HC Deb 19 November 1952 vol 507 cc1984-2012

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

9.10 p.m.

Mr. H. Hynd (Accrington)

It would be possible, I think, to link the subject I wish to discuss with the one which has just been discussed, but probably it would be better to deal with it entirely separately. I am glad that we have a little more than the normal time for the Adjournment Motion. I claim that this subject is one which deserves a great deal more attention than it has had so far.

I had better begin by explaining to some of my hon. Friends and hon. Gentlemen opposite who have been asking me during the last few days what the word "geriatric" means, that the dictionary meaning is: "That branch of medicine which treats disorders and diseases associated with old age." I think that we can deal with this as an entirely non-party matter. It is a new field of medical science which is rapidly developing, I believe with very satisfactory results. I should like to deal with this subject as the care of the aged infirm in its widest sense, not forgetting the possibility of rehabilitation wherever that is possible.

This is a growing problem because of the increasing proportion of old people in the country. My information is that most county councils are facing serious problems in this connection, while the old people themselves are finding that it is causing unhappiness and preventable suffering due to the lack of facilities. I am encouraged to note that the Ministry are alive to the problem. In their current Annual Report they say—and I think that it is worth quoting—that: The problems of the aged and infirm who waver between sickness and health and of the 'borderline' case are particularly difficult to solve. The hospital authorities are responsible for the care of the sick, and the local authorities, under Part III of the National Assistance Act, 1948, for those who are not sick but are in need of care and attention; this division of responsibility could lead to difficulties when it is not clear on which side of the line a particular patient properly rests, but it must not become the cause of hardship. It is, therefore, important to achieve the closest and smoothest co-operation between the hospitals and local authorities if the needs of the chronic sick and the old and infirm are to be met. Sometimes persons brought to hospital are found to need not medical treatment but simply care and attention, but have no known home or person willing to care for them; such persons should be placed as soon as possible in accommodation provided by the local authority, but hospital authorities have been told in a memorandum dated 2nd November, 1951, that they should not be refused admission to hospital while other more appropriate accommodation is being found for them That paragraph recognises that there is a problem, though I suggest that it is much too complacent about the existing facilities which I claim are totally inadequate.

Just in case you are beginning to look at me with lack-lustre eye, Mr. Speaker, I would point out that I am not proposing fresh legislation. I shall try to explain my proposal in a few minutes. So far as I can ascertain, the old people are divided into four distinct categories. I think it would be useful if I mentioned what are those categories. I am not dealing with the senile old people, who are an entirely different problem.

First, there are those able to live at home with some occasional help. They are being catered for very successfully, I believe, by such things as home helps; by the "meals on wheels" service which is often operated by the W.V.S., and by a certain amount of district nursing. I say straight away that it is far better, wherever it can be done, to keep the old people in their own homes and to try to help them in those various ways.

There is a second category of people who are living in hostels for the able bodied; people who have no homes and no one to look after them, as mentioned in the paragraph I quoted a moment ago. They are looked after by the county council under Part III of the National Assistance Act, and also in some cases by voluntary societies who have provided suitable hostels. They again are fairly well catered for under that Act.

Then we come to the third category of the chronic sick, and here the picture is by no means so satisfactory. They are in hospitals where beds are available, and where there are beds available the chronic sick are very often admitted either to the hospital itself or what are now called long-stay annexes, where they get skilled nursing with medical supervision. But in the same report which I have just quoted we read to our horror that there are 8,800 chronic sick waiting for beds, and that in the hospitals where they have such chronic sick beds there are 3,100 beds under-staffed. That is a very serious position, and even bed cases of chronic sickness today have to wait a very long time, usually, at any rate in my area, for people to die and thereby release the beds.

There is at the moment in the hospital area in which my constituency is situated a waiting list of 212 chronic sick people who have to wait nearly five or six months before they have any hope of admission. Recently we have been comforted by the news that at Clitheroe an annex to the hospital is to be made available which will provide 50 beds of that type.

I would call the attention of the Parliamentary Secretary to a letter I received only an hour or two ago, which tells me that the Manchester Regional Hospital Board have now notified the district hospital committee that it may not be possible for the Board to ask for a starting date for the work on that place until January, 1954. That really is not good enough. I think it scandalous, even at the present time of financial stringency, that important, essential and urgent work of this kind should be postponed until January, 1954.

In my area they have attempted to deal with the problem to some extent by an unofficial arrangement of co-operation between the regional medical officer and the hospital authorities. It is quite an unofficial arrangement, which reflects credit on the officers concerned, and is one which could be copied, and indeed is operated elsewhere. But it ought to be on some kind of official basis.

Under that arrangement, the medical officer classifies the cases which are brought to his notice and notifies the hospital authorities accordingly—"This is Category A," or "This is Category B," or "This is Category C." Of those 212 cases on the waiting list, to which I referred, 50 are category A, and I am told that they have no hope at all of getting admission in less than five to six months.

May I give one example of the type of case? It is a man, 72 years old, who has high blood pressure, is bedfast and suffers from arterio-sclerosis of the brain, and arthritis. His wife is mentally feeble. He has been on the waiting list since August. This is a terrible situation, and I hope it will be borne in mind when the Minister considers the information which I have given her about the Clitheroe Annex having to wait until January, 1954.

Category B people, who have no hope at all of getting admission, are like this; a woman, 76 years old, has had a stroke; she is almost completely bedfast and recently, while she was trying to put some coal on the fire, she set herself alight. She is looked after by her husband, who is 77 years old. But, in Category B, she has no hope at all of getting a bed.

In my area, I regret to say, there is no geriatric service at all. That is bad enough, but now I come to the fourth category—and this is the category which provides what I consider to be the real problem, with which the Ministry ought to be dealing and with which, I hope we shall hear tonight, they are dealing. This is a category of people, who, as the Ministry of Health Report says, are on the border line between health and sickness.

In our desire to pass proper legislation, we, in the House, have fallen into the error of assuming that people are either well or sick, and now we find in practice that there are many cases in this no man's land between health and sickness—people who may be occasionally sick and occasionally well, for instance. At the present time, unfortunately, they do not seem to be the clear responsibility of one authority or the other—neither the hospital nor the county council.

For example, I know of a case of an old lady with no legs, partially blind, but not sick. The county council do not want her in the hostel, because she needs a certain amount of attention and they have not the nursing attention to give her. The hospital do not want her, because she is not acutely sick and she would be occupying a bed which is probably wanted for urgent sickness or for somebody awaiting an urgent operation. The hospital are therefore chary about accepting the responsibility, perhaps to the detriment of other patients.

Or it may be that these people have been in hospital and the hospital can do no more for them, so that they are temporarily discharged—and yet they are unable to look after themselves and there is nobody at home to look after them. They may be suffering from arthritis or a bad heart. Their relatives may be willing to look after them but have not the accommodation to do so. We know so many families which are living in such conditions that, with the best will in the world, they cannot look after aged relatives. Yet, as I say, the hospitals do not feel justified in giving beds to these aged people when those beds are required for more acute illness.

What is the remedy for this? I suggest better liaison between the two authorities of the type which I have already mentioned, who operate unofficially in the area covered by my constituency, but I also think there is an intermediate type of rest home which is very badly needed.

That is not only theory, because it has been tried and proved in practice. What is needed is not just somewhere where they can go for a week or two, but a permanent place for people who are aged and infirm but not chronic sick. It could be and should be linked with the geriatric service of the nearest hospital, because many of these people can be put on their feet again by proper geriatric treatment. Many of them need more sympathy than medical attention, and this new medical science has done wonderful work in that direction.

Unfortunately, neither the county council nor the hospital seems to have the power to set up these homes at the present time. Section 21 (1) of the National Assistance Act, 1948, lays a duty on local authorities to provide: (a) residential accommodation for persons why by reason of age, infirmity or any other circumstances are in need of care and attention which is not otherwise available to them; That seems to cover them, but then officials begin to ask the questions, "Is an infirm person a sick person, is a sick person an infirm person?" And they begin to pass the case from one to the other, or rather the case falls between one and the other because nobody seems certain when infirmity is sickness or vice versa. I find that the dictionary definition of infirmity is "lacking in bodily strength or health." Some hospitals define that as sickness and some do not.

The alternative Section 26 of the 1948 Act allows some local authorities to arrange with voluntary organisations to do this kind of work. Here, in the absence of fresh legislation, I think may be the most fruitful field for inquiry. There is at Stanmore not far from this House an excellent institution called "Springboks House," so-called because the funds were provided from South Africa. There an experiment is being carried out, as far as my information goes, very successfully indeed.

In the Hornsey area there are several places run by Mrs. Hill, with whom I had the honour to serve on Hornsey Borough Council for some years. She has been a pioneer in this work, and by voluntary action, with the sympathy of the local authorities, she has been able to do the kind of thing which I think ought to be more generally done. There is also a body called the National Corporation for the Care of Old People, which is run under the auspices of the Nuffield Foundation. I suggest that the Government might very well give more encouragement to bodies like that if they are not prepared to do the job themselves or to get the local authorities to do it.

The ultimate aim of the whole thing must be to have in every area a comprehensive service for the care of old people, with someone responsible for linking its various parts together. That is most essential. We have a good example at present in the T.B. scheme, where one officer can decide what is to be done. At present, as far as I can find, there is no officer with the responsibility of going to an old person and deciding which authority shall deal with him or her. That is a very serious situation.

Furthermore, this comprehensive service which I have suggested must be closely associated with the geriatric service in the hospital. I am afraid that the "closest and smoothest co-operation," which was mentioned in the paragraph from the Ministry of Health Report I quoted a few moments ago, is just not working satisfactorily. That is the main point to which I wish to draw the attention of the Minister.

I have no doubt that she is very sympathetic to the case which I have endeavoured to put forward, but I urge her to do everything she possibly can to implement the intention of that paragraph in the Report. I hope that she can give us some news that will bring some hope and comfort not only to the old people concerned but to the medical officers and those who are very interested in this question who, in many cases, are struggling against heavy odds to get something done.

9.30 p.m.

Mr. J. K. Vaughan-Morgan (Reigate)

I am sure the whole House is indebted to the hon. Member for Accrington (Mr. H. Hynd) for raising this subject. It is perhaps one of the most important social problems facing us at the present time, and if I had been fortunate in the Ballot today I was proposing to move a Motion dealing, not only with geriatrics but with the whole wider subject of a unified policy for old people in general.

This is not a party matter, because there are hon. Members on both sides of the House who feel as strongly as the hon. Member for Accrington does about it. We have here a great social problem, not only of the sickness of old people, but of our ageing population. Whoever forms the Government, now or in future, will have to do a lot of very hard thinking on this subject, to try to see how we can cope with the social, medical and economic problems of an ageing population.

The hon. Gentleman said that a large number of hon. Members had asked him what was meant by the term "geriatrics." Those of us who are here tonight, and those who read the OFFICIAL REPORT, will know a great deal about this subject after his very lucid survey. I do not wish to repeat anything of what he has said, but I should like to underline the difficulty of securing admission of the acutely-ill patient. The hon. Gentleman did refer to that, but I rather wanted to enlarge on it a little, because on page 17 of the same Report to which he referred there is the following sentence: The difficulty sometimes met in securing admission of acutely-ill patients over 65 has been mentioned in earlier Reports and there was evidence during the period under review that, particularly in times of exceptional pressure, there was difficulty which might have been avoided in securing admission for other patients. In the year 1952 it is an astonishing reflection on all concerned that such a sentence could still be written. I know this problem is one with which the Ministry is concerned, and with which the National Council for the Welfare of Old People is very concerned. Last year there was the case of a man who died in the street, on the lines of the case to which the hon. Gentleman drew attention, having been refused admission to hospital and not having been considered suitable for admission to a home. It is inconceivable that that could happen in the Year of Grace 1952.

This problem can be solved by co-operation, but I believe—and there are others who share my opinion—that, in the long-run, while co-operation may work in 95 per cent. of the cases, there will always be the odd case in which the machine will break down. There ought to be somebody with the statutory powers which the relieving officer had in the old days, of demanding and insisting on admission to hospital.

Granted that the accommodation the patient got in the old days was not as good as it is now, but, somehow or another a hospital roof was put over the sick person's head because the relieving officer had the statutory right to demand it. Nowadays the view of the Ministry is that it can and should be secured by co-operation. As I have tried to suggest, that may not always work, and I think the Ministry ought to bear in mind the restoring of that statutory power to somebody.

If we have to find a substitute for the relieving officer, let it be either the medical officer of health or, in my view just as suitable, the county welfare officer who could, if necessary, secure, if not necessarily admission to a hospital, at any rate admission to a home. The Ministry must bear in mind that that statutory power might have to be given. I hope that will be borne in mind.

I conclude by saying that I was very struck by some remarks of the Minister, which were reported, in a speech on tuberculosis. He said that tuberculosis would be wiped out within the lifetime of many of us now living. I am sure that we shall all be thankful if that horrible scourge can be removed from the human race in this country, but we have to bear in mind what it will mean in terms of medicine and hospital requirements. As we cure all these diseases the number of the population who live to a great old age will be increased, and consequently the demand for hospitals, and I think that in all our hospitals and throughout the medical service priority should now be given to this question of the health and welfare of old people.

9.36 p.m.

Mrs. E. M. Braddock (Liverpool, Exchange)

This problem is one of the legacies which was left to us from the old days of Poor Law when old people, whether they were sick or not, were, if they were destitute, put into workhouses or institutions and left there without adequate attention. It was just a question of giving them food and keeping them clean until they died.

Under the 1948 Act, the whole conception of the attention given to older people was revised. The problems which that has left to us are very difficult ones indeed. Now, when an older person has an accident or requires medical attention, there is no question of that person going into an institution where no one attends to him. The 1948 Act has made it possible for every individual of whatever age to go through the ordinary receiving bodies of the hospitals concerned and receive medical or surgical attention. So the treatment of older people has taken on a completely new aspect, and we get, of course, new words springing up, such as the word "geriatrics."

In Liverpool, and in the hospitals there for which I have some responsibility, there is the opportunity to watch the progress which has been made in relation to this matter, and it is simply amazing. I have seen old people from 70 to 80, and in one case a man of 92 who broke a leg, who in the old days, before the 1948 Act came into operation, would not have been considered as suitable for medical or surgical treatment. In the case of this old gentleman, because of the new service and the new approach to this problem, he was attended to as if he were a comparatively young man, his fracture was mended, and he was able to get up and walk about again.

This problem of dealing with the older person means that we need additional medical services and doctors who specialise in this particular branch of work. I believe that the whole question is one of classification—of deciding whether these old people need active medical attention for the purpose of getting them well as quickly as possible and allowing them to go back home, or whether they need permanent attention because there is no one to look after them and if they are left at home they will lie in bed and be neglected.

A report has recently been considered by the various branches of the service—the teaching hospitals, the local authorities, the management committees of the hospitals, through the regional boards and the universities—asking for discussions among all those bodies to see whether it is possible to establish in an area co-ordination between those services, so that the difficulties which have been created can be ironed out. I think that will be very useful.

The other problem left to us is that of accommodation. If we have not the accommodation to deal with these people, then obviously they cannot go into hospital. Nothing was more depressing in the years before the new Act came into operation than to go into a hospital ward and to find it filled only with very old people. I think that is a wrong approach to the problem and that we shall have to deal with these old people as sick or injured people instead of segregating them and placing them in separate wards and departments.

First of all, we must make arrangements to see that they are dealt with as people requiring active treatment. They ought to be able to obtain, and, in fact, do in the main obtain, that type of treatment, especially in local authorities which have been giving these up-to-date services for some years past. In such areas old people are not all put into one ward. I think that from a nursing and training point of view it is very important that nursing staffs should know how to deal with elderly people when they are suffering from the same complaints as those afflicting younger people.

In the main, the problem is one of accommodation, and I will put the position of Liverpool. I have a Question down for tomorrow for oral answer, which I do not suppose will be reached, with reference to accommodation for which we have been waiting in Liverpool for some time. The management committee and the regional hospital board have obtained accommodation for 100 cases of chronic sick aged persons. We in Liverpool are desperately short of hospital accommodation, as the Parliamentary Secretary will know if she looks at what happened there during the recent influenza epidemic. The accommodation is there, but we are waiting for a starting date. It is a building which was evacuated by an orphanage during the war, and it has been standing empty for approximately four years. The plans are ready and the arrangements are made, but we cannot get a starting date from the Ministry so that we may get on with the job.

We were hoping, in view of the very large number of people with whom we have to deal in Liverpool—it has a population of 750,000—that we would be able to have this accommodation ready for use this winter. But there is now no possibility of that, despite the fact that everything required to furnish the hospital has been ordered. Nobody can do anything because there is this hold-up in regard to a starting date. That is something which could be attended to straight away and which would resolve the difficulty of finding accommodation in our area for this type of case.

These are long-term problems and are not easily solved. We must adapt our attitude towards them in the light of how things work out. In the main, it is a question of classification. In various places people are occupying hospital beds when they might be got up and accommodated outside so that the beds could be available for more urgent cases. I recognise that this is a very difficult matter today owing to the completely new approach to the subject, but it is being done in certain places, though not to the extent that it should be done. That is something that the Minister should look into.

As regards medical attention, I want to pay a tribute to those specialists and medical attendants who have given this matter their personal attention, because what they have been able to achieve where they have these geriatric units is really most remarkable. An extension of such services is required and further assistance must be given in relation to that position. Also, the general practitioners must be considered in relation to this matter.

The hon. Member for Reigate (Mr. Vaughan-Morgan) said that there ought to be some co-ordinating officer in a local authority. I think we must give our general practitioners more responsibility.

Mr. Vaughan-Morgan

I was referring only to the admission of the acutely sick.

Mrs. Braddock

I was coming to that. The views of the general practitioner who knows the family and the circumstances of the case ought to be listened to. Everybody is entitled to have a doctor now for the purpose of visiting him or her at home if necessary, and more power ought to be given to the general practitioner to say whether he considers a case ought to be given a bed in hospital. Somebody has got to take the responsibility of saying whether there is a bed vacant or not for the admission of the case, but we are inclined to overlook too extensively the responsibility of the doctor who visits the home and on whose list the patient is.

Very often the doctor will say that if the patient could go into hospital quickly for a short period, then there is a possibility of his being discharged perfectly fit and not occupying a bed for a long time, whereas if he has to remain at home because there is no accommodation, or because the matter of priority does not apply or because the need is not fully considered, a stage may be reached where the person becomes a permanent invalid because he has not had emergency or immediate attention in time.

The problems are terrific. At every meeting of the management committee of which I am a member, we have to face these problems, and I know that other management committees have to do the same. But the question of co-ordination, responsibility and classification—I cannot stress that too strongly, not so much on the question of age but on the question of illness—are matters requiring consideration. Although the purpose of geriatrics is to see that older people are cured as quickly as possible, we must not let too much stress be put on old people as old people; we should regard them as persons who need medical attention. Some sort of medical attention is necessary. The older people have got more sorts of complaints than the younger persons have.

We are indebted to my hon. Friend for raising this matter tonight. It is one on which I could talk for a long time, but other hon. Members may want to express their views. The Minister and the Parliamentary Secretary ought to keep all these matters well in mind, for new Acts and new approaches create new difficulties. We discussed one the other night when we debated accommodation for mental defectives. That is another difficulty arising from a new approach.

We ought not to be despondent about the position, or under-estimate the amount of work and the amount of skilled services requiring to be done. We should continue to work in this matter in order to see that our people are as healthy as they possibly can be and for as long as they possibly can be. We want to see the people cured quickly and returned to their homes again, thus avoiding the necessity of long stays in hospitals and the occupation of hospital beds.

9.48 p.m.

Sir Edward Boyle (Birmingham, Handsworth)

The hon. Lady the Member for Liverpool, Exchange (Mrs. Braddock) has made a very interesting speech and it is a pleasure to follow one who has had such a wide experience of this subject. On one point I strongly agree with her, and that is the importance of the general practitioner having considerable say as to whether his patient should be admitted to hospital or not, granted the existence of accommodation.

I am particularly glad to have the opportunity of making a very short contribution to this debate, because in Birmingham we have a Council for Old People which has done extremely good work. I know the hon. Member for Sparkbrook (Mr. Shurmer), were he here, would entirely agree with me in saying that. I think we ought to remember, when we discuss this question, the amount of voluntary work for the old people carried out in all our big cities today. The problems arising out of an ageing population are ones which will give rise to even more difficulties in the years to come.

Apart from the financial problems involved, and the need for more accommodation, there are also the purely administrative issues, and the hon. Lady was right in saying that we must consider the question of classification. As my hon. Friend the Member for Reigate (Mr. Vaughan-Morgan) and the hon. Member for Accrington (Mr. H. Hynd) both pointed out, there are many people who are not sick and who vet at the same time cannot be classified as well. Sooner or later this matter will have to be dealt with. I am grateful to the hon. Member for Accrington for having initiated the debate, and I shall be very interested to hear from the Parliamentary Secretary what plans the Ministry of Health have for meeting these problems.

9.51 p.m.

Mr. A. Edward Davies (Stoke-on-Trent, North)

We join with our colleagues in congratulating my hon. Friend the Member for Accrington (Mr. H. Hynd) on having brought up this subject for consideration tonight. Whatever the State does for the aged, there is a great field remaining for voluntary workers. Whatever our differences may be in political ideology, it will be a sad day when we believe that we can unload old people into some kind of institution and expect everything for them to be done there.

I have discovered that old people have a great desire to remain in the community where they were brought up, and that it is very great hardship and tragedy when they have perforce to be sent into what they regard as an institution. As has been shown tonight, a new approach has been made in recent years to this matter by all sections of the community, and not least by the Labour Government. There is a new attitude, as there is indeed to the whole problem of sickness. I would stress what my hon. Friend has said, that in the sphere of mental health there is a sort of dark and unhappy world, full of phantoms and hideous things of every description, and that it needs to be looked at closely and hard in the face so that as soon as circumstances permit we can start the work of classification, segregation and accommodation.

Although I stress the need for voluntary work to go on—thank God it is going on in all parts of the country by people of good will—much is being done for the aged people by themselves as well as by kindly disposed people. We all rejoice to hear it. On the other hand, there are circumstances when nobody is left in the family to take care of an old person, and particularly an old man.

A case was brought to my notice a short time ago in Stoke in which three old men were living together in some ramshackle property away from everybody else. They were of great age and were a great danger to themselves. They were not clean, and they ought to have been in hospital, but the accommodation was not there. There was nobody to demand accommodation for them in a hospital. They were just waiting for somebody to die. By the good will of an alderman who was on the welfare committee their case was taken up. Fortunately or unfortunately, somebody died that evening, and one of the old men was admitted to hospital next morning. The others were taken later.

How far is the Ministry coping with this problem of accommodation? It will be within the recollection of all of us that when the Minister of Health is answering Questions the problem of adequate steel supplies is often raised. How far has work on accommodation schemes been held up because there was no steel? In the case of Liverpool, Birmingham, Stoke and elsewhere the matter has been acute. I am glad to say that the Minister has been most helpful to Stoke, and that we have a prospect of providing accommodation.

Can the Parliamentary Secretary tell us the nature of the problem in terms of new accommodation and what are the prospects of meeting this need? How does it all measure up? Is it because of shortages of steel? As my hon. Friend has said, how far it is a problem of staffing these places? Is there a shortage of nurses, and if so, what is being done about it? I hope we shall hear something about these points tonight.

9.55 p.m.

Mr. Harmar Nicholls (Peterborough)

I do not want to take up any time in repeating the excellent arguments that have already been put forward in this debate for the Minister's consideration. We are all very grateful to the hon. Member for Accrington (Mr. H. Hynd) for having raised this subject, because in all our constituencies we all have precisely the same problems put in front of us as have been explained by the various hon. Members who have contributed to the debate.

The one thing on which I should like to say a few words is the possibility of enlisting outside bodies who could play a part in providing accommodation. If there are charitable organisations and people who have endowments that they can use, we ought to try to encourage them to pay attention to the case of the old people.

The Ministry can only go so far. We know that the contributions they can make are all contained within the general economic strength of the country. If we had unlimited money and materials, and unlimited people to call upon to provide the staff, then we should be right to hammer hard at the Minister to ensure that all these needs were met. We recognise that the Minister can only do what the general overall economic and financial strength of the country will allow. In that connection, I reinforce the plea made by the hon. Lady the Member for Liverpool, Exchange (Mrs. Braddock), and by all the other Members, for my hon. Friend the Parliamentary Secretary to see that all the efficiency that it is possible to bring is brought to bear on this question. If it is possible to give a starting date for buildings that have been planned and approved, then let it be given. We hope that within the allocation of all health services, proper proportionate attention will be given to this problem affecting old people.

As my hon. Friend the Member for Reigate (Mr. Vaughan-Morgan) said, the problem is one that will get bigger and bigger. We cannot see the end of it. The report on population shows that the question of the ageing population is one to which we must continue to give a good deal of attention. It is not a matter of a queue that will get shorter, but one which, by the inevitable process of living will get longer. I believe that the Ministry will do their best, but I do not think that, within the limits of the financial provision, they will be able to catch up with all that is wanted for this problem of the old people as well as all the other health services.

The hon. Lady the Member for Liverpool, Exchange spoke the other night of the queue of the mentally deficient. The official figures show, I think, that in 1948 there was a waiting list of 3,900. That figure has now gone up to something like 7,900. This is another field in which we urge the Minister to give assistance, although there is a limit to what can be done out of the financial provision it is possible to allot for dealing with these services.

However good the Minister might be, however excellent the committees which are set up, in the long run a committee, however good, can never replace the "good neighbour." If we can encourage the good neighbours throughout the country and encourage the charitable organisations to pay to old people the kind of attention that a few years ago they paid to orphanages and things of that sort, they may well be able to make this extra contribution towards meeting the problem over and above what the Minister herself can do.

If we all, in our various capacities, throughout the country, can encourage such trusts and organisations, and if we can encourage industrial undertakings, with their own welfare services, to try to provide old persons' health homes—

It being Ten o'Clock, the Motion for the Adjournment of the House lapsed, without Question put.

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

Mr. Nicholls

If we can encourage industry to set up old aged persons health homes as part of their welfare services, that, in addition to what the Minister can do, may go some way towards meeting this problem, which is going to grow as the years go by.

Once again I wish to congratulate the hon. Member for Accrington on enabling us to discuss this problem and to give our good wishes to the Parliamentary Secretary and her right hon. Friend in trying to spread the allowance granted them by the Chancellor of the Exchequer on as wide a front as possible.

10.1 p.m.

Mr. James Johnson (Rugby)

I intervene because of the evocative point made by my hon. Friend the Member for Accrington (Mr. H. Hynd) a short time ago. This matter has been taxing my mind for a long time and also, I believe, the minds of medical officers of health. I am speaking of border-line cases, not only physical but also mental.

I should like to ask the Parliamentary Secretary whether later she can tell me the procedure followed in mental borderline cases which are certified in this situation. Let us take the case of an old gentleman who is bodily and mentally weak and living alone. He may go out for a walk, not feel well, and collapse upon the pavement. He may be all alone and not quite sure where his home is, or how to get back. In that case an officer may be called in from the town hall, perhaps a social welfare officer.

I understand that in that case, if there is no accommodation—and we have been told that it is difficult to find accommodation in hospitals for elderly people in this plight—there may sometimes be what one might term abuse. It is fatally easy then for an officer to have to make a decision to call in a doctor perhaps and have this old man certified for a mental institution. It may be a borderline case and very difficult for one to make up one's mind.

I submit that it is fatally easy to take what I might term the easy way out. There may be, and I am told that in the past there has been, abuse of this kind. I should like the Parliamentary Secretary to tell me what is the procedure in such a case, and whether any case of this kind has been brought to her attention. I think it is asking very much to place the decision of a qualified medical officer upon the social welfare officer from the town hall. There is need for a co-ordinating officer in these cases. This matter has taxed my mind for quite a while and I hope that the hon. Lady can give us some explanation and tell us, in particular, whether this sort of thing has been happening and how it may be overcome.

In the end there is only one way of avoiding this very difficult situation. That, of course, is by building more geriatric homes. I was very worried when I heard earlier that the new wing at Clitheroe and many other institutions of this kind are not being built. I hate to introduce a discordant note, but when one sees schools have not been built which could have been built and, in this instance, that hospitals or wings of hospitals are not being built, one is forced to say that perhaps if we did not build so many houses under the campaign of the party opposite, we might build more wings of hospitals and more schools.

Mr. H. Nicholls

Surely the hon. Member would be the first to admit that the basis of good education and the basis of good health starts in the home. So the provision of homes is really helping both education and health.

Mr. Johnson

I do, but it is a question of where the emphasis is placed. I submit that if we had more wings of hospitals built and more people taken there, more housing accommodation might be released to serve the purpose which we both so ardently wish to see served. So I put this question to the Minister: has she had any instances of abuses in the way I have indicated, and would she say what is the exact procedure by which these old people have, I fear, sometimes been sent to institutions of this kind?

10.6 p.m.

Mr. James Carmichael (Glasgow, Bridgeton)

We have had a very interesting discussion on a subject to which I have paid great attention not merely in this House but in local government. I intervene tonight only because the question of the aged people of Scotland cannot be separated from that of the aged people of England. I make no complaint about the Secretary of State for Scotland not being in his place, but I feel that it would be unfair for a debate on a subject which is so important to the whole House to continue for an hour and a half without an intervention by a Scotsman.

This problem is becoming just as serious in Scotland as in England. I regret to say that there is a tendency by all of us to regard people, when they reach a certain age, as having reached the stage when they cannot be cured. There is a psychological approach as much as a medical approach at present. The Report of the Department of Health for Scotland deals with the aged sick and the English Report deals with the chronic sick, but these are the same type of people. I submit that there has been a falling back in dealing with this problem during the last few years.

Almost every week-end when I go home I am disturbed by the fact that aged people cannot get into hospitals. I must admit that during the period when many local authorities were entirely responsible for the aged we could get the aged into the hospitals much more quickly. That is because there was not the clear classification in those days that we now have. As a result of the development of the teaching hospitals, the age of the patient began to be considered. When the local medical practitioner is demanding the right of his patient to be admitted to hospital, he is always called upon to provide all the necessary particulars, and the age is generally a stumbling block in such cases.

It is admitted in the Report that there seems to be no possible chance of seriously tackling this problem at an early date. Let me put before the House the situation as it is put in the Scottish Report: The provision of adequate facilities for old people who need hospital treatment continues to be one of the most difficult problems. Waiting lists remain high, and in present circumstances it is impossible for the Hospital Boards to make a start on long-term plans for the development of geriatric units in specially provided accommodation. I am not so sure about the segregation of the sick people. When we are building our hospitals there should not be the classification to the extent that some people desire, but that is exactly what is happening in Scotland.

I know of one hospital in Glasgow—it is referred to in this Annual Report—which the local authority thought almost 20 years ago it was time to close but which is now being turned over entirely to the aged people. There will be 80 beds, and the announcement that they will be exclusively for the aged people indicates to those aged people that they are going in there because nothing can be done for them except give them kindly nursing, and that in due course they will be carried out. That is a completely wrong approach to the whole problem.

My intervention is due to the fact that this is primarily a Treasury matter. The hon. Member for Peterborough (Mr. H Nicholls) was very anxious that we should make more use of the people who used to help voluntary hospitals and who have in their time done a lot of work for aged people. Without detracting from any views which the hon. Member holds about voluntary efforts, I say frankly that this question of dealing with sick persons cannot be handled in a voluntary way. It is a very important aspect of our social services, and I therefore ask that the Ministers who are responsible should examine these paragraphs of this Report very carefully indeed.

I do not know if the hon. Lady who is to reply to the debate has studied these paragraphs closely, because I know that there are so many documents to be put out in one's name when one is a Minister that there is often insufficient time to study them oneself, but both these Reports are worth considering. Indeed, when we are dealing with a universal problem, I think it would be quite a good thing if the Ministers for Scotland and England got together to tackle this very serious matter.

I should like to conclude with a point about Scotland. The Report goes on: But the problem generally is a serious and growing one, which will require for its solution a concerted effort over a long period. The reason I draw attention to this Report is that if we go back over the years we get the same kind of report, and this is a job that will require a whole lot of attention over a long period.

What I want to know is when there is to be a real start. I know that improvements are being made, and I know that, apart from politics, there is a general tendency for a much broader outlook on our social services, but I feel that we are not driving hard enough in connection with the aged sick, and I therefore ask that some kind of effort should be made by the Health Departments for both England and Scotland to put some pressure on the Treasury in order that they might go ahead with much more building of accommodation for sick people.

I am very appreciative of the opportunity which has been given to me by my hon. Friend in raising this matter tonight, and I thought that a slight contribution from the other side of the Border might, at least, speed the day when we shall get a very big improvement in the conditions of the aged sick.

10.12 p.m.

The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)

I am grateful indeed to the hon. Member for Accrington (Mr. H. Hynd) for having initiated this very important and interesting debate, and we all welcome very much the longer space of time which has given to hon. Members more opportunity for taking part.

It is, perhaps, a measure of the importance which we attach to this subject that the hon. Member who introduced it was dragged from a dinner, and I myself was about to walk on to a public platform, and both had to race back to the Chamber, because the other business on which the House was engaged had not taken quite as long as we anticipated. Nevertheless, we have had the opportunity of hearing a wide debate, to which many hon. Members who themselves are associated with regional boards and hospital management committees have been able to make most helpful contributions.

To clear up one small point and get it out of the way first—it was raised by the hon. Member for Rugby (Mr. J. Johnson)—concerning the question of a patient whom the hon. Gentleman feared might be certified by an over-zealous medical officer who was anxious to find him accommodation of some kind, I think that his fear is very much over-emphasised. The patient can be sent voluntarily, but only voluntarily, for observation if he shows some sign of mental disorder, to various hospitals, and it is entirely up to him to discharge himself any time he wishes. On the other hand, if patients are certified, they can only be certified first on medical examination, and then on the order being signed by a justice of the peace. Hon. Members who are justices of the peace will bear me out on that point.

I think that the provision that at present exists is adequate to safeguard the liberty of the subject and the needs of those people who, because of some slight senility, should not really be classified as mental patients. Some of the somewhat scare propaganda about the manner in which people are pushed into mental homes is without justification. I am sure that those hon. Members who are associated with hospital boards which deal with mental hospitals, will bear me out when I speak of the care which is taken in this matter and the responsibility shown by justices of the peace who do not lightly sign these orders.

I am sure that the hon. Member for Bridgeton (Mr. Carmichael) will forgive me if I do not give him details of the services and improvements in Scotland. I should indeed be infringing upon the rights of my colleague the Joint Under-Secretary of State for Scotland. The hon. Gentleman would be the first to tell me that Scotland has its own Scottish Office. Generally, the problems are the same in the two countries. Much that I have to say about England and Wales will apply equally to the progress made in Scotland.

While I appreciate the gravity and the size of the problem—I do not pretend or seek to under-estimate it—I think that all hon. Members will agree that we have done a great deal since the introduction of the National Health Service Act. The hon. Member for Accrington suggested that there was a grave gap between the service provided on the medical side and that provided on the local authority side. Where co-operation is working to the full and where beds are available, then the statutory and administrative arrangements should be adequate to meet any of the cases mentioned by hon. Members, though I do not deny that there is a shortage of beds compared with the demand.

Clearly, hospital authorities are responsible for the sick and local authorities are responsible for those who are not to that extent sick but are in need of care and attention. It is an obligation. It has been recommended through the Boards to all hospitals that they should not refuse border-line cases where there is a recommendation from the G.P. or the welfare officer because the person lives alone and cannot obtain proper attention and care.

The making of a new classification, of a border-line section between the two, will not give us any more beds. It will only make two lines of approach and three classifications to sort out instead of one line of approach and two classifications. I do not think that the solution lies in merely finding another group and another classification. That will not give us one more bed or one more annexe. The solution lies very much in more accommodation and better use of what we have.

Since I have occupied the post of Parliamentary Secretary, I have answered Adjournment debates on accommodation for T.B. patients, for the mentally deficient, and tonight, for old people. It is a problem reflected in every sphere of the National Health Service where the regional hospital boards have to weigh up the legitimate claims of the various sections. They have to make up their minds whether, with the capital it is possible for us to allow them in any one year, they should give priority to T.B. beds, or whether the greatest need is perhaps for additional beds to be allocated to the mental or the chronic sick.

There is far more to this problem than a mere shortage of beds. There is much more that could be done by close co-operation between all the authorities concerned. We wish to see flexible co-operation between the local authorities, and the hospital services, using all the powers at their disposal in respect of the aged, so that any possible hardship to individuals can be avoided.

I wish to deal with a special category mentioned by the hon. Member for Accrington which was also dealt with by the hon. Lady the Member for Liverpool, Exchange (Mrs. Braddock). I agree with her most cordially on the question of the wonderful work done in the geriatric units. There is no such organisation as a specific geriatric service as such. The service uses a general medical service; whether it is a question of physiotherapy, or orthopaedics, or whatever it is, that service is complete in the hospital either for the old person or the young. Therefore we do not want some isolated geriatric service.

Mrs. Jean Mann (Coatbridge and Airdrie)

There are quite a number of geriatric wards in Great Britain.

Miss Hornsby-Smith

The hon. Lady has not had the advantage of hearing the whole debate. I know that her hon. Friend the Member for Liverpool, Exchange will agree that the division of opinion, small though it is, between myself and the hon. Member for Accrington is not that there are no geriatric wards under the Health Service or the Medical Service Act, but that there is the same medical service to the old as to the young and if they go into a geriatric ward, if they have orthopaedic or physiotherapy treatment it has the same value in every case.

Mr. H. Hynd

Is the hon. Lady certain of that? My information is that there are people who are specialising in this treatment for old people; not only dealing with them in an orthopaedic way, but rehabilitating them; and that there is a special way of dealing with old people, and that that is the side which is being developed.

Miss Hornsby-Smith

Yes, but there are general surgeons and general physicians—I do not want to enlarge on this point. We really want to see that the best possible treatment is available to anyone whether they are sick or old. The point I wish to make is that there is no differentiation or scale of treatment, whether it applies to the young or to the old sick.

The great advance which has been made is that there are wards, geriatric wards, for old people where, instead of their being put into the poor law institution, as the hon. Lady mentioned, they now obtain all the medical services that equally apply to others who may be much younger. We are well aware that the question of the chronic sick is one of the most difficult problems we have to face. The shortage of beds is part of the problem, but not all of it. It is true that at present we have 57,000 chronic sick beds and that, from a survey taken during the war in England and Wales, assessed on the rising old age population, we believe that we require something like 80,000 beds in all.

But, for the chronic sick, we have a waiting list at the moment, as the hon. Member for Accrington indicated, of 8,800. In 1950, we had 2,000 more beds than in 1949. We are steadily increasing the accommodation both in old people's homes and by adaptations of the old public assistance institutions, and here I would pay tribute to those authorities who have gone to great lengths to gut and to remake, as it were, the inside of these old public assistance institutions, and make them into very fine accommodation providing very pleasant and cheerful surroundings for old people seeking sanctuary in their later years.

Apart from the shortage of staff, and we have 3,100 beds un-staffed which would be available if the staff were available, there is also the problem which we are combating and overcoming of greater co-operation and of getting the right person in the right bed at the right time. The terms "aged" and "chronic" are too often regarded as synonymous. Geriatric services in hospitals today have been greatly developed. In fact, no less than 40 per cent. of the so-called chronic sick can today be rendered fit for discharge from hospital.

We have a further problem with regard to patients when once they become fit for discharge, which is to find somewhere to which they may return. This should be to their own homes wherever it is possible.

There are not enough old people's homes and hostels to provide for all the old people; we recognise that there is still a serious shortage of that accommodation. But we must impress upon a very small minority of the population—a minority of which hon. Members who deal with their constituency correspondence will be aware—that there is a tendency, amongst that minority, to say, "Oh, well, once the old lady is in hospital we have nothing else to do and our responsibility has finished."

If the hospital cure a patient and make her ambulant, and if the family have accommodation and are reasonably situated, then the family have a duty to their parent to take her out of hospital again. There is a minority who believe that their personal family responsibility disappeared with the creation of the National Health Service, instead of their appreciating to the full that if, under the Service, we can make the old person ambulant and fit, then the place where she is happiest and where she wants to be, is back with her own family and in her own home.

Hospital authorities have also been encouraged to provide long-stay annexes, which deals with a point in which the hon. Member for Accrington is particularly interested. A patient who no longer requires hospital treatment, and is yet not well enough to go to an old person's home or back to his own home, can stay in a long-stay annexe. More annexes have been provided in the hospitals and, in particular, the King Edward Hospital Fund has provided the capital for a number of these long-stay annexes, particularly in the Metropolitan area, where they are working with very great success indeed.

It has been alleged that, owing to the disappearance of the relieving officer—and my hon. Friend the Member for Reigate made this point—it is more difficult to secure accommodation. But the mere appointment of some other new officer, by whatever term he is called, will not provide beds in a hospital if the beds are not there. I am quite convinced that with the general practitioner, who should be in contact with his patient; with the county welfare officer; with the almoner of the hospital, if she is dealing with an out-patient whose condition is deteriorating—with all those people, there are qualified persons with all the facilities and the contacts at their command to make what provision lies within their power to provide accommodation for the old persons.

One hon. Member suggested that the general practitioner should have greater authority to decide whether or not a patient should go into a bed. Frankly, that raises very grave difficulties. There may be many general practitioners in one area but only one hospital in that area; and the only person who can decide the priority between Mrs. Jones and Mrs. Brown is the hospital superintendent who gets two separate reports from two different doctors. I do not think we can take from the superintendent of the hospital the responsibility of allocating, according to the best of his judgment, the priority of the cases put to him, not by one doctor but by many doctors in the area served by his hospital.

Another point made was the difficulty where a particularly acute case exists and the superintendent of the hospital says he cannot take the case in. But any medical officer always has the power and responsibility in acute cases to use the bed service which inquires around a much wider range of area for immediate admission of an acutely ill patient which the medical adviser deems it necessary should have immediate admission.

Mr. William Keenan (Liverpool, Kirkdale)

Do I take it from what the Minister has said that the medical officer of health has authority to do what we are asking the medical practitioner to do? May we use that information?

Miss Hornsby-Smith

Yes. If the medical officer is satisfied that the case is sufficiently acute, he has the power and responsibility to apply for the emergency bed service to do all they can to find a bed for that acute case.

Another difficulty arises with patients who cannot be released because of the difficulty of finding accommodation for them as quickly as we should like—and that is in the financial advantage to relatives of keeping their old people accommodated in hospitals and homes, particularly the former, and also in the undoubted decline in the sense of responsibility in some families when they feel that it costs them less when their parents have gone into one of the hospitals or homes. There is also the fact that more people are prepared to go into homes than ever before because they have lost the Poor Law stigma and—

The Question having been proposed at Ten o'Clock, and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at Half-past Ten o'Clock.