HC Deb 13 November 1953 vol 520 cc1337-72

1.51 p.m.

Mr. R. T. Paget (Northampton)

I am very glad to have such an ample opportunity to raise a question which I feel everybody will recognise as one of very great importance, namely, the treatment and alleviation of the chronic sick. I want to start with what may appear to be a very small point, but one on which I hope to get some satisfaction. I certainly will not make any party point about it, because I have now raised it with four Ministers of Health, two of each party, and all four Ministers have entirely agreed with me. They have all said that we must do something about it and they have all done, so far, precisely nothing.

It is the question of changing the names of hospitals and institutions which have a name that will cause distress to people going there—the homes for incurables. What effect does it have on the mind of a person, perhaps with her mind already a little unbalanced, to be taken from her home and to have to enter through portals which might as well be labelled, "Abandon hope all ye who enter here"? Even more grave is the case of the cancer hospital. Perhaps there is no word which is more terrifying to people today than "cancer."

A great many people are not told what they are suffering from because doctors know that the mind has a great effect on the body's capacity to recover. If one puts fear in the mind one reduces that capacity. Yet people are taken to a cancer hospital and every time a meal is brought to them they see inscribed on the plates "Cancer Hospital." They see the name also on their pillows. The bringing of this name continually to their minds can have a serious effect upon their chance of recovery and even far more effect upon their general peace of mind. Another case is that of the consumption hospital—again a name carrying fear, and carrying it quite unnecessarily.

I have been patient about all this. As I have said, I have raised the matter with four different Ministers and I feel that it is perhaps not unreasonable that I should bring it to the Floor of the House to see whether public opinion can bring about a change. Each Minister has told me, "This is not my business. It is the business of such-and-such hospital board or district board." I hope that we shall not have that answer today, because it is really irrelevant. If a Minister showed resolution about this I do not believe that he has not enough influence to get his way. It may not be his business and it may require action by somebody, but if he puts his mind and determination into it he can get action taken by somebody else. It is something that has gone on too long and requires altering.

That, as I have said, is a small point within this vast problem. I put what I now have to say interrogatively. I am not trying to attack the Government or the Minister. I realise the size of the problem. I happen to know a single block of buildings in which there is a man dying from cancer of the sensory part of the brain which involves his being in continuous pain and with no hope of recovery at all. He is not in hospital. He is inoperable and no hospital can do anything for him, but he ought to be somewhere where at least he can die comfortably. The pain he suffers is such that he bangs his head against the wall. His case is infinitely distressing. There is nowhere where he can go, because there is nowhere where he can be treated. All that can be done is to keep him under dope. It cannot be said that he is entirely helpless, it is just that his case is hopeless and that the cancer will prove fatal.

There is another agonising case in this block. He is suffering from endema and cancer of the lung. That is not painful, except that slow strangulation takes place and the process goes on for an indefinable time. There is ghastly distress when he is trying to get his breath or when he is attempting to make any movement. There ought to be somewhere where he could go to die in peace. There is another case of a woman who is suffering from a tremendous swelling of the body from incurable dropsy.

It is a question of waiting to die in these cases, but death could be so infinitely more comfortable if there were only somewhere where these people could be looked after. If we allowed animals to die as these people die we should be very quickly brought to book. I am not making any kind of attack on the Ministry of Health. I am only trying to draw attention to the matter and to obtain some information about plans and what we can hope to do to deal with these terribly distressing cases.

There is another class of case, that of people whose sickness, though chronic, is of a very much milder nature. They are the old people whose main complaint is that they are not really capable of looking after themselves. Two years ago I was in one of the great London hospitals, just before Christmas. Those of us who have had the experience know what a tremendous effort is made just before Christmas in these hospitals. The decorations there were something of which I had never seen the like. They were magnificent.

In one ward there were many old people. The sister said to me, "These old people break my heart. I have really no business to have them here. They ought to have been discharged. There is nothing wrong with them except age, but I have not the heart to send them away before Christmas. They are perfectly all right now, but I know very well that if they go they will be back again soon, because once they leave here their health will be destroyed by the neglect that will result. They are not capable of looking after themselves."

That is the class of old, lonely people that I have in mind. Many of them are slightly senile and the various organs of their bodies are not working quite as well as they used to do. They can be kept comfortable and happy if only they can be looked after but will suffer all the pain of illness and disease if they cannot be looked after. They are not like the cases I have just mentioned, for which only hospitalisation can be provided. These are cases in which a much lower level—in quantity if not in quality—of attention is required than is necessary in a hospital, some place where they can live and do a great deal to look after themselves but where at least there will be people who can keep an eye on them and can see that they do the things which are necessary to keep them in health, and who can to some extent, without being patronising, treat them a little as the children they have tended to become.

That is the sort of problem. We do so much for children today, and it is a wonderful thing that we do so, but I feel that of the helpless in our community it is the old who are today neglected. I have, therefore, taken this opportunity to raise this question so that we can hear what the Ministry intend to do.

2.2 p.m.

Mr. Leslie Hale (Oldham, West)

I am sure that the whole House is very grateful to my hon. and learned Friend the Member for Northampton (Mr. Paget) for raising an issue which ought to be kept constantly before the House, and for putting it in the way he has done, in one of the best speeches I have ever heard him make. There has been rather more of the heart than of the head in his speech, a marked and definite improvement so far as he is concerned. [Interruption.] I am rather surprised that that arouses any astonishment because I should be very willing to argue—and we have two and a half hours in which to do so—that it is only emotionally that one can arrive at any rational decision on any subject at all. The application of logic and reason produce a reductio ad absurdum on any subject, particularly in connection with those problems dealing with human beings. However, I do not proposed to yield to that temptation.

I am glad that my hon. and learned Friend has talked of the difficulties of the chronic aged sick, because that is one of the major problems today and one of those to which a good deal of attention has been given amongst many voluntary societies without any marked and noticeably corresponding attention from the Ministry of Health.

I should like to say a word about voluntary societies. I have never been one of those who thought that when we introduced the National Health Service we should abolish voluntary societies or spurn their work. It is clear that under a National Health Service there is even more need for voluntary societies, more need for calling people's attention to the benefits which are available and for seeing that they get the benefits to which they are entitled. In this sphere voluntary societies have a great work to do.

So far as Oldham is concerned they are doing it. We in Oldham are very rich in such organisations. Only last week I received a letter from Mr. McIntosh, who leads the Oldham P.S.A. Brotherhood, which does magnificent work. He is in his 51st year as president, and he was 40 when he became president, so that at 91 he is still working for his fellows. We also have in Oldham an association known as the Inskip League of Friendship, which is so non-political that two of the vice-presidents are the right hon. and learned Member for West Derby (Sir D. Maxwell Fyfe) as a former Recorder of Oldham, and myself. That means that it qualifies in every way as a non-political body.

I think that the most moving thing I have ever attended was their annual party for the disabled, when people came in ambulances, cripple chairs, some in mobile chairs which they had just acquired. They showed a cheerfulness under handicap and a genuine happiness which was deeply moving. That is an association, perhaps the best of all associations, that is run by disabled people themselves, in which people who can just get about look after the people who cannot move, and people who might be called "ambulants" look after the people who cannot walk. It is a noble association which is well worth looking at.

I wish to refer more to the work of the Oldham Old People's Welfare Committee, the third annual report of which, issued recently, calls attention to some of the problems. I would here say that it is not necessary for voluntary societies invariably to be penniless. It is not necessary for the Ministry to take the view that they are not entitled to help from time to time. When they are doing work for the country and doing work of real help, much money can usefully be disseminated and spent among voluntary societies.

They have been concerned with erecting huts in the parks for the old who walk with difficulty. A large sum of money has been provided for that purpose by the National Corporation for the Care of Old People, who are largely indebted to the Nuffield Foundation for their substantial finances.

The Committee call attention to one case which seems to me to be a classic example of the sort of case to which we are anxious to call the attention of the House today. I quote: Mrs. A. is in her 86th year and lives alone in a cave-like residence hidden away behind alleyway and court. She sleeps in the same room as she cannot get upstairs, and her view from the window is a bare brick wall. Her legs and feet are very swollen, and she seems always in pain to some degree. Arrangements were made for a Home Help to call each week to help in cleaning and shopping. When Mrs. A. had violent toothache and could not get to the dentist, her doctor was told and when examining her mouth found an abscess under her one remaining tooth. This we promptly removed, giving the lady permanent freedom from toothache. On another occasion Mrs. A. was found heating a brick in the oven with the idea of warming her tummy "— that is the word used in the report— wherein she had a pain. A rubber hot water bottle was provided and gave much relief. Arrangements were also made with the Ambulance Service for Mrs. A. to be taken to the Boundary Park Hospital Foot Clinic where she received attention. She quite enjoyed the trip, and is now much more comfortable. This question of chiropody for the aged, particularly aged women, is most important. It seems to be one of the services which they are never able to get. There is no one to say that it is available if one knows where to look and if transport is available. It is curious how the foot seems to give the most trouble, difficulty and pain to the aged, particularly aged women.

To continue the quotation: The next requirement was a pair of spectacles which her doctor had recommended. The Optical Department of the Oldham Industrial Co-operative Society, when told of the circumstances, sent a car for the old lady and fitted her up with the needed sight-aids. Mrs. A. was without a clock in her room and had to depend on callers to find out the time. She was provided with a clock—I am paraphrasing—and it was later possible for her to have the use of a radio set on loan, which brought a great deal of joy. Those of us who criticise the B.B.C. from time to time do not make allowances for the real joy which they bring to the people who have no facilities for conversation and no chance of hearing music, except in these conditions.

To continue the quotation: Mrs. A., despite her ailments and unprepossessing abode, is as cheerful a person as you can wish to meet. She looks forward eagerly to the regular visits of the visitor, and has been taken on trips to the seaside, and so on.

I do not know whether that old lady of 86 survives to carry on life's battle, but she is typical of so many gallant souls living, so far as towns in Lancashire are concerned, in circumstances in which they are deprived even of the sight of the sky, certainly of the hills and dales, carrying on with indomitable courage, many of them in these difficult circumstances, all of whom are entitled to our constant attention and care.

I think it was a former Prime Minister, the right hon. David Lloyd George, who said that the way we treat the old people is a crucial test of our national quality. The nation that lacks gratitude to those who honestly worked and did their best for the world when they had the strength to do so does not deserve a future. It has lost the sense of justice and the instinct of mercy. I remember that in 1945, when we opened up the National Health Service, I said, perhaps somewhat facetiously, that it would give people a year or two of extra life. In fact that has happened, notwithstanding the alibis provided by the Parliamentary Secretary to the Ministry of Food, who seems to think that it has been done by the doctors single-handed. But we have not only to add years to life—we have to add life to years. Is it worth while going on living sometimes unless there are some modest comforts available and some hope and chance of participating in life as we believe it should be?

So far as the care of the chronic sick is concerned, it is a lamentable thing to say, but little has been done. There have been conference after conference, meeting after meeting, organisation after organisation. In my own area the Mayor of Salford showed considerable initiative and called a conference of the voluntary organisations in Salford. A discussion of the whole problem was initiated and a comprehensive report provided, but I am unable to find that much has been done at all. They quoted the mobile meal service at Preston, and the mobile physiotherapy units which can do so much in the face of consistent opposition from the Ministry of Health—

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

Mr. Hale

If the Parliamentary Secretary will consult the Bristol Report, she will find repeated more than once the difficulties of carrying on physiotherapy units at all in the face of the consistent opposition of the Ministry of Health to general practitioners running an organisation in physiotherapy. It cannot be run by a specialist service from door to door and home to home.

I am sorry to have to introduce a controversial note but it has to be done. The fact is that the recent Report of the Ministry of Health, written presumably by an honest civil servant—not a statement to be made by the Minister to the House but a factual report to the country—almost opens with these words: The restrictions which the general economic situation has imposed on capital investment in the hospital service have prevented hospital authorities from undertaking more than a small fraction of the new building work that is needed if the fullest use is to be made of the opportunities provided by the National Health Service. In particular the first new post-war hospital has yet to be started. That is a lamentable confession. To those who hold the views which I hold, it is not quite so surprising, because this has been the situation in town after town. I do not suggest for a moment that this may be laid at the door of any one party or Ministry. We introduced the National Health Service and did a great deal for the whole community. It is true that I tried to get permission to get an extension for the Oldham Infirmary, and was unable to do so, because of the urgent need of other building work, war damage replacements and so on.

That has gone now. Now we are not stopping building hospitals because we are building other things essential for the welfare of the community. We are stopping building hospitals to provide battleships, guns and tanks. Every time loans are asked for by some town to provide the necessary extension to a hospital, it is told. "You can have guns and flame-throwers as the first priority." We are back under the old wax priorities, and that is set out as clear as I hope I have said it in the Report of the Ministry of Health on the services for the elderly and handicapped. These are indeed the opening words on page 118 of the last

Annual Report: The continuing limitation of the volume of capital investment available for building schemes under the National Assistance Acts and the re-imposition early in 1952 of control over the distribution of steel which entailed a severe curtailment in the quantity available for the purpose had the inevitable effect of delaying the start and in some cases the progress of work on a number of building projects. That is where we have arrived eight years after the termination of the war. We have reached a situation in which it is solemnly recorded that we cannot continue even those urgent projects which have been started, and they are being delayed in order to divert steel for more battleships. Even the first post-war hospital for the aged has not yet been started because it is necessary to provide steel for guns and flame-throwers.

Let me quote from a report on the position of science in relation to the aged.

Mr. William Shepherd (Cheadle)

I appreciate the strength of feeling of the hon. Member in this matter, but it should not go out from him that there is an enormous amount of steel being devoted to war purposes and a relatively small amount for what are non-war purposes. I am speaking without the figures to hand, but if the figure of steel consumption for war purposes is 10 per cent., I should regard that as high.

Mr. Hale

I am not quoting that figure. I am quoting what is said by the Ministry of Health, and they say we cannot build hospitals because of the re-imposition of controls and the diversion of steel to other purposes—

Mr. Shepherd

That is not quite the same.

Mr. Hale

What I do know as a taxpayer with a demand for taxes in my pocket which I cannot pay—and before catching the 6.18 train tonight I have to write asking for a six months' delay—is that we are spending £1,500 million on armaments.

The report I was proposing to quote is the report on the aged and chronic sick of the Birmingham Regional Hospital Board, in which it is stated: It is humiliating to confess, but unfortunately true, that our ignorance of the anatomy, physiology, biochemistry and pathology of the aged is almost total; material is everywhere available for study but everywhere neglected. That is an incredible statement to be made in 1951. It is almost a corollary of the amazing statement that, in a world suffering from malnutrition for years, when we went into Belsen and tried to cure people dying of starvation no one knew how to treat them, no one knew what to do, and the wrong treatment was given because no one knew enough about malnutrition. Here we have in a most responsible document, which is in no sense a political document, a statement of that kind.

The general hospital system is made clear in one other quotation from the same document which has emerged from Dr. Lowe's and Professor McKeown's analysis of the position in the Birmingham region: … about one-tenth of the total available number of hospital and infirmary beds is required for the treatment of patients over 65 years of age. The proportion of such patients in the wards at the present time is no less than one-third but we have shown that the majority of these have no need of hospital care and could well be accommodated at home or in simple and less expensive institutions. That brings us to the real problem which has no easy solution, that of the shortage of nurses, particularly nurses with special qualifications for the treatment of the chronic and aged sick. When I say "special qualifications," I do not necessarily mean special academic qualifications or even medical qualifications. There are a good many elderly nurses who could be brought in to care for the aged. Many of these aged people are not in need of high medical attention in the sense that they have diseases requiring special knowledge; but they are incapacitated and senile and need the gentle care of competent women. I believe there are many people who could be brought back into that service, and I ask the Parliamentary Secretary to remember that under the National Assistance Acts and the National Health Service Act her obligations are peremptory. She is under a statutory obligation to provide the necessary services.

Perhaps the noblest of all the experiments undertaken under the last Labour Government was the extension of hostels for aged people. In Oldham we have a large number of hostels, most of them largish, but on the whole modest-sized houses. They are not very great houses, not great domains, but they provide for those aged people who are not bedridden. There is a model service which costs very little per head compared with the institutional service. Something quite new in the treatment of the aged—the use of hostels—could easily be extended to a range of chronic aged sick who are bedridden or classed in medical terminology as frail ambulants, people who want attention but who can walk a little but take to bed from time to time. There is room for a great experiment in that direction, and I hope that the Parliamentary Secretary will say that the matter is being considered.

The Bristol report is a model report on the treatment and care of the chronic sick in Bristol. It was issued this year by the Bristol Local Medical Committee and it lists a number of matters to which attention should be given in dealing with the chronic aged sick—those who have not secured admittance to hospital but are bedridden at home. Speaking of physiotherapy in Bristol, it says that a mobile physiotherapy service is operating on a voluntary basis from funds from private sources, that it is limited in equipment and personnel and might be extended with help from the regional hospital board and the local health authority.

On page 8 of the report, they say that the service is handicapped by lack of funds and by the opposition of the Ministry of Health to mobile services working under "general practitioner control." There is a reference to chiropody. They say what I have already said on the subject. They refer to the provision of night attendants in housing areas where there are large numbers of aged which might eliminate the possibility of some accidents.

There is a reference to laundry services. This is most important. I am a director of a laundry and I do not want to damn my own activities, but washing is expensive in these days. Old people, very often bedridden old people, through physical incontinence, are put to very great expense in laundry bills. There is a very great need in some cases for special assistance.

The report states that nursing appliances such as bed pans, bed rests and mattresses are loaned by the local association, but the supply is limited and cannot meet all requirements. It is rather a sad observation in 1953 that the economy campaign, or the reduction of some £60 million in our National Health Service expenditure, has reached the stage at which voluntary associations caring for the sick cannot get enough bed pans to go round and cannot get a sufficient number of appliances of this kind—the simplest of all—to provide for the needs of the aged.

The report refers to a library service, to convalescent homes, to the out-patient geriatric service and to the necessity for the provision of special housing services for aged people. The latter is a matter of great importance. Within the bounds and expenditure of the present system, certainly within the authority that the Minister now possesses, much more could be done for the aged poor. I suggest that a little more generous help to voluntary societies might be one of the main ways of helping. The intimation that in certain classes of service they might have a little financial help might make all the difference in the provision of this service to the aged.

I do not want to weary the House on the subject of chronic diseases. So far I have dealt only with the chronic diseases of the aged. I will deal with certain other matters briefly, because I suspect that I might be out of order if I developed them to a great extent. There are one or two which are very important. I have referred before now in this House to the problem of diseases of the central nervous system which appear to be on the increase and which certainly play an extraordinarily high part in the percentage of aged sick admitted to hospital. I refer particularly to disseminated sclerosis and Parkinson's disease. My impression is that in the North of England the people are peculiarly liable to those two diseases. Certainly the reports on the diseases indicate that they have a greater incidence there, for reasons which at the moment no one can understand.

I do not want to say one word about chronic diseases which would cause anyone pain or any person suffering from them to lose hope. It is true, and one should say it at once, that one can have disseminated sclerosis at 18 and have a spontaneous remission at 40 and die at 80. But that is the hopeful aspect, and it is not a very high hope. I want the hon. Lady to consider this matter seriously. As these diseases of the central nervous system develop, people become more and more confined to invalid chairs and to their rooms, and they depend on the infinite kindness of most British families. I would say without wishing to be unkind that perhaps the poorer families show the most kindness to the sick and give more generously because they give themselves and do not delegate quite so much as other people.

One of the real tragedies of these diseases is that the disease becomes worse as the sufferer begins to think that he is becoming a burden upon his fellows. There must come a time when his fellows realise that there is a very heavy burden indeed, even if they do not disclose it to the patient and never say a word about it. So we get a progressive situation in which in the poorer houses a disease of this kind and the misery of it increases and the hopes of a cure, which are largely based upon the confidence and optimism of the patient, diminish. There is not much hope of a permanent cure but, for spontaneous remission and recovery for a period, the real hope is on the patient not concentrating his mind on the matter but on being able to preserve in the face of suffering an optimism which it becomes intensely difficult to promote.

All these circumstances mitigate against and tend to aggravate the matter. I have made this suggestion before, and I make it again. One knows that in these days the building of new hospitals is very expensive. Indeed, I am not sure that the average hospital is an ideal place for men suffering from Parkinson's disease, paralysis agitans, disseminated sclerosis and diseases of the motor system, diseases of the neurotic nerves associated with it and diseases of the central nervous system.

Up and down the country there are great aerodromes which were occupied during the last war by thousands of people. Many of them are equipped with brick buildings in which people could live in comfort—indeed, in a good deal more comfort than we enjoyed, if they were given better "grub" than was given to us in 1941. On these aerodromes there are huge hangars. Of course they would need a great deal of adaptation; they would have to be heated, but they are ideal places where, in one huge building, people living in bath chairs could wheel themselves to table and feed together communally.

If the Ministry would take one of these great aerodromes and spend a little money on it to provide quarters in which people could live and where they could have room to move about in invalid chairs, a great deal of good would result. They would be able to feed in the hangars, where Mr. Rank and his organisation—who, whether we agree with his views or not, is always generous about these matters—could show some of the best films produced in this country, though they are not all very good. There could be social centres in which these people would be given a new comradeship, a new lease of life and a new hope. There we should have the research laboratory in which we should be doing the research which is so essential in these two types of diseases.

The hon. Lady will know that no information is available yet as to the causes of these diseases and that everyone differs about them. So far as Parkinson's disease is concerned, I believe there is no theory at all. Also, nothing much is known about disseminated sclerosis. People talk about environment and inherent predisposition and nutritional trouble, and so on. The wretched young man who joins the Army A1 and contracts this dreadful disease during his service is told when he comes out that he has failed to establish that the disease was due to Army service because it is impossible for anyone to establish anything about it, as nobody knows anything about it at the moment. I cannot develop that subject further, because I imagine it would put me out of order.

There is another very important aspect of the problem of chronic diseases, and that is the problem of industrial diseases. The hon. Lady is not concerned with the payment of pensions for industrial diseases, but she is concerned with the cure of industrial diseases and with the medical attention to be given to them.

One of the problems to which the Government have given attention, and one of the matters for which they are entitled to thanks—perhaps not wholehearted, full-blooded thanks but the thanks due to someone who has given a little at any rate—is that of byssinosis, pneumoconiosis, anthracosis, silicosis and the whole range of dust diseases in lungs. I believe we are gradually making progress in this direction. The Bill which is to be introduced in a week or two's time is a genuine step in this direction.

I have always urged that the simplest thing would be to abolish the whole business of appeal tribunals and arguments about industrial diseases and to say, "If you have got it, you have got it. Do not let us waste any time arguing where you got it, how you got it or why you got it." If one has a chronic disease one needs attention whether one contracted it in a cotton mill or on the sands of the Egyptian desert or got it from some dusty place—even from a dusty answer.

If we made it the simple rule that" When you have got it, you have got it," it would cost very little indeed. Most sufferers get National Health and National Assistance benefit anyhow, and putting this on the plane of industrial injury benefit would cost the country very little and would give a great deal of satisfaction. It would save an enormous amount of expense in legal and medical arguments as to whether a man had pneumoconiosis or bronchitis, byssinosis or silicosis, and whether the disease was contracted in a jute or a cotton mill. A fantastic amount of argument would be saved.

These dust diseases have a very tragic result in that they bring to people in the later stages depression of mind, misery of body and a feeling of hopelessness, and this requires very special attention. Coming from a coalfield, I have had a great deal to do with both byssinosis and pneumoconiosis, and I know that in the case of both diseases there is a tendency as the years go by for there to develop a depression and misery of mind and a feeling of utter hopelessness and helplessness. Here, in particular, there is work which the voluntary bodies could do. It would not be a bad thing if every voluntary body devoted itself for the time being to finding out whether all sufferers get the benefits to which they are entitled, and when they have established that, they can attempt to get a little more benefit for them in the years to come.

In general, the aged are having a very bad time at the moment. There is no question whatsoever that the cost of living index bears no relation whatever to the problems of the aged. The budget of the aged, whether they be chronic sick, frail ambulants or able-bodied, contains items of overwhelming importance compared with items in the cost of living index. The cost of living index shows that the cost of clothes has gone down. But the aged do not buy clothes. They go on living in the clothes they have worn for years, and the portion of their budget which they spend on clothes is very small. They have to put first things first, and the first thing is food, and that has certainly gone up, and, moreover, the cheaper ranges of food which the aged buy have gone up most.

The next thing is fuel, which has gone up very substantially. The hon. Lady ought to have in mind that some Government at some time must have this problem in mind. There are houses in Oldham where fuel is absolutely necessary. Fires have to be kept going in them somehow or other, day in and day out, in order to maintain them at a standard even remotely approaching that of being fit for human habitation. If the fire goes out, water comes down and the damp comes in, and troubles accumulate and increase. The expenses increase, too, because in a day or so the furniture and bed clothes, such as they are, become mouldy, and that means that more must be bought. Therefore, the aged have to put food and fuel first, and they have also to spend money on laundry, which is an expensive item, unless they are fit enough to do most of their own washing with the limited facilities which they possess.

It is a grave problem. The great problem of the aged generally would be out of order, and so I cannot deal with it. I hope the hon. Lady will pass on the message to the Government that we shall continue to raise the matter until something is done. I hope that, in the meantime, she will be able to tell the House that she will give a great deal more attention to these problems than appears to have been given in the last two years and that steps will be taken on the lines of some of the suggestions which have been made.

2.37 p.m.

Mr. Harold Davies (Leek)

The House is indebted to my hon. and learned Friend the Member for Northampton (Mr. Paget) for having raised, in his vivid and sympathetic speech, the problem of the aged and chronic sick.

I would emphasise what was said by my hon. Friend the Member for Oldham, West (Mr. Hale), who appealed for more direct aid to the voluntary services for this purpose. In my constituency, at Kidsgrove, we set up, after a tremendous voluntary effort, an old people's welfare centre. With the co-operation of the Staffordshire county committee, which was gladly given, it was equipped with radio, television and the types of games that old people enjoy. I have been to the centre many times, and there, without an institutional atmosphere, is developing the friendship and co-operation among old people which is necessary to make them feel that they belong somewhere. More help ought to be given to voluntary organisations to enable them to develop the atmosphere of cheer and friendship in such places.

My hon. Friend mentioned chiropody. There never was a greater need for the National Health Service to recognise fully qualified chiropodists who could give attention to chronic and aged sick. I have seen in hospitals old and decrepit people whose feet are in a terrible condition, and this has made their lives completely miserable. A small outlay by the National Health Service upon chiropody would bring comfort and happiness to thousands of old people suffering in this way. Could we not, therefore, look at this question of chiropody in relation to the attention required by the aged and chronic sick?

There are two other small points, one of which has not been touched upon in the debate. How right was my hon. Friend the Member for Oldham. West when he said that facts alone do not necessarily move people. A certain amount of emotion is needed, and to rely on logic and learning without experience is to wander completely in the void. I want to look at some aspects of the care of the aged and chronic sick which have been neglected.

A few weeks ago, the Home Office produced a startling White Paper entitled "Accidents in the Home," and the astonishing fact was brought out that 1,000 more people are killed in the homes of Britain every year than are killed in road accidents. The national newspapers and Parliament are continuously trying to solve the problem of death on the roads, but one of the most dangerous occupations in Britain today is living at home. The Englishman's castle kills 1,000 more people every year than do accidents on the roads. It may sound paradoxical, but it is perhaps more dangerous to sit at home than to walk down the Strand at the present time.

I analysed these figures in the Home Office White Paper, and I find that 58 per cent. of the deaths in the home are due to falls, 13 per cent. to burns, 12 per cent. to suffocation, and 8 per cent. to coal gas poisoning. The Home Office document also goes on to analyse the figures, and shows that, as far as the majority of these deaths are concerned, 50 per cent. of the deaths in the homes of Britain concern people over 65 years of age. I want to know how many of these are aged and chronic sick whom nobody has visited for so long.

On the borders of my own constituency, two old people were found gassed. They had not been visited for about 10 or 12 days. Then, someone broke into the house and found that the gas taps were leaking. The sense of smell of these old people was not sufficient for them to recognise their danger, so two more deaths were added to the list of accidents in the home to aged people. In a civilised community, no aged or chronic sick people should be left alone for 10 or 14 days at any time, and, whatever anyone else may say, my hon. Friend the Member for Oldham, West was right in what he said, because I have here the Ministry of Health Report showing that the Treasury limitation on the volume of capital investment for building has resulted in a limitation of the amount of money to be spent on—

Mr. Hale

The hon. Member should not base my claim to accuracy on a Ministerial document. I am right because I take the trouble to verify my facts and to attain a high degree of accuracy.

Mr. Davies

I want to assure the House that my hon. Friend quoted the Report, and that his verbiage was accurate as, no doubt, were his statistics, though they did not depend on the Report.

Let me finish the point concerning accidents in the home. The cost in disablement and death we do not know, because we have never made a true analysis, but we know that 5,000 hospital beds are filled every year through accidents in the home. According to this Report, over 50 per cent. of them are occupied by people over 65 years of age. How much of that could be avoided if we had a sufficient service to look after these aged and declining people?

This brings me to my last point, concerning the design of houses. How far does the Ministry of Health seek the advice and help of their architects in building these bungalows for the old people in regard to the design of these homes? We learn that 8 per cent. of the deaths in homes are due to bad design of the house, with steps in dark corners, and so on; in fact, 8 per cent. of the deaths last year were due to that cause. All this could be eliminated with a little co-operation between the people who have to deal with the care of the aged and sick and those who can give advice to the architects' departments of the local authorities. Or do they already give such advice?

I do not want to introduce any party political strife into what I believe has been a worth-while debate in which sympathy on both sides of the House has been revealed, but I should like to point out that this business of the possibility of a new Bill dealing with rent restrictions, far from being an instrument of policy, will be mere necromancy. This is the worship of the dilapidated and dead property which we see in all our towns, and the improvement of some of these old dark buildings will not decrease the number of accidents in the home affecting old people.

Summing up, I am sure that both sides of the House have appreciated this opportunity to draw the attention of the Ministry of Health to the growing importance of the care of the aged and chronic sick, and I hope that the Parliamentary Secretary will let us know what policy, if any, the Ministry of Health may have in mind to reduce the number of accidents in the home because of the astonishing fact that more people are being killed in the homes of Britain than on the roads, and 50 per cent. of these are people over 65 years of age.

2.48 p.m.

Mr. Ivor Owen Thomas (The Wrekin)

It is no exaggeration to say that within the last quarter of a century we have been living through a process of stimulation and exercise of a social conscience, and it is a shock today to realise that nothing in the way of a national responsibility for the care of the sick, aged or neglected was effected in this country, or possibly, in any other country, more than about 50 years ago.

Most of us are old enough to remember the first great piece of social legislation in the Bill which set up the National Health scheme introduced into Parliament by that great Parliamentary and social figure the late David Lloyd George. We have seen it grow from very small beginnings to its present stature, but, though we may compliment ourselves upon the great achievements of the last 30 or 40 years in this field, there is still very much to be done.

Today, the debate has centred upon the maintenance, care and welfare of the aged and chronic sick section of the population. That is one end of the problem. At the other end are the helpless and neglected youth of the population. I think it is probably true to say that there is now more social responsibility exercised in the care and attention given to the helpless and neglected young than there is exercised in the maintenance, care and welfare of the aged and chronic sick.

To have achieved the stimulation of a social responsibility in this field is something. It is a feature of the development of our civilisation within the last 50 years, though running parallel with it, that there was greater destruction caused by war than ever before; but we have still a long way to go. In building up our great social services, even now we are not far beyond the foundations.

When hon. Members on this side get up to criticise there is a tendency for the retort to come from the Government benches, "What did you do when you were in power?" We ought to get away from that childish kind of retort when we are dealing with a vast social subject. We might as well realise that social problems of that kind will not be solved within the lifetime of any one Government, whatever their political complexion. We must first face up to these problems and then co-operatively deal with them as rapidly as circumstances permit.

There are many points of social life to which special attention should be given immediately. That which has been raised this afternoon is one of the most serious of them. Nothing is more tragic than the neglected, aged person. When attention is called to the matter it stimulates sympathy, but vastly more than sympathy is wanted. It needs serious, organised social attention and it is a responsibility that every Government, whatever their political complexion, should face.

My advice to the Ministry responsible for the operation of the National Health Service would be that if it is found that there is not sufficient power in existing legislation to improve the lot of those people the Minister should bring forward the necessary legislation. If there is not sufficient information available correctly to assess the position there is ample ground for the setting up of a Royal Commission to get at the facts and to make recommendations.

Voluntary societies exercise their charitable functions to deal as effectively as possible with these matters. Only within the last 100 years the great novelist, Charles Dickens, directed the attention of the public to the terrible things that wore happening in the poor-houses. Within the lifetime of many of us that blot on the national life has been gradually extinguished. There is still a lot to be done, and I hope that the Government will not content themselves with pointing out that their predecessors, the first majority Labour Governments, did not do as much as they could have done.

Successive Governments should face this problem and deal with it by building upon the foundations that have already been laid, so as gradually to eliminate it as a social evil. The problem must be dealt with continually, and not only for the people who are now sufferig, because it will not be solved completely and finally. We must deal with it as a continuous social service to prevent recurrence of the evil in future generations.

I hope that the Parliamentary Secretary will indicate that she and her colleagues in the Government are working along the lines of building anew on the great foundations laid by the Liberal Government of 1910. If we achieve as much progress during the next 40 years as has already been achieved we need not be ashamed. In addition to analysing the problem and discovering the facts, it is the responsibility of the Government to do what they can to remove unnecessary suffering among the many thousands of our aged and helpless sick.

2.56 p.m.

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

I am sure that we are all grateful to the hon. and learned Member for Northampton (Mr. Paget) for initiating this debate, as well as for the contributions from other hon. Members opposite. I shall deal, first, with the matter as it affects the naming of hospitals, on which the hon. and learned Member feels so strongly. I sympathise very much with his sentiments and I am sorry that I cannot go as far as he would like me to do. If there is a great deal of local feeling about this, and if local opinion desires a change, I am sure that any recommendation made by a hospital management committee would be most favourably received by the Regional Hospital Board.

There is a different feeling in the South about the name "infirmary" from that which exists in the North. After the introduction of the National Health Service, a number of southern infirmaries changed their name, but up North the name carries a different association. We still have places like the Bolton Infirmary and the Manchester Royal Infirmary. If anybody suggested that they should change their names there would be an enormous controversy.

If any local hospital management committee wishes to make a change, the regional hospital board is empowered to accept alterations and I have no evidence that they have ever refused a reasonable application from a hospital management committee so to do. Applications from teaching hospitals would require the formal approval of the Minister, and to my knowledge such approval has never been withheld when requested.

I have looked up the list of incurables hospitals and I find that mostly they are not under our jurisdiction. They are privately run and we have no power to interfere.

Mr. Paget

The Ministry may have no power to alter the name, but could they not make suggestions? It is a bad thing for people to be taken into a hospital labelled "cancer hospital." Could not the Ministry make a suggestion that it might be a good idea to change?

Miss Hornsby-Smith

That there is a conflict of opinion about this point is obvious, in view of the fact that those who run these hospitals have not shown any desire to change the names. Let us take the cancer hospital as an example. As a unit it stands in very high repute, and it may be that the hon. and learned Gentleman is putting undue emphasis on the phobia about titles. The reputation of that hospital, and of others like the T.B. hospital, stands high.

I am sorry that I cannot go further with the hon. and learned Gentleman, but I can say that if any representations were made to my right hon. Friend, I am sure he would be very sympathetic towards them. At the same time, I think that the main decision must be made by the people associated with the hospital and the local users. If the outcry against the name of any particular hospital were such as to warrant a change, I am sure it could be done.

I do not seek in any way to deny or hide the size of this problem of looking after the chronic sick, but, like all the priorities in the National Health Service, it can only have its share of the available accommodation and the financial means at our disposal. That does not mean to say that progress has not been made. Indeed, so far as general accommodation for the chronic sick in National Health Service hospitals is concerned, the number of beds has already risen from 50,300 to 54,000. The number of contract beds which we have in institutions and hospitals owned by voluntary bodies has also risen from 538 to 1,754.

A marked increase has also taken place in the treatment made available in out-patients departments, and particularly in physiotherapy. The number of new out-patients has risen from 2,210 in 1950, to 6,071,* with total attendances of 26,247.*

* These figures were later amended to 3,595 and 14,665 respectively.

Unfortunately, despite the addition of nearly 4,000 beds, the waiting list has continued to rise owing to the increasing number of the old-age population and the increased span of years which our population is now living. At the moment, we have waiting lists of approximately 9,000. It has been assessed by surveys made in Birmingham and other cities that 25 per cent. of that number are not, in fact, chronic sick, but people who could reasonably be accommodated in Part III accommodation, and who require, not medical attention, but normal care and attention.

One of the problems with which we are faced when a patient is removed from Part III accommodation to a general hospital accommodation, is that after being rehabilitated and made capable of going back to Part III accommodation—as, fortunately, is frequently the case—we often find that the vacancy in the Part III accommodation has been filled by somebody on the waiting list, and is, therefore, not available for the patient who went into hospital and who has been rehabilitated and is ready to go back to Part III accommodation.

There is a very considerable problem confronting all hospital authorities and regional hospital boards, and one has to accept that there is a constant conflict between demands for general medical care and those for chronic sick care. There is the argument that a bed for the chronic sick has generally a very low turnover and may be occupied for a year or two, whereas a bed in the general medical wards may have 20 patients in the course of a year. There is also the argument that the occupation by the chronic sick of beds in general hospitals prevents the rehabilitating of many younger people if they require surgical or medical treatment, and delays putting them back into industry. It would be useless to deny that there is that conflict. Therefore, a balance has to be struck, and we try, as far as possible, to see that a fair proportion of hospital accommodation is given to the chronic sick.

Mr. Hale

The whole point is that the chronic sick should not be there at all. They should not be using infirmary and hospital accommodation. The chronic sick who are senile or bedridden, and who are not in need of specialist attention, should be accommodated in special institutions. It is a waste of the public service for institutions with surgical staffs and highly-qualified medical staffs to have their beds occupied by people who are not in need of highly-qualified medical attention, but only of constant supervision and help.

Miss Hornsby-Smith

I accept partly what the hon. Gentleman says, and agree that there are some units which care for that grade of chronic sick. Only those who require limited attention are accommodated in units of that kind, and we do need more beds for them.

On the question of those in our general hospitals who need close attention—many of the cancer cases, for example—there is this conflict of balance between the manner in which the beds should be allocated. One particularly cheering statistic which has come out in the last two years' figures is that we are getting a better turnover of patients in these hospitals—a turnover in that more are being rehabilitated and are going out rather than a turnover by way of deaths. I do not want someone to say that the turnover is because the patients are dying. It is a turnover of those patients who are going out and who are rehabilitated.

We find that although the beds in 1951 only increased by 3.3 per cent., the number of persons who passed through them was 10.1 per cent. In 1952, the number of beds went up by 1.1 per cent., and the number of patients by 9.5 per cent. There has also been a great increase in the work of the outpatients' departments.

With the new trend in rehabilitation in the geriatric service and with the increased facilities in the outpatients' departments, about 40 per cent. of the chronic sick are thought to be fit for rehabilitation if they could have that measure of treatment at the hospitals. Considerable progress has been made in the geriatric service and about 60 geriatric units are now in operation. Nearly all the regional hospital boards have now a specialist geriatrician whose task it is to see that these services are extended and provided throughout the area under his control.

Mr. Paget

What is a geriatrician?

Miss Hornsby-Smith

The opposite to a pediatrician. It is someone specialising in the care of the old. The specialist geriatricians recently appointed in many of the regional areas have concentrated their efforts on this rehabilitation of patients, and the opportunity which there is to provide for people a service which will put them on their feet again and make it possible for many of them to go back to their own homes, as they would prefer. Sometimes the problem arises that one cannot persuade families to take the responsibility of the patient who has been rehabilitated, but that is a problem outside the general problem of the chronic sick which we are discussing today.

There are, of course, as well as the elderly chronic sick the young chronic sick and there are a number of homes run by voluntary organisations where we have beds under contract. There is also the great work being done by the hospitals such as the St. John of God, Scorton, the Searchlight Homes, the Shaftesbury Homes and the Chailey Heritage, which is the National Health Service, and the new development of the hospital to be set up jointly by St. Thomas's Hospital and the National Association for the Paralysed, which will provide largely for young chronic cases.

There, again, one of the difficulties is that when we centralise these chronic young sick in particular homes, we quite often find that they are divorced from their families and have either to go into a home many miles away from their homes, where they can be accommodated with people of their own age, or in a nearer home with old people.

The hon. Member for Oldham, West (Mr. Hale) complained bitterly about the restrictions on building limitations. They have been common not only to this Government, but were common to the previous Government. At least, this Government can claim that there is in progress the first completely new hospital to be built since the National Health Service came into operation; and, as the hon. Member knows, priority has been given, with, I am sure, the approval of all sides of the House, to the question of mental illness and to the mental side. This 1,040-bed unit, the first new hospital in any form to be built since 1938, has gone to the mental side. That priority decision having been made, other new buildings must take their place in the queue.

The hon. Member will be aware that we are still under financial limitations as to the money we can spend. I cannot accept his view that we could gaily set aside a defence programme, which was passed by his own party when in Government, to provide for all the building priorities that we would like to see in the hospitals. There is no restriction on steel as such; capital investment is the restriction, but real progress is being made in old people's homes, and a considerable number of care and attention homes have been opened in the last year.

Many more homes are being opened. New units are being opened for the old senile people who are not capable of looking after themselves, but who require something rather more than Part III accommodation without being certified. One thousand beds have come into operation during the last two years under this heading alone. This is very real progress, which hon. Members opposite might acknowledge.

The question of nursing staff, raised also by the hon. Member for Oldham, West, is a problem in all aspects of the Health Service. As the hon. Member said, we can staff the old people's homes and the chronic sick units by the State enrolled assistant nurse rather than the fully trained State registered nurse, and we make extensive use of nursing auxiliaries under the supervision of fully qualified State registered nurses.

The routine attention which is required by these old people does not require the close technical skill of the fully qualified State registered nurse. We require many more nurses, both State registered nurses and State enrolled assistant nurses, and we are constantly appealing and launching recruiting drives to increase the staffs so that we may open up some of the beds which we have available for the chronic sick but whish at the moment are un-staffed and cannot be used through sheer lack of staff.

The local authority work does not, strictly speaking, impinge much on the chronic sick work, except in so far as local authorities provide health visitors, home nurses and home helps. That is generally in the case of temporary illness, and not to a very great extent with the chronic sick. But these services have been steadily developed and there are a continuing number of enrolments as home nurses, home helps and health visitors. The figures are progressively rising under all local authorities.

Mr. I. O. Thomas

The hon. Lady has mentioned several times the difficulty of obtaining sufficient nurses. What are the rates of pay and conditions for nurses? Is the Minister satisfied that they are sufficiently attractive to secure sufficient nurses?

Miss Hornsby-Smith

The question of wages, as the hon. Member knows, is a matter for the Whitley Council and not for advance decision by my right hon. Friend.

Mr. Thomas

I am not saying that it is a matter for advance decision by the Minister. I am asking the hon. Lady's opinion about existing wages and conditions. Does she think that they require substantial improvement to overcome the difficulty caused by the shortage of nurses?

Miss Hornsby-Smith

The hon. Member is asking me to commit myself fairly firmly. So far as general nursing is concerned, I think the wages are secondary to the fact that we are running into a much reduced number of people in the 18–19 age group, from which we enrol our girls for nursing. In addition, there is the tremendous competition of other industries and occupations, with which a national service could never compete on grounds of money alone. The appeal to nursing is very much one of interest and of vocation. As the hon. Member knows, there have been rises of salary in the nursing service both under the former Government and under this Government. I do not think that pay is the primary difficulty in general nursing.

As to mental nursing, discussions are now going on about the differentiation in rates of pay for mental nursing, which brings with it different strains. It is well-known that my right hon. Friend feels that there could be some increase in the differential rate for that side of nursing. Beyond that, I cannot go this afternoon.

The question was raised of nurses looking after old people in their homes at night to prevent the necessity of them going to hospitals. We would certainly do nothing to prevent that, but it is extraordinarily difficult—I have discussed the matter with the Kent Medical Officer of Health, in my own county—to persuade people to give this type of night work.

Generally, those who could do it are married women, and while they will do part-time work during the day when their husbands are out, they will not do night duty. The number of people who could be got to do night duty on a part-time basis is very limited indeed. There is no question of our turning down offers or failing to enrol people for this work. It is not a type of work which appeals to very many people.

The hon. Member for Oldham, West also referred to the old people's welfare committees. Recently, the thousandth committee was formed. They are all doing magnificent work. Again, they deal less with the chronic sick, than with the normal aged whom they visit and for whom they do certain duties and services. Most of the work is for the aged who require sympathy and care and small help as well as advice as to the statutory benefits to which they are entitled. I agree with hon. Members that magnificent work is being done by these bodies. They are doing it in consultation and indirect co-operation with the local authorities.

Mr. Hale

And without adequate financial resources.

Miss Hornsby-Smith

In some spheres of their work financial resources are provided by the local authorities, to which in some spheres there is a substantial grant by my Ministry. We are not quite as black as the hon. Member paints us.

The report from Bristol was mentioned, and the hon. Member for Oldham, West suggested that we are not helping or co-operating in providing physiotherapy for these old people.

Mr. Hale

It is the Report which makes the suggestion, not I. I do not know. That is what the Report says.

Miss Hornsby-Smith

We will hold the hon. Member guiltless on this occasion, but the fact remains that there has probably been more extension in physiotherapy clinics and in geriatric and outpatients' departments for the old people than anywhere else.

I know of the controversy at Bristol. Certain general practitioners wish to provide a service in this centre. It is fully within the power of the general practitioner, if he feels any of his patients require this physiotherapy treatment, to direct that the patient should enjoy the far wider facilities that are available in the hospitals. If necessary transport can be provided.

It will be appreciated that there are better facilities in hospitals than in any unit, whose services must be limited and whose equipment must be a great deal less when compared with that provided in the hospital. It is a local controversy, and I will admit that to the hon. Gentleman, but we feel that the best service we can provide is under a consultant in a hospital, which is better than a small, mobile unit.

Mr. Hale

I am obliged to the hon. Lady for giving way for I am sure she wants to get the thing in its right perspective. This is the dilemma. There are cases, as she says, that should go to the hospital for expert attention, but then there are the sort of cases like those we have mentioned, elderly people who suffer in the legs and want a bit of massage and like attention.

To get that for them it would not be right to go to the expense of taking them to hospitals and occupying the time of the specialist. It would be right, we think, to have a mobile unit for the general practitioner for dealing in the home with what is essentially a medical practitioner matter.

Miss Hornsby-Smith

I do not agree wholly with the hon. Gentleman, although he always makes his argument sound very plausible. The question is where to begin and where to end. It is a difficult problem, and we feel that the money available can best be used by fully equipped units and by the consultant service to which any general practitioner can refer his patient.

The geriatric units help not only the aged, but the young "chronics" who find themselves in these general hospitals. At the moment, between 15 and 20 per cent. of our beds are blocked because of our inability to find places to which to transfer our rehabilitated patients. We cannot get them back into Part HI accommodation because of the vacancies having been filled, and often it is found that the families are not as ready as they might be to take them back. Another development in the field of the treatment of the chronic sick has been the expansion of the domiciliary consultant services, whereby consultants can visit patients in their own homes and again, in co-operation with the local authority, nursing staff and service can be provided.

As the hon. Member for Oldham, West said in dealing with the question of research into these chronic diseases, there is as yet no known cure, and in many cases the cause is obscure as well. There are many centres where research is being conducted, particularly at the National Hospital for Nervous Diseases, the Middlesex Hospital and the Royal Victoria Infirmary, Newcastle, where constant investigation is being conducted into these cases. This is particularly so in the case of disseminated sclerosis. Often, however, hopes are raised unduly by new drugs and new treatments because of some remission in the condition of the patient which may not be attributable to the new treatment or the new drug which has been tried, and later, unhappily, those hopes are dashed to the ground.

All over the world scientists and specialists are endeavouring to find causes and cures and are constantly trying new remedies. There has been a great extension in the treatment of patients during their periods of remission by rehabilitation aid in order that they can get a brighter and cheerier outlook on their position, and can make the best of their periods out of pain and of remission from their disability.

A high proportion of these patients has been enabled to lead fairly normal lives in this remission period and the full gamut of the services are at their disposal. We can only hope that the research which is continuing will ultimately result in some cure for these dread diseases, as also for Parkinson's disease. In the case of the latter, where there are a number of younger patients as well as the old, they can usually be cared for in Part III accommodation, some of which may come under the educational care of the handicapped and some under our own aegis. They can usually be cared for in this type of accommodation until their condition becomes acute and they are bedridden.

Strictly speaking, the point raised in this debate about industrial injury does not come under my Department and I cannot enter into the suggestion that it should be no longer an industrial injury but a universal injury and that payments should be made regardless of its origin. However, I will draw attention to the suggestion. I am authorised by my right hon. Friend the Minister of Pensions and National Insurance to say that there are at present 40 prescribed diseases on the list within the limitations of acceptance, which were pointed out in this debate, but that at present the whole question of cover for diseases provided by the Act is under review by a Departmental Committee under the chairmanship of Mr. Beney.

The terms of reference are to review the present provisions of the National Insurance Industrial Injuries Act on which benefit is paid for industrial diseases and injury not caused by accident and to make recommendations. There are three members of the T.U.C. on that inquiry and hon. Members will realise that no changes can be suggested until the report is received; but the matter is under earnest consideration.

We have the problem of the chronic sick very much before us as one of the many priorities of the Health Service. We realise the limitations of accommodation, but we have provided and are progressively providing more accommodation, always remembering that the biggest limitation in all these matters is the shortage of nurses. We believe that we have taken great steps towards the rehabilitation of people who become sick and of the chronic sick who hitherto would never have got out of their beds or left the institutions again. Nowadays, they are being rehabilitated and brought back to near normal life.

I believe that this debate has done good in so far as it has drawn attention to one of these great priorities. I can assure hon. Members that we in the Ministry are doing all in our power, within the limitations of finance and resources, to reduce so far as we are able the disabilities from which this particular priority class suffer.

Mr. H. Davies

May I point out that, while we are grateful for the hon. Lady's reply, there are a number of points which, perhaps naturally, she was unable to answer. For instance, we are interested in chiropody for the aged and sick. It has not been recognised as a form of treatment and it is vitally important to some of these old people.

Miss Hornsby-Smith

I am afraid that we are still having to adhere to the decision made by the previous Government; I do not say that in any spirit of throwing it back at the party opposite.

The decision was made and we have adhered to it, and with so many priorities to meet at the moment we cannot accept the extension of this new service beyond those services already in operation. Those local authorities who were already operating a chiropody scheme before the National Health Service came into existence, are empowered to continue to operate existing units. London County Council, for example, is one, but we have not yet felt able to go beyond that and to authorise local authorities generally to set up a new service.

3.29 p.m.

Mr. Barnett Janner (Leicester, North West)

I have listened very carefully to the reply given by the Minister to points in the debate, which unfortunately I was unable to hear. There are one or two questions which I should like the hon. Lady either to answer now, if she can, or to keep in mind for some future occasion.

It is some months now since I raised this same subject in this House. We have received, as we invariably do, a very courteous and very disarming reply from the hon. Lady. She has a disarming smile and a disarming way of meeting criticism, but nevertheless we are not satisfied with such progress as has been made since the last occasion on which this problem was raised. We are not satisfied that the progress has been such as to justify our feeling optimistic about the future. It is an alarming thing that there are still 9,000 people on the waiting list, as the hon. Lady said today, and that she anticipates that that number will increase. That is a very serious statement for a responsible Minister to make.

Miss Hornsby-Smith

I did not say I anticipated an increase.

Mr. Janner

I withdraw the reference to anticipation of an increase, but I do not think it would be unreasonable if I suggested that, in view of the fact that an increase has taken place up to now, there is a possibility of a further increase.

This is a priority matter for many reasons, not merely because of the immediate necessity which presents itself but because it cuts across the whole of the set-up of our life in this country today, as the hon. Lady knows, particularly in view of the fact that the number of aged is increasing in proportion to the number of the rest of the community. Therefore, I think she should use the same disarming smile in her efforts to make the Treasury relax in the direction we desire, because that is the real problem.

I am quite certain that when she says that there are financial reasons which stand in the way of progress in this matter, she is merely acting as an unwilling advocate on behalf of the Treasury. I suggest to her that she should not let the Treasury interfere with the work that she has in hand in this direction, because it is false economy. Not only is it a false economy, but it is a disastrous one.

It is all very well for the Minister of Housing and Local Government, for example, to talk about his 300,000 houses a year. We have from time to time pointed out that the balance of hospital accommodation, for example, and other services is being disturbed because the Minister wants to adhere to the slogan which he placed before the country at one time and to try to convince the country that he is doing the right thing. But the aged and chronic sick are entitled to proper accommodation and also to proper housing. It may be a costly matter, but it has to be dealt with.

Families who occupy the hundreds of thousands of houses referred to from time to time will consider it a much greater blessing if their aged sick are properly accommodated and if they have not to deal with them in their households in a manner which places them in great difficulties. I am not for a moment suggesting that there is not an obligation on children to see that their parents are comfortable and happy in their old age, but as the hon. Lady knows, it is frequently the case that both members of the family, husband and wife, have to go out to work, or for other purposes, and the aged people are left in circumstances which are far from being good. It would be infinitely better in such cases if they could be attended to by the services which should be provided for them after the years they have given in the service of their families.

It is a good thing that we should be considering this matter on a Friday afternoon just before we rise, because I think it is good that the country should realise that at the end of a heavy week we have in mind, although there are not many Members left here, something which is of considerable importance to the community as a whole.

I should have liked to hear a statement that the Ministry were in full sympathy with the points made regarding geriatric treatment, homes for the aged, nursing and everything else, and were forcing the Treasury to do something. It would be possible for that to be done, for the Minister is not wanting in words, and I am certain that the Chancellor and his advisers could be persuaded to do the right thing. I want the hon. Lady to know that she has the support of the House and the country and that people will be prepared to allow other priorities to stand aside while this matter is being attended to.

The lives of these old people can be made much happier if they can obtain the care and treatment they need. It is not a matter of research. We have made considerable advances in experimentation in these matters. We know what geriatric treatment can do. We have the example of the work of Lord Amulree's department in the hospital at St. Pancras and we know how aged people, bedridden for years, have been able to get about again. So it is not necessary for research work to be carried out before we can decide what should be done. We know what should be done, but we are not doing it, and that is a very serious thing for a civilised country to admit. If the hon. Lady feels she has not sufficient arrows in her armoury, I would remind her that the care of the aged is a Biblical injunction, and the Treasury might be moved if that were quoted to them.

I would ask that she give a little more attention to one other point raised this afternoon, the question of the naming of hospitals and homes. It is true that, as she said, the homes for incurables are not directly under her care, but that should not deter her. No one will ask that her Department be surcharged if a little publicity in that regard is carried out. There is no reason why the Ministry should not publicise the fact that it is a disturbing thing for any hospital to have a name which brings distress to the people being treated there.

It is most serious for a person who is incurable to be constantly reminded of that fact. Medical men exercise the discretion which reposes in them and do not tell some patients when a disease is incurable; yet we have throughout the country homes and hospitals which use names which in themselves bring to the notice of the people who are treated there that they are not likely to come out of those places alive.

That may not appear to be very important, but I suggest that what we would do in our own homes towards our own near and dear ones in trying to blunt the edge of their sorrow and anxiety we might usefully do for those who are not within our own immediate circle. The Treasury is not so depleted as all that, and even if this would involve spending a few pounds, it should be done. If the hon. Lady would try to get one of the information departments of the Government to move in this matter, she would be doing something of real use.

At some future stage, either I or perhaps some hon. Gentleman opposite will raise these serious issues again. I hope that next time the hon. Lady gives an account of the work of her Department in these matters, she will tell us what has happened between now and, say, December of this year, instead of telling us what has happened in a period like 1950 to 1953. That might help her in the need which she has to persuade those who hold the purse strings to release them.

Question put, and agreed to.

Adjourned accordingly at Seventeen Minutes to Four o'Clock.