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No Attendance Allowance for Cooking
1029
Medicine and the Law No Attendance Allowance for Cooking with renal insufficiency and bone changes was in receipt of an attendance allowance from June, 1977. In August, 1980, she underwent a renal transplant operation and dialysis ceased soon after. In November, 1981, a medical practitioner acting on behalf of the Attendance Allowance Board considered a new claim, made in view of the imminent expiry of the certificate, for attendance allowance, and found that the claimant did not satisfy any of the conditions in section 35 (1) ofthe 1975 Act. In May, 1982, another delegated medical practitioner reached the same conclusion, though he noted that some ordinary domestic duties were performed on behalf of the claimant. He decided, however, that: "Even if such duties are required to be done because Mrs Woodling is too disabled to carry them out for herself, they do not qualify as attention in connection with her bodily functions and cannot be taken into account in consideration of her requirements". He therefore ruled as irrelevant, and did not consider further, part of the evidence before him which purported to show that all cooking was done for the appellant for which she now claimed an allowance. Mrs Woodling had stated earlier: "I live by myself but have a lot of help. As I have bone complications, I am not able to lift anything heavy. They do all my shopping, cooking, cleaning, washing, and ironing, and other housework has to be done for me-any weight activity is prohibited". Mrs Woodling’s appeal came before Woolf] who held that he was bound by the Court of Appeal decision in 1981 (Regv National Insurance Commissioner, ex parte, Secretary of State for Social Services (1981)2 AlER 738; Lancet 1981; i: 1008). The question then came before the House of Lords and the appeal was dismissed. Section 35 (1) of the 1975 Act provides as follows. "A person shall be entitled to an attendance allowance if... either-(a) he is so severely disabled physically or mentally that, by day, he requires from another person either (i) frequent attention throughout the day in connection with his bodily functions, or (ii) continual supervision throughout the day in order to avoid substantial danger to himself or others; or-(b) he is so severely disabled physically or mentally that, at night, he requires from another person either (i) prolonged or repeated attention during the night in connection with his bodily functions, or (ii) continual supervision throughout the night in order to avoid substantial danger to himself or others." A person requiring attention only during the day or during the night receives a lower allowance than someone requiring attention during both day and night. Lord Bridge of Harwich said that for this appeal it was unnecessary to examine the extent of Mrs Woodling’s disability. The only criticism levelled at the decision of the Attendance Allowance Board was its conclusion that Mrs Woodling was not entitled to attention during the day (no claim for attention at night having been made), and its error in excluding from consideration Mrs Woodling’s requirement of another person’s assistance in in connection with her bodily preparing her meals-"attention functions". Until 1979, it was the practice of delegated medical practitioners to exclude cooking from the relevant "attention" to be considered. It was now clear that the policy underlying section 35 of the Act stopped short of providing an attendance allowance for all who are incapable of looking after themselves without some outside help, even if that help were frequently required. Large areas of domestic work were deliberately excluded. Lord Bridge found it reasonable to infer that the Act was there to provide a financial incentive to encourage family or friends to undertake the difficult and sometimes distasteful task of providing sometimes intimate care within the home for those who are so severely disabled that they must otherwise become a charge on some public institution. A
PATIENT
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House of Lords, Feb 9, 1984. Lord Diplock, Lord Fraser ofTullybelton, Lord Scarman, Lord Roskill, Lord Brandon ofoakbrook, and Lord Bridge of Harwich. Woodling and the Secretary of State for Social Services.
DIANA BRAHAMS, Barrister-at-Law
Commentary from Westminster Drug Addiction DOCTORS and the health service in general must take a large part of the blame for the growing problem of drug addiction in Britain, an MP has told the House of Commons. Doctors usually know little about the causes and possible cures for addiction, and often do not want to know, Conservative backbencher Sir Bernard Braine accused, when he raised the question of drug abuse in a Commons adjournment debate (which means he secured the debate on his own initiative, it not being a Government debate). His object was to educate both the medical profession and the Government about the urgent need for a new approach to
addiction. Sir Bernard was chairman of the National Council on Alcoholism for eight years. At the beginning of that period, he pointed out, it was hard to convince anyone that alcoholism was an illness: "Alcoholics were a nuisance, their behaviour unpleasant and embarrassing," he told MPs. That situation was now much improved. But just as there has been a need for education about alcoholism, and an awakening of awareness of its social and economic cost, so we now need to face up to what was happening in drug abuse, Sir Bernard continued. Many people had written to Sir Bernard about drug problems in their families, and in all cases the writer’s feelings of helplessness had been made worse by the difficulty of finding help or support. "So often the complaint is that general practitioners-the first line of defence against illhealth-have little knowledge of the problem." Organisations offering help were difficult to find. Professional advice was often diverse, and led to confusion. One consultant had written to Sir Bernard saying that treatment was rarely available within the NHS, and in many parts of the country there were no treatment centres at all. "Even where those treatment facilities are available there is almost always a long delay, sometimes up to two months, before even an initial assessment of the addict can be provided, and an even longer delay-three months or more-before definitive treatment facilities are made available," Sir Bernard said. Many people in the NHS do not want to know about drug addiction. For them, drug addicts "are problem children: there are higher priorities and. more pressing needs elsewhere". There is little information for addicts and their families about where help can be obtained. Sir Bernard’s correspondents ask "Where can we get help?". The NHS lacks an expert, comprehensive, and sustained treatment for the various phases of drug addiction illness. Doctors have told Sir Bernard that their own profession lacks understanding and knowledge of addiction, which although it is self-inflicted should still be treated as an illness. Regional health authorities seemed to be failing to take drug addiction seriously enough. There were no specialist services for addicts within the NHS in Cornwall, Devon, Wiltshire,
Gloucestershire, Kent, Essex, Northamptonshire, Suffolk, Cumbria, Yorkshire, Herefordshire, Worcestershire, Leicestershire, Derbyshire, Durham, and Bedfordshire, he said. Even in London some boroughs were outside the catchment area of the capital’s fifteen specialist drug centres. Although the Secretary of State for Social Services, Mr Norman Fowler, has asked RHAs to report to him by September on the scale of the drug problem within their own
Medicine and the Law No Attendance Allowance for Cooking with renal insufficiency and bone changes was in receipt of an attendance allowance from June, 1977. In August, 1980, she underwent a renal transplant operation and dialysis ceased soon after. In November, 1981, a medical practitioner acting on behalf of the Attendance Allowance Board considered a new claim, made in view of the imminent expiry of the certificate, for attendance allowance, and found that the claimant did not satisfy any of the conditions in section 35 (1) ofthe 1975 Act. In May, 1982, another delegated medical practitioner reached the same conclusion, though he noted that some ordinary domestic duties were performed on behalf of the claimant. He decided, however, that: "Even if such duties are required to be done because Mrs Woodling is too disabled to carry them out for herself, they do not qualify as attention in connection with her bodily functions and cannot be taken into account in consideration of her requirements". He therefore ruled as irrelevant, and did not consider further, part of the evidence before him which purported to show that all cooking was done for the appellant for which she now claimed an allowance. Mrs Woodling had stated earlier: "I live by myself but have a lot of help. As I have bone complications, I am not able to lift anything heavy. They do all my shopping, cooking, cleaning, washing, and ironing, and other housework has to be done for me-any weight activity is prohibited". Mrs Woodling’s appeal came before Woolf] who held that he was bound by the Court of Appeal decision in 1981 (Regv National Insurance Commissioner, ex parte, Secretary of State for Social Services (1981)2 AlER 738; Lancet 1981; i: 1008). The question then came before the House of Lords and the appeal was dismissed. Section 35 (1) of the 1975 Act provides as follows. "A person shall be entitled to an attendance allowance if... either-(a) he is so severely disabled physically or mentally that, by day, he requires from another person either (i) frequent attention throughout the day in connection with his bodily functions, or (ii) continual supervision throughout the day in order to avoid substantial danger to himself or others; or-(b) he is so severely disabled physically or mentally that, at night, he requires from another person either (i) prolonged or repeated attention during the night in connection with his bodily functions, or (ii) continual supervision throughout the night in order to avoid substantial danger to himself or others." A person requiring attention only during the day or during the night receives a lower allowance than someone requiring attention during both day and night. Lord Bridge of Harwich said that for this appeal it was unnecessary to examine the extent of Mrs Woodling’s disability. The only criticism levelled at the decision of the Attendance Allowance Board was its conclusion that Mrs Woodling was not entitled to attention during the day (no claim for attention at night having been made), and its error in excluding from consideration Mrs Woodling’s requirement of another person’s assistance in in connection with her bodily preparing her meals-"attention functions". Until 1979, it was the practice of delegated medical practitioners to exclude cooking from the relevant "attention" to be considered. It was now clear that the policy underlying section 35 of the Act stopped short of providing an attendance allowance for all who are incapable of looking after themselves without some outside help, even if that help were frequently required. Large areas of domestic work were deliberately excluded. Lord Bridge found it reasonable to infer that the Act was there to provide a financial incentive to encourage family or friends to undertake the difficult and sometimes distasteful task of providing sometimes intimate care within the home for those who are so severely disabled that they must otherwise become a charge on some public institution. A
PATIENT
...
House of Lords, Feb 9, 1984. Lord Diplock, Lord Fraser ofTullybelton, Lord Scarman, Lord Roskill, Lord Brandon ofoakbrook, and Lord Bridge of Harwich. Woodling and the Secretary of State for Social Services.
DIANA BRAHAMS, Barrister-at-Law
Commentary from Westminster Drug Addiction DOCTORS and the health service in general must take a large part of the blame for the growing problem of drug addiction in Britain, an MP has told the House of Commons. Doctors usually know little about the causes and possible cures for addiction, and often do not want to know, Conservative backbencher Sir Bernard Braine accused, when he raised the question of drug abuse in a Commons adjournment debate (which means he secured the debate on his own initiative, it not being a Government debate). His object was to educate both the medical profession and the Government about the urgent need for a new approach to
addiction. Sir Bernard was chairman of the National Council on Alcoholism for eight years. At the beginning of that period, he pointed out, it was hard to convince anyone that alcoholism was an illness: "Alcoholics were a nuisance, their behaviour unpleasant and embarrassing," he told MPs. That situation was now much improved. But just as there has been a need for education about alcoholism, and an awakening of awareness of its social and economic cost, so we now need to face up to what was happening in drug abuse, Sir Bernard continued. Many people had written to Sir Bernard about drug problems in their families, and in all cases the writer’s feelings of helplessness had been made worse by the difficulty of finding help or support. "So often the complaint is that general practitioners-the first line of defence against illhealth-have little knowledge of the problem." Organisations offering help were difficult to find. Professional advice was often diverse, and led to confusion. One consultant had written to Sir Bernard saying that treatment was rarely available within the NHS, and in many parts of the country there were no treatment centres at all. "Even where those treatment facilities are available there is almost always a long delay, sometimes up to two months, before even an initial assessment of the addict can be provided, and an even longer delay-three months or more-before definitive treatment facilities are made available," Sir Bernard said. Many people in the NHS do not want to know about drug addiction. For them, drug addicts "are problem children: there are higher priorities and. more pressing needs elsewhere". There is little information for addicts and their families about where help can be obtained. Sir Bernard’s correspondents ask "Where can we get help?". The NHS lacks an expert, comprehensive, and sustained treatment for the various phases of drug addiction illness. Doctors have told Sir Bernard that their own profession lacks understanding and knowledge of addiction, which although it is self-inflicted should still be treated as an illness. Regional health authorities seemed to be failing to take drug addiction seriously enough. There were no specialist services for addicts within the NHS in Cornwall, Devon, Wiltshire,
Gloucestershire, Kent, Essex, Northamptonshire, Suffolk, Cumbria, Yorkshire, Herefordshire, Worcestershire, Leicestershire, Derbyshire, Durham, and Bedfordshire, he said. Even in London some boroughs were outside the catchment area of the capital’s fifteen specialist drug centres. Although the Secretary of State for Social Services, Mr Norman Fowler, has asked RHAs to report to him by September on the scale of the drug problem within their own