HC Deb 06 June 1951 vol 488 cc1180-90

Motion made, and Question proposed, "That this House do now adjourn."—[Mr. Royle.]

12.5 a.m.

Mr. Anthony Greenwood (Rossendale)

The problem of the aged sick, to which I am drawing the attention of the House tonight, is one which is becoming more acute in view of the increased percentage of our population over retirement age, and it is one which we shall have to face during the next few years. There are two needs which exist side by side. The first is to keep our old people fit so that they can lead a normal happy existence, and, secondly, if those old people fall sick, we should provide adequate domiciliary and hospital services for them. I do not believe that today we are completely satisfying either of these needs.

All of us in this House must receive harrowing letters from constituents complaining about the difficulty of getting old people into the chronic sick wards of our hospitals. In my own hospital group area of Bury and Rossendale there are something like 150 old people waiting for admission to hospital, and in an admirable speech at Bournemouth last week the Parliamentary Secretary gave the figure of 7,000 for the whole country waiting for chronic sick beds.

I should be the last person to belittle the benefits which have flowed from the National Health Service and the National Assistance Act, but I am not sure that at the moment the old people are entirely gaining from either. I think most of us must feel a great deal of sympathy with an article that appeared in "The Times" on 10th April this year which referred to the "administrative no-man's-land" which exists between various welfare services. We must take steps to ensure that there is proper co-ordination between the National Health Service, the National Assistance Board, the local authorities and the voluntary organisations. At this stage, let me say how pleased I was that in his speech last week my hon. Friend referred to the valuable work the voluntary organisations are doing. I want to ask him tonight—and this is my first question—whether he is satisfied with the extent to which these various public and voluntary services are being co-ordinated for the benefit of the old people.

I believe that the problem is not primarily one of providing adequate accommodation; there is also the very important problem of getting a new outlook on the aged sick. First of all, I think, we have to stop them from going to hospitals if we can. We have got to see they are got to hospital when it is absolutely necessary. The figures in my own hospital group area in Lancashire show that 40 per cent. of those in chronic sick wards are not actually in need of hospital treatment. When old people are of necessity in hospital we must set out to cure them, and then we must try to get them out of hospital again to lead an ordinary existence. Today, unfortunately, too many old people are literally dumped on the steps of our big hospitals.

We know the doctors are overworked; we know families have difficulties and responsibilities to face up to; and all too often the accommodation in which the old people live is not really suitable for them in which to get the domiciliary treatment which we have it in mind to give them—while the worst thing anybody can do to old people who fall sick is to take them from their familiar surroundings, give them the impression they are not wanted, and so place them in conditions where it seems to them that the only hope of escape is death.

I suggest that the first thing we should do in dealing with this problem of old people is to keep them in their own homes wherever it is possible and suitable to do so. There they have the attention of their general practitioner, an old family friend. They can have the attendance of specialists available to them under the National Health Scheme. The services of physiotherapists and chiropodists must be available. Facilities for occupational therapy to patients in their own homes must be provided. Nursing must be available. Welfare organisations must provide for the laundering of dirty linen. Local authorities must go rather farther than they have done so far in the provision of home helps, and voluntary organisations must get down to the job of providing old people in their homes with meals and helping them in getting up coal, delivering library books and other jobs of that kind, which can mean so much to their comfort and welfare.

I believe that if we provide domiciliary treatment along these lines not only will it benefit the old people in helping to keep them fit, but it will also be in the interests of the public at large, because it will allow more effective use of hospital beds and has the added advantage of being cheaper. If we can provide domiciliary treatment of that kind, it will be at an expense of something like £3 a week, as against between £4 and £5 a week in hospital, and anything between £8 and £15 a week in the chronic sick wards of our hospitals. I want to ask whether, in fact, we are making progress in the development of such a domiciliary service.

If it is unsuitable for old people to stay in their own homes, then we need either the ordinary welfare type of hostel which caters for the person who is occasionally sick, or the different kind of hostel which caters for those who alternate between sickness and good health. That is the kind of accommodation we ought to be providing, so that old people who cannot look after themselves can have the advantage of accommodation of that kind and not go automatically into the chronic sick wards of our hospitals.

These are the kind of hostels being provided by big local authorities like Manchester, Salford, Lancashire County Council and local authorities in other parts of the country. We need more of these hostels so that, wherever possible, old people who would automatically go into chronic sick wards should be given a chance to recover and lead normal homes lives and not be condemned to the chronic sick ward. We have a saying in Lancashire—"they dee i' bed"—which, I am afraid, is all too true. For many old folk in the past admission to a chronic sick ward was tantamount to a sentence of death. If hospital treatment is necessary, then in the first place it should be on a short-term basis.

We find, unfortunately, that too often old people are put in bed in hospital for convenience, to keep them out of trouble, when it is not really necessary to have them in bed at all. Equally unfortunately, there is often no serious attempt to diagnose, and consequently no serious attempt to provide treatment. I am not suggesting that in any way as a criticism of the personnel who manage our hospitals. I mention it as evidence of the need for a new attitude of mind and for more adequate staffs than many hospitals have at the present time. I should not like anything I say tonight to be construed in any way as being criticism of the men and women who give such magnificent service in our hospitals, in work which is always cheerless and sometimes unpleasant.

Whatever the cause of the situation, the fact is that beds which could be used for other patients are today being occupied by men and women for the simple reason that they are old and nobody has made any effort to cure them of their trouble and get them fit again, so that they can get out and lead ordinary normal existences. Recently one hospital set up a long-term annexe and moved into it eight patients all of whom had been in the hospital occupying beds in the chronic sick ward for five years. During that time those eight people had taken up bed space which could have been used for the treatment of 360 acute surgical cases.

Besides the need for diagnosis, I suggest that every hospital ought to be encouraged by the Ministry of Health to set up a geriatric department. Geriatrics is a science which is still in its infancy. The efforts of Dr. Marjory Warren and Dr. Cosin have shown what can be done in rehabilitating old people. One of the results of their work has been that some hospitals which have followed the treatment they have prescribed for old people have been able to reduce the number of beds devoted to chronic sick to one-third or one-quarter of what it was before.

The first geriatric unit in a teaching hospital is that under the supervision of Lord Amulree at St. Pancras. In an article in "The Lancet" on 20th January, 1951, Lord Amulree gave tables showing what happened to two classes of patients, first, the patients who had been "inherited" and, secondly, the patients admitted after the geriatric unit was set up. Of the first class there were 155, and Lord Amulree wrote: We can say…that though 95 per cent. of these patients were at one time bedridden, by the end of the year their physical state and mental outlook had improved so much that the bedridden cases had been reduced to 10 per cent. The patients composing this 10 per cent. have gross physical deformities which make it impossible for them to sit in chairs. Many of these deformities we believe were preventable. He goes on to discuss the 89 new cases admitted, and says: Of the 29 remaining in the hospital"— which means that 60 were cured of their trouble during the year— —we consider that 18 (20 per cent. of the 89) are suitable for hostel accommodation; and in fact some of these patients are now awaiting the opening of a hostel which is to be attached to the hospital. Only 11 of the 29 (about 13 per cent. of the 89) are regarded as irremedial. I give these figures to show what can be done by a hospital which gets down to the task of dealing with the aged sick, finding out what is wrong with them and putting them right.

My right hon. and hon. Friends at the Ministry of Health are aware of the problem and what can be done to deal with it. In 1948, and again in 1950, they issued circulars to the regional hospital boards emphasising that when these people enter hospital they should first go into the acute ward so that there can be no question of the chronic sick ward being inevitable. It seems to me that after treatment in the acute ward two courses are open. First, the patient, if cured and if proper accommodation and care are available, can go home, preferably after a stay in a convalescent home. Unfortunately, at the moment we do not appear to have enough convalescent homes to deal with cases of this kind.

The second course, if there is no home or if the patient is too ill or too weak to leave hospital, is that he should go to a special long-stay annexe attached to the hospital, with medical and nursing staff available. The effect of that would be to release extremely expensive equipment in the acute hospital ward for the purpose for which it was intended. I know that my hon. Friend has been devoting a good deal of attention to the question of long-stay annexes, and I hope he will tell us something about them when he replies. So long as my right hon. and hon. Friends are in charge of the Ministry of Health, I believe that the chronic and aged sick can be sure of sympathetic and imaginative treatment of a kind all too frequently denied them in the past.

12.20 a.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Blenkinsop)

I apologise for intervening so quickly in this short debate, but I am anxious to deal fairly fully with the remarks which have been made, because this is a subject of very real importance, and one which I am sure is of wide interest to everyone. In some quarters there is anxiety about the problem which my hon. Friend the Member for Rossendale (Mr. Anthony Greenwood) has raised and I wish to give as much information as possible, though I should have welcomed a much longer debate.

I agree most wholeheartedly with what my hon. Friend has said about the importance of preventing old people from becoming chronic cases The word "chronic" is a confession of failure and one which we do not want to use. It is true that, in the past, cases have been incorrectly labelled as chronic which have proved to be not chronic at all, and under treatment have been brought into quite active community life again. Therefore, our first care must be to improve our domiciliary services; to help to prevent cases from becoming chronic; and also to assist in the work of the hospitals in providing accommodation for those who can be discharged.

In our view the greatest need of all is to bring together the many voluntary and statutory agencies working in this field. It is now over a year ago that we issued a circular to local authorities urging them to take every measure to initiate the effective co-ordination of all the bodies engaged in welfare work for old people. I am glad to say there has been a great response to that. Many local authorities had already taken action before the circular was sent out, but there has been a further spurt of activity, and I am glad to see how many committees of this kind have been established. There are now 42 county old peoples' welfare committees, which is a considerable increase over the figure even of nine months ago. In general, they include both voluntary and statutory bodies. Our desire is to avoid the overlapping which sometimes occurs between voluntary bodies and to ensure that the knowledge which comes in to voluntary and official bodies is shared.

I am particularly anxious to encourage the setting up of committees in those areas where this has not already been done, for it will prove a real sign of activity and an encouragement to everyone to do what they an to assist the voluntary bodies in the very many practical jobs which would ease the position of old people. That would help enormously in tackling this problem, and assist the hospitals as well.

Mr. J. N. Browne (Glasgow, Govan)

Has the hon. Gentleman been given any guidance whether any particular Ministry has an overriding authority in any area in deciding about the care of old persons?

Mr. Blenkinsop

In general, the welfare services which are run by the local authorities, and for which the local authorities have responsibility, fall within the care and purview of the Ministry of Health. After the alteration in functions, there are, of course, certain matters dealing with housing and so on which are dealt with by the Ministry of Local Government and Planning, but the major responsibility and the whole of the work of the welfare committees of the local authorities come under the Ministry of Health.

Mr. Browne

The hon. Gentleman does realise that there is an overriding authority?

Mr. Blenkinsop

I do not see any difficulty there. The division as between the Ministry of Health and the Ministry of Local Government and Planning is not causing any difficulty in this problem. The difficulty which arises is one of the divisions that occur locally much more than nationally, and the changes made some months ago have not made the slightest difference in the prosecution of this work.

In addition to the work we are doing on the preventive side in the local committees, which we regard as very important—and we are taking further action to encourage increased activity—we are most anxious to help those who, with the best will in the world, cannot be treated in their own homes. As I am sure my hon. Friend knows, many local authorities have set up residential hostels under the provisions of the National Assistance Act and these are steadily being increased. There are now some 350 in England and Wales and I understand that another 400 are in preparation.

Those are small hostels and the 350 provide accommodation for about 8,000 old people. Those were intended mainly, if not entirely, for the healthy old, but, of course, cases naturally arise of people who fall into sickness—and, I am glad to say, out again—and that raises a problem of whether those cases should be moved into some other type of hostel or whether we can make provision to meet their needs where they are already. It is not a good thing to make more changes in the conditions and surroundings of old people than we can help. Therefore, I do not want to visualise the provision of too many varieties of accommodation, which might mean too many changes for the average old person.

There is, nevertheless, the problem of whether or not we can encourage the provision of some intermediate accommodation for those who are partly sick and partly well. I think this is a field in which we ought to have some experimental provision before we do anything very definite over the country as a whole. I am most anxious that no administrative difficulties, of which there will be plenty, shall stand in the way of provision of accommodation of this sort, and I am sure that, if there is a real need for accommodation of this type, we shall be able to provide it.

The main problem, however, still rests with the hospitals. It is true that this is not so much the problem of extra accommodation as one of trying to make better use of existing accommodation. I very much agree that it is possible, with a better turnover of hospital beds, to meet very much, if not the whole, of the very real and serious problem of the waiting list which now confronts us. I join with my hon. Friend in paying tribute to the very many who have done such fine work in the hospitals, particularly in the last year. He mentioned some names, and there are many others all over the country who have done fine work in this field.

We certainly are taking every step we can to encourage very much more of this active work. To be fully effective, this depends upon our securing exchanges between residential hostels and the hospitals. That often is not so easy to achieve as we would like. We want much more effective co-operation between all the different authorities concerned. That we are out to achieve, and we believe we are achieving it. It is more a matter of the co-operation of those concerned on the spot than of setting up committees at regional or national level.

But there is one particular field in which experimental work is being carried out which I am anxious to encourage. For instance, I went this morning to look at one hostel which has been recently opened. The funds were provided by the King Edward VII Hospital Fund for this hostel and also for a series of others which are to be opened shortly. These hostels, which are quite small, are residental, and are attached as annexes to particular hospitals. They are intended to cater for the type of case which is not a permanent bed case, but which does require regular nursing and medical care, but yet can, by the fuller use of both good nursing and medical care, be encouraged to become ambulant again and, we hope, fit to be discharged to his or her home. This much relieves the pressure on hospitals and beds, and is proving already to be of real value to the old people.

I have seen some of the old people who are in these hostels. I am delighted with the response they have achieved already in this very short period. I hope it will not be long before we have more of this type of accommodation. This, I think, will show that we are anxious to deal with this matter, not from one angle alone. We realise that that would be of no value. We want to attack the problem of the welfare and care of the aged sick from many different angles, so as to secure effective relief.

It is true that we must have effective co-operation from voluntary and statutory bodies to achieve that. Over the wider national field we want to secure co-operation between hospitals, local authorities and the professional services concerned. We are securing advice on this, and I believe that we shall shortly have constructive advice upon securing the extra co-operation between the main bodies concerned, which is so necessary. We shall not hesitate to act upon it as quickly as possible.

12.34 a.m.

Mr. J. Enoch Powell (Wolverhampton, South-West)

The more one studies the expenditure on the hospital service, which is one of the most acute problems in the whole range of the social services, the more one is impressed by the fact that the cost of the social services is very largely governed by the rate of turn-over. As hon. Members have emphasised, the care of all sorts of aged sick and the turnover in the hospitals is of great importance, and it logically follows that the priority of any measures which take the aged sick out of the hands of the hospital service is equal to any other single direction in which the hospital service is being expanded. Also, that this measure, like any other measure which will promote a more rapid turn-over in the hospital service, and thus a reduction in overheads, will be the truest economy which we can carry out in that service.

The Question having been proposed after Ten o'clock on Wednesday evening and the Debate having continued for half an hour, Mr. DEPUTY-SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at Twenty-five Minutes to One o'Clock.