§ Motion made, and Question proposed, That this House do now adjourn.—[Colonel J. H. Harrison.]
§ 10.37 p.m.
§ Mr. Arthur Palmer (Cleveland)
The matter which I propose to raise this evening—the care of the aged sick—is not, of course, peculiar to my constituency of Cleveland, but if I raise it in a constituency context it is because my attention has been drawn to the serious situation in this matter of the care of the aged sick by the local authorities in the constituency and their medical advisers.
The House had a very useful debate on the general situation in March, 1953. The hon. Lady the Parliamentary Secretary to the Ministry of Health will remember that debate. It was introduced on a Motion moved by my hon. Friend the Member for Leicester, North-West (Mr. Janner) and hon. Members on both sides of the House took part in the debate. Much mention was made on that occasion of the serious delays that were occurring in all parts of the country in securing admission to hospital for the elderly sick.
It would be right to say that on that occasion the hon. Lady, who spoke in the debate, did not deny the general truth of some of the allegations then made. If I may be allowed to quote her words, the hon. Lady said: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…"—[OFFICIAL REPORT, 6th March, 1953; Vol. 512, c. 781.]Since that time two years have passed, and, from the evidence which has been sent to me by the local authorities in my constituency, it seems that very little real improvement or progress has been made. In fact, I can say that in Cleveland the situation is just about as depressing as ever. The cases which I propose to quote for the attention of the Parliamentary Secretary are from the case-book of one very hard-working and capable medical officer whose services are shared 1893 by three local authorities. I could quote others, because I know that other local authorities and medical officers have had similar experiences, but I feel that there would scarcely be time for me to make the area of my quotation so extensive.
My informant has been anxious to stress that he is referring not to the aged so-called chronic sick—he thinks that the local authority services here are reasonably adequate; the home nursing service, the domestic help, and various forms of special homes—but to the situation which so often arises when an elderly man or woman requires expert medical attention in hospital at very short notice. As I think this evidence shows, all too often the hospital authorities can accept no responsibility, because of the age of the patient. There is a tendency—conscious or unconscious—to think that, if admitted, the old man or old woman may stay indefinitely, with a consequently heavy and embarrassing pressure upon the scarce bed space.
I will quote very quickly three cases—although I have particulars of seven here—and I shall be glad to hear the comments of the Parliamentary Secretary in due course. The first case concerns:A lady in the late seventies, who lived by herself in a cottage; she had a sister who lived in the same locality, but the sister was not in much better fettle than she was. Her tired heart began to fail; she got dizzy spells… The visits of the domestic help for a few hours a week and of the home nurse were not enough; what she required was hospital care and nursing"—these are the words of the medical officer—which I advised and which she did not receive. Some time after, since she had not been seen about, her house had to be broken into, when she was found helpless and half conscious. She was removed to hospital as an emergency, where she died.The second case is somewhat similar.A lady in the eighties who had a failing heart with mental confusion and dizzy spells in which she fell…had been looked after before she got so ill by her nephew and his wife; both were elderly, the latter had a tired heart and the former had his work to do. She had been found one morning lying in the unfurnished front room half naked, and in January too! This case, in my opinion, required admission to hospital at once… After repeated efforts of her doctor and another nephew of hers who is, I believe, a member of the local hospital management committee, she was admitted the following Wednesday or Thursday and died a fortnight later.1894 The third case is as follows:A lady in the seventies with heart disease and mental confusion, living alone, had domestic help for some time but then refused that service; she used to wander about and had several heavy falls. Her own doctor appealed to me to do what I could to get her into hospital, so I wrote to the Geriatric Physician on the matter. The neighbours came to me complaining that it was quite beyond them to look after her.Some three or four weeks later she was admitted to hospital.I think that it would be agreed by the House that those cases—which I believe to be authentic—show an extremely serious state of affairs, and I should like to ask the hon. Lady just what practical steps are now being taken by her right hon. Friend and by the Department to remedy the situation. I am aware that that which I have described is not special to my constituency; but it does not seem any use for any of us, on either side of this House, to boast of the glories of the Welfare State when this kind of inhumanity—for that is really what it is —exists.
In Cleveland, however, we have what seems to us to be at least a limited local solution. It is certainly one which is being urged by the local authorities and the trades council, which is also taking an interest in the matter; and it is a solution which could apply if the Minister and the regional hospital board allowed it. At Guisborough, in the heart of my constituency, there stands, open to the sky, the present shell of a hospital building which was started before the war. It is unfinished and attached to a general hospital which was once a Poor Law institution. If the necessary work were done, this completed hospital building could accommodate many old people, especially if made into a special unit for the purpose.
That is the course being recommended locally, and I put a question to the Minister on the subject in the last Parliament. The right hon. Gentleman said at that time that there were no funds available and that, in any case, it was a matter for the regional hospital board. I have here a letter from that board at Newcastle, which states that, although the board would like to do more, nothing can be done at present to complete the unfinished building at Guisborough because of other urgent claims on its capital funds.
1895 There is a tremendous stress, we all agree, on the funds of regional boards but I must say that here there seems to be a gigantic irony at work. We are told that we live in a period of unprecedented prosperity; that there is full employment and maximum production; the sun shines, and the wheels revolve, and although taxation is high, so are profits and wages. Yet the people in my constituency are told that the nation is too poor to complete this hospital. That does not sound very convincing to me, ten years after the end of the war.
I was out in the sunshine today, and happened to be at the end of Kingsway; I cannot remember how long it is since I was last there, but as though it had sprung from nowhere, there is now a great new office block; and in Pall Mall I saw club buildings being taken down, no doubt to be replaced by another edifice. Yet there are no bricks and mortar for this hospital at Guisborough. Of course I realise that kind of illustration cannot be taken too far, but, as I have said, there is a gigantic irony in that, while boasting on the one hand of our great prosperity, on the other we are too poor to complete a hospital for humane and kindly purposes. Something must surely be wrong with our sense of social priorities when that hospital remains unfinished and old people die—and I do not think that that is an improper remark—because nobody apparently is capable of organising help.
I should be glad if the hon. Lady could tell the House what progress is being made in the proper hospital treatment of the aged sick, and also for some information as to whether it is possible to start work fairly soon on this Guisborough hospital. I assure the hon. Lady that there is tremendous local feeling in my constituency on this matter. I am under great pressure from the local authorities and every section of public opinion. I cannot be convinced that there is not the money available to do the work which is so urgently necessary.
§ 10.51 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
The hon. Member for Cleveland (Mr. Palmer) has raised, particularly in connection with his own local area, a problem which is a difficult one 1896 for the whole country. I will deal first with the general progress made nationally and then specifically with local points and particularly the Guisborough hospital.
There is no doubt that the greatly increased proportion of elderly people in the population, coupled with the fact that people are living longer, makes the care of the chronic sick one of the major problems facing the National Health Service. The Phillips Committee has reported that whereas in 1911 only one person in fifteen was of pensionable age, in 1954 two in every fifteen were of pensionable age and it is estimated that by 1979 the number will approach three in fifteen.
This problem of the rapidly growing aged group requires, and is receiving, the closest possible attention. The impact of the ageing population on the hospital service is one of the major items in the review which is now being conducted by the Guillebaud Committee. Above all, this problem calls for the closest cooperation between all the authorities who are responsible for the care of the elderly. It involves home helps, health visitors and home nurses, welfare accommodation, old people's annexes, geriatric units, general hospital in-patient and outpatient treatment, and units for the chronic sick.
If any one section is not pulling its weight in the closest co-operation with the other, the burden on the other services automatically increases. It is, therefore, impossible to emphasise too much the need for the very closest day-to-day cooperation between the hospitals, the local health and welfare authorities, the general practitioners, and the various voluntary organisations, all of whom are concerned with this problem.
The need for beds for the chronic sick varies from area to area very much in accordance with the efficiency of the other services provided. It is not, therefore, practicable for the Minister to lay down a hard and fast, rigid percentage of beds which shall be so allocated. A Scottish Committee, however, made an assessment that in ideal circumstances there should be one chronic sick bed per thousand of the population. The ratio of beds in England and Wales is 1.2 per 1,000. Therefore, if all these services were operating in co-operation, as we 1897 should like to see them operate, we should have an adequate number of beds for the chronic sick. Over-all, it is true to say that the need is less for new beds than for the better use of existing beds, coupled with an increase of domiciliary services and welfare accommodation.
To this end, since the debate which the hon. Member for Cleveland has mentioned, a nation-wide survey has been conducted to provide the fullest and most accurate assessment of the nature and quality of health and welfare services for the chronic sick and elderly throughout the country and to find out whether there are black spots and whether the cooperation or balance between the various services is as we should like to see it.
Fundamentally, old people prefer to stay in their own homes, living their own independent lives, as long as possible, and our whole policy is directed towards that end. Those who suffer severe but temporary illness have been tremendously helped by the geriatric units which in a short time have done outstanding work in treating many thousands of people who in the past would have gone into a chronic-sick ward and have stayed there for the rest of their days. There has been a very remarkable extension of the domiliciary services, a very large proportion of which has been devoted to the old people, and the number of home helps has trebled since the inception of the National Health Service. There have been nearly 800 small homes for old people built to provide accommodation under Part III of the National Assistance Act, and we are increasing the number at a rate of between 3,000 and 4,000 beds a year.
There remains the residue of old people requiring hospital treatment, many of whom are cared for under the general comprehensive services of the Health Service which are available to people of all ages. Over 55,000 of the available hospital beds—11.5 per cent.—are occupied by chronic sick, 1,400 being provided in long-stay annexes. We have in addition 3,032 patients treated under contractual arrangements. Over-all, therefore, the problem is not now a lack of beds but of getting the right patient into the right bed; of seeing that patients who are admitted for a short-term illness can be transferred back to Part III accommodation or to their own homes with 1898 domiciliary help when they are able to go.
The threefold plan upon which we are working is to provide active treatment and rehabilitation in geriatric units for those who will benefit from it and can be restored to normal activity; to provide convalescent annexes for those convalescing after active treatment who no longer need intensive nursing care; and to provide long-stay annexes for patients who can obtain no further benefit from active treatment but who still require nursing and occasional medical care for an indefinite period, and possibly until the end of their lives.
I want to emphasise that the entry into any of these groups is a medical decision, and I frankly regret that the hon. Gentleman did not let me have the details of the three cases he raised. I hope he will do so, because it is only fair, in the case of what I think he will agree with me when I give the figures for Cleveland is a reflection on the hospital service, that it should be given an opportunity of investigating those cases and of giving reasons either for refusing admission or why it was unable to admit those patients. I shall be happy to investigate the cases which he has raised if he will let me have the details.
Similarly there has been a vast increase in the out-patient treatment given to old people. So far as the local aspects are concerned, a chronic sick survey was carried out in Tees-side at the end of last year. The records then showed that urgent cases could be admitted immediately and that the delay in the case of non-urgent cases at Guisborough Hospital was one week. The waiting list is a live, though a small one, and is regularly reviewed. That really is the gravamen of the point I made earlier, that at the time of the survey there were three men and three women on the waiting list at Guisborough and sixteen women on the list for Portrack Hospital. But, and this is the real point, there were at that time two women and two men at Guisborough, and fifteen women and thirteen men at Portrack, who were fit for discharge to welfare homes which were under the local authority. So that those figures were almost in balance if the co-operation between the authorities had been fully operative and if it had been possible to make those necessary transfers.
§ Mr. Palmer
I am sorry to interrupt the hon. Lady but what I am interested in, and what I think the House is interested in, is what steps the Department is taking to ensure that this co-operation occurs.
§ Miss Hornsby-Smith
One of the ways in which it could occur is if cases such as the hon. Gentleman feels have failed to be provided for locally are referred to us, and we have the opportunity of seeing where the fault lies, either with the hospital or with the local authorities.
The group has also a consultant physician who is available to visit patients in their own homes and to assess their need for admission. In the Teesside H.M.C. area there are 115 beds for active geriatric treatment, 20 of which are at Guisborough and 2.0 at Hemlington, and 189 beds for chronic long-stay cases, of which 107 are at Portrack and 44 at Guisborough.
The total chronic sick provision on Tees-side is therefore 304 beds, and that gives the figure of 0.8 chronic sick beds per thousand of the population against the regional figure of one. A much less well-served area is Gateshead, where only 0.2 beds per thousand of the population are available. It is quite obvious that this area would command a higher priority in any development that the Board is considering in relation to beds for the chronic sick.
On the question whether or not my right hon. Friend should support particular claims and priorities within the region, it is the duty, laid down by Act, of the regional board to plan development and make its own priorities between the competing demands of various specialties. The funds available to the Health Service, although there has been a substantial increase in capital allocation, are not unlimited. The Regional Board has to decide, in the light of its own knowledge of the area and the circumstances with which it is in much closer touch than we are at the Ministry, whether this project or that project shall receive priority.
To deal particularly with the Guisborough Hospital, which has 74 beds, I would say that a scheme was started in 1939 to build a 68-bed, two-storey, block intended for chronic sick patients. The 1900 scheme was abandoned in 1942, when only the walls, sub-floor and roof had been completed. In 1948 the building passed to the Newcastle Regional Hospital Board, but the Board has not felt able to give any high priority to its completion—not least, I understand, because there are serious structural difficulties. A subterranean spring has been discovered underneath the block which would necessitate pile-driving and would increase the estimated cost of building it to £50,000, which is more than the present capital value of the building.
It must also be emphasised that it is no true comparison to compare the need when the project was mooted in 1939 with the need today. In those days there were far fewer domiciliary services for old people, far fewer old people's homes, far less geriatric services for the aged, and, therefore, many people who in those days would have had no alternative but to go into a chronic sick ward, and there end their days, are now being helped by domiciliary care or, alternatively, are being rehabilitated through the general hospital service and the geriatric units.
The question of welfare accommodation is a difficult problem which requires far-sightedness and close cooperation on both sides to get the right patient in the right bed, or the patient home, if the patient is fit to go. Over-all, in the region, there is reasonable provision, though I do not deny that some areas, and Gateshead in particular, are below average. Speaking generally, the need is for greater flexibility in transferring cases which have recovered from the chronic sick stage to the welfare stage.
There are still some areas to complete before we can give a report for the whole country. We do realise that there are some areas which may fall short of requirements. When we get the full report we shall be able to apply what we believe to be the necessary remedies. Overall, the services have been substantially increased for the old people in that area. The Regional Board must be left with the authority to make its own decisions as to priorities and specialties within its area. On the basis of the very intensive and detailed survey made on Tees-side, I cannot agree that the situation is as grave or as insoluble without an extension to Guisborough Hospital as the hon. Member would suggest.
§ Mr. Palmer
No doubt the hon. Lady appreciates that this is the view of the local authority, which is in close touch with the problem every day.
§ Miss Hornsby-Smith
There are two sides to this problem, since the chronic sick are dealt with by the Hospital Board and by the local authority. If the hon. Gentleman cares to send me the cases which he has raised, I shall be only too happy to investigate them fully and thoroughly. It would be quite wrong for me to pass comment on the allegations that have been made about the failure of 1902 the hospital service to admit these people, without fairly hearing the case which the hospital authorites might wish to put. I am grateful to the hon. Member for the way in which he put his case, and I agree with him that he has raised a most important point, but I do not accept the view that the facilities in the area fall as gravely short as his speech would imply.
§ Question put and agreed to.
§ Adjourned accordingly at seven minutes past Eleven o'clock.