened carefully and sympathetically to all that has been said and I know that many of the cases which have been raised by hon. Members on either side of the Committee are cases of people who are not insured. I know that the desire is as far as possible to help the severely disabled.
Mr. B. Taylor
The hon. Lady is not correct. The cases which we have recited are of insured persons who are covered by the National Insurance Scheme. It is putting it too high to say that the majority of cases do not come within the ambit of that scheme. Most of them do.
I was under the impression that most of them did not, particularly those concerning people who had been sick for a long time before the onset of the scheme. In any case, there will be examples which are not affected by the scheme.
I have listened to all the arguments, but we have not had time to consult Enoch Powellthe Minister of Health, or Sir Keith Josephthe Minister of Housing and Local Government, because the Amendment appeared on the Notice Paper for the first time only this morning in company with others. That would be a valid reason for saying “No” to a major change in the insurance scheme.
I would be so glad if the hon. Lady would afford me the courtesies which I have accorded her.
I want the hon. Lady to afford me the courtesy of giving me an opportunity to explain an apparent discourtesy to her. The Amendment appeared so late because the Committee stage of the Bill has been rushed on the tail of the Second Reading, giving very little time to give notice of Amendments. That is not our fault.
I think the hon. Lady will realise that we cannot have a great change as a result of so little consideration of what is predominantly a rates [column 273]Bill, and the reason we are trying to rush it through is to get the benefits of the Bill to people as soon as possible.
I have listened to what the hon. Lady said, and I undertake to consider how best, within the framework of the National Insurance Scheme, we can help the severely disabled. That is what I think the hon. Lady wants.
I make this plea. I hope that those who have made the chronic sick and severely disabled their top priority for the purpose of this debate will not, when we discuss other beneficiaries of the National Insurance Scheme, in turn, make these beneficiaries their top priority, because it does not add up.
I hope that as a result of the undertaking given on behalf of Niall Macphersonmy right hon. Friend that within the framework of the National Insurance Scheme we shall consider how best to help the severely disabled, the hon. Lady will not press the Amendment.
Mr. B. Taylor
Will the hon. Lady or her right hon. Friend give the House an undertaking that the National Insurance Advisory Committee will be asked to look at this matter?
I cannot accede to that request at the moment. The Committee has a great deal of work in hand, and I would prefer, under the direction and guidance of my right hon. Friend, to look at it first.
On a point of order. Has the hon. Lady the right to assume that because we have stressed this Amendment we are likely to lay stress on other Amendments on the Notice Paper? The hon. Lady ought to deal with this Amendment and wait to see what happens in respect of the others.
The Temporary Chairman (Sir James Duncan)
I do not regard that as a point of order.
Mr. E. Fernyhough (Jarrow)
The hon. Lady ought to be aware of the fact that since the Conservative Administration came into power, in 1951, no Amendment moved by an hon. Member on this side of the Committee to a Bill of this kind has been accepted.
Miss Margaret Herbison (Lanarkshire, North)
The hon. Lady ought not to chide us on this side of the Committee and give us advice about what we should [column 274]consider to be our priorities, and what we should not. I assure the hon. Lady that as we go through the various Amendments we shall put up as strong a case as we can for each one of them. Whether she continues to chide us or not will not concern us in any way.
We have been discussing three Amendments. The hon. Lady in her reply—and I am not chiding her for this—dealt mainly with the Amendment dealing with constant attendance allowance. As I say, I am not chiding her for that, because almost all my hon. Friends who took part in the discussion referred to the need for constant attendance allowance for these people.
I think that the hon. Lady could have dealt with the second Amendment in which we say that the basic rate of sickness benefit for the chronic sick should be raised to the basic rate of industrial injuries benefit. It may be that the Government could not possibly make a decision about this overnight and would have to give careful consideration to it, but, with regard to the other two Amendments, I should have thought that the Minister and his Parliamentary Secretary had for many months been considering what could be done in respect of constant attendance allowance and unemployability supplement.
In her reply, the hon. Lady said that many of the cases raised by hon. Members on this side of the Committee were not covered by the National Insurance Act. This shows how ignorant she is of the cases we are discussing. The hon. Lady spoke about hon. Members from mining constituencies continually raising these matters, and chided us that we always tried to ensure that the industrially disabled received more than those who were disabled through ordinary sickness. Many of us who come from mining areas know of many insured people who are desperately in need of this constant attendance allowance and I shall give some examples.
In any industrial city, town, or village, it is possible to find living in adjoining houses two severely disabled people. In one case the pneumoconiosis medical board has decided that the man is suffering from pneumoconiosis, and he receives industrial injuries benefit. In addition, he receives unemployability [column 275]supplement, and perhaps hardship allowance. Then, when he needs constant attention in the home, he is given the constant attendance allowance. The result is that quite a substantial income goes into the home.
The other man may have almost as severe a chest condition. His own doctor says that he is suffering from pneumoconiosis. Specialists in an infirmary examine him clinically, have him X-rayed, diagnose the X-ray plate, and say that he is suffering from pneumoconiosis, but when he goes before the pneumoconiosis medical board, the board says that he is not suffering from that disease. He may be suffering from emphysema, or perhaps chronic bronchitis. The extent of his suffering is as great as that of the man next door who is suffering from pneumoconiosis, but what does he get by way of benefit?
The man receives National Insurance benefit which, as the hon. Lady says, can continue throughout his life, thanks to legislation introduced by a Labour Government, but he does not receive unemployability supplement or hardship allowance, and when the day comes when he needs constant attention he does not receive constant attendance allowance.
The difference in the treatment of those two types of people has been causing us deep concern for many years. I accept right away that the Minister could not possibly today agree to an Amendment to give both types the same basic rate of industrial injuries benefit. Even if the right hon. Gentleman cannot accept the payment of unemployability supplement—though I hope that very soon such a proposition will be accepted—he could at least agree to the payment of constant attendance allowance. Those who struggle on year after year without a constant attendance allowance lead very narrow and miserable lives due to a lack of money. I am sure that the Minister himself has been listening carefully to this debate, and I ask him to give serious consideration to the question of paying them constant attendance allowance.
My hon. Friends have raised the problem of the wife who has had to give [column 276]up her job to look after her husband who needs constant attendance because he is suffering from emphysema, or bronchitis, or has suffered an injury at work or through a road accident, and the family income is thus reduced. The time comes when the man needs so much attention that the wife becomes over worked and overstrained.
In two cases in my constituency wives have died as a result of overwork, although their severely disabled husbands are still living. If the constant attendance allowance had been paid in those cases those wives would have been able to have a little assistance each day to help them in caring for their husbands. Even that little assistance, paid out of the constant attendance allowance, would have been a very great help. We are not asking for anything that cannot be granted.
My last point is the first to which the Parliamentary Secretary referred. She said that the whole principle of National Insurance was based on benefit for absence of earnings, or incapacity to work, while that of industrial injuries was based on benefit for loss of faculty. But in respect of what is the constant attendance allowance given? It is not for loss of faculty, because whether a sick man is in receipt of industrial injuries benefit or sickness benefit he may need the same constant attention. The principle which she felt to be almost insuperable does not affect the constant attendance allowance at all, although it may affect the basic rate. I hope that we will examine the whole scheme at some time.
We shall not press all three Amendments, but if the Minister is not able to tell us that he is willing to accept the Amendment that has been moved, we feel so strongly on the matter—because we have a great amount of experience of the hardships involved—that we will press it to a Division.
Question put, That those words be there inserted:—
The Committee divided: Ayes 195, Noes 257.