Stewart-v-Advocate for Scotland [2000] UKSSCSC CSDLA_512_1998 (30 May 2000)
R(DLA) 2/00
Mr. D. J. May QC CSDLA/512/1998
10.8.99
CS (Lord President, Lord Caplan and
Lord Milligan)
Care component - whether attention was required in connection with the bodily function of urinating and in particular, following completion of that function
The claimant, a child whose disability was described as being "chronic asthmatic - bed wetter" claimed the care component of disability living allowance. A disability appeal tribunal decided that he did not qualify for either the day time or the night time conditions in section 72(1)(b)(i) and section 72(1)(c)(ii) respectively. In particular, it was accepted by the tribunal that enuresis was a disablement to which section 72 applied but that the level of attention required was neither repeated nor prolonged. The claimant appealed to a Commissioner who upheld the appeal, substituting his own decision to the same effect. The Commissioner held that inter alia the tribunal had not determined whether enuresis was a mental or physical disablement and that was an error. However the Commissioner also considered further if for the sake of argument it was accepted that the claimant had a disablement they had erred in failing to identify any impaired bodily function and, by inference, in accepting that attention could be given in connection with the bodily function of urinating. The claimant appealed to the Court of Session.
Held, allowing the appeal, that upon the assumption that the requirements for disablement were met:
- the Commissioner was wrong as a matter of law to exclude attention provided following completion of the bodily function of urinating merely because the attention did not assist in the actual bodily function of urinating. The attention did not have to be "in the performance" of the bodily function. The Court agreed with the observations of Lords Goff, Mustill, Slynn and Clyde in Cockburn v. Chief Adjudication Officer [1997] 1 WLR 799 [R(A) 2/98];
- whether attention following completion of the bodily function of urinating will qualify for an award of care component is a matter for consideration in the circumstances of each case under reference to the statutory requirements as a whole.
The Court stated that the appeal before them was not concerned with what was required by disablement to meet the statutory conditions.
The Court of Session set aside the Commissioner's decision and remitted the case to the tribunal for rehearing.
[Note: In the course of the Opinion of the Court of Session, a passage from the speech of Lord Hope of Craighead in Cockburn v. Chief Adjudication Officer [1997] 1 WLR 799, 823 is wrongly attributed to Lord Clyde]
DECISION OF THE SOCIAL SECURITY COMMISSIONER
"The tribunal erred in law in its decision that on the facts found the attention required did not amount to "frequent attention throughout the day". "Frequent" has been defined by case law as "several times" and it is submitted that attention given four times per day, which was found as a fact by the tribunal, does amount to frequent attention in law. The attention given, in addition to being frequent, must be given "throughout the day". The tribunal did not, in its decision, mention Isaac's pattern of needs throughout the day. However, the evidence given at the tribunal was that the attention was given in the morning, at lunch time, in the afternoon and in the evening. It is submitted that this amounts to attention "throughout the day"."
"4. [I] has becotide - two puffs four times a day, bricanyl - four times a day and occasionally six times a day and slofylin - in the morning and in the evening.
....
- [I] cannot push down and inhale at the same time and so his mother always attends to the administration of the becotide.
- It takes five minutes each time for the administration for the inhalers and medication."
In giving reasons for their decision the tribunal said:
"The tribunal accepted the appellant's evidence that she attended to [I's] medication. However, the tribunal were of the opinion that on each occasion this would take some five minutes and since on a regular basis this amounted to four times a day, although occasionally it might be more, the tribunal were agreed that this was not for a significant portion of the day and neither could it be found to be frequent attention throughout the day. Since the basic criteria for an award of the care component of DLA had not been satisfied the tribunal had no need to consider whether the attention required by [I] was in excess of that required by children with no disability."
"the tribunal erred in law in deciding that the 20 minutes per night attention which was given to [I] was not "prolonged" attention."
Again in respect of prolonged attention reference is made to what was said by the Master of the Rolls in R(A) 2/80.
"8. [I] wets the bed 5-7 nights in the week.
9. Once or twice in the week [I] will wet twice in the night.
- [I's] mother takes 20 minutes to attend to him when he wets the bed."
In giving reasons for their decision they said:
"So far as night needs are concerned the tribunal accepted the appointee's evidence that most nights in the week she has to attend to [I] once a night for 20 minutes at a time. The tribunal were agreed that this was not prolonged attention. The appointee required to attend to [I] twice in the night, only once or twice in the week and so the tribunal were unable to find that the attention required by [I] was repeated during the night on a regular basis. Since the tribunal did not find the primary criteria for a night time award to be satisfied they had no need to address whether the attention required by [I] was in excess of that required by a child with no disability."
"It seems to me that to suffer from enuresis is to suffer from a disability. Whether it is physical or mental in origin, or whether its origin can or cannot be established, is irrelevant."
I do not accept that as a sound statement of the law. It is contrary to the views reached by Mr. Commissioner Skinner in R(A) 2/92, which as a reported decision had the assent of the majority of Commissioners. I am satisfied that the establishment of a disability caused by a medically recognised, physical or mental condition is an essential prerequisite. To hold otherwise would broaden the scope for disability allowance far beyond what is envisaged by the statute.
"11. The tribunal also find that the claimant required repeated attention during the night with the bodily function of urinating. The evidence in this case in my view does not disclose that the claimant required attention in connection with urinating rather it was service in respect of the consequence of urinating which he received namely the changing of pyjamas and sheets. I refer in that connection to finding in fact 7."
The situation is not dissimilar in the present case in relation to the findings in fact made by the tribunal.
I went on to say in CSDLA/296/1998:
"12. In the case of Cockburn v. the Chief Adjudication Officer [R(A) 2/98] a judgment of the House of Lords was focused by Lord Hope of Craighead where he noted:
"There are two bodily functions involved in Mrs. Cockburn's case. The first is that of urinating. Her disability in regard to that function is her incontinence. But she does not require assistance in the performance of the function or urinating. Her problem is that she cannot cope with the consequences of her incontinence due to her arthritis. The assistance which she requires is in connection with the other bodily function, which is that of moving her limbs."
The situation is not dissimilar in the present case where there is no assistance which can be given to the claimant in the performance of the bodily function of urinating. Even if the enuresis had in itself been found to be a physical or mental disablement or the consequence of such as Lord Slynn said in his speech in Cockburn in respect of the requirement for attention in connection with bodily functions impaired by disablement:
"The attention is provided by removing or reducing disability to enable the bodily function to operate or in some cases to provide a substitute for it."
That was not the service provided to the claimant when he involuntarily urinated while in bed."
Date: 10 August 1999 (signed) Mr. D. J. May QC Commissioner
The claimant appealed to the Court of Session. The decision of the Court of Session follows.
DECISION OF THE COURT OF SESSION
Mr. J. J. Mitchell QC and Mr. S. G. Collins (instructed by Brodies, WS) appeared on behalf of the Appellant.
Mr. A. R. Dewar (instructed by Mr. H. Macdiarmid) appeared on behalf of the Respondent.
LORD MILLIGAN:
"Subject to the provisions of this Act a person shall be entitled to the care component of a Disability Living Allowance for any period throughout which .... (c) he is so severely disabled physically or mentally that, at night - (i) he requires from another person prolonged or repeated attention in connection with his bodily functions ....".
The present appeal is concerned, and solely concerned, with the meaning of "attention in connection with his bodily functions". In particular it is not concerned with what is required either by way of disablement or to qualify attention as prolonged and repeated in terms of the statutory provisions concerned. For present purposes we simply assume that these requirements were met. The phrase with which this appeal is concerned was first put in issue in the case by the Commissioner, who allowed the appeal made to him on other grounds but refused the application expressly because there was no "attention in connection with his bodily functions" on the tribunal's findings in fact. The terms of the tribunal's findings in fact were:
"The appointee claimed DLA for Isaac on 8 May 1996.
Isaac suffers from asthma and enuresis.
Isaac has no mobility needs.
Isaac has becotide - two puffs four times a day, bricanyl - four times a day and occasionally six times a day and slofylin - in the morning and in the evening.
Isaac cannot push down and inhale at the same time and so his mother always attends to the administration of the becotide.
Isaac's mother would not leave him in the bath.
It takes five minutes each time for the administration for the inhalers and medication.
Isaac wets the bed 5-7 nights in the week.
Once or twice in the week Isaac will wet twice in the night.
Isaac's mother takes 20 minutes to attend to him when he wets the bed".
"17. However I consider that even if the tribunal's failure to establish whether the claimant suffered from a disablement caused by a recognised physical or mental condition was in error, if it is for the sake of argument accepted as such, their treatment of the night time attention conditions in respect of attention required in connection with bodily functions is seriously defective. They have not identified any bodily function which was impaired. If it can be inferred that the claimant's impairment was related to urinating, which realistically I think it can it is not at all clear upon what basis the tribunal found that he reasonably required attention in connection with that bodily function. In paragraph 11 of CSDLA/296/1998 I said:
"11. The tribunal also find that the claimant required repeated attention during the night with the bodily function of urinating. The evidence in this case in my view does not disclose that the claimant required attention in connection with urinating rather it was service in respect of the consequence of urinating which he received namely the changing of pyjamas and sheets. I refer in that connection to finding in fact 7."
The situation is not dissimilar in the present case in relation to the findings in fact made by the tribunal.
I went on to say in CSDLA/296/1998:
"12. In the case of Cockburn v. The Chief Adjudication Officer [R(A) 2/98] a judgment of the House of Lords was focused by Lord Hope of Craighead where he noted:
"There are two bodily functions involved in Mrs. Cockburn's case. The first is that of urinating. Her disability in regard to that function is her incontinence. But she does not require assistance in the performance of the function or urinating. Her problem is that she cannot cope with the consequences of her incontinence due to her arthritis. The assistance which she requires is in connection with the other bodily function, which is that of moving her limbs."
The situation is not dissimilar in the present case where there is no assistance which can be given to the claimant in the performance of the bodily function of urinating. Even if the enuresis had in itself been found to be a physical or mental disablement or the consequence of such as Lord Slynn said in his speech in Cockburn in respect of the requirement for attention in connection with bodily functions impaired by disablement:
"The attention is provided by removing or reducing disability to enable the bodily function to operate or in some cases to provide a substitute for it."
That was not the service provided to the claimant when he involuntarily urinated while in bed".
- Mr. Marshall on behalf of the claimant accepted on the authority of Cockburn the parameters placed upon the conditions and in particular the quotation from Lord Slynn quoted by me in paragraph 12 of CSDLA/296/98. He did however submit that in respect of the word 'operate' used by Lord Slynn this meant operation in a normally socially accepted manner which included such matters as washing the claimant and changing the bed clothes. However I am not satisfied that that is what was intended by Lord Slynn in his speech. It is quite clear that no attention for the bodily function of urinating was given by washing the claimant or removing, washing and replacing the bed clothes. It is thus clear to me that even in enuresis for the sake of argument was accepted as a physical or mental disablement that would be insufficient to bring him within the statutory parameters. Thus in apparently accepting that the claimant had requirements in connection with his bodily functions, which by inference was urinating they have erred in law and their decision must be set aside."
"In my opinion, in the case of an unfortunate woman who because of her arthritis cannot cope with her incontinence, the services of changing her clothes or her bed linen and remaking her bed, even (as part of the same operation) rinsing out the soiled clothing removed from her, are sufficiently personal to fall within the section".
He distinguished the taking away of laundry to be washed as transcending personal attention of that kind. Lord Mustill (at p. 804), after dealing with cases involving accompanying a claimant to the lavatory, said:
"Assume now that the applicant does not manage to get to the lavatory in time and needs help to change his or her clothes and put things straight. I think it quite a small step to say that here the help is given in connection with a bodily malfunction which, as I have said, I would equate with a bodily function. And if this is right the same must be the case with the changing of bedclothes and nightwear and other tasks. ... I would go one step further still. If the other person, having come in to strip the bed etc. had stayed to rinse the linen and hang it up to dry I believe that this, too, would have fallen within the section..... There are cases where it is better to concentrate on the words themselves, in the context of the actual dispute. In my opinion this is one. I see here a sufficient continuity between the applicant's incontinence and the presence of the other person to deal with the consequences on the spot to satisfy the section. If the other person had been asked why she spent an hour or so in the flat she would say that she had gone to help out with the applicant's bladder problem".
Lord Slynn, who dissented in the result of the Cockburn case, which involved refusal of the applicant's appeal, said (at p. 818):
"In considering these cases it is important to bear in mind that the 'care component' of the attendance allowance is concerned with 'care' and with 'attention'. The question in each case is whether the particular activities said to be 'attention' is reasonably required by the individual because of the severe disability affecting the relevant bodily function and is reasonably required in connection with that function. This question must be considered as a whole and I do not think that it helps to adopt particular categories which cannot ever be capable of constituting 'attention' ..... I do not think that attention necessarily involves physical contact. In particular, in a case like the present, the attention may involve acts of physical contact and acts where there is no physical contact. Preparing a warm sponge and soap and rinsing the sponge afterwards is as much a part of attention as the physical contact involved in cleaning the body. So, equally, I do not think that removing soiled, and providing clean, clothes and bedclothes, though in both cases it may begin by physical contact with the person involved, ceases to be capable of being attention because the cleaning of the clothes does not involve physical contact".
Lord Clyde (at p. 823) said:
"She does not require attention in connection with the performance of the bodily function of urinating, but the fact that she is incontinent of urine increases her need for attention in connection with the other bodily functions which I have described".
The passage in the speech of Lord Hope referred to in paragraph 17 of the Commissioner's decision thus stands alone in support of the Commissioner's decision so far as the speeches in the Cockburn case are concerned. In particular the speeches of the other judges provide no support for the contention that the fact that Mrs. Cockburn's problem was that she could not cope with the consequences of her incontinence due to her arthritis was in itself fatal to her case. Nor do they support Lord Hope's view that the assistance requires to be "in the performance of" the function of urinating.