CHRONIC AND AGED SICK (ACCOMMODATION)

HC Deb 06 March 1953 vol 512 cc705-87

11.4 a.m.

Mr. Barnett Janner (Leicester, North-West)

I beg to move, That this House expresses its concern at the shortage of hospital beds for the chronic and aged sick, and the lack of accommodation for those who need care and attention rather than medical treatment; urges the Government and hospital authorities to hasten the establishment of a comprehensive geriatric service to cover the whole country, in view of the increasing proportion of old people to the total population; calls upon local authorities and voluntary bodies to use to the full their powers to safeguard the welfare of the aged; and urges the Government to take all possible steps towards a solution of this grievous human problem. I am glad to have the opportunity of raising this question today and of asking the House to discuss the problem of accommodation for the chronic and aged sick. I hope that I shall receive support for my Motion from hon. Members on all sides of the House.

It is difficult to assess which of the social problems confronting the country should receive precedence of treatment, and that is why the Labour Government introduced such comprehensive social Measures, including the National Health Service Act and the National Assistance Act, which apply more specifically to the subject of this Motion. They felt, and I think the country now realises that they were right, that it was impossible to deal with just one or a number of the social problems without covering a very wide and comprehensive field.

I do not think that anyone will deny the immediate urgency of the subject dealt with in this Motion, whatever else may have to be attended to in order that other grievances may be remedied. I am raising the matter today because I am convinced that despite a great deal of writing and talking on this side of the House sufficient action is not being taken to face up to the problems involved in looking after the aged and chronic sick in the community.

We must deal with this subject on the assumption that far from being a declining problem, the number of aged will, according to all reports and investigations, sharply increase in the coming years. One hundred years ago there were only 1 million people in Great Britain over the age of 65. They represented less than 5 per cent. of the population, and for every old person there were nearly 30 of full working age.

Today, there are more than 5,250,000 people over the age of 65, representing nearly 11 per cent. of the population, and for every old person there are only about six of full working age. It is estimated that in 25 years' time the number of aged persons will have soared to 8,250,000 men and women over the age of 65, and that they will represent no less than 16 per cent. of the population.

Many causes have contributed to this result, but, in my view, it is due in the main to the introduction of hygienic living conditions and the conquest of deadly diseases. But whatever may be the cause, the fact remains that the proportion of older people to the rest of the population is much larger than it was, and is increasing.

Owing to this increasing expectancy of long life most families already have, or will have, one or more of their members coming within the range of those about whom we are speaking today. No class, colour or creed is outside the subject matter of this Motion. It would be more than ungracious not to praise in the highest terms the sacrifices gladly made by large numbers of children and relatives to keep their aged kith and kin, and by neighbours and particularly by the many voluntary bodies whose members toil incessantly to improve the lot of the aged and the chronic sick and to make them feel that they have friends who really care about them.

In my own constituency I have at times joined happy parties of old people held by the various Evergreen Clubs provided by voluntary workers in the constituency. It has been a great pleasure to see how these old people enjoy the amenities provided on those occasions. I have sung and even danced with people over the age of 80, and on one occasion with a person almost 90 years of age.

In my constituency there is the Wyggeston Old People's Home which I visit from time to time and where the happiness of those catered for is quite obvious. Nevertheless, it is our bounden duty to keep the situation under constant observation and to find ways and means whereby proper attention can be given to the needs of the aged sick at all times. Efficient organisation and the use of common sense have worked wonders already in many areas. The deterioration of the aged into a limpid condition has been shown to be avoidable by the use of up-to-date occupational therapy and physiotherapy. Geriatric units have fully justified their worth.

Men and women from such experienced voluntary bodies as the National Old People's Welfare Committee, the National Council of Social Service, the National Corporation for the Care of Old People, the W.V.S. and the Red Cross Society have a fund of information on this subject which is available. If it were followed up it could produce a plan to cope with and remedy other phases of the problem. I trust that the Minister will take all this advice and experience into consideration and I hope that a comprehensive statement will be issued by the Ministry indicating what they feel, after they have taken these things into consideration, is the proper way of dealing with the problem as it exists today.

But it cannot be denied that personal care and attention required by the old become more and more exacting to their families as each day goes by. In the rush of daily life it frequently happens that their families are absolutely unable to do what is essential to help them, much as they would like to do so. Some children and other relatives of aged people become neglectful of. or exasperated by, the duty which is theirs to perform. The burden becomes too heavy for them, and too many old people are left to loneliness which creeps on them and gnaws at the little strength which they have left.

In almost every part of the country there are instances of old men and women who lead a lonely and consequently miserable life. I have seen a number of these cases myself and have been deeply moved by their condition. I am sure that my experience in this respect has been shared by all hon. Members.

It might be useful to refer to a few cases to illustrate the problem which we are facing. There was an interesting leading article in the "News of the World" on 4th January this year. It was headed "A Tale to Shame The Nation." I should like to quote a short passage from it. It said: We ask every man and woman with a conscience to reflect today on the story of a couple who have grown very old. They are, in fact, probably the oldest couple in the land, George and Sarah Vicars, both 96 years of age. And a fortnight ago we told how they were preparing to spend the 78th Christmas of their married life at their daughter's home. That 78th Christmas together never came. Their daughter was ill and unable to look after them. On Christmas eve, George and Sarah, who went to the altar together long before most of us were born, were taken to hospital and put in separate wards. There they spent Christmas; this couple whom all the trials and troubles of the years had failed to part; this 'Darby and Joan' of whom Britain may well be proud. We make no criticism of those who had to deal with their case. We do not doubt that the difficult problem of these old folk, unable to fend for themselves, was tackled with humanity and sympathy within the limits of the resources available. The indictment—and we have repeated it many times—is against the whole nation. So long as we refuse to face up to the problem of the old people stories like that of George and Sarah will go on. I am informed that a short time ago a number of cases were brought to the attention of the Minister of Health by a women's organisation. There were cases which had been brought to their notice by one of their branches and these throw a light on the situation. I should like to refer to some of them as a background to this debate.

An elderly patient was discharged after a surgical operation. The hospital almoner requested a home help as there was no one available to look after the patient. Help was supplied for meals, cleaning, and so on, but only daily. A home help arrived on the second day to get lunch, but could not get into the house. The police were called and they found the patient quite mental, recognising no one after being alone in the house all night long. A doctor and nurse were called. The home help organiser stayed with the patient until 8.30 p.m. when the nurse called to give a sedative, thus ensuring that the patient would be quiet all night as she was again to be left alone. Next day the home help arrived to find the patient completely senile and wandering all over the house. The doctor then certified her and she was admitted to hospital.

This patient should never have been sent home alone with only a daily help, and, clearly, that night alone, immediately after hospitalisation, deranged her mind completely, and the sedative completed the job. If the hospital had been able to keep her longer or to send her to a home for chronic patients, she might never have become mentally deranged.

Here are some other cases, and I am quoting cases from only one branch of one organisation. A very old lady was discharged from hospital with the suggestion that a domestic help was necessary. She carried on for some months, and then she fell and broke her collar bone. The National Assistance Board brought the case to the notice of the county medical officer. The doctor said that there was no bed available in the hospital. The county welfare authorities refused to accommodate her on the ground that she was not suitable for Part III accommodation under the Act. The county medical officer stated that the case was not suitable for daily home help as the patient was too helpless to be left at home all night. Weeks of argument took place between county welfare, county medical officer, private doctor, bed bureau and National Assistance bureau, until, ultimately, the patient was admitted to hospital.

In another case a person aged 71 had a stroke, was incontinent and helpless in bed and was alone for four days before being admitted to hospital. In another case a partially paralysed person, who was demented, was left alone most of the day. This patient—and this is extremely interesting—waited for three years for admission to hospital. The admission to hospital was arranged three days after her burial.

In another case a brother and sister were living in appalling conditions. The man was seriously ill. Sitting in front of the fire, he fell in twice. The woman was senile and deaf, and had hurt her head, arms and chest in falling off the sofa on which she lay all the time. They were unable to use sanitary arrangements and so a pail was kept in the room. This case was bandied about between the district nurse, the minister's wife, the county medical officer, the home help organiser and the National Assistance Board. The local Member of Parliament also intervened. It was after three weeks' effort by all concerned that these two old folk were moved into hospital. This is a particularly bad example of time being wasted because too many people were involved.

I could quote many other cases, of course, as I think could almost every other hon. Member. Those to which I have referred, however, should suffice to indicate that there is a strong case for a further examination of the situation so that it may be dealt with immediately. There is, of course, a greater sense of the urgency of dealing with the problem in some districts than that which prevails in others.

In my own constituency and its immediate neighbourhood the situation in many respects is not as bad as in some other districts. The work which is being done by the welfare officer of Leicester and his staff is highly commendable and is being carried out with as little interference by other Departments as possible; but there is still much left to be done there.

I propose to deal with the position as it affects the country in a general way. The National Health Service Act caters for the sick and the National Assistance Act for those needing care and attention which is not otherwise available to them because of age or infirmity. The provisions of the two Acts do not overlap, and this creates a kind of "no man's land" between them. Thus there are old people who, because they are not sick enough for hospital and yet need more care and attention than can be given to them in their own homes—or would normally be given to them in a local authority home—are not receiving the attention they require.

There are aged people in local authority homes elsewhere who ought to be in hospital, but who cannot get in because of the shortage of beds for the chronic sick and aged. In many districts there are long waiting lists of persons who cannot be accommodated because of that shortage of beds. There are many people living in their own homes who should be in hospitals and there are others in their own homes who should be in local authority homes and who, if they are not looked after speedily in that regard, will, in time, undoubtedly become cases for the hospitals. They depend on relatives and friends to look after them and on such other domiciliary services as exist.

On the other hand, there are aged persons occupying hospital beds who could be restored to a condition of health which would enable them to enter hostels or residential homes if there were any to which they could go where they would receive the attention they need.

The position is a Gilbertian one. These hospital beds are not able to be properly used because they are occupied by old people who, through the years, have deteriorated physically and mentally so that they are incapable of being discharged to their own homes, where these still exist. At the other end of the scale there are many aged and chronic sick in dire need of hospital treatment who cannot receive it because beds are not available.

In 1950, the Ministry of Health issued a circular to all regional hospital boards and boards of governors of teaching hospitals, asking them to set up annexes or special homes for those old people who are well on the way to being cured and do not need the detailed care which normally sick persons must have. It is difficult to get the building figures for hospitals broken down, but it appears that little has been done to implement this circular. There are some such buildings, but the Ministry of Health must accept the blame for not having been more energetic in supplying this need.

The amount which the Government allow the hospital authorities to spend on maintenance and repair is very little compared with what needs to be done. I understand that the sum allowed for this purpose this year is only about two-thirds of what it was for the last financial year. Surely this is a case where we are being penny wise and pound foolish?

I would ask the Minister to give us today the figure of the number of hospitals with geriatric units. These units perform a splendid service where they exist. Only a few days ago I visited Lord Amulree's unit at the St. Pancras Hospital, which is part of the University College Hospital Service, where I found that a large proportion of the old people were being restored to such full health as an aged person can enjoy.

I agree with the submissions which have been made to the Minister by the National Old People's Welfare Committee, and those advocated by the National Corporation for the Care of Old People. They deserve particular consideration. They advocate that an endeavour should be made to make the hospital beds which exist more readily available by the following methods: In each group of hospitals there should be a complete geriatric unit which should work in conjunction with the domiciliary services. This should be achieved as speedily as possible. There should be a closer liaison between local authorities and hospitals.

This would be very much easier if each side were not so tightly tied down to certain categories for which they might accept financial responsibility. There will always be borderline cases and provision must be made for these. At present, no one has jurisdiction over both Acts to demand accommodation immediately for an old person in one or other of the two places—home or hospital. Furthermore, no ruling has been given for those who are stranded in what I have referred to earlier as the "no man's land."

This makes both sides very cautious about accepting responsibility for any case which is in the least doubtful in so far as responsibility is concerned. It should be the duty of one person to inquire into the requirements of old people on waiting lists and to allot beds in hospitals or other accommodation elsewhere accordingly. If sufficient and adequate domiciliary services are available in the district the demand for hospital beds can be decreased and a better use made of the existing beds.

One person should also be responsible for making a decision without delay—cutting through all the red tape and financial difficulties—on the question where sick or infirm people requiring accommodation should be housed. The last annual report of the Ministry of Health contains some very interesting and useful suggestions which, if they had punch behind them and attempted to compel the various bodies concerned to do what the Ministry says should be done, would help very much to improve the position which I have outlined.

The immediate establishment of short-stay annexes near the hospitals and in close association with them should be available for those who are in the course of being transferred from the hospitals to their homes or other accommodation, and the number of other annexes attached to the hospitals should be increased for the use of the permanently bed-fast patients or the really chronic sick.

The term "chronic sick" is a relative term. It might mean a very ill or ailing person or, in the case of the aged, a person who has no very serious defect other than that of age and for whom nothing further can be done but who need a great deal of help with washing and similar things. They are a hospital responsibility. They may not need skilled nurses but they should be constantly cared for.

There should be an ample supply of permanent rest homes for those who need more care and attention than is available in ordinary Part III accommodation. I am told by the bodies to whom I have referred that voluntary societies are discouraged from providing short-stay annexes or rest homes because there is no certainty that regional hospital boards and local authorities will accept financial responsibility for the maintenance of the residents.

The close division of financial responsibility under the present law is sometimes prejudicial to the interests of the old people themselves. The establishment of more accommodation for short and long stay residents who no longer need full hospital care—which accommodation is obviously less costly to run than hospitals—could help to prevent many people from occupying more expensive hospital beds. I appreciate that staffing is one of the main difficulties, but I feel that this is not insuperable.

I want to draw the attention of the House for a few minutes to the very serious question of the mentally senile. The accommodation of old people suffering from mental deterioration is just as great a problem as the others. In spite of assurances given during past debates in the House, it is common knowledge among those who have to deal with old people that many are being certified weekly and are being admitted to mental hospitals. This is because there are few other places to which they can go. There are lengthy waiting lists for admission to mental hospitals, and younger persons who could be treated often have to wait for admission owing to the fact that mental hospitals are full of old people who are really suffering only from deterioration of the mind associated with old age.

Some magistrates, acting under the Lunacy Acts, refuse to certify old people in this condition. There is, however, nowhere else for many of them to go. The old people may be suffering from widely varying degrees of "senile dementia." They may be forgetful, mildly confused, hallucinated, or extraordinarily difficult in temperament. They cannot be cared for, except in the mildest stages, in the Part III homes, as it has been found by experience that their behaviour often disturbs the other residents and also the general atmosphere of these homes.

In addition, most voluntary organisations and local authorities will not set up special homes for these people because they know that the National Health Service is unable to take them off their hands when they reach an advanced stage, and, also, that if the mental health officer is called in there is a justifiable reluctance to certify these old people. Even if magistrates do certify them, it is a step which is often taken by them on their second or third call to an old person and under protest, owing, as I have said, to the absence of other accommodation for these people.

The certification of these old people—I wish to bring this problem to the notice of the House—has a distressing and far-reaching effect not only upon them but upon their living relatives, and often even on the unborn generations. For example, certification of a member of one's family can be a bar to emigration to certain countries. In this way, even the third generation may suffer, because a grandmother, whom they may not even have known, was certified in her very old age as being a mental case.

In an article in the "British Medical Journal," as part of the refresher series for general practitioners, Professor Kennedy, of Durham University, wrote as follows: The certification of patients of 65, or of those whose mental illness is dependent on degenerative physical disease such as arteriosclerosis or renal failure, is not desirable, especially when it is clear that the patient may not live very long. Patients of this kind are usually too ill or too lacking in enterprise to be of much danger to others, apart from the episodes of confusion which often occur in the course of a general decline in their mental powers. The need for dealing with such episodes without moving the patient is recognised at most geriatric units and many nursing homes specialising in old people take patients who, while certifiable, have nothing to gain from certification. No special legal provision exists for patients over 65. There is no obligation to certify a patient for whom room can be found in a geriatric ward, provided that facilities exist there for dealing with episodes of disturbed behaviour if they occur. Admission to an observation ward under the Lunacy Act, Section 20, may allow time for the confusion to subside, so that if admission to a mental hospital is still necessary, it can be as a voluntary patient. It is to be hoped that when enough accommodation in geriatric units becomes available the certification of patients in a terminal confusion or dementia will cease to be necessary. I also saw reported in the Press a speech by the President of the National Association of Health and Welfare Officers, who said: The disposing in the mental hospitals of old people suffering from some degree of senility because there is no room for them in hospitals treating the chronic sick is the gravest blot on what is otherwise an excellent health and hospital service. More accommodation should be provided for those whose mental deterioration makes them unsuited for ordinary residential accommodation, but who are not certifiable.

So many subjects are involved, and I do not want to take up too much of the time of the House, but there are one or two other matters with which I ought to deal. Local authorities should make more provision for the accommodation of the frail. Lack of suitable housing should never be a cause for seeking accommodation in a welfare establishment; this should be provided by housing authorities and, if necessary, in hostels.

I am sorry that I do not see anyone present from the Ministry of Housing and Local Government, but I hope that the Parliamentary Secretary to the Minis- try of Health will bring this to the attention of her colleagues. The health of many elderly people could be prevented from deteriorating to the point when they need hospital treatment or other residential care. If they were provided with more suitable housing, I think that the majority of elderly people would prefer to live independently as long as possible.

A recent publication estimates—and this should be taken into consideration by the Minister, in conjunction with her right hon. Friend the Chancellor of the Exchequer—that the costs of caring for an elderly person in his own home, including all local home services and pension and National Assistance, amounts to £135 per annum. The cost of maintaining a resident in an old people's home is estimated at approximately £180. A hospital bed, however, is estimated at some £500 a year. The advantage, therefore, of providing sufficient suitable housing for elderly people is obvious from an economic standpoint.

In "Housing for Special Purposes," the supplement to the 1949 Housing Manual, stress is laid on the need for co-operation between housing and welfare authorities. If the views expressed by the Ministry would be followed generally, this would help to improve the position.

The Housing Act, 1949, enables local authorities to give some of the services which are necessary to enable people to remain in their homes and to remain in the homes which are provided by the local authorities. It enables them, for example, to provide laundry facilities, either direct or through voluntary agencies. It would be helpful if direction could be given to local authorities to implement their powers in this respect where laundry facilities for elderly people are inadequate. Where really foul linen requires cleansing, would it not be possible for encouragement to be given to hospital laundries to undertake this, particularly where elderly people are within the orbit of a geriatric unit?

One of the major difficulties of keeping elderly incontinent people at home or in residential homes is the washing of laundry. Although the National Assistance Board can help to augment the supply of linen in certain cases, and in London the Central Council for District Nursing have a central supply of bed linen and nightwear available for elderly sick people nursed at home, laundering facilities are still required.

In an experimental scheme which has been undertaken in another town, a person has been appointed to look after the laundry requirements of the aged and chronic sick. The laundry is collected and dealt with, and voluntary helpers iron some of the laundry that needs ironing.

There is the question of attendance on old people at night. Some of the cases to which I have referred indicate the vast importance of the problem. Help of this kind can be given under the present Acts, but it is not being done to anything like the extent to which it should be done. There is need for more temporary accommodation for infirm elderly people living in their own homes who have relatives or friends looking after them, so that the friends or relatives can have a holiday and a break which enables them to continue to care for the elderly person.

One geriatric unit which has experimented in this way has been able to offer accommodation in the past year to 60 elderly infirm people. The attention of local authorities and regional hospital boards should be drawn to the need for this type of temporary accommodation. There are other facilities, such as the services of chiropodists, and so on, which might be supplied for the aged people.

There is a duty upon the community as a whole to make the last years of its elders pass in happiness and tranquility, with as little pain to them as possible, either mentally or physically. Indeed, when we see an old man or woman each of us surely must reflect that, "There, perhaps, by the will of God, shall go I." I ask the Parliamentary Secretary to regard this Motion as an appeal to her to do what she can to meet in as full a manner as she possibly can, the needs of the aged members of the great family to which we all belong. They have been generous to us in helping to build up our nation. We have no right to see them want for proper care and attention.

11.41 a.m.

Mr. Kenneth Robinson (St. Pancras, North)

I beg to second the Motion.

I think that the whole House would wish to congratulate my hon. Friend, not only on his having chosen so important and interesting a topic for discussion to- day, but also on his very constructive and moving speech. Medical science has done a good deal in recent years to prolong human life and to ease the sufferings of old age, but what we must ask ourselves today is whether we, as a community, have done all that we could do to make old age as happy—as positively happy—a time as it can be.

We are dealing today with a very real human problem. It is a problem that has many facets, social, medical, administrative, and even statistical, but basically it is a human problem. There are many people who believe that the younger generation today are to some extent shirking their responsibilities to the old, that they are apt to turn to the State to look after their aged parents instead of doing their duty towards them. These people complain that this is, in a sense, a breakdown of family life. I think we ought to hesitate before we condemn.

We should also think of the young mother with two or three small children to look after who may find it physically impossible to look after a sick and elderly mother or father as well, and particularly we should bear in mind, before passing judgment in this matter, the housing conditions in which some of those people have to live. It is obviously better for old folk, if they possibly can, to remain at home among their own people, but where this is impossible it is right and proper that the State should step in and help.

I approach this subject with no special knowledge. I know very little about it beyond what I have learned as a member of the North-West Metropolitan Regional Hospital Board, but it does so happen that we have in that region taken especial care over this problem, and I think we have made particularly good progress. The Board's achievement in this field, as in all other fields, owes more than I can say to the vision and the energy of our Chairman, my hon. Friend the Member for Tottenham (Mr. Messer), whose services, I am very sorry I have to tell the House, we are losing at the end of this month.

The first thing we know about this problem is that it is going to get bigger. My hon. Friend has quoted figures to illustrate that. This problem can be seen in its true perspective in the Report of the Royal Commission on Population. The evidence is all there for hon. Members in Chapter 9, but the essential figure is that within 25 years from now the proportion of the population over the age of 65 will have increased by 50 per cent.: a 50 per cent. increase in a quarter of a century. The proportion is expected to remain at this figure for the rest of the century. There will be, no doubt, some mitigation of the problem as the value of preventive medicine becomes felt and sickness as a whole decreases, but hon. Members will realise that the aged section of the population will be the last to benefit from this advantage.

So much for the future. But even today it is very difficult, indeed almost impossible, to get any idea of the size and extent of this problem. For one thing we have no common definition of the term "chronic sick." It is a difficult thing to define, I quite agree, but possibly the hon. Lady the Parliamentary Secretary to the Ministry of Health and her right hon. Friend may help in this matter. I am not suggesting they should try to lay down for us a hard and fast definition, but that they should give some guidance to hospital authorities and local authorities, so that we can get some common understanding of the term, if only to put our statistics on a reasonably standard basis.

The Minister of Health has issued a Report for the period ended 31st December, 1951, which contains the latest figures that are available. Possibly the hon. Lady may have some later ones. That Report shows that there are roughly 57,000 beds allocated in hospitals to the chronic sick over the whole country. The waiting lists total just under 9,000. At a first glance that may not appear a particularly serious problem: there are far longer waiting lists for other types of beds. Really, however, these figures of waiting lists are almost meaningless, because different criteria are applied not only by different regions but even by different hospitals in one and the same region.

These figures give no idea of the size of the problem for, I think, two reasons. The first reason is that in almost every hospital the admissions to chronic sick beds are far more numerous from amongst those who are not on the waiting lists than from those on the waiting lists itself. Most of the admitted patients are chronic sick whose condition suddenly becomes acute, or else are old people who have contracted some additional complaint which converts them into emergency cases.

The second reason, largely arising from the first, is that general practitioners, who are key figures in this problem, are apt to take up a defeatist attitude about these waiting lists. They know that their chances of getting a chronic sick case accepted into hospital are very remote unless the social conditions of the patient are particularly bad or unless the case becomes an emergency, and so they just do not put the cases on the waiting lists.

This leads me to a further argument for allocating more chronic sick beds in hospitals. If we had more beds we could have old people treated for chronic conditions at an earlier stage in the development of their disease. There would be a higher proportion rehabilitated. Treatment would be shorter and deaths would be fewer, and in the long run considerable economies could be made because of improved use of the beds in the hospitals and the quicker turnover.

But, of course, more beds, as the hon. Lady knows, mean more money, and more nurses. In the North-West Metropolitan Region we could, if we had the money and the staff, allocate within a few weeks at least another 300 beds for the chronic sick; but we have not got the money, and only the Minister can help here. Also we are finding it desperately difficult to recruit more nursing staff.

There is a special problem here, where, I think, the hon. Lady and her right hon. Friend may be of some assistance. It would help enormously if we could get student nurses seconded to chronic sick units for, say, three months of their training. The difficulty is that we are having to use pupil assistant nurses, and the General Nursing Council, for reasons which, no doubt, seem good to them, do not allow student nurses to work in the same wards as pupil assistant nurses. Can the Minister use some influence with the General Nursing Council, to get them to alter that decision? My hon. Friend referred to geriatrics on several occasions. There is no doubt that there has been a minor revolution in the last few years in the whole medical approach to this subject of the care of the chronic sick. I do not think that it has received enough publicity, at all events outside the medical profession. That is another reason why I welcome this debate today. Perhaps it will give an added momentum to these new methods of solving this problem.

Geriatrics is not a word which Members will find in any pre-war dictionary, so perhaps I may be forgiven for saying a few words about its meaning. This branch of medical science was virtually unknown 20 years ago. There were several pioneers experimenting in the 1930's, but the Teal impetus came only with the introduction of the National Health Service five years ago. Very roughly, the aim is to emphasise the rehabilitation of the patient, to enable him wherever possible to stand on his own feet again and to live as normal a life as old people can live among their own folk, or if necessary in local authority welfare homes.

The whole emphasis is on active treatment. This is in sharp opposition to the old methods, too often employed, of allowing old people to become bedridden and stiff, in steadily deteriorating health, and to lie there and await the coming of death, be it soon or late. Geriatrics implies a combined social and medical approach to the problem. It implies a close liaison between the hospital authorities on the one hand and the local authorities, voluntary bodies and above all general practitioners on the other.

There is some opposition within the medical profession and outside it to the whole idea of geriatrics. There are people who regard it as a large and unnecessary new machine for dealing with a comparatively simple problem. There are others who complain about the development of a single specialty to deal with a wide variety of disease. I do not at all share that view. It is my view, and I hope also that of the Minister, that there should be a properly integrated geriatric unit in every general hospital above a certain size—at a guess I should say those with more than 500 beds, possibly fewer.

In my submission, there are four main requirements for a comprehensive geriatric unit. The first is a consultant geriatrician in charge, with an almoner and other appropriate staff to assist him. The second is the allocation for the chronic sick of a number of beds adequate for the catchment area served by the hospital. The third is a half-way home or hostel. The fourth and last is a long-stay annexe. Both the latter should be attached to a particular hospital if possible, or, if not, to a particular group of hospitals.

We have not yet enough qualified and experienced geriatricians, but I am informed that there are adequate training facilities for registrars in the existing geriatric units. It should be the job of the geriatrician, besides the obvious one of treating the patients under his charge, to analyse the waiting lists and establish priorities for admission. In order to do that, it is essential that he should himself visit the chronic sick in their own homes once the general practitioner has submitted them for the waiting list. In the case of certain old people in particularly difficult social circumstances the almoner should visit as well.

It is only in this way that the proper priorities for admission can be established. The geriatrician could also arrange out-patient treatment, if necessary, while the patient is awaiting admission. There is great psychological advantage in domiciliary visits to the patient, who sees the doctor who is to look after him when he goes into hospital. The patient becomes an individual, not just a name on the waiting list.

I have already dealt with the second requirement—beds. I should, however, make the point that the catchment area for the purposes of the chronic sick must be larger than for other types of beds because the teaching hospitals make very little contribution to this problem. It may be churlish of me to say this when I have in my own borough the excellent unit at St. Pancras Hospital, now part of University College Hospital. But it is, I believe, unique, and in general the teaching hospitals do not help in this problem of the chronic and aged sick.

The third requirement is the half-way home to provide an intermediate stage between hospital treatment and discharge to home or to a welfare home. The function of the half-way home is that of a hardening process, to enable these old people to fit themselves to take their place in the world again. The length of stay is probably not more than a couple of months on the average, and the whole emphasis should be on movement and turnover. That is the whole purpose of geriatrics, to get flow and mobility.

These half-way homes are doing excellent work. I went to one in my own division the other day. It was a delight to see an old lady who had been bedridden for three or four years and quite incontinent walking about without the aid of a stick and even climbing stairs with some difficulty, awaiting discharge to her own home. But half-way homes are run on a most unsatisfactory basis at the moment. Admirable pioneer work has been done by voluntary bodies such as the King Edward Hospital Fund for London, which now has about a half-dozen half-way homes serving the London area. There are other voluntary bodies which have added to the number, but the total cannot represent more than a few hundred beds for the whole of the London area.

This job cannot be left to voluntary organisations. The responsibility should be squarely placed on the hospital authorities or the local authorities, but it must be placed somewhere. In any case the hospital authorities normally enter into contractual arrangements about the running of these half-way homes. The Government must take the lead in this matter. I should like to support my hon. Friend in saying that they must take the lead in the whole question of divided responsibilities in this field. It really is an unsatisfactory situation; there is local authority responsibility for one thing and hospital authority responsibility for another and this no-man's land in between. The whole question needs looking into very thoroughly.

Long-stay annexes are self-explanatory. They are for old people with some incurable degenerative condition and who are more or less bedridden and need simple nursing rather than continuous medical treatment. There are still far too few of these. The point about both the half-way homes and the long-stay annexes is that they are far cheaper than hospital accommodation. It costs half as much money, or less than half, to keep a patient in a bed at one of these half-way homes than it does to keep a patient in hospital. That argument at least should appeal to the Ministry of Health.

For those who doubt the value of the geriatric service, perhaps I may quote one or two figures. At the St. Pancras Hospital, when the unit under Lord Amulree started, about 150 chronic sick beds were occupied, mainly by cases transferred from other hospitals. At the end of 12 months, under old-fashioned methods of treatment, 75 per cent. of those people remained in hospital; their average length of stay there was 30 months. Of the new patients admitted during the first year of Lord Amulree's regime, only 33 per cent. remained at the end of the year, and more than half of them were suitable for hostel accommodation had there been a hostel available at that time. The average stay at the hospital had dropped sensationally, from 30 months to a little more than 10 weeks, which gives some idea of what can be done by intelligent geriatric treatment.

After the introduction of geriatrics, it used to be reckoned that roughly a third of the patients died within a year, a third were discharged and a third became long-stay patients. More recent experience has shown that that is much too pessimistic. The figures in my own region are far better. I think that, on the whole, only about 20 per cent. now become long-stay patients. I recently went round an excellently run geriatric unit in my own constituency, where I was shown figures for six months' admissions. At the end of six months, about one-third of the patients had died, more than half had been discharged home and only 10 per cent. remained in hospital.

Clearly these figures are not conclusive, but they are at least an indication that the geriatric unit is already justifying itself by the results achieved. Can we have some more information on this subject? Will the Minister institute a comparative survey of the results in chronic sick hospitals which have a geriatric unit with the results in those which have not a geriatric unit and which carry on in the old way? If the Minister cannot undertake this survey, will she at least encourage some outside body to do it? We ought to have this information in order to satisfy ourselves as to the best way of dealing with this problem.

I have spoken longer than I intended. I wanted to say a word about welfare homes and certain problems which have cropped up in my own constituency with regard to them. I should like to mention in conclusion two or three special aspects of this problem. There is the even more tragic problem of the young chronic sick. It is vitally necessary that these cases should not be in the same wards as the aged sick. Not only do we want separate wards for the young chronic sick but, if possible, separate establishments. One has just been started in the North-West Region, but far more are needed.

In these cases, and also in the case of the aged sick, occupational therapy is extremely important. Will the hon. Lady stimulate hospital boards to do their utmost to segregate the young from the old? Will she also turn her attention to the question of holiday beds?—that is, the provision of facilities to enable old people living with relatives to get away to hospital for a week or two for treatment which benefits the older person and also relieves the family—perhaps the harassed mother of the family—for a week or two. That is something which, I think, could be extended with advantage.

Finally, there is the problem, which my hon. Friend referred to, of those old people whose mental faculties have begun to deteriorate; not those who should be in a mental hospital, but those who have become senile and are unable to look after themselves for other than physical reasons. Hon. Members may remember that some three or four years ago questions were put in this House about the certification of this type of patient. In some parts of the country this had reached almost the proportion of a scandal. Old people were being certified, because there was no other way of getting them into hospital, with great distress to the relatives in consequence. Arising out of that, a circular was issued—I believe by the right hon. Member for Ebbw Vale (Mr. Bevan) when Minister of Health—calling the attention of hospital authorities to this tragic problem.

In the North-West Metropolitan Region we have established a small hospital to deal with this particular problem—the Abbot's Langley Hospital. It is, I believe, a unique experiment. It is a success, and one which I think ought to be widely copied. Mental patients are taken to this hospital under no form of certification whatever, no legal sanction: they are simply hospital patients. They are treated and where possible rehabilitated. In many cases that is not possible, but everything is done to make their last months or years as happy as possible.

I hope that the House will accept the Motion of my hon. Friend and that the Government will not only accept it but will translate its recommendations into positive action.

12.6 p.m.

Sir Austin Hudson (Lewisham, North)

Very often at this stage of a debate on a Friday either on a Bill or a Motion an hon. Member who is called third rises to move the rejection of the Bill or Motion. I feel quite certain that today no hon. Member will do anything of that kind.

The first thing I want to do is to congratulate the hon. Member for Leicester, North-West (Mr. Janner) both on his choice of subject and on the wording of his Motion. It will allow us the widest possible scope for debate. I was particularly glad to see the words: …accommodation for those who need care and attention rather than medical treatment, It is not only hospital beds which are required—that has been ably brought out by the two Members who moved and seconded the Motion—but accommodation for elderly people who need care and attention.

There is quite a lot to be said for the system which, it is said, used to operate in China—I do not know whether it does now—whereby one paid the doctor when one was well and not when one was ill. In this case—and I want particularly to address my remarks to this—we want, if we can, to prevent people from becoming chronically sick when they are ill or when they are merely old. May I add my congratulations to those of the hon. Member for Leicester, North-West with regard to the old peoples' clubs? They are known by different names in different parts of London and in different parts of the country. In Lewisham, they are known as "Darby and Joan Clubs." They are doing exactly the same work, and admirable work, for lonely old people. I should also like to say what good work is being done by voluntary visitors to people who are sick or old, who help them in their troubles.

As the mover of the Motion said, this is not a new problem. It is one which has been aggravated by the great strides which medical science has made in the last 100 years. I reckon that if my life had been lived 100 years ago, I would have been dead twice from various illnesses which at that time medical science did not know how to cure. Therefore, I should not become an old person. Expectation of life has increased owing to medical science, and people who would have died at the age perhaps of 60 now live to 70, 80 or 90 years of age.

All of us have come across distressing cases in our constituencies. A family may approach one to get the old people into hospital or some other suitable place because it is no longer able to look after them, and we all know the difficulty that we have in finding suitable accommodation. In addition to the constituency aspect I have seen the problem from two rather different angles. I am a member of the court, and also a past master, of one of the 12 great city companies which has some really excellent homes for old ladies in the South of London, which were established many years ago. Originally, the homes were in what is now the Geffrye Museum, in the Kingsland Road; the buildings were of such antiquity and architectural interest that they have been turned into a museum.

I was master during the latter years of the war, and it was the duty of the master and wardens of the company to administer the homes on behalf of the company. When a vacancy occurred there were always a large number of applicants and we had to be very careful in selecting the right person. One of the things which was always impressed upon me was the necessity to avoid accepting someone who needed great medical attention. We had to have the applicants thoroughly examined by the apothecary—we were too old-fashioned to have a doctor; we had an apothecary who was, of course, a doctor—and only those people who could pass the examination could be admitted.

I say that because I do not think one could have better accommodation for old ladies who are entirely on their own than we have in the South of London. There are blocks in which the ladies have their separate rooms. We have a matron and an assistant matron. However, we were unable to look after the bedridden, and if the ladies eventually became bedridden and chronically sick they had to be moved to hospital, and they hated that, for if there is one thing that old people dislike it is movement of any kind. Although I am certain that the homes are doing very good work, they cannot be used for looking after the "chronic sick."

I am reminded by something which was said by the hon. Member for Leicester, North-West of the fact that the design of these homes overcomes the extreme difficulty of persons being alone at night. These ladies have their own rooms, but if they are not well all they have to do is just go outside and knock on the next door and then the matron can be informed. In such circumstances these ladies do not feel that they will be entirely on their own if they should get, say, a heart attack, and that is extremely important. Later, I shall say what I think is necessary for people who should have care and attention rather than medical treatment.

Like the hon. Member for St. Pancras, North (Mr. K. Robinson), I am a member of a hospital board, that of one of the big London teaching hospitals. We encounter exactly the same problem as he so ably described. We have felt it necessary to keep beds as far as possible for people who can be cured and sent out and not to fill them with chronic sick. So much is that so that at each monthly meeting of the hospital house committee the resident medical officer reports the number of people who have been in the hospital for a long time and their names are sent to the medical committee for a report to be made upon them, not so that they may be thrown out into the streets but so that we may ensure that the waiting lists of those who desire operations or other medical treatment are not unduly blocked by the chronic sick.

We have been able recently to ease the problem by sending some of our older people, particularly old ladies, to one of our convalescent homes in the South of London. which, luckily, we have been able to staff and in which we have been able to open extra beds. I visited it the other day, and found the people very happy there. We have been able to start occupational therapy there, which is vital, as the hon. Member for St. Pancras, North said. But this does not solve the problem, for we have been able to send only a handful of people to the convalescent home, the great part of which is filled with patients from a number of London hospitals who are genuinely convalescent.

I now want to tell the House what I think is required. I do not mind admitting that some of these suggestions come from other people in my constituency. By a coincidence, at a luncheon meeting of my association—it had nothing to do with politics—we were discussing the question of the aged and the aged sick. One thing which is certain is that the aged want a different type of hospital from the ordinary hospital.

We want a much more home-like atmosphere. We do not want bare boards which are so necessary in a hospital. We do not want high beds: we want low beds. It must be a different type of place altogether. We also want a different type of nursing. I am not now speaking of those who require operations, and so on. We require staff upon whom the patients can look as friends; we do not want merely efficient nurses whose job is to get the patient well as soon as possible.

We want as many people as possible to have their own homes, which in many cases will be only rooms, and, if possible, to look after them themselves. Nothing is more dreadful when going to a home for old people than to see them sitting down with their heads bent forward, doing nothing. If they are capable of doing it, it is as well to let them look after their own home, perhaps doing a little shopping, for they will then be happier and no great harm will be done.

Perhaps the ideal would be to have a hospital built or adapted for the aged or chronic sick—now called a geriatric unit—surrounded by homes similar to those of my company in which the people who want care and attention can live. If those persons get beyond it or have to go into hospital they can simply be moved into the central hospital. That would probably overcome the dislike of movement on the part of all old people. Such a system would be extremely beneficial.

I sincerely hope that such hospitals will not be called homes for incurables. Whenever I go up Putney Hill I see an excellent institution there, but I always feel that there is something daunting to be put in a "home for incurables," as that home is called. It seems so final. In my first constituency, many years ago, there was a home called "The Home for Forlorn and Desolate Females" That shows what they could do if they really tried in the old days. A different example of what we do not want in modern days, but which we have to use and adapt from the past, is an example in my present constituency. Old people there who have no one to look after them go to an enormous institution called Ladywell Lodge. Ladywell Lodge used to be called "The Institution" and before that it was called "The Workhouse." It is the same building, built of brick in enormous blocks, some of the buildings being very high. They do the best they can with the garden.

I say straight away that they look after the old people there extremely well and try to make the best of those great dormitories and to make them into homelike rooms where they can sit. But it is a hopeless job trying to make an old workhouse building into a homely place for the aged.

I hope that the Minister of Health, in conjunction with the Minister of Housing and Local Government, will be able to get on with building fairly soon and that we shall not try to make the homes too elaborate. I am told—I do not know whether it is true—that local authorities are not allowed to build houses for the aged unless each person has his own bathroom. We can go back to the harrowing story told by the mover of the Motion. These old people are frightened of being alone at night. Suppose we could put two, or even three, of them in a bed-sitting-room, or in two rooms and they had one bathroom for the two, or even three, persons. They would then be all together.

I am not being mean about this; it is really an effort to economise on building and, at the same time, to get away from the difficulty of old people being entirely alone. These people would then feel that they had someone next door whom they could knock up if necessary. I believe that it would be cheaper to build like that and I do not think it would mean that the people would be unduly hampered for want of bathroom space but we would get over the difficulty, which is so important, of leaving these people alone at night.

I have made one or two suggestions which are the result of discussions with different people. All parties and all Governments have done a lot in recent years, but I hope that this debate will be useful in bringing about an even greater improvement.

12.24 p.m.

Miss Jennie Lee (Cannock)

Although this morning we have been dealing with the problems of old age and chronic sickness, I at least have not found this a depressing discussion. I feel that in the background there is a fundamental optimism, an optimism that we must, if we can, communicate to elderly people. Maybe we are the ideal institution for making that form of communication, because one reassuring feature of debates of this kind is that we may be quite certain to have colleagues in our midst over 60, some over 65 and some over 70.

It is not entirely accidental that we have a most vigorous Prime Minister in full possession of all his senses—whether we agree that he uses all the senses in the way in which he should is another matter—of the age of 78. The Leader of the Opposition is a young and vigorous man who has been celebrating his seventieth birthday. It is good to keep the relative picture in mind, as otherwise we can become oppressed by the thought that we are facing a future in which a larger and larger proportion of the community will belong to the older age group.

This morning we are dealing specifically with aged people who are the chronic sick, but, like others who have spoken in this debate. I am worried about the number who become classified as chronic sick and are using up hospital beds, fully trained nurses and hospital equipment, when we could, I believe, by a great drive reduce those numbers. A nightmare which every Minister of Health must have is that a larger and larger number of hospital beds and hospital equipment will be taken over for the care of the aged and chronic sick. I think there is agreement among us this morning that we want to reduce that number to the absolute minimum.

I hope there will be further agreement that that cannot be done if we do not keep our general building programme for hospitals moving forward and at the same time keep up our repairs of hospitals. It is absolutely essential that that should be done. Treatment which extends the length of the working life should not only become widely known but generally available. This is important for the national economy and also for individual wellbeing.

There is the old saying that one is as young as one feels. We are mocking certain illnesses if we use that phrase, but it is quite true that there is a psychological attitude which can sometimes make men and women old before their time. Whilst I would not venture to trespass on the strictly medical side of this subject, particularly when my hon. and so learned Friend in these matters, the hon. Member for Barking (Mr. Hastings), will be speaking, I hope, before the end of the debate, I think it is true to say that all of us who have had to cope with this problem among our own families and friends have found a complete revolution in the attitude towards the diseases of old age and that the more people can be kept going and the more they can be active the better.

We have to get out of our minds the idea that we are being kind to father, or mother, or any other elderly person in our care, if when they are approaching 70 we want them to put up their feet and stop doing anything. That is a recipe for shortening their lives and reducing their happiness.

I hope the Government will seriously consider several propositions which have been made, the effect of which would be to reduce the amount of hospital space that is being used by the chronic sick today, and of having more homes of a much simpler nature which do not require full hospital equipment in order that the old people shall be looked after. I would inform the hon. Member for Lewisham, North (Sir A. Hudson) that a sub-committee of what is now the Ministry of Housing and Local Government considered plans for blocks of flats in which single people would be mixed with elderly people, and in which bathroom facilities would be shared. It was thought better to have facilities in a corner for the cooking, and that to share a kitchen was more objectionable than sharing a bathroom. It might be the next stage towards avoiding the need for elderly people to live on their own.

That brings me to the question of accommodation for old people. Of course they cannot be expected to live in houses where too much work has to be done. But if they can have a little corner of their own, where they could make their own cup of tea, or make their own bed—where they could look after themselves—it would not only be the best bargain, to put it at its lowest, from the community point of view, but it would be best for the old people themselves.

I hope we shall supplement certain existing benefits and facilities. Unless National Assistance rates are increased, more old people will seek entry into homes or hospitals, because it is not possible for old people to cope with the present cost of living without further assistance.

Those people who are engaged in the home help services, or who are district nurses, should be very proud of the job they are doing. Where old people are being nursed back into good health and normal living, it makes all the difference in the world to their families to have visits from the right kind of district nurse. In recent years we have become used to talking about baby sitters for children. It is a fine idea, whether done commercially or through a private arrangement with relatives, neighbours or friends. It allows young couples to get out together. But I think there is also a case for having "grandma sitters" or "grandpa sitters" who would visit the old people and break the monotony of the evenings which old people spend on their own. Or they might relieve relatives who are looking after the old folk.

I hope the House will not try to avoid the public responsibility of looking after these people by saying that it should be left to their families or to private charity. I believe we have an inescapable public duty to provide the essential framework of accommodation and medical care for old people. But families must not attempt to avoid their responsibility. There is also the part played by community organisations, when people get together to provide entertainment for each other.

The "Darby and Joan Club" such as we have in my constituency, is one of the most delightful and successful of modern welfare ideas. I hope that in speaking about such organisations we shall not refer to old age, because a lady of 60 or a man of 65 joining the clubs in my constituency are considered to be young. The right psychology for the old person is, "We have to live until we die, we have to keep going and keep active." The community must try to provide the essential services so that old people may derive the best from life and there are opportunities for the community to build up a varied social life for old people.

I shall probably offend hon. Members who represent constituencies in cities if I say that this sort of thing is more easily done in the villages than in the cities. I may be wrong, but I feel that people get lost in the great cities. The ideal would be for the minimum number of old people to be in hospital and for those who cannot live on their own to be in homes, which are not too large, where they can be looked after. But there is a great majority who need the protection afforded by the efforts of the State, and of local organisations who find pleasure and happiness in doing things for old people.

I hope the result of our debate today will be that those organisations who are doing a good job of work will try to do even better, and that the Government will not attempt to escape from the essential responsibility of providing a minimum amount both of accommodation and medical service for our old people.

12.37 p.m.

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

I am grateful to the hon. Member for Cannock (Miss Lee) for having introduced a spirit of optimism into this debate and for reminding us of the balance of responsibility between the State and private organisations. I find difficulty in knowing where to start on this subject—I hope I shall know where to finish. Regional hospital boards and the National Health Service play their part. Local authorities, organised charities, such as the National Corporation for the Care of Old People and the Old Age Pensioners' Association also have a part to play.

The regional hospital boards have to find more beds. As the hon. Member for Leicester, North-West (Mr. Janner) said, the number of old people is increasing, and we must face that problem. It is better that we should face it now than leave it for future generations to solve. The problem is not one of beds alone, but also of organisation and a new approach to rehabilitation. The material needs of the old folk are threefold: they need beds, more geriatric departments and an extension of residential accommodation.

The hon. Member for Cannock spoke of a larger number of beds being occupied by old people. I hope I shall be corrected if I am wrong, but I believe that the aged and chronic sick occupy fewer hospitals beds today than before the war. Before the National Health Service was introduced, the local authorities inherited hospitals from the old parish councils. They had the right to put into those hospitals those who came within the ambit of Public Assistance. Now no class has a prior right of admission to hospital. Also—and this makes the position worse—hospitals are steadily being upgraded by accepting a higher proportion of acute cases.

What is the solution? We do not want any tendency to the establishment of big wards full of old people waiting patiently and resignedly for death. Previous speakers have spoken of nurses without training. I have a suggestion to make. Is it possible, as one of the many solutions, to instruct all hospitals to set aside compulsorily a proportion of their beds for the aged and chronic sick? I do not see why that should not be done. I may be wrong, but my view is that some hospitals are more difficult than others about accepting aged people.

The second material need is more important than the need for beds. We need small geriatric departments linked to the general hospitals where all the efforts of the medical and nursing staff are aimed towards rehabilitation. I had intended to say a lot on that subject, but the hon. Member for St. Pancras, North (Mr. K. Robinson) has said it much better and with much greater authority.

I come to the third material need, about which I hope to be able to make a contribution. I have felt, like my hon. Friend the Member for Lewisham, North (Sir A. Hudson) that the hope expressed in the 1948 Act about Part III accommodation has not been realised. Perhaps the standards have been too high. It is dangerous to talk about lowering standards and I hope that the House will not feel that I am suggesting anything which is wrong. I merely wish to suggest that the position might be examined. There is no doubt that the Part III accommodation has not been provided in the quantity that we had hoped.

Hon. Members have said that old people do not like being moved. I am not sure that they are right. There may be a class of old people, especially those who live alone, who would not mind being moved if they could take their furniture and precious effects with them. Why should not we have an old house with a number of rooms, each room with a gas fire and with a name plate on the door? Old people who are almost able to look after themselves could take their furniture and effects. The house should be near the shopping centre so that the people may go to the pictures and to the shops. There should be a bathroom and lavatory and perhaps a kitchen where they can cook a big meal. There should also be a lounge, but the old people should have somewhere where they can lock themselves away and be on their own if they wish.

I was doubtful about making a suggestion like that, because I know that it is not Part III accommodation, but my attention has been drawn to a letter published in the "Manchester Guardian" on 5th March. This letter expresses what I have in mind so well that I should like to read part of it. It was written by a lady in the Women's Voluntary Services, who says: In 1946, at the request of the Salford Housing Committee, the Women's Voluntary Services undertook the management of houses then requisitioned by the corporation. The accommodation provided for each tenant is a bed-sitting room where she can have her own possessions round her own fireside and be able to entertain her friends when she pleases. She has a rent book—a most prized possession—a key to her own door, and the front door, the use of bath, kitchen, scullery, cooker, washboiler, etc. The rent ranges from 7s. to 13s. a week according to the size of room and includes electric light, outside window cleaning, hot water, kitchen coal. A house warden lives rent free on the premises in return for certain services. … These houses are proving a real success. There are 12 fully occupied, accommodating 80 tenants. They are self-supporting. If, after payment to the Corporation, collected by the W.V.S., there is any surplus, this is used to improve the conditions of the house, such as installing modern fire-grates, and so on. Home helps are arranged in cases of indisposition and the W.V.S. 'Meals on Wheels' service is available if needed. That expresses exactly what I have said would be not a solution, not a substitution for Part III homes, but something in addition. If any council likes to requisition a big house and provide that sort of service for the old folk, then at least they will have my full support. But, having gone so far, perhaps there is another solution to which we should perhaps give even greater weight. It is that people are best, where they have suitable homes, helped in their own homes. The nursing and domestic help services are an essential part of the problem. I am fortified in that belief by the fifth annual report of the National Corporation for the Care of Old People. On page 5 it says: The Governors, in their fourth annual report, stated their belief in the need for more domiciliary services and their investigations during the past year have confirmed and greatly strengthened their earlier opinion. I am sorry to see that the hon. Member for Tottenham (Mr. Messer) is not here. I am sure that he would wish me to repeat something he said in 1950 in this House. He said: I want to support with all the power that I can, the claim that we keep these old people in their homes as long as possible."—[OFFICIAL REPORT, 29th June, 1950; Vol. 476, c. 2628.] I have visited many homes and met many of these part-time and whole-time home helps. I join with the hon. Member for Cannock (Miss Lee) in their praise. I have never seen them do a bad job. There are often times when home helps could do the job in an unfair way; but one never catches out the home help. I have never heard anything but praise of their work. Let us bring to the notice, especially of those who perhaps have no trade except that of housewife, how much they can add to the community and to their own pockets by taking on this type of work. A difficulty is caused by the problem of off-time and week-ends, though there is a partial solution to that.

In these days of stringent financial difficulty the expansion of the home help system offers not only the best solution but, what is more important to the taxpayer, in the long run it is probably the cheapest solution. We do not expect the State to solve the problem alone. It is a growing difficulty. Something should be said about the old age pensioners' organisations. We have no "Darby and Joan Clubs" in Scotland, but we have many organisations and many men and women who give of their time. They provide something which the State can never provide—friendship, recreation, laughter, and those little comforts that no State could possibly provide.

They perform a most useful service by telling the old people when they ought to go to the National Assistance Board, or arranging for officials of the Board to visit the people. In that way, a great deal of help is given, and it is not charity, and the old people do not regard it as charity. It is just common humanity and neighbourliness in its best expression, and I should like, at least, to thank the people in my own constituency for what they do, and I also know of what is done in others. They can help in being links in the chain, and, in an emergency, they can hold the fort until the authority takes over. They are always ready, at any time of the day or night, to take over and keep things going until the authorities come in. They can also provide a service during the week-ends when home helps cannot take over the job.

Lastly, there are the recognised charitable institutions, and I do not want to say more than a word or two about them, but I have two suggestions to make. First, we all appreciate how institutions such as the National Corporation for the Care of Old People and many others essentially co-ordinate the local authorities' work, Government spending and voluntary spending. They are essential links in the chain, and I should like to ask them, if they have money to spare, to help in two directions.

First, although it is expensive, I believe that old people would like television sets more than any other single luxury. After all, why should they be denied the luxury of conversations between the hon. Member for Aberdeenshire, East (Mr. Boothby) and the hon. Member for Devonport (Mr. Foot)? If any charitable organisations can find the money, let them try to give television sets to old people. Secondly, old ladies' clubs. In Scotland, there are plenty of old men's clubs, but no old ladies' clubs; it is extraordinary, but it is so. I should like to see these organisations helping us to establish old ladies' clubs, or, better still, because they are old enough to be trusted together, mixed clubs, in which they could have a meal occasionally, if not every day.

I have tried to give a picture of the national situation in which the local authorities, organised charities and voluntary bodies play their parts, but what of the children? What part do they play? Their help comes first, and. though I do not want to bring a discordant note into this debate, because one would hardly think that this was a matter of party politics, I must say that I have told the hon. Member for Islington, North (Mr. Fienburgh) that I was going to raise this point. If I had not read the "Daily Herald," perhaps I should not be taking part in this debate.

On the question of the children, I must read to the House an extract from an article written by the hon. Member for Islington, North in the "Daily Herald" of Wednesday, 4th March. It is the most astonishing thing, and I hope that the House will not take it too seriously. It says: When we talk in Parliament on Friday"—— that is, today— about the aged and chronic sick, the Tories will no doubt suggest that children should look after their parents. I am not quite sure——

Mr. Wilfred Fienburgh (Islington, North)

Would the hon. Gentleman do me the favour of reading on?

Mr. Browne

I am going to do so in a minute.

I noted with great satisfaction that the hon. Member for Leicester, North-West and the hon. Member for St. Pancras, North dealt with this matter in a very kindly and human way, keeping a proper balance. The hon. Member for Leicester, North-West said that it is wrong not to praise in the highest terms the sacrifices made by children and relatives of the aged sick. The hon. Member said, as is so true, that the personal care of the aged becomes more exacting as the days go by. The hon. Member for St. Pancras, North said that many people thought that the younger generation were rather apt to look to the State instead of doing their duty themselves, and that it was not so.

I must tell the hon. Member for Islington, North that, in my experience, the children do look after their parents to the best of their abilities, and I recall to mind one case of a midde-aged lady, a spinster, working on her own in a hospital office, who was looking after her aged mother, who was over 70 and bedridden, and was also looking after her mother's sister, who was nearly 80. bedridden. senile and incontinent. I do not think any suggestion should be made that children do not look after their parents.

I was going to continue the quotation from the article written by the hon. Member for Islington, North, but perhaps I had better repeat the first sentence: …Tories will no doubt suggest that children should look after their parents. But the children themselves are wickedly overcrowded in thousands of cases. I agree with him, and we are doing all we can to overcome the leeway of the housing problem, and the speech of any Scottish hon. Member on this side of the House on this question can almost be given in one sentence. It is that, last year, in housing, we broke every record for the number of houses built since records in Scotland have been kept. More than that we cannot do. This is not really politics; it concerns us all. We shall all become aged and chronic sick sooner or later, and, if I do not get a pair next week, it will be sooner rather than later.

To sum up, to the regional hospital boards, I would say that they should set aside a proportion of their beds and show a greater keenness and interest in geriatric work. To the local authorities, I would say that they should not forget accommodation for old people; nor should they forget to try to build accommodation other than Part III accommodation, and should also step up the domiciliary services. To the charitable institutions, I would say that they should carry on with the good work they are doing and should remember the provision of television sets. To the Old Age Pensioners' Association, I would simply say, "Thank you; we need all the help you can give." Finally, to the hon. Member for Islington, North, I would say: does he really suggest that Tory children are the only ones to look after their parents?

12.57 p.m.

Mr. Somerville Hastings (Barking)

I am sorry not to continue and expand the note of optimism of the last two speeches. I do not think that we shall solve the problem of the aged and chronic sick until we have in every locality a single authority for all health functions and for welfare functions as well, so that the care of the old people, whether they are well or ill, may be dealt with as a continuous process by a single authority. Short of that, the more liaison we can have between existing authorities, the better.

I take this view for two reasons. The first is that the line of demarcation between health and sickness in old people is a constantly changing and irregular one. Old people get ill more frequently than the young, and they get well more slowly. They do get well in many cases, but not a few of them do not get well completely, and they remain for a time more or less invalids.

The second and even stronger reason is that old people move very badly when they are ill. Many old people who are moved to hospital are dead within a fortnight of their removal. I have never been able to understand the reason for that fact. I used to think it was a legacy of the Poor Law, and that the old people remembered the old Poor Law days, when their colleagues went to the infirmary and very rarely came out. I do not think that is so, because the same thing applies to those who have never heard of the Poor Law—well-to-do people who are moved into the best and most expensive nursing homes.

The fact is, however, that old people hate to be moved from their homes and fare very badly when they are moved. Therefore, what we want to do is to keep them in their homes and treat them when they are sick as much as we can, always providing, of course, that they have a home, that there is someone there to look after them and that their trouble is not such as to need operation or hospital treatment.

Some of the best things that have been done in recent years for old people have been the increased facilities for dealing with them in their own homes. I will mention a few of them. In many areas there are preventive geriatric out-patients departments to which the old people are encouraged to come for physiotherapy and other treatment. They play games and it is really an inspiring sight to see how they enjoy themselves on those occasions. In some areas health visitors periodically visit all those over 65 years of age to see that they are doing well.

In one area—and this, I would remind my hon. Friend the Member for Cannock (Miss Lee), is actually in London—a youth club distributes to old people brightly coloured cards with instructions to put them in the window when they want help. When the cards are so displayed, the youth club members look in and ask what is the matter and whether they should call in the district nurse or the doctor, or do a bit of shopping. That helps very much. In other cases neighbours call in or home nurses visit old people night and morning.

In that way, their health is watched over in their homes. When a doctor rings up one hospital with which I am associated administratively and asks that an old person may be admitted, if the case is not urgent we send a geriatric specialist to consult with the doctor to see if facilities can possibly be provided for looking after the old person at home. With that geriatric specialist there goes, in many cases, a social worker to see to the social and financial needs of the old person.

Local authorities, too, are doing a great deal to bring the hospital to the patient. They provide home nurses, home helps, air beds, oxygen apparatus, and, if necessary, even baths which are carried to the patient's home. There is also the service of "Meals on Wheels," which is provided directly or indirectly by the local authority, and many other valuable services are provided by local authorities for those who are ill at home.

A major problem is the washing of foul linen, but even that is being solved in some places by the local authority getting the hospital to do the washing and paying them for it. It is of very great importance that the local authority should be able to help such patients in their homes instead of their having to go to hospital.

But the trouble is that everything locally is so arranged as to encourage the patient to be sent to hospital instead of being nursed at home. The overworked local doctor knows that from the medical point of view his patient will get better treatment in hospital. Then there are the relatives and friends. There is such a thing as tyranny by the aged and sick and of daughters being sacrificed to and by their elderly parents. That is something which has to be considered in all such schemes as we are discussing today.

In some areas a very useful arrangement is made. The aged patient is admitted to hospital while the family go away for a holiday, provided, of course, that an agreement is made that they will be taken back later. I understand that such agreements are generally carried out. Sometimes even a short stay in hospital may do the aged patients a lot of good, and the mild discipline of the hospital may be of advantage to them as well.

Lastly, not only is it in the financial interest of the patient that he should go to hospital, but also in the financial interest of the local authority which has to provide these services because, whereas hospitals are paid for entirely by the State, 50 per cent. of the cost of the services rendered to the patient in his home, except, of course, for medical treatment, comes from the rates.

Again, there is not only the interest of the local authorities in getting the patient into hospital to be considered. There is the hospital side of the picture. Hospitals complain of being what they call "silted up" by old people. I do not like the term, but it is expressive. What they mean is that a general hospital costing perhaps £10, £20 or even £30 a week per bed gets filled with old people who do not need skilled attention and nursing, to the exclusion in a year of perhaps 10 or 15 acute cases that might otherwise be returned very rapidly to health as useful citizens.

Arrangements have been made to mitigate that trouble by providing annexes or homes of recovery which are run in association with hospitals. In one hospital, on the administrative board of which I sit, we have developed what we call a recovery home where old people, after spending a little time in hospital and being carefully looked over, are sent if they do not need any active treatment and where they do very well indeed.

Everything goes on satisfactorily until the same conflict which I have mentioned before comes up again. The problem is what to do with the old person when he or she is well enough to leave. In many cases, when they come into hospital their relatives or friends make other arrangements, or their homes are given up. In such circumstances, what most of us would wish to happen would be for the old people to go to one of the hostels provided by local authorities.

I have seen these hostels in Woodberry Down, Highbury and Lansbury. and I know how very satisfactory they are from the point of view of old people. It is almost pathetic to see an old man, particularly in a mixed home, who has not, perhaps, worn a tie for many years, putting one on and brushing his hair, and to see the old ladies putting pieces of ribbon in their hair. Everything goes on as happily as it possibly can in these hostels until one of the old people becomes ill and then the same conflict breaks out afresh.

The welfare authority can deal only with ordinary illnesses which are looked after by the general practitioner. If anything more is required they have no power or authority to deal with it. The conflict again is found between the hospital authority and the local authority, and the old person very often has to be moved to hospital although he would do much better if left in the hostel and cared for there.

I do not feel that we shall solve this problem until in each area there is a single authority for all health functions and welfare functions as well. It is not right to take up time now to suggest how this should be administered and worked out. I should like to see an all-purpose planning authority in each of the present hospital regions, so that the hospitals could be treated as a unit and used to best advantage, with a second tier for administrative purposes of a much smaller area, containing perhaps not more than 250,000 people, so that individual care could be given to those concerned. I want to finish as I started by saying that in my view we must provide as much liaison as possible between all existing services, public and private, which deal with old people. But the eventual solution of the problem must be an all-purpose authority.

1.12 p.m.

Mr. Richard Fort (Clitheroe)

I am delighted to be able to follow the hon. Member for Barking (Mr. Hastings). It has certainly been my experience in an entirely different part of the country, one with an unusually large proportion of aged population, that the main difficulty with which we are confronted really comes from the matter which has formed such a thread throughout the hon. Member's speech. It is that there should be one official or one department in each area responsible for looking after all the geriatric services in that area.

Others who were in this House at the time threw out the old relieving officer, but without in any way wishing to see a return to the Poor Law and its tradition, it has been my experience that there were certain functions which the relieving officer controlled which no one today is able to fulfil. Probably the saddest difficulties and the greatest tragedies which I have come across in my constituency have originated because there has been nobody, either on the local authority side or on the medical side, whether hospital management committee or general practitioner, who could say, "This person is in such a poor way that he should be in hospital," or, alternatively "This person is just trying it on and the family should be able to 'do' it "—as we say in Lancashire—" and keep him out of hospital and at home, where he would be a great deal happier."

With all the awareness of the problem which not only we in this House have, but which is now so much more widely felt throughout the country, I should like to say that the big weakness is that there is no one person who can be responsible for making decisions on geriatric treatment in each part of the country. I am not quite sure why the present or the past two Governments have been so chary about facing this problem of co-ordinating these different services through one person. Far from it being an additional expenditure, the appointment of one man with a small staff would be a definite economy when one considers the large number of people who at present become involved in trying to settle these problems.

Whatever may have been the feeling in 1948, when the present National Assistance Act was passed and all the local arrangements were changed, local authorities, by and large, recognise the problem now and would be prepared to fit into what would constitute a very great administrative change in the present arrangements. The time is ripe for that change, because everyone is so conscious of the problem. I hope that when the Minister speaks we shall have something more than a mere general blessing and a recognition of the problem, which is what we have had from Governments when we have discussed this subject during the last five years.

I should like to make a suggestion which I dare say is open to be shot down by those with more expert knowledge than I have of local government arrangements or of the workings of the hospital system. I think that my suggestion would certainly fit in with the ideas of the hon. Member for Barking. I suggest that in each group, or, indeed, associated with each hospital management committee, there should be a geriatric unit which should have as its head, or at least closely associated with it, somebody with very much the same powers as had the old relieving officer. Whether on the hospital side, the general practitioner's side or the local welfare side, he should be able to say, "This is as bad a case as we have had today and should be found accommodation in hospital" or alternatively, "This is merely a try-on. We must make it possible for the family to keep this person at home and we should arrange that the domiciliary service should be giving rather more help than it has been giving." That might be one way of tackling this problem. I believe that we are now very much on the right lines in facing this problem of the elderly in general and of the chronic sick and the elderly sick in particular. But we recognise that there is no one key to the door. This is an immense social, medical, financial and administrative problem. Once we recognise that there is no one way of dealing with it, all of us, without raising party polemics, without rousing support for this or that solution and conscious that it must be tackled from many sides, will be proceeding in the right way.

From what I have seen in my area, the old folks' own organisations play an important role in helping to make elderly people happy—of which an important part is keeping them at home. This has been referred to most emphatically by the hon. Member for Cannock (Miss Lee). At the meetings of these organisations many old people make great demands and we have interesting and sometimes heated arguments with them, and it good for us to hear their viewpoint.

But what is profoundly good is the fact that these organisations are set up and run by the elderly people themselves. It is work to which they feel they can give their lives. They feel that they are doing a useful job, and they can learn the details of the different problems which affect them. It gives them an interest in life which no other organisation could do.

The other organisations which I want to mention are the admirable old folks' welfare organisations which so many local authorities have encouraged in their localities. In my district they are entirely unattached to any particular faith or political party. They are free from the paraphernalia of local government and there is a charming and easy informality about them. Of all the voluntary organisations, they are the ones which have attracted the greatest proportion of those people who are not specialists in one or other aspect of social service.

Inevitably, large organisations such as the National Council for Social Services are manned by people who make a life job—and a very important and worth while job—of supervising the running of various voluntary social service organisations, but the old folks' welfare committees have managed to get away from the formality of either the social and voluntary bodies or the local government bodies. So long as we continue to collect information and ideas from all these different sources and so long as we continue to be open-minded about action based on this or that information, there is real hope that we shall make the lot of our old folks gradually easier and easier.

I hope that the Government will note that the biggest single step we could take at present would be to look at the whole administrative organisation with a view to giving powers to one person in each locality—or at least a small organisation with a man at the top—to decide whether people should go into hospital or keep out. That is a single large step which can be taken now. For the rest, let us continue as at present, enthusiastic for the cause and open-minded and conscious that we still have a lot to learn about it.

1.24 p.m.

Mr. F. Beswick (Uxbridge)

I should like to join with all those who have expressed appreciation at the fact that my hon. Friends the Members for Leicester, North-West (Mr. Janner) and St. Pancras, North (Mr. K. Robinson) have brought up this problem and have focused attention upon it. I am personally grateful to them for the very informative and instructive speeches with which they moved and seconded this Motion, as I am to those who have spoken subsequently and who have had much greater experience in dealing with this problem than have I.

I thought my hon. Friend the Member for Cannock (Miss Lee) was a little too optimistic in her approach to this problem—at any rate at the beginning of her speech. It has become apparent to me, in the limited experience which I have had, that before we can be quite so optimistic as she was there must be a stronger lead from the centre, from someone who accepts the responsibility for directing activities on both the welfare and the health sides of this problem. Someone representing that central authority should be doing the work in the field in the different localities. Until we get that we cannot begin to do the things which require to be done, at any rate with the necessary tempo.

I agree with the hon. Member for Clitheroe (Mr. Fort) that the approach to the solution of this problem must cover many different activities. There is one contribution which could be made in greater measure towards a solution, and I want to make three points in support of my opinion that this particular contribution should be given every possible encouragement.

It is a mistake—and in this I disagree with my hon. Friend the Member for St. Pancras, North—to try to isolate or segregate a chronic sick person for statistical or other purposes. A person who may appear to be a chronic sick one week or one month, is subsequently not sick for a shorter or longer period, and during those times when that person is able to get up and move around it should be possible for him not only to look after himself but—as is the case with certain organisations—to help his fellows.

In the interests of the patients and also those who have to look after these people, to the extent to which we can cope with that problem and avoid having a building, ward or institution in which there are rows of chronic sick persons, the better it will be both for the patient and those attending him. There is nothing more depressing than the kind of ward which I have visited on occasion, containing two rows of aged people with an atmosphere of rather patient hopelessness surrounding them.

The criticism which has been made to me by those who have had to care for these people is that once they have taken to their beds there is an incentive, administratively, to keep them there, because there is so much more work involved if they are up and about for any time during the day. Apart from that, once these people have gone to a hospital bed there arises the difficulty of finding a home to which they can subsequently go if their physical condition enables them to leave the hospital.

The second point about which I feel very strongly is that in this and in other sectors of our social life we ought to do much more deliberately to encourage voluntary help and activity. We must—especially, perhaps, from this side of the House—stress more and more that the Welfare State does not mean that we are excluding voluntary assistance and activity. The Welfare State should mean that we are providing more opportunities for useful voluntary work, and we should, therefore, as a State deliberately seek to infuse a greater voluntary element into the solution of this problem and to give every possible assistance to those voluntary organisations which are already doing what they can.

The third point that I want to make and which has always been borne upon me as I have seen the various aspects of the problem is that in so far as we can provide homes, hostels, institutions, or whatever they may be, we should try to get the size one within which the humanitarian feeling is possible. One of the happiest phrases which my right hon. Friend the Member for Ebbw Vale (Mr. Bevan) used in recent years was when he described bigness as the enemy of humanity. That is all too often true.

I should like, therefore, to see more homes and hostels, in which we have not only the sick, not only one sex, and in which care is given not only by full-time professional people, but by voluntary and part-time helpers. We know that this is possible because most of us have seen some such hostels actually at work, and within my own constituency of Uxbridge we have such an old persons' hostel, which is doing work as noble as it is useful.

The building, which is a large house, was originally purchased by the Red Cross. It is now run by a committee. The full-time staff comprise a housekeeper, two persons for doing the domestic work, a gardener and a night attendant. The rest are all voluntary part-time workers. They are part-time, but they are wholehearted.

They care in this large house for about 21 old persons. Before they enter they need to be ambulant, but inevitably if they enter at around the age of 70 there are usually a number of sick among them. Throughout this last winter there were mostly seven or eight who were bedridden. There was extremely fine cooperation with the general practitioners, who came to give attention not only to those who were bedridden but they sought to see that everything was right with the others. Although, strictly speaking, the seven or eight who were bedridden should, perhaps, have been moved out into hospitals, the fact is that at this home we had a homely atmosphere in which proper attention was given to seven or eight sick persons without the necessity of moving them or placing additional burdens upon the local hospitals.

The question of cost has been mentioned by my hon. Friend the Member for St. Pancras, North, and the figures which have been given to me bear out what he said. The cost of maintaining one person in such a home as this is less than half, and often much less than half, what it is in any institution, hospital, or other larger home with a full-time staff. From all points of view, therefore, it seems that this is the kind of unit which we should encourage.

I wonder whether more could not be done by the Minister of Health to give encouragement to the local organisations who are prepared to initiate homes of this kind large enough to secure economies in administration, but small enough to allow the humanitarian atmosphere to be developed, catering for both men and women, a proportion of the sick as well as the fit and ambulant, and staffed by voluntary as well as full-time helpers. This would provide an opportunity for social service which in itself would be valuable to the community, in addition to providing a part solution to this big problem with which we are concerned today.

1.36 p.m.

Sir Robert Grimston (Westbury)

I have listened to practically the whole of the debate and I think that most things that could be said have been said. What has certainly emerged is that there is no single solution of this problem. I was very glad to hear the hon. Member for Uxbridge (Mr. Beswick) express the opinion that it certainly was a problem in which both voluntary effort and the State must combine, and I find myself very much in agreement with his remarks in that connection.

Another thing we must realise is that some of the things that require to be done cannot be done in the short term. There is, however, one thing which, I believe, can be done in the short term and to which I should like to direct the attention of my hon. Friend the Parlia- mentary Secretary. In his excellent opening speech, the hon. Member for Leicester, North-West (Mr. Janner), the mover of the Motion, gave several examples of most distressing cases where delay was caused and where, in fact, existing delay was aggravated by what was happening with the administration.

The hon. Member cited in particular one case where at least four sources were involved: the National Assistance Board, the hospital board, the local Member of Parliament and the local authority. It took them three weeks to get done what was necessary to be done. There is obviously divided responsibility, and this wants looking into.

I very much hope that my hon. Friend will be able to say that she will look into this administrative aspect and see whether it cannot be tidied up in such a way that, as was suggested by one hon. Member, some single authority might be made responsible to give a decision in cases where, if it is not given quickly and a wrangle ensues, the distress is enormously increased. I hope my hon. Friend can say that that aspect at least can be looked into quickly with a view to remedying, not, perhaps, a great many cases, but cases which could be very much more quickly and better handled if the administration of the matter were less divided than at present.

In a certain part of my constituency there is a home where a number of old people live in great happiness. It is not a State-supported institution. They all pay what they can, and they live there very happily. They have, however, one dread in their minds, and that is as to what is going to happen to them if they fall sick, because the place where they live is not able to care for old people when they become sick and require attention. That definitely worries those people, who otherwise are spending their old age in really pleasant and happy surroundings.

I come to a suggestion which was made by my hon. Friend the Member for Lewisham, North (Sir A. Hudson). He suggested that if and when it becomes possible, as I hope it will, to construct homes for those people—new buildings—they will be so laid out that the homes are gathered around a hospital or near to a hospital to which the old people can go when they become sick and have to move from the homes, and can be moved there with the minimum of disturbance. It seems to me that that is a suggestion which covers the points I was trying to bring out in the illustration I gave of the case in my own constituency.

As I said when I commenced, a great many points have been brought out during this debate, and there is no one single solution. However, many valuable suggestions, I think, have been made. This is a Private Members' day, and I have not the slightest doubt that this Motion will be passed nemine contradicente, but I very much hope that the Parliamentary Secretary, when she replies to the debate, will be able to say that the Motion has the good favour of the Government. I hope also that she will be able to say something about the administrative problems to which I have referred.

1.42 p.m.

Mr. Wilfred Fienburgh (Islington, North)

I am delighted that the article I wrote for the "Daily Herald," to which attention has been drawn, provoked the hon. Member for Govan (Mr. J. N. Browne) to make a speech in this debate. As he will have guessed, it was intended to provoke something more than speeches, and I hope that when she winds up the debate the Parliamentary Secretary will indicate what action is to flow, not from my provocation in the "Daily Herald," but from the very soundly timed provocation of this Motion.

I want to pick up one or two of the points made by the hon. Member for Govan, because I think it would be wrong if he were to ride off too easily on his attitude that children can nearly always look after their parents. First of all, of course, part of this problem relates to people who have no children at all, and, therefore, have no one closely connected with them to look after them. However, I put that on one side. Second, there is the problem of overcrowding. The hon. Gentleman did say that, in view of the housing record of the Minister of Housing and Local Government, the overcrowding problem had been alleviated. That has nothing to do with the postulation in my article.

A family which is comfortably and reasonably housed without any overcrowding at all, and is on no housing list and has no priority for housing, can become overcrowded when it takes on the responsibility of housing and looking after a bedridden parent. The problem of overcrowding is especially severe where there is a large number of young children in a family. This is a factor which affects a child's ability to look after his or her bedridden parent, no matter what the housing needs may or may not be.

There is another thing that ought to be borne in mind, and that is the distortion of the normal flow of family life which can result from having to look after someone who is bedridden and sick. One of my hon. Friends has referred to the tyranny of the old and sick. Add to the tyranny of the old and sick the tyranny of the children who are teething, the children who are growing up, the children who are themselves going through childish ailments, and the ordinary housewife can be driven into a sort of dementia in a very short time. I think that has to be borne in mind.

I anticipated that this argument would come up in this debate, and that is why I wrote what I did in my article. Sometimes it is a little too facile, in view of the ordinary housing circumstances, in view of ordinary domestic circumstances, to suggest that in all cases—I am sure the hon. Member for Govan would not suggest in all cases—this strain can be taken by the children; but to suggest that I was trying to imply that children should not support any part of this load is a quite unwarrantable distortion of the statement I made in my article.

Mr. J. N. Browne

I agree with the hon. Gentleman's sentiment, but what I disagreed with in his article was that part of it in which he suggested that it was the Tories who suggested that the children in all cases should look after their parents. I think we all agree that in certain cases the children can and in certain cases they cannot, but do not let us confine this view to the Tories. It is also a view on the other side of the House.

Mr. Fienburgh

I quite accept that. One of the things we have noticed and have commented upon between ourselves on this side of the House during the debate is that it is only the nicer Tories who have taken part in the debate.

Frankly, this is not a problem which will worry me personally for a very long time. I remember when I had a superannuable job some time ago that I was called upon to sign a superannuation document which set out the date of prospective retirement as 1985. This was so far in the remote future that it seemed to me a matter, at that time, that did not appear to be very cogent. Having become a Member of Parliament for a normal London working-class dormitory constituency of streets of terraced houses, many of them sub-divided, and subdivided again, I find that the problem, particularly of the aged sick who live alone; who have no children within reach—and we must remember that in parts of London the distance between one street in one suburb and another street in another is a very great factor—and needing constant care and attention, has become increasingly borne in upon me.

It is not for us to argue that those people should not live alone. The mere fact that they want to live alone is enough to suggest that they are entitled to do so. There is a whole host of reasons why they want to live alone. Many old people do not want to live amongst old people. They say, "We do not want to live amongst a lot of old people just sitting around watching each other die, and waiting for funerals as the only spark of brightness for us in a week." Many of them want to live where there is a little life and youth and where there are children. They want to stay in an area to which they are accustomed, because the familiar view from a familiar window is in itself something to which they cling.

Of course, it is as dangerous to generalise about old people as it is to generalise about young people. Some old people are very adventurous indeed, and are prepared to go jaunting off to new places and to new faces at the drop of a hat. But some like to go off for walks in the familiar streets and to visit shops which are familiar to them, and, perhaps, to have a glass of Guinness in a pub which is familiar to them, and others like to go to the local "Darby and Joan Club," or whatever it is called, because that, again, is familiar to them. The strong pull of that which is familiar is something which makes people want to stay where they are even though they may have to accept some sacrifice in order to do so.

Another reason, of course, is that they are quite obviously, many of them, scared stiff of the institutions and welfare homes. If the hon. Member for Govan wishes to toss political points about this Chamber I would say that a reason why they are so afraid of going into welfare homes is the backlog of memory about Poor Law institutions for the administration of which the hon. Gentleman's party were in the main responsible. However, rightly or wrongly, they are afraid. They are afraid of the look of the buildings, all of which cannot be replaced immediately.

Great steps have been taken to improve them. Walls have been painted; carpets have been put down; easy chairs introduced; billiards tables made available. But the very grimness of the places puts them off in many cases, and, what is more, people just do not know about the improved conditions inside the homes.

What I should like to see is something to make the improved nature of these institutions and homes a little better known. Let someone who is utterly terrified of going there be allowed to go there for tea one afternoon, and walk about the place, and meet the people living there, and then go back another afternoon; and so gradually let the old people learn for themselves that these places are not as bad as their long memories lead them to suppose they may be.

Then we have the problem of those who may not be chronically sick because of some deep seated trouble but who may be just a bit off colour at, say, 6 o'clock in the evening and at 9 o'clock at night, when the streets are quiet, when there is no one about, may be taken ill. That is the kind of person—living alone—to whom we ought to give some attention. Apart from the fact that many chronic sick or near chronic sick do not want to go into the welfare homes—these homes are not allowed to admit the chronic sick. They are restricted to accommodating people who are, relatively speaking, able to look after themselves to a large degree. In fact most welfare homes in the country are breaking the law at the moment. They are doing so, not in admitting chronic sick cases, but in continuing to look after the chronic sick who have become so after entering the welfare home.

According to the state of the law, I am informed by the L.C.C., these people should be sent to hospital but they cannot be sent because the hospitals have no beds available. These people are kept where they are and are looked after. That is a matter in respect of which we might allow the law to catch up with actuality. These people should be allowed to stay where they are. They do not want to be suddenly pitchforked out of the home into a hospital because they fear that the hospital is only an interregnum; they see the coffin coming nearer. If they are allowed to stay in the welfare home in relatively familiar surroundings they may be much better off.

Many old people are afraid to go to hospital. It is not the same kind of fear that they have about welfare homes; it is because they are old and do not like the thought of going to hospital, and they will resist it right to the end. There is also the difficulty that hospitals have not the beds available. That means in many areas that there are old people who rely on the camaraderie of the aged—of old people looking after each other. Although in its first stage that camaraderie may be very lively, as a chronic-sick person stays in bed and needs looking after it tends to wear thin in time. Neighbours may be available, but even the charity of neighbours wears thin.

The welfare services are available, such as the meals-on-wheels service but it is still true that people have sometimes to put their names on a waiting list before meals can be provided by this service. There are the invalid meals service, home helps, etc., all of which have been mentioned. But I wish to touch on one gap which has not been adequately covered in today's discussion, the need to provide social workers who can, as it were, act as grandmothers or grandfathers to all the grandmothers and grandfathers in a locality.

The difficulty is—we have a case in my constituency—of those people who are isolated in their rooms, able to call upon the help of neighbours for a short time, able to call upon the welfare services in the long-term but who need some more general and yet intimate supervision from time to time. There is in my constituency a street called Whadcoat Street, which is now being pulled down. It has always been a problem street, a slum quite unrelated to the rest of the area. It happens to have created itself as an offshoot of Seven Sisters Road. Because it was a slum area the Caxton Settlement was set up to alleviate conditions in the street. The Settlement is still there although the street is to be pulled down and the people are being moved. It is looking after the few old people still left in the street.

We find that a whole range of problems are beginning to crop up when these old people move from the shelter of the Caxton Settlement. They are taken from one cliff face in London and put in another cliff face somewhere else, that is, one of the long straight streets which have been divided up into individual rooms. These old people move from the area where they know people, where they have the protection and help of social workers, to areas where similar facilities do not exist.

Not only are they alone in the new area, but because there is no general provision of this kind of social help for the aged they are doubly alone. I suggest, therefore, such provision, perhaps through the extension of local authority services, perhaps through voluntary work. Do not let us, however, over-estimate the availability of voluntary workers to meet this task.

I agree with those who say that voluntary work must be harnessed to professional paid work. All of us in this House have come here through the interplay of politics, and have, in our constituencies and elections, relied upon voluntary work to a very large extent. We all know how voluntary work is doubled and trebled in effectiveness if there is a corps or cadre of professional workers to co-ordinate and organise it, sometimes to prod and sometimes to help it and always to inspire it. That is what is needed here. In addition to the other ideas which have been put forward, I suggest the need for the provision of a cadre of professional social welfare workers, whose main task would be to look after the old sick people living alone in their area.

Do not let us be too optimistic. There has been too high a note of optimism in the discussion today. In my very short time in this House, I have noted that it is apt to word-spin itself into a kind of delirium which is far removed from the realities of the situation. We have today exchanged words, outlined possible solutions and potential remedies; we have picked out the best of circumstances in different areas and added them together. Therefore, the impression might well be gained by someone hastily listening to, or reading the report of this debate, that all these things which have been suggested as possibilities are now realities, and that the best of circumstances which we have described represent the generality of circumstances throughout the country. Let us remind ourselves that much of what we have been saying is in the realm of supposition, example and suggestion, and that below all the word-spinning which we have been doing there is still the reality of sick old people living alone, and that something must be done to look after them.

1.58 p.m.

Mr. F. P. Bishop (Harrow, Central)

I have listened to the debate with the greatest interest, and I should like to join with all the hon. Members who have spoken in congratulating the hon. Member for Leicester, North-West (Mr. Janner) on raising this subject and giving us a chance of such an interesting debate on such a very important matter.

I should like to join with the hon. Member for Islington, North (Mr. Fienburgh) in respect of his closing remarks about the danger of our being perhaps too optimistic in the views we are expressing about the provision which is being made for old people in this country. I say that because, if I have one criticism to make of the very valuable debate which we are having, it would be that in considering the general nature of the problem that confronts us we have perhaps tended to overlook the really dire urgency of the problem in some aspects and in some cases.

Perhaps the House will allow me to draw attention to that aspect of the matter by referring to two of the many cases of this kind that have come to my notice in my constituency recently, and which are now the subject of discussion. I am sure that every hon. Member has experience of similar cases, but I should like to mention these two. There is the case of a "Darby and Joan," as they have been called—an old man of 85 years of age and his wife aged 81. The old man has recently had a stroke and is now completely helpless. His wife, at the age of 81, is left to take care of him. She herself is under medical attention and is really far from well. The only help which they have been able to get is through the geriatric service which, I am glad to say, we have in my constituency, and which is very effectively run.

The old man has been taken into hospital several times for periods of three weeks to give the old lady a rest from the task of taking care of him. That is the best that the service has been able to do. But it is not enough, because the old lady herself is quite beyond the task of looking after a helpless husband and herself. On one occasion she collapsed and was found lying on the floor in the small house in which they live, and the husband, having lost the power of speech, was unable even to call for help. That is not a situation that we can possibly regard with any sense of complacency.

The other case is that of a son who is looking after his aged, helpless mother. He writes to me: My mother has now reached an advanced senile state. She has been like this now for the past 12 months and, unfortunately, she is no longer able to look after herself and I have had to attend to her wants in every possible way. I have to feed her now. She has no control over her bowels and this I have to attend to. I used to have a cousin of mine come to the house every day for the past two years to be with her, but now she is unable to come owing to illness. In fact, this man is left to attend to his mother entirely by himself. He says: You will appreciate that the jobs I have been doing for my mother are not those a man should do for a woman, but, to be frank, she is my own mother and I do not mind, but the anxiety of it all has had an influence on my work. There again, the geriatric officer has done his best and provision has been made for the old lady to be taken into hospital and cared for for periods of a few weeks at a time, in order, not only to look after her so far as possible, but to give some relief and rest to the man who has to care for her.

I have been in touch with the officer, and I should like to pay my tribute to the work of the geriatric service and of the officers who are facing an almost impossible task; and not only to the geriatric service but to the welfare department in my constituency, which is doing the utmost it can in circumstances of very great difficulty.

This House cannot be content with a situation which is becoming increasingly difficult. The geriatric officer tells me that whereas a little while ago it was possible to take these cases in for periods of eight weeks at a time, the demand has become so great that that period has gradually had to be reduced, until the most that can now be done is to take them in for three weeks. That is something, and the service is doing the best it can.

I hope that when the Minister replies, she will be able to tell us that some attention is being paid to this urgent problem, and that there is some hope of better provision being made for these cases. We can have the best geriatric service in the world and the best welfare service in the world and everyone combining to do all that they can, but if we have not the beds and accommodation there is nothing, beyond what the accommodation available will permit, that any service or anybody can do.

On the general problem, I should like to associate myself with those who have said in this debate that this is not entirely, and, indeed, not even primarily, a matter for the State or for the local authorities to attend to. I believe very strongly that the family is the basic unit which, ideally, should be able to take care of its old members, just as it should be able to take care of its young members, and that for the old people nothing can take the place of the family with whom they have lived and with whom they desire to stay and spend their declining years.

I would not say a word to suggest that I am detracting in any sense from what I believe to be the obligation and duty of every family as a unit to do its utmost to provide for the old members of the family who desire to end their days in its midst. Unfortunately, circumstances have changed and things have become more difficult for the family.

I remember, if I may venture on a personal reminiscence, that when I was young we lived in a big old house. We had not very much of this world's goods, but we had plenty of space. We had three old ladies to spend their last days with us. They became bedridden in my father's house, and all ended their days with us. The eldest was well over 90 and the youngest well over 80. We were able to take care of them and provide for them in every way. What one can do in a rambling old house, even if one has not much money to support it, is much more difficult to do in a three-room flat, and part of the problem we are facing is related to the changed social conditions of our life today. That does not, in my opinion, detract in any way from the obligation of the family to do the utmost it can for its own old members.

I am one of those who believe that, in general, we have gone too far in an effort to establish the Welfare State in this country. We are probably trying to do too much for the active and able members of the community who ought to do more for themselves. That does not apply to this problem of the old people who have ceased to be able to help themselves. That, I think, is an unescapable obligation which falls upon the community as a whole to the extent that the individual family is not able to take care of it.

I think that nothing marks more completely the character of a community—its Christian character, if I may put it that way—than the manner in which it deals with its obligation to the old people who are beyond caring for themselves. Therefore, I wish to support the Motion. I hope that the Minister will be able to tell us that this obligation is fully in the mind of the Government, and that they intend to do everything they can to implement it and to meet the urgent requirements which all of us, as Members of the House, are aware of in our own constituencies, and of which I have ventured to quote one or two examples.

2.9 p.m.

Dr. Edith Summerskill (Fulham, West)

May I first congratulate my hon. Friend the Member for Leicester, North-West (Mr. Janner), the mover of the Motion, on the excellence of his choice. It is usual on occasions of this kind, when there is a subject which appeals to both sides of the House, to extend these congratulations, but I can assure my hon. Friend this afternoon that I feel very sincerely about this subject.

Indeed, I regard the matter which is being discussed here today as the most important medical-social problem of today. It affords, I believe, a challenge to the Welfare State which I hope that the Minister will take up. It is, of course, not a new problem. Old age has always been with us, infirmity has always been with us, and chronic sickness has always been with us. It was Dean Swift who said, in the 18th century: The last act of life is always a tragedy at best. If we go back to Roman times, it was in 150 A.D. that Juvenal said: Old age is more to be feared than death. Although it is contended by some that this is an age of speed, an age of fantastic invention, an age of petted and pampered youth, a century in which we have forgotten the aged and their ills, it will, perhaps, be agreed that, after all, by the standards of other times, at least the healthy aged of the 20th century, since the abolition of the Poor Law and the establishment of retirement pensions, enjoy a security and a dignity unknown in the past. Nevertheless, in terms of services as distinct from pensions, the aged and infirm represent the cinderellas of the Welfare State.

Almost every speaker has referred to the disproportionate increase of old people in the population. The figure that we must keep in our minds is the number of people who will be over 65 in Great Britain in 1975. I hope that at that time many hon. Members who are sitting here today will still be alive, although if the temperature of the House is not raised above what it is today I am afraid that we shall all have joined the chronic sick by that time. By 1975 there will be in Great Britain 8.5 million people over 65 as compared with 5 million today. Indeed, the social problem of old age in the not too far distant future may be the most difficult which any Government has been called upon to face.

This is not Britain's problem alone. The other day I telephoned the United States Embassy wondering whether that great and wealthy country had solved its problem. The Embassy kindly sent me a book dealing with the social services of the United States. On referring to the part of it which related to the condition of the aged sick I discovered that the problems of the United States today are precisely ours.

The fact is that the expectation of life is prolonged in consequence of the progressive development in the field of therapeutics. What can we anticipate? In 20 years' time, maybe, we shall have solved the problem of cancer. In 20 years' time—who knows?—we may have made such investigations into hormones that when we sit on the Front Bench and feel a little weary we may merely have to retire from the Chamber and take the appropriate tablet and we shall be rejuvenated. The average expectation of life then—who knows?—may be 100 years. I have on my left a bright young thing of 70, in the person of my right hon. Friend the Member for South Shields (Mr. Ede). When we say that in 1975 the numbers of aged will be 8.5 million, who knows whether or not our calculations may be entirely wrong?

We have heard a great deal about geriatrics today. When I was a student we had never heard of such a word. I came into politics because of my enthusiasm for reducing the maternal mortality rate, for improving child welfare, and so on. Those things are now almost old-fashioned because we have solved so many of the contemporary problems of that day. Now we have to address ourselves to the other end of life. I am sorry to say that there are those in my profession who rather deplore the fact that we have introduced a specialised branch of medicine called geriatrics. I welcome the development, because it focuses the attention of the public and those engaged in the administration of the social services on this problem.

My hon. Friend's Motion refers specifically to the chronic sick, but I have no doubt that he had in mind not only those who are suffering from some acute or chronic pathological condition, but also those who are called by the doctors—a horrible term, I agree—"frail ambulants." The term is descriptive—it may apply to the hon. Member for Lewisham, North (Sir A. Hudson) and myself in 10 or 20 years' time—of hundreds of thousands of old men and women who, by reason of their age, cannot adequately cope with home life, who are not suffering from any pathological condition, but are frail and need a considerable amount of help.

It has been said that these people often find themselves in institutions whereas they might well have been catered for in their own homes where they would have enjoyed a greater measure of happiness and, at the same time, would have cost the State far less. Unfortunately, it is common for this type of person to be retained in chronic wards because there is nowhere else for them to go, and for them to be kept in bed because it is easier for the overworked staff to keep them in bed.

There are all kinds of literature on the subject. I was very impressed by what a doctor wrote about the infirm being kept in bed and tied down with a tight sheet for many years, in consequence of which even their feet became a little deformed. That was not cruelty on the part of the nurses; it was because the poor women who worked in the wards, sometimes caring for 30, 40 or 50 people, had to control the old people so that they might finish their own work.

It is unfortunate that many hospitals, including the teaching hospitals, are reluctant to allocate a fair proportion of beds to the aged sick, although I contend that the medical student, without training in the care and treatment of this type of patient, is not adequately equipped to enter medical practice. It should be recognised by every hospital authority that the chronic diseases of the aged, which went untreated in the past, today yield to treatment. An hon. Member mentioned the case of an old woman who had been in bed for three years because nobody bothered about her, and then someone who was particularly interested in her condition devoted his attention to her case and she was able to rise and to carry on as an ambulant for many years. The teaching hospitals particularly must take the lead, because other hospitals watch them. It will be profitable if they are prepared to allocate a number of their beds to these people.

First, we must decide upon the proper classification of elderly patients. It is important not only from the patient's point of view but also from the State's point of view. My hon. Friend the Member for Tottenham (Mr. Messer) has told me that in some London hospitals old people are being kept in beds which are costing the State £15 a week each whereas the cost in a long-stay annexe is perhaps £3 10s.

Furthermore, it is in the interests of the patients themselves to be catered for in different institutions according to their needs and capabilities. Nevertheless—this is a very important point which has not yet been stressed by anyone in the debate—when the sorting out process has been completed, it will be found that only 3 per cent. of the five million who are today over 65 are accommodated in institutions. Let us, then, keep the problem in its proper perspective. Some hon. Members have devoted the major part of their speeches to the need for providing more institutional accommodation. The fact is that only 3 per cent. of the aged are in institutions.

If that is the case the problem is clearly a domiciliary one. Although my hon. Friend the Member for Barking (Mr. Hastings), whose experience has been very wide, made a speech with which I entirely agree, he and I had not conferred with each other before this debate. Out of our experience of the treatment of these people we have recognised that the problem is one of providing more adequate home accommodation, care and nursing.

These old people who live alone have no pressure group. Perhaps if the old people had a pressure group in this country this House today would be packed on every bench. They are inarticulate, unorganised and sit quietly in their little homes awaiting for the time to go.

Mr. J. N. Browne

I do not think it quite fair to say that they are unorganised, as the National Federation of Old Age Pensioners' Associations is a very strong body which represents very well the old age pensioners all over the country.

Dr. Summerskill

I do not qualify in age, but I became a member last week and paid my 4s. 6d., but perhaps that is anticipating things.

Such organisations really only touch the fringe of the problem. The people we are talking of are mostly confined to their own homes and the organisation for old age pensioners prides itself, quite rightly, on the meetings they hold and their capacity for attracting people. We are talking now about the infirm and, if the hon. Member examines the figures, he will find that only a very small proportion of the people with whom we are concerned today are members of the old age pensioners' organisation.

Indeed, if they had an adequate pressure group would they not be in the Lobbies today? Where are the green cards coming in from the pressure group? There is no sign of any pressure group in the Lobby, but, if we were discussing steel, beer, armaments, of any of these things——

Mr. Browne

Equal pay.

Dr. Summerskill

I agree. Thank heaven that a pressure group is now beginning to form on equal pay.

If we were discussing any of those problems pressure groups would be there and the galleries would be packed. But no, we are talking of people who are unorganised. I should like to pay tribute to hon. Members on both sides of the House who have turned up for this debate to speak for these helpless people.

As I said, for the most part they live alone, or are cared for by a spinster daughter who contrives to combine her job outside the home with looking after her father or mother, or by a married daughter already overburdened with family responsibilities. All kinds of things have been said today about the families of these people. It is a constant source of wonder to those of us who are in contact with these households why the rest of the family are prepared to accept the sacrifices of one daughter but always claim the right of criticism, particularly at the end. Only doctors recognise this. When the end comes, during the last day or two, the doctor, for the first time, sees strange members of the family who claim all kinds of right to criticise. I hope that my words will go out from here and stir the dormant consciences of some of these people.

To emphasise that this is primarily a domiciliary matter, I wish to quote Dr. Sheldon, of Wolverhampton, who has made notable contributions to this problem. He said: The burden of old age in the future can never be dealt with by the purely caretaker policy of promoting sufficient homes and institutions. The burden will remain a domestic one. It is this aspect of the subject with which I want to deal, but, first, I wish to comment on what has been said about hospital accommodation. It would be at once agreed that where a definite diagnosis has not been made the patient should be admitted to a hospital for investigation and subsequently either sent home—the almoner having satisfied herself that all the appropriate services are available outside—or to a long-stay annexe or old people's home. If this plan is followed the proper treatment of the aged infirm at home, with the help of out-patient geriatric services in conjunction with discretionary allowances from the National Assistance Board, can change the whole outlook of the patient and the family.

It is of the utmost importance for those responsible to ensure that a comprehensive geriatric service is operating in every locality. What do I regard as the important component parts of an outpatient geriatric service? Some people have mentioned physiotherapy, but at the moment the Ministry of Health is not satisfied that that kind of service should be operated by the individual general practitioner. I appreciate the point—the general practitioner may not have sufficient time to supervise this work which must be carried out in a proper manner.

What other things are necessary? A mobile meals service has been mentioned, and such a service, subsidised by the local authority, is an indispensable part of the service. In the case of an old person living alone the supply of one hot meal a day solves the major cooking problem of an infirm, but otherwise healthy man or woman. It is a fact that as age advances our food requirements grow progressively less. One good hot meal a day solves the whole problem of getting out saucepans and cooking vegetables, meat, and so on. That is a most important part of any geriatric service.

Secondly, there is the fully staffed district nursing service. I say a fully staffed service; I agree that we have the framework, but are we satisfied that our nurses in the district nursing service are not in some cases overworked and compelled to cut down visits to old people because staff is insufficient? I cannot over-emphasise the importance of this service. Sixty per cent. of the work of district nurses is concerned with elderly people. The arrival of this woman, efficient, knowledgable, with poise, capable of handling the situation, can completely change the attitude of a helpless relative towards a sick person by her capacity to instruct and to handle the situation.

It astonishes me how small a value society places on this splendid service. There are these women, comparatively young, with knowledge, patience, tact and a capacity to undertake hard physical work. I wonder whether hon. Members who have paid tribute to them know that the lowest paid get £4 10s. a week and their board. Yet to keep one of these old people in a general hospital costs the nation £15 a week. The poor little nurse, getting her £4 10s. and board, can and does pay as many as 70 visits a week to old people. Just think what nonsense our present organisation makes—how stupid it is for us all to work in these watertight compartments. Obviously, if we are to approach this matter in an economic way we should ensure that a proper, well staffed district nursing service operates in every area.

Home helps have been mentioned and I am very pleased that hon. Members have paid them a tribute. A good home help can effect such changes in the home that, once more, neither the aged nor their relatives would demand institutional care and valuable beds would be saved. Unfortunately, there is a shortage of home helps in every district. Why? The answer is simple. Any woman prepared to do part-time domestic work in private service today can command 2s. 6d. an hour. From my constituency which adjoins Chelsea, Putney and Kensington—those distinguished hot-beds of Toryism—women can take a bus to work, and be paid 2s. 6d. an hour for comparatively light domestic work. But local authorities are authorised only to pay much less to the home helps who are expected to do arduous and often distasteful work. The task of cleaning up the one-room home of an old man who has been living alone for years does not appeal to everyone.

Here, again, is a stupid economic approach to the problem. Because we are so mean—perhaps that is a cruel thing to say—because we are shortsighted and pay so little to these excellent home helps that they are not attracted to the job, we are compelled to send an old person away to occupy a £15-a-week bed in a general hospital. That is why I agree with my hon. Friend the Member for Barking that we must have a coordinator who can tie up all these loose ends and make this service work in a sensible way.

Many people have said that it would be a good idea to have convalescent homes where old persons could be sent for a fortnight or a month to give their relatives a holiday. The fact is that local authorities have the power, and may arrange for patients to stay in convalescent homes under the auspices of the National Health Service Act. This temporary boarding out of old people is a very useful part of the geriatric service, and affords relief for kindly, but overworked relatives.

Another essential part of the service is the supply of sick room appliances. It is possible to visit a home where an old person has had a stroke and to find the relatives distraught, and anxious to have the patient removed as soon as possible. They will plead lack of knowledge, lack of sick room appliances, and so on. Again, these can be supplied by the local authority under Section 28 (3) of the Act.

Laundry has been mentioned. I agree that relatives who have to look after a sick person who is incontinent, who is slopping tea and food all over the bed-sheets, are eventually reduced to a state of hopelessness and helplessness. They feel that they cannot manage any longer. It is all these comparatively small things which gradually wear down the relatives of old people; and they complain to the general practitioner.

How sorry I have felt this winter for the general practitioners. As was rightly said, the general practitioner is now deprived of the services of the relieving officer. I remember that in the old days my father, who was a hard worked general practitioner, would say that the only thing to do was to call in the relieving officer, a very important part of the machinery. The relieving officer would examine the situation and weigh up all these things, thus allowing the general practitioner to get on with his proper job.

Now the position is quite fantastic. The time wasted this winter by general practitioners having to attend to these matters cannot be estimated. A general practitioner goes to a home and is faced with this appalling problem. He then has to return to his surgery and telephone to hospitals and try, somehow, to get accommodation for the old people. He has to solve what is, after all, a domestic problem.

But I have digressed, and I come back to the laundry. This work is one of the things which bears so heavily on the relative. But, again, most local authorities have made special provision for dealing with the laundry. Furthermore, the National Assistance Board is empowered to make a special allowance to cover laundry charges.

Another part of the service is chiropody. That should play a great part in outpatient geriatric service, because the condition of the feet of elderly people is deplorable, and that is not an overstatement. That condition is a legacy of the days when children's shoes were passed down from one member of the family to another and when the feet of little children working as part-timers in factories became deformed. It is a legacy of the days when it was usual for people to have cheap and bad fitting footwear.

I do not regard chiropody as a luxury. Foot treatment may transform the life of an old person who is confined to his room because the very process of walking is too painful. We have excellent clinics in London and I have sent many old people to them. Most of these clinics charge 2s. 6d., and I have seen an absolute change in the attitude of people who have visited them.

I remember one old woman who had bunions, and who hobbled, and for whom life was sheer misery. She came back to me after visiting one of these clinics and said, "I feel a different person. I have been able to walk with comfort for the first time in 20 years." In addition, she had sat next to another old person at the clinic. Their chairs were arranged in a row. The other person was also suffering from bunions and they spent the afternoon discussing bunions.

How trivial these things appear to us, but if one's feet are painful one's activities are limited, and a lot of these old people are confined to their bed or their chair because of the condition of their feet. Therefore, I attach great importance to the chiropody service. However, I pride myself on always trying to be practical and not to keeping my head in the clouds. I know perfectly well that it is difficult to set up a service to cater for all these 5 million people, because we have not a sufficient number of qualified persons, but let us try to tackle the problem.

These are some of the component parts of a geriatric service, but I have not mentioned what I believe to be the most distressing feature of old age, namely, loneliness. Here is a job for the middle-aged woman with time to spare; whose children have left home; who is longing to care for someone, to exercise her maternal instinct on someone, no matter how old that someone may be. The only qualification for the job is a kind heart. I include this as a practical part of the geriatric service. They may help with the changing of a library book. They may do the shopping or the mending or have a regular chat with the old people.

So that I could feel that I had talked to a person very near to this debate, I called yesterday on an old man I have known for many years, who is bedridden and has heart trouble. I said, "How are you?" and he replied, "All right." I said, "I am going to make a speech about you tomorrow. Tell me what you think should be done to make your life more happy." He said, "You know, you have come to the wrong man. Look at the way I am looked after. Somebody is popping in here all the time." That was most interesting. That man has a bad heart. A male nurse calls on him as part of the local authority service, and his daughter lives next door. She is a first-class woman with a very kind heart who regards her father as a pet rather than a nuisance. After he had sat back in his chair, he said, "People are popping in all the time."

That old man attaches great importance to that. This emphasises the point that we might provide people with every kind of nursing assistance, home help, medical help, and so on, but if they are deprived of human companionship we shall not have succeeded in helping them as they should be helped. I have tried to outline what I consider are the component parts of the geriatric service.

I agree with my hon. Friend the Member for Barking that the pressing need is for a comprehensive co-ordinated scheme in which the old person, the geriatric service, the hospital and the National Assistance Board play their part. The time will come when we shall be able to congratulate ourselves on the fact that this has been achieved. When that time comes the aged of this century may well enjoy what they so richly deserve— …an old age, serene and bright, And lovely as a Lapland night.…

2.42 p.m.

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

This has been a most helpful and constructive debate. I join in the congratulations offered to the hon. Member for Leicester, North-West (Mr. Janner), not only on the terms of his Motion but on the full and constructive speech he made. He set the pace of the debate. We are on common ground on the general aims of the Motion. It is fair to say that the urgency and magnitude of the problem is generally recognised by the local authorities, the regional hospital boards and the hospital management committees whose officers have to deal direct with many of these cases.

We are doing our utmost to bring in to their fullest extent various branches of the voluntary social services which interest themselves in the care and welfare of the old. Hon. Members have indicated the magnitude of this problem. I need only emphasise the extent of the problem which faces us, which faced our predecessors and which will face any Government in the next 30 years, and the manner in which we are endeavouring to tackle it. It is well known that our gravest limitations are mounting expenditure, the difficulties of the capital investment programme and the shortage of manpower especially in the nursing side of the service.

But, as the right hon. Lady the Member for Fulham, West (Dr. Summerskill) said, this problem is probably the biggest challenge to the welfare State in its magnitude and in the speed with which it is growing. It is one which can make or break the over-all programme and the idea behind the Welfare State. I think that every hon. Member has given a different estimate for a different year. I am sure that the figures were accurate for the years to which they applied. I hope that I shall be forgiven if I quote another set of figures. Whereas there were 2,750,000 old people of pensionable age in 1911, we shall have 9,500,000 in 1977. Put in another way, instead of one in 15 of the population being of pensionable age there will be three in 15.

If we think in terms of the task to be performed in relation to the working population who will have to sustain this service, we find that at the beginning of the century for every 100 people in employment there were 10 people of pensionable age. Today there are over 20 people of pensionable age for every 100 working members of the population, and in less than 20 years' time there will be 30 people of pensionable age for every 100 of the working population. Not only have we to meet an increased birth rate during the earlier part of the century, but we have also, thanks to medical science, to face up to the problem of longevity. Medical science is to be congratulated on the manner in which it has increased our span of life. Today the expectation of a man of 65 is another 12¾ years and of a woman of 60 it is l8¾ years.

There is another great problem we must face that has a bearing on any decision we may make in this House which also means an increasing burden for the next generation. The latest estimates of the Government Actuary of the cost of retirement pensions are: £420 million in 1958: £580 million in 1968, and £700 million in 1978.

That gives a picture in varying aspects of the magnitude of the problem which has been faced frankly in this debate. Even within the last year there has been an increase in the number. There were 82,000 more people over 65 at mid-1952 than there were at mid-1951. The problem grows apace. In fairness to the hospital management committees and local authorities, I must say that in face of a problem which is growing faster than they have had facilities to meet it, they are doing their best to deal with this vastly increasing aged population.

In the main, the services for the sick and aged are part of the social services provided not exclusively for the aged and the sick but generally as part and parcel of the National Health Service and the welfare services of the community. There has been a good deal of discussion, and the point has been made that the link and co-ordination between where the hospital service finishes and the residential and home service begins is not sufficiently good.

I was surprised to hear the right hon. Lady refer to the co-ordinating function which the much abused relieving officer performed in that he had the authority to take action. I hope I shall be forgiven for reminding hon. Members opposite that they proudly boasted that they had done away with him. It is under the 1946 Act, which they introduced and which we have continued, that the system has been set up by which the hospital service deals with the care of the sick, and the welfare services, such as old people's homes and the domiciliary services of home helps, health visitors and home nurses, are provided by the local authority.

I shall bring to the attention of my right hon. Friend the concern expressed by hon. Members on both sides of the House that perhaps we require another review to see how this link can be better forged. Perhaps we must look at the matter again. I know that hon. Gentlemen opposite will accept responsibility with us. It was their scheme and we are now working it. Perhaps it ought to be looked at again.

I know that my right hon. Friend is specially interested in seeing that coordination between these services works and that we provide services for old people in their own homes if possible If they have to go into hospital we should provide the speediest means by which they can become ambulant and be discharged to the their own homes.

Within the hospital service, the residential home service provided by the local authorities and the various services provided in the home, a vast expansion has taken place, but it has not caught up with the increasing number of old people. To take the hospital services first, in 1951 we had available for the chronic sick 57,000 beds, but, of course, it is not only a case of snatching a few beds for sick people away from others, because hon. Members opposite who are interested in the Health Service have on other occasions asked for more beds for tuberculous patients and maternity cases, and we have to allocate, as fairly as we are able between the various specialities in the Health Service, such beds as are available.

We have, unfortunately, a waiting list of 8,800, and I agree heartily with all those hon. Members who have expressed their congratulations to those geriatric units where the turnover has been so vastly increased that we have been able to deal with far more old people with a smaller increase in the number of beds. By so doing, we believe that a very large percentage of old people, instead of remaining chronically sick, can be made ambulant and return to their own homes. We have 3,800 unstaffed beds, and if we could obtain the staff we should be able to effect a major improvement in the situation both in regard to the chronic sick and the geriatric units.

I will bring to the attention of my right hon. Friend the suggestion made by the hon. Member for St. Pancras, North, but I am sure that the hon. Member will be aware that the question of how nurses are used is a matter for the General Nursing Council. I am sure my right hon. Friend will see that the hon. Member's suggestion is considered in the proper quarter.

Our desire and aim is to see that we get the right person in the right bed, and, to that end, my right hon. Friend has been most anxious to encourage the geriatric service and the local authority services in order that, as far as possible, people shall be treated at home, but that, in the last resort, beds must be found for them in the hospitals. There are 70 specialist geriatric units in hospitals, and, during the last year, a further 10 geriatricians have been appointed by regional hospital boards to specialise in this type of work. I know that hon. Members will think that it is not enough, but I can assure them that the service is growing.

So far as the trend of patients is concerned, I am afraid the 1952 figures will not be available for another month, but, in 1951, while the number of beds in use for chronic sick patients rose by 1,700, which is just over 3 per cent. the number of patients treated rose from 83,852 to 92,390, so that, although the number of beds increased by only 1,700, the geriatric service dealt with 12 per cent. more patients.

Some arrangements have been made by the regional hospital boards whereby patients may be treated at hospitals outside the service, and 1,770 patients were so treated in 1951, so that, in round figures. the number of patients treated through the Health Service rose from 84,000 to 94,000 by the end of 1951. In regard to 1952, I have figures for only five out of the 14 regions, but they show another increase of per cent. in the number of patients treated and a further 1½ per cent. in the number of beds in use.

So far as out-patients and domiciliary services are concerned, the hospital authorities have been asked by the Minister to work to the present programme, and, in some cases there are plans to provide long-stay annexes on the lines which certain hon. Members have suggested. Where we have a concentration of medical services and a unit providing adequately for people who cannot be dealt with at home, but who are chronically sick and should be able to receive proper care—and in this case active hospital treatment—the number is affected by the extent to which we can provide capital resources for the provision of accommodation. In so far as residential accommodation is concerned, I am grateful to the right hon. Lady opposite for the very effective manner in which she put people living in their own homes into the proper proportion, because the vast majority of old people of pensionable age will continue to live in their own homes, and it would be a very grim outlook if that were not to be the case.

Several hon. Members have referred to the possibility of homes to which old people could take their own furniture, in which direction I saw an experiment carried out by the National Council of Social Service in Ulster, where such a home has been set up. Instead of going into a home in which all the furniture was of the same uniform design, old people going into it were able to take their own furniture and make the place their own home, in addition to which they were provided with a midday meal. I remember that one old lady had made a number of pink iced cakes and was waiting for her granddaughter who was coming to see her. This had been done by a voluntary body—with a grant from the central authority—but I feel sure that there may be a field there into which we should look in order to see if it does not provide yet another aspect of providing for people in order to make them feel that they are in their own homes.

In regard to residential accommodation provided by local authorities, the figure is now 62,000, which is a rise from 47.900 in 1949. Since the war, over 500 new small homes have been built. accommodating 14,000 patients, and, at the present time, homes for another 4,200 are in process of being built or adapted. Plans have been prepared for accommodation for a further 2,200, and this is an aspect of the Health Service in which progress is continuing and local authorities are going ahead with this service of residential accommodation. In 500 voluntary homes run by various associations there are 16,000 people, of whom between 6,000 and 7,000 are partially maintained by the local authority.

Some rather hard words were said about the old National Assistance institutions, some of which have been adapted. They were called grim and gloomy. With this vast programme in front of us and the enormous increase in the number of people of a greater age. and with the recognition that some people are sufficiently capable of looking after themselves in a very modern and up-to-date type of home, while others are not and also require someone to be available to them during the night. it would be quite unrealistic to suggest that in any short term of years we could scrap the old Public Assistance institutions which are at present used to house many thousands of the population. What we can do—and I congratulate the local authorities which have done it—is to follow the example of Manchester, where an old institution has been adapted, because these adaptations are quite admirable. There is sufficient privacy and yet there is available the immediate care and attention for those who may need it. We should mislead ourselves if we thought that we could do without these vast institutions in any short period of time, and, therefore, we should encourage local authorities to make the best possible use of them and to make them into as happy and cheerful homes for these old people as they possibly can.

As far as help given in the home is concerned, there has been a great extension in the domestic help service which is of such very great importance in preventing people who fall sick for a short span of time from going to hospital. The number of domestic helps rose from 11,000 in 1948 to 25,000 at the end of 1951, and the service is largely given in households containing old people.

Then there is the home nursing service for which we require more staff, although, of course, there has been a steady increase in their numbers. No charge is made for that service. So far as the voluntary services are concerned, there is the National Old People's Welfare Committee which, with the full support of the Ministry of Health, has set up local old people's welfare committees throughout the country in 52 counties and 978 local areas.

I cannot agree with the right hon. Lady when she says that old age pensioners are inarticulate. I have something like 2,000 paid up members in the old age pensioners' association in my constituency, and the last thing I would call them is inarticulate.

Dr. Summerskill

Will the hon. Lady say whether they are the sick and infirm who are confined to their rooms. or those who come to meetings?

Miss Hornsby-Smith

They are both. In fact, they do an immense amount of visiting and looking after those who cannot get out to clubs and to the various activities which are so extraordinarily well run, not only by the old people's welfare committees but by many local authorities.

I join with hon. Members on both sides of the House in paying tribute to the immense amount of valuable work being done by voluntary organisations such as the W.V.S., the Red Cross, the Rotary Clubs, and all sorts of other organisations who take out individual members or go and sit with them or read to their and provide so much of that human and personal service which cannot be provided by the State.

Mention has been made of the "Meals on Wheels" service in which the Women's Voluntary Service has played such a great part. I agree with the right hon. Lady that, if the main meal of the day can be provided, that is a great contribution towards the welfare and happiness of the individual.

I will now say a few words about the financial commitments with which we are faced. It is our aim to develop those aspects of our health and welfare services which will increase the comfort and care of the aged without imposing an intolerable financial burden on the community. That is not only a burden which we may impose through Parliament at this stage and in this year; it is a burden which, whatever standard is set here and now, will be increased by at least 50 per cent., even if the individual rates or the individual service are not thereafter expanded, because of the increasing number of old people.

My right hon. Friend places the emphasis on providing as far as we are able for people to be treated in their own homes. It has been stated on both sides of the House that that principle was far more economic, and the right hon. Lady gave some graphic examples of how much less expensive it is to provide help for these old people in their own homes than it is to put them in a £15 a week bed in hospital. That is the most costly item.

The cost of maintaining the chronic sick in hospitals in 1950–51 was £14,300,000; in 1951–52 the cost had gone up to £15,400,000, and more accommodation is still needed. The cost of residential accommodation was £6,240,000 for nine months in 1948–49—that is £8,320,000 over the full year. It has gone up for 1951–52 to £12,700,000. There has been a steady increase. If there is a message that should go out from this debate I hope that it will be that we recognise the problem, that we ask the public to realise its magnitude, but that we also show that whilst we have not beaten the problem yet at least we are progressively continuing to expand and develop and provide the services which we believe the aged and sick should have.

I have no separate and specific figures that I can give in relation to local health authorities' services, because their services are provided not only for the old and the sick but for all. However, the cost has gone up year by year and, in that cost, a large proportion has been applied to the aged and to sick.

Many points of interest have been raised in this debate which have found general agreement on both sides of the House. I feel that the objectives set out in the Motion are common to hon. Members on both sides, as portrayed in their speeches. There can be no difference of opinion in any quarter on the desirability of our doing everything possible for the chronic sick and old people. It is clear from information given about the work of the hospital service and the health authority services, such as home nursing and home helps, that continual progress is being made and that great strides have been made, particularly in the provision of residential homes for old people.

What the future development should be will have to be shown by increased experience of the problem. Today we have had general agreement on one pitfall—the link between the local authority and the hospital side not being sufficiently well forged. But I assure hon. Members that the Government will do everything in their power to see that advantage is taken of experience, whether to press on with improvements of the kind which have already been made or to develop along new lines which may appear to be better and more right after the four years or so of experience of the Act.

I do not apologise for labouring the point that there is no escape from the limitations of capital resources, maintenance expenditure and manpower that can be devoted to this one sphere of the social services. There are other subjects upon which hon. Members opposite wax equally eloquent when there is a different Motion on the Order Paper. But the Government, the local authorities, the voluntary agencies concerned in the welfare of the elderly are all active and desirous of seeing fulfilled the aims which are outlined in the Motion moved by the right hon. Gentleman. I apologise for again referring to the hon. Member for Leicester, North-West as the right hon. Gentleman. [An HON. MEMBER: "He will be some day."] I can assure the House that the Government are concerned to see that all possible steps are taken, whether on well-tried paths or in new directions, to ensure that the sick and the aged are given every care and attention. We agree with and recognise the concern of the House about the importance and the urgency of this very real and very human problem. I am pleased to say that my right hon. Friend the Minister of Health has asked me to accept the hon. Member's Motion. This is a vast problem. It cannot be solved by the State alone but jointly with the State, the community, the various voluntary services and, not least, the family. We hope we may go forward together to better the conditions of the aged and sick.

Mr. Janner

I feel very loath to ask the hon. Lady to say anything further after the gracious way in which she has accepted the Motion, but I should like to know whether she has any information to give on the point which I raised about the so-called mental cases. I dwelt on the point at some length in my speech and I should like to know whether anything will be done to alleviate their position.

Miss Hornsby-Smith

The hon. Gentleman will be aware of the provisions that are made to try to insure against such circumstances as he outlined in his remarks upon this subject. The annexes I referred to are intended for those senile persons who are not suitable for a general hospital chronic sick ward but are certainly not certifiable. It is our policy to encourage as much as possible—and to permit so far as we are able—the building of annexes which would take on those persons who are senile and might otherwise be improperly certified.

3.11 p.m.

Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)

It may be within the memory of some hon. Members that I dealt with a very similar debate when I held the office which is now held by the hon. Lady the Parliamentary Secretary to the Ministry of Health.

This is a subject which is very dear to the hearts of Members on both sides of the House and we are all very gratified that we have had such a valuable and instructive debate. When I dealt with this problem it seemed to me that we were sometimes afflicted with a general feeling of good will on this subject and that there was a lack of precise recommendations for advance on which we could easily work. On occasions I almost wished that there were rather more differences of opinion, so that we could try to concentrate our attention on particular aspects of the problem in the hope of getting a more rapid advance. This is a vague and rather general field on which it is very easy to express general good will, but not quite so easy to get clear and specific proposals for advances which are at the same time reasonably practicable.

I want to emphasise the sense of urgency which we should all feel with regard to this subject. I would not differ in any way from the vast majority of the remarks which have been made today, but I think it should be possible to bring the attention of the House to three or four major practical issues with which we should deal before we pass from this subject.

It is agreed by everybody that our main attention must be focused upon the importance of the development of domiciliary services. While I held office I did what I could to encourage the development of the old people's committees, representative both of the statutory and voluntary organisations. I am glad to say that these have been set up over a great part of the country, but not all of it. It was my view then, as it is today, after seeing the work of some of the more effective and efficient of these committees, that a great deal could be done if we could get some of the many voluntary organisations, which are doing excellent work in this field, to work together instead of overlapping as so many of them do.

In many areas it has been found that a committee which is representative both of the various statutory authorities—local authorities, the Ministry of Health, the National Assistance Board and others—and the voluntary bodies can set up some form of central register of some of the oases at risk, which can be operated, for instance, from the office of the local authority city almoner, who can, at the same time, contact both voluntary bodies in respect of services which they can render in particular cases and statutory bodies for assistance in some of the more complex problems, including that of financial relief, so as to ensure that we no longer have in our community any people who have no con- tact at all with the outside world. It is not so much the lack of people who are interested in this problem as to try to secure their co-operation together for a common object.

To use the example of my own City of Newcastle-upon-Tyne, which is common to many others, we have found that by setting up a central register we have been able to make a good deal more progress than we were able to do before. We have, certainly not an ideal scheme—far from it—but we have got very many of the voluntary bodies to come together and to share out the problem and to avoid some of the overlapping that occurred before. It is quite an urgent thing to try to get more efficient cooperation of this kind, and I hope that it might be possible for the Ministry to send out a circular to local authorities to try to ensure that before next winter effective and efficient committees of this kind are in operation throughout the country.

Secondly, I am rather disappointed that so little has been done to work on the experience of the long-stay annexes that have been set up, and to which reference has been made, by the King Edward Fund. We hoped that we would get a great deal of benefit from this valuable experiment that was made here in London, where I have seen much of the work that was done and where, I believe, we now have some half dozen or rather more of these units in operation. They have been set up with the valuable combination of the help of voluntary organisations in providing initial expenditure and some of the administrative staff, and with the assistance of and under the medical control and direction of the regional hospital boards and management committees so far as provision of patients and running expenses are concerned.

That seems to me a quite useful and admirable jointure of the voluntary and statutory bodies, and I think everyone would agree that they have worked extremely well. They have enabled much more active work to be done in the hospitals, because many of the cases for whom the hospital could be expected to do little more have been transferred to some of these long stay units, where certainly, as I know from experience in seeing some of them, the patients concerned have been so very much happier and where they have in some cases been encouraged to take a much more active part in life because they are living in much more homely and understandable surroundings.

I hoped myself that after a little experience of the work of these residential homes it would have been possible to develop the homes to quite a considerable extent all over the country, and I am very disappointed that it has not been possible to do more. For example, I feel that every general hospital of any size ought to have an annexe of this kind available to it, under the complete medical control and direction of its chief geriatrician.

This does not seem to me to be something that requires necessarily a vast expenditure. It is something where we can call in the joint aid of voluntary organisations, of whose good will there is no doubt, together with, perhaps, some impetus from the Ministry. I hope that here, too, a much more active drive can be made before the coming winter. I hope we can ensure that many more of these units are established in other parts of the country outside London where the King Edward Fund does not apply. It should be possible to institute these units throughout the country before much further time has passed.

I am always somewhat wary about arguing that there should be many more beds in the hospitals. Very largely, it is a question of better use of the beds there. On this I agree with many others who have spoken in the debate. Above all, there is the question of using our hospital beds for treatment of old people as we use our hospital beds for treatment of young people, regarding the hospitals as essentially centres for investigation and treatment, and with the intention of the patients staying in hospital a relatively short period of time.

We know that, in practice, the truth is quite the opposite. The tragedy is that today, in so many of our hospitals, because of the limitation on the number of beds, because of the lack of any alternative accommodation for cases, it is only the most severe cases, that are almost past any help by the hospitals, that are finally admitted; and we are faced with this really impossible situation, which we really must do something to overcome. Until, at any rate, some of our hospitals have a reservoir of beds to use—I do not think it need be a very large number—we cannot make progress in many areas in the country in this more active treatment which is so urgently needed.

I speak with particular experience of our own conditions where I belong, up in Newcastle, where those who have been wanting to tackle this problem in an active way are feeling a very desperate sense of frustration because they have not been able to open up the modern units they would like to open up, and bring into more and more use the few beds they must make available for these cases that, as I say, are really past hospital help, but that, because of the social conditions, the conditions of their homes, they must finally admit in the very worst possible circumstances.

I am one of those who are a little anxious about how far we should press the argument about the geriatrician being a specialist. I fully agree with the importance of geriatrics and getting wide understanding of it throughout the medical profession—indeed, throughout the general public. I do not want it to be permanently regarded as an isolated specialty. I firmly believe that this form of treatment is a treatment in which the general practitioner as well as everyone else can join. I am always rather careful of excluding the general practitioner from more and more fields of general work, and I am just a little anxious lest, in pressing the view of excluding geriatrics, after we have excluded pediatrics and excluded all the other "atrics," there will be nothing left for the general practitioner at all.

I know that that is not our desire. What we want to see is diffusion throughout the medical profession of the knowledge which we are gaining from the experience in the geriatric units, but I would always say this in warning, that we must insist that these geriatric units should—the whole purpose of their development should be to—work in closest co-operation with the general practitioners and should not in any sense be an isolated specialty.

I would refer to the experience of the work being done in very difficult physical conditions in Sunderland, where I think we have been doing some of the best work in this field in the country, and where the excellence of the work is partly due to the very fine doctor in charge. It has been due to the good will he has built up between his unit and the general practitioners in the town.

Now they regularly consult him and consult his unit. He has built up a very fine out-patients' unit, where, naturally, day by day very many cases that are met with by general practitioners are sent along, to the Sunderland General Hospital, for treatment of this sort; and after they have been discharged from hospital after treatment, they can go back, with the co-operation of the general practitioners, for a general check-up from time to time.

I am, therefore, very anxious to impress this view—I do not suppose there is really any difference of opinion about it—that in developing, as we certainly must, our geriatric units, we must develop them with the full co-operation and help of general practitioners throughout the country, inasmuch as that they are the people whom we expect to carry out, with their own service in the home, very much of this new treatment which we find today is perfectly feasible.

I do not wish to say any more, as there are other subjects down for discussion. We have had a most valuable discussion today, and I hope that we shall be able to take a much more vigorous step forward in tackling some of these practical problems which I have tried to pinpoint in my remarks. In any forward movement on them the Minister will have, I am sure, the united support of Members on both sides of the House.

Question put, and agreed to.

Resolved, That this House expresses its concern at the shortage of hospital beds for the chronic and aged sick, and the lack of accommodation for those who need care and attention rather than medical treatment; urges the Government and hospital authorities to hasten the establishment of a comprehensive geriatric service to cover the whole country, in view of the increasing proportion of old people to the total population; calls upon local authorities and voluntary bodies to use to the full their powers to safeguard the welfare of the aged; and urges the Government to take all possible steps towards a solution of this grievous human problem.