HC Deb 14 December 1953 vol 522 cc162-72

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

9.59 p.m.

Mr. David Llewellyn (Cardiff, North)

It is a stroke of unconscious irony that the leading article in the "Manchester Guardian" which coincided with its report on the conditions of the neglect of the aged sick carried the headings "Cruelty" and "Whose fault?" above very different topics. Though aged sick in uncertain numbers are suffering cruelly I think it would be more helpful to inquire—

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. Kaberry.]

Mr. Llewellyn

—I think it would be more helpful to inquire where the fault lies rather than on whom. Of one thing I am sure, and that is that any suggestion that the upper strata of the Administration are less acutely aware of the problem than they should be is quite wrong. My own contracts with the Ministry of Health and with the Welsh-Board of Health lead me to an entirely different conclusion. I have found an awareness of the problems of the aged sick well in advance of public opinion. Those who doubt this would do well to read the Annual Reports of the Ministry of Health for the past two years.

I have avoided trying to classify old people into neat categories because they fall very quickly from one category to another. At one stage they are the borderline cases who waver between sickness and health so that it is hard to say whether they are sick and the responsibility of the hospital or in need of care and attention and the responsibility of the local authority under Part III of the National Assistance Act. Sometimes as the Minister well knows, their illness is known, and sometimes their misery is undetected until they die.

I wish to refer to a recent case, and I apologise to the House for reading at some length about it. In a London borough one September morning the Queen's district nurse was called to an attic room in a tenement house five storeys above a basement. She found there a woman aged 78 who had been treated at a hospital out-patients' department for a fractured right wrist which was in plaster. The time of her next visit had not been arranged. The woman, according to the nurses report, was in an appalling condition. She was sitting in a chair from which she was unable to move and suffering from delayed shock. She was doubly incontinent and her back from hips to knees was completely raw with gangrenous areas. The nearest water tap was two storeys down and the nearest lavatory three. The old woman was unable to get either food or water as the tenants of the basement who had been bringing a drink morning and evening were that day going away on holiday. The whole room including the bed and contents of the drawers was alive with bugs. The window could be opened only with the greatest difficulty and the stench was horrible. The superintendent of the local district nursing association immediately reported the case to the nearest doctor and to the sanitary inspector and the welfare officer of the local authority with the intention of getting the patient into hospital at once. She learned that all three had already made every effort to do so but without success. Eventually the superintendent of the nursing association and the local medical officer of health, the welfare officer and the sanitary inspector, the doctor first concerned and the local old peoples' association between them, after some passing the patient, daily appeals to hospitals and the emergency bed service found a bed for the old woman after 19 days. I think the nursing superintendent's note at the end of the case is of interest: This is in contrast with the system previously prevailing whereby the relieving officer would have had no difficulty in getting the patient into the workhouse infirmary immediately she was found. It is argued that now that the poor law infirmaries are merged into the general hospital system, comparisons with pre-National Health Service days are no longer valid. But against this there is an impressive volume of demand from general practitioners for an extension of statutory powers. I will not dwell on this, for obvious reasons. I should like to ask the Minister, first, whether he is content that the statutory powers are in fact wide enough? Secondly, what subsistence is there in the charge that general practitioners are exaggerating the gravity of cases and understating the ages of some of their patients, and even resorting to such devices as dialling 999 in order to get that elderly patient into hospital? Thirdly, is my right hon. Friend satisfied that his memorandum of 2nd November, 1951, to the effect that those simply in need of care and attention should not be refused admission to hospital while other accommodation is being found, is being fully observed?

I want to say a few words about the shortage of beds in hospitals for the chronic sick. In November, 1952, the Parliamentary Secretary to the Ministry of Health said in this House that there were 57,000 beds for the chronic sick, and that, from a survey taken during the war in England and Wales assessed on the rising old-age population, something like 80,000 beds for the chronic sick were required in all. I should like to know whether the Minister is of opinion that that assessment is a right one.

It is, of course, self-evident that no amount of co-ordination or extension of powers could provide one new bed or a nurse to tend it. It may well be, however, that the best use is not being made of existing beds even now. There was recently, as my right hon. Friend knows, a snap test of hospital patients in Birmingham to find out how many old people could be returned to their homes provided that more domiciliary help could be made available. I have not got the figures to show the success of that operation, but I believe that a considerable number were released to their homes.

I suggest to the Minister that similar tests should be made throughout the country so that a more comprehensive picture of the bed situation could be obtained. It is encouraging to learn from the Report for last year of the increased services being rendered by the home nursing service, though the decline in the number of whole-time workers in the domestic help service is disappointing. I think, too, that a meals service as run by the W.V.S. or, possibly, better, by the Preston Corporation, is a necessary supplement to the care of the aged sick. I hope that soon the Minister may have some information to give of the financial and social results of the Preston experiment.

Lastly, I wish to say a few words about the social attitudes that are taken to the problem of the aged sick. Some people think that this is primarily a social problem which only becomes secondarily a medical one when neglect has passed to a late stage, and that the root of the problem lies in the fact that as the bounds of welfare are stretched the bonds of family are weakened. They think that this is not so much a matter for the Ministry of Health and the doctors as for the people themselves.

The argument runs that if the young would only look after the old, the State would have no need, or less need, to worry. That line of thought is in some ways quite out of keeping with contemporary conditions. It seems to me to some extent to overlook the fact that many young people today have too little space, too little leisure and, in many cases, too little skill for the care of the aged sick in their home, and at the best of times and under the best of conditions it can be cruel to force incompatible temperaments together in a small space. At the same time, it is a common experience among the silent army of sick visitors, whose knowledge is sometimes insufficiently sought by old people's welfare committees, that parents are left in wards and in their homes to die without a visit or a letter from their children. I cannot find any words—nor, I am sure, can any other hon. Member—sufficiently strong to condemn them.

I have tried to raise this very large subject in a very small space of time in order to permit my right hon. Friend to give full details of the progress which is being made. I have tried to state what I have to say in a cool and dispassionate manner, but I am horrified by the realisation that this Christmas there are old people, immobile, incapable, incontinent through senility, without proper nursing, and for whom there is no room in the hospitals, waiting for death in conditions of indescribable filth, misery and loneliness. Only yesterday a country vicar told me of his experience of the plight of the aged sick in the countryside of Wales. He thought it so terrible that he was firmly of the opinion that students at theological colleges should be taught nursing as part of their training. I do not know where the fault lies, but in so far as the aged sick are neglected, it is a disgrace to us all.

10.12 p.m.

Mr. John Hynd (Sheffield, Attercliffe)

I congratulate the hon. Member for Cardiff, North (Mr. Llewellyn) upon raising a subject which many hon. Members would have wished to raise had they been fortunate in the ballot for the Adjournment. I want to underline the plea which he has made.

In most big cities there are social service committees, social care committees and organisations of that type which are doing excellent work, but their difficulty in attempting to cover the field is that they are often not aware—it is not easy to see how they can be made fully aware—of all the cases in the back streets of our cities. I hope that the debate will result in publicity being given to the situation and that neighbours will be encouraged to draw the attention of the welfare care committees to the plight of such people.

I have met too many cases of old people living alone without assistance and being unable to look after themselves. I have been very much hurt by the tragic case of an old gentleman living in Sheffield. He has spent the whole of his life in social work of one kind or another. In his later years he has devoted himself entirely to the cause of old-age pensioners. He did general organising work for them and tramped the streets of Sheffield on their behalf, and was one of the leading figures in Sheffield's old-age pensioners' movement. He and his wife suffered very severe illnesses. His wife eventually became incapable of moving any further than round the room, which she did by hanging on to the table and the walls.

The old gentleman developed severe arthritis, but he continued with his social work until he was unable to leave the house. In spite of their situation, the two kept their house in remarkably good condition. Eventually, about three years ago, the old gentleman was moved to hospital. In the meantime his wife has died. The old gentleman has been lying in hospital for about three years almost unable to speak and with practically no visitors. I do not blame his old associates for this, because I think most of them died off or went away, or, for one reason or another, lost touch with him; but here is a man who has spent the whole of his life in unselfish service lying in hospital for two years completely helpless and apparently without anybody being interested in him.

It is difficult to say what is the cure for that kind of situation, but perhaps the publicity given by this debate or steps taken in other directions to give publicity to the matter may encourage people who have been associated with such people to take a little more interest in them when they find themselves spending two or three years in breathing their last, alone and apparently without friends.

There are many cases of that kind, and I am grateful to the hon. Gentlemen opposite for raising the matter. I hope that, as a result of the debate and the steps which the Minister may take, some of these people may find some alleviation of their situation.

10.16 p.m.

The Minister of Health (Mr. Iain Macleod)

My hon. Friend the Member for Cardiff. North (Mr. Llewellyn) has taken as his text tonight the important articles and perhaps the still more interesting correspondence which followed them in the "Manchester Guardian," and he has stated his case with his accustomed cogency and moderation. I should like to take up as many of his points as I can within the limits of the time left to me, but I should like to make clear at the start that this is not in any sense a reply either to the correspondence in the "Manchester Guardian" or, indeed, to the vast problem of the aged and chronic sick. In a speech of 15 minutes, it is only possible to scratch the surface of this—perhaps the most baffling—problem in the whole of the National Health Service.

I should like, first of all, as a background, to give a number of figures, and I will give them almost without comment, because I think that hon. Members, and even those who cannot be here for this debate, may like to study them, because they show the position we are now in.

In 1911, there were 2¾ million people over pension able age; in 1947, they had risen to 6½ million; and in 1977 it is estimated that they will reach 9½ million. Secondly, the expectation of life for a man of 65 is now 12¾ years, and for a woman of 60, 18¾ years. In England and Wales, there are 54,000 staffed hospital beds for the chronic sick and 3,600 lie empty for lack of nursing staff, but that figure has been steadily reduced each year from its peak of 4,700 in 1949. At the same time, the staffed beds have increased in the same period from the figure of 50,000.

On the most important question of turnover, in 1951 the number of beds increased by 3.3 per cent., while the number of patients treated increased by 10.1 per cent. In 1952, the comparable figures are 1.1 per cent. and 9.5 per cent. The out-patients attendances have risen from 7,000 in 1950 to 14,665 in 1952. The number of in-patients treated through the National Health Service rose from nearly 85,000 in 1950 to 103,000 in 1952. The waiting list is a figure which I give with all possible reservations, but it has been fairly steady at about 9,700. The last figure I want to give is that, in residential accommodation provided by local authorities, there are now 62,000 places in England and Wales, and, since the end of the war, 600 homes with accommodation for about 18,000 persons have been provided. Without comment, that is the statistical background to the human and social problem that faces us. The problem remains serious and has become more serious, and the pattern of life today makes a solution of it more difficult than in the past.

My hon. Friend asked specifically whether it would help if we had again, as we had before 1948, a relieving officer with power to order a bed to be made available for a particular case. This is a most important and interesting subject. I used to hold the view before I became Minister, and indeed before I became a Member of this House in 1950, that this was the answer, but I am bound to say that I do not now think it would be a satisfactory answer. I agree with Lord Amulree—and other members of the executive of the Medical Society for the Care of the Elderly—in what he said in the "Manchester Guardian" that this is not the solution of this particular problem.

Would such an officer be a local authority officer or a hospital authority officer? If of the local authority, would it be possible for him to direct that the hospital board should make a bed available? Even more important, would he be a layman or a medical officer? If a layman, it is difficult to see how he could decide between the medical priorities; and if not, it is not easy to see how that could be an improvement on the present position. We may delude ourselves by too easy a comparison here between now and the position before 1948, when local authorities had institutions, and it was possible for them to order a person to the institution in the circumstances that have been outlined. The decision could then be made whether to put them on the home or the infirmary side.

We have to face the fact that in many areas now there is simply no bed to which such a person can be allocated, and, secondly, that there is an immense and difficult problem of the priorities that must arise when a decision has to be made between allocating a bed either to someone who is of the aged or chronically sick class or to a younger person who is acutely ill and needs urgent treatment. My mind is in no way closed on this matter, but it is important that we should have practical answers to some of the practical questions that I have put forward tonight. My own study does not yield an answer directly for my hon. Friend that to re-create the relieving officer would be the right solution.

It has been suggested that it would be a good idea to build prefabricated institutions where simple care could be provided. Those who suggest it recognise the danger of a lower standard of medical care. I am always afraid that short-term solutions may remain with us longer than we intend, and it would be the final irony of the Welfare State if all we could find to solve this immensely difficult problem were to bring back the relieving officer and to rebuild, in whatever form, the workhouses. I do not think that is the road.

I think the solution lies rather in the home than in the hospital. There are three main services concerned: the hospital service for those who need medical and nursing care; the residential home for those unable because of age or other difficulty to cope with the strain of modern life and who have no relatives to whom they can turn; thirdly, services in the home. These services are headed by the general practitioner, together with health visitors, domestic helps and the help given by such splendid organisations as the British Red Cross, St John, local W.V.S. and other local welfare committees to which reference has been made. I think all three services must march together, but I think that the House will agree that, ideally, we should try to keep people as long as possible in their own homes.

My hon. Friend referred to the estimate of 80,000 beds that had been made. That was a war-time estimate, and I think, one which was made before the effects of geriatric treatment and the enormously increased rate of turnover to which I have referred, were apparent, but, although I am not sure on this point. I doubt if it took into account also the very considerable number of beds which have been provided by local authorities. Indeed, the problem is not so much one of creating new hospital beds, although I do not doubt that in many areas there are considerable shortages, and that we must build further, but of distributing the services that are available in the best possible way.

In fact, I think we must see all progress in this field as one—the additional hospital beds to which I have referred, the increased rate of turnover, to which I attach the greatest importance, the extension of out-patients services, the increased provision of residential homes, the development of welfare committees and services provided by voluntary organisations, the development of geriatric service—all these, I think, are part of the picture of progress, slower, of course, than we would like, but by no means negligible.

I should like to refer to one matter before I come to my last point. It was suggested in the articles to which we have all referred tonight, that those who are on what is called the higher level in my Ministry are "less acutely aware than others of the need." I think I should say that I know that is not true. I do not just say that because these people who are criticised work with me and for me, but, more important, because I happen to know them. I have not the slightest doubt that everything that can be done is most sympathetically done.

In my last minute or two I should like to refer to the main point, perhaps, that was raised both by my hon. Friend the Member for Cardiff, North and the hon. Member for Attercliffe (Mr. J. Hynd). That is the question of the duties that we have, beyond the duties of the State. I do not deny for a moment that there are tragedies with the welfare State such as my hon. Friend has outlined tonight. It is a terrible thing that they should happen, but it is true that the mesh of the social service State, as it is called, is, in many cases, too wide.

It is true also in this field that the line blurs between those who need hospital treatment and those in need of care. But it is not only the State that should be considered in this field when someone is found alone in the circumstances which have been mentioned. Let us by all means ask if the State has failed, but let us also ask if the family, and the neighbours as the hon. Member for Attercliffe stated, are doing all they can. What happened in regard to the local authorities, the voluntary bodies and the church? Surely this is genuinely a problem for us all, and that such things should happen is certainly a reproach to the State, and to us as citizens and Christians as well.

Question put, and agreed to.

Adjourned accordingly at Twenty-nine Minutes past Ten o'Clock.