CHRONIC SICK AND ELDERLY (SERVICES)

HC Deb 29 November 1957 vol 578 cc1443-525

11.5 a.m.

Mr. Leslie Thomas (Canterbury)

I beg to move, That this House welcomes the initiative of Her Majesty's Government in organising a nation-wide survey of services available to the chronic sick and elderly; approves the steps taken by the Minister of Health to make known to hospitals and local health authorities the best and most effective practice in services for old people as revealed by the survey; and calls upon those responsible authorities who are not doing so to implement the Minister's advice.

Mr. Speaker

Before we proceed, perhaps I might say that I have considered the Amendment to the Motion, which is in the name of the hon. Member for Bermondsey (Mr. Mellish), to add at the end of the Motion the following words— but regrets that the survey was limited to the services available and was not a fundamental examination of the problem itself; and further regrets the absence of any proposals for a comprehensive national approach to this problem", but have decided not to call it because, in so far as it would add anything to the Motion, it would restrict the debate to that part. It is for that reason that I have decided that I should not select it.

Mr. Thomas

I count myself fortunate that by the luck of the draw I am able today to bring before the House for discussion a subject which contains so many problems of such tremendous social importance. For far too long this section of the Welfare State has been a Cinderella. For far too long it has lacked a guiding hand in co-ordinating all the authorities and organisations which have responsibilities in this sphere.

By its very nature, the problem is a continuing one, but it is also an ever-growing one. We have available to us today in this country knowledge and resources which were not enjoyed by previous generations, and because of that there is no excuse if we fail to appreciate in time the changes in our circumstances which demand an alteration in our approach and in our policy.

During the past 30 years, a vital change has been taking place in the age structure of our population, a change which has very serious economic as well as social implications. The survey referred to in the Motion clearly shows that in less than 20 years' time, just a generation, approximately one in five—the actual proportion is 23 per cent.—of the population will be retired. That is just double the proportion of only 25 years ago, which is in the memory of all of us.

Fundamental to the survey are the Guillebaud Report and the Phillips Report, to which I shall refer frequently in my speech. The Phillips Report says: The old are no more a homogenous group than the young or middle aged. Their needs vary and provision must be made in different ways The problems arising from the needs of old people have originated from or been aggravated by a number of circumstances. It is important that there should be agreement among all on the causes if an effective policy is to be pursued in satisfying the needs of these people, not only for their own benefit, but on economic and financial grounds and to relieve the strain on the welfare services.

The problems arise, firstly, because of the increased expectation of life. They arise, secondly—I do not necessarily put these causes in any special order of priority—because of the rise in the cost of living and the diminution in the value of the £. This is especially so in the fixed income groups, of which these people constitute such a large part. Unless we win the battle against inflation, the already too rapid erosion which is occurring of the savings which people have made for their old age and retirement will breed a sense of fear and insecurity which in itself will cause a degeneration and a deterioration in mental and physical condition.

A third cause is the housing shortage for old people, which I wish to discuss more fully later. Another cause is smaller families. I feel—probably everybody feels this—that there is a moral obligation upon the younger generation to attend to the welfare of their parents in the later years of their lives when they cease to be active. Of course, the diminishng size of families will impose a greater strain on the next generation.

Many people have suggested to me—and perhaps hon. Members take the view—that another cause of the problem is the decline in filial affection and a tendency to shelve responsibility on the Welfare State. I do not believe that. But the smaller size of families is an important factor in attempting to mitigate the problem of caring for the old. Another source of the problem is the lack of institutional accommodation—Part III, convalescent homes and holiday accommodation.

While both the Phillips and Guillebaud Reports drew attention to the problem as a whole, they revealed gaps in both the Welfare and Health Services. About six weeks ago, my right hon. Friend the Minister of Health, in Circular 14/57, defined the separate responsibilities of those two services. I think that that is the first time a circular of that nature has been issued. By defining their respective responsibilities, my right hon. Friend has done much to bring that degree of much closer co-ordination, liaison and co-operation which is so essential.

It is essential because experience has shown that too many of the services supplied by voluntary bodies, local authorities, hospitals and other health authorities have been inclined to be operated too much in watertight compartments. Part V of the Guillebaud Report refers to this matter. One of the conclusions of the Report is that the key to the problem stemming from an ageing population lies in the preventive and domiciliary services. We all know that prevention is better than cure. My experience leads me to believe that domiciliary care may well be the key to the problem.

Only last Thursday, my right hon. Friend the Minister of Housing and Local Government sent out a circular in which he stressed the need for higher priority for old people in the provision of accommodation. I hope that all authorities responsible for providing that accommodation and for siting other accommodation will not merely, for the sake of what one might call bureaucratic tidiness, deny the needs apparent in this matter, even if there is a little extra cost. I hope that they will not attempt to isolate this accommodation from the rest of the community, but will site it close to social amenities and within easy access of neighbours, families and friends.

In planning for the old, the provision of social amenities is essential, and I hope that my right hon. Friend will bring all the pressure he can to ensure that the highest priority is given to this sort of accommodation, whatever it may be—two-roomed flats, Part III accommodation, which is the residential type with communal living rooms and communal feeding centres and where a warden or some such person is in charge—

Mr. B. T. Parkin (Paddington, North)

What do they use for money?

Mr. Thomas

Perhaps the hon. Member will develop that point later. It is important to integrate, under one authority if possible, powers to provide accommodation for old people.

Another part of domiciliary services—in which I have included the provision of proper accommodation—covers the mass of services. Here I pay tribute to all those voluntary bodies and workers who do so much of this work and who provide so much relief, happiness and health and who do a tremendous job. As they are so numerous, it would be unfair to mention any one, although we all have our own particular voluntary body to whom we give our support.

I hope that my hon. Friend will convey to his right hon. Friend the Minister of Housing and Local Government the importance of giving further consideration to conferring more direct power on the lower-tier authorities, non-county boroughs and district councils, to undertake these services. At the moment, these services can be undertaken at those levels only by stretching to the limit and beyond the powers conferred by Section 31 of the National Assistance Act, 1948. I know that local authorities are trying to do what they can, but sometimes their auditors have to lean over backwards to pass the accounts.

A breakdown of responsibility, a further delegation, is necessary, because that level of authority is much nearer to the problem and much more alive to what is needed. At the moment, the authorities generally concerned are county boroughs and county councils. My own county of Kent is vast and the county officers are much too remote from the problem of the day. That is true of other large counties.

I want now to refer to certain individual domiciliary services. I feel that we should give a much broader interpretation than is now given, or has been given, to what we know at present as the home help service. I shall not be popular with my right hon. Friend the Minister nor, perhaps, with my right hon. Friend the Chancellor of the Exchequer in what I am about to say, but I believe that a little expenditure in these directions would have tremendous savings in the Health Service. I should like to see the home help service include a small payment whereby neighbours and others, probably retired people themselves but more active, could pay an occasional visit and do the little odd job about the house when perhaps the landlady or whoever normally looks after an old person is out or may be taking a rest.

Another aspect and extension of this domestic help is what I call the home and the night sitters. I know that certain local authorities make some kind of provision, but this essential service is usually run on a cost basis to the patient; and is subject to a means test. A small payment in this direction would considerably help and would keep many of these people out of residential accommodation and, what is more important, out of hospital beds, which, especially in geriatric wards, are much more costly. If a little more help could be gven by the local authority or from National Assistance funds, we could perhaps obviate the need to maintain these people in the hospitals. The resultant saving might be greater than the actual cost.

Other welfare services include laundry and baths. In their approach to the question of public baths, local authorities should have in mind the needs of old people, some of whom, of course, cannot get to the baths. Why not institute a general mobile bathing unit, with a nurse and an attendant, which could be brought nearer to a patient's home; and in the construction of public baths, why not provide something which is more adapted to use by an elderly person who might be partly infirm and finds it difficult to use the ordinary type of bath?

The big service of meals on wheels is a favourite of mine, but I shall not develop it at length today. Some time ago, a Private Member's Bill dealing with this subject was introduced by the hon. Member for Bradford, East (Mr. McLeavy) and completed its Committee stage, but, unfortunately, the time machine of this House put it out of existence. The aim of the Bill was to amend Section 31 of the National Assistance Act to enable local authorities to help the voluntary bodies in the provision of meals on wheels. I gather, however, that the subject is to be approached again in another Private Member's Bill, and, no doubt, we shall have a lively discussion on it.

Holiday centres are of real importance in preserving the mental and physical well being of the elderly; and it is important too to give a break to perhaps a member of a family or somebody who is looking after an elderly person. The National Assistance Board might perhaps help with the railway fare so that the patient or the elderly person can have a break at least once a year, whether for the purpose of visiting a relative in the country or staying at a convalescent or special home by the sea or in the country. There is a shortage of this type of accommodation. Properly run, it could, I think, be adequately provided at a cost within the means of an old-age person.

In the other services provided by the medical authorities, the two most important people are the general practitioner and the health visitor. For this reason, it is important that there should be the closest liaison between them both and the hospital authorities. Perhaps in this connection, too—again, it would effect tremendous savings in hospitals—the Minister would consider the possibility of a mobile geriatric unit. If he could produce a simple blueprint for those authorities who have to cover wide country areas, it might be useful. My only suggestion on this involves the staff. I shall not develop the medical side, because there are eminent members of the medical profession here today, and I would not attempt to interfere in that direction.

There are possibly too few hospitals which are recognised as training hospitals for nurses. The survey points out that one of the key problems is the shortage of staff in all directions. Could arrangements be made whereby student nurses could spend part of their training in geriatric units in hospitals other than training hospitals, and as part of their training go round with the district nurse or the health visitor, so that they may see the problem on the spot and get at one of the origins of it?

In this domiciliary sphere, which I consider to be the most important, the work of both sides is so closely linked and so interdependent that they should be administered as one scheme. At low levels, the head of the team should probably be the medical officer of health, because if we are to be really successful, a properly co-ordinated administrative service must be provided with constant liaison, particularly between those who are responsible for visiting, say, Part III homes and the hospitals. There are many in Part III homes who require hospital treatment and there are many in hospitals who do not require all the services that a hospital provides but who can well do with the attendance which is provided in Part III homes.

My right hon. Friend has shown that he recognises that there has already been too long a delay in starting the practical measures for the services required in the rehabilitation of these people. My main point is that the first requisite of a properly planned service is accurate information—that is to say, accurate information of the needs and the extent to which they are met in every area.

Every medical officer of health should be supplied by the Ministry of Pensions with the names of people who retire, so that he can keep a register of people immediately they commence retirement. I think also that arrangements should be made for the National Assistance authorities to supply the medical officer of health with names and details of those who are applying for or are receiving National Assistance, because poverty is probably one of the main causes of this problem. It is a sad thing that today the figure is between 50 per cent. and 60 per cent. of those on National Assistance and in the group which we are now discussing.

I consider that the general practitioner should advise the medical officer of health immediately of the slightest sign of any deterioration in the condition of an old person. It should be an important part of his duty, and he should have proper facilities and a register of his patients to assist him. In the event, the local authority could produce a proper list by keeping in touch with all the local voluntary bodies and the services for which they are responsible. With this information, and with the delegated powers which I think should go to Metropolitan boroughs and down to county district levels, I am sure that an efficient and economic service could be built up which would provide real happiness for these people.

The Reports of the Guillebaud and Phillips Committees have drawn attention to the matter, and in his circular my right hon. Friend has done much in defining the responsibilities of a real, live cohesive service. I believe this a problem which should constantly be brought to the notice not only of all the authorities but of every individual, particularly those who are retired but are active, because they would get a lot of enjoyment out of giving up part of their time to assisting one of these services. Let us go forward with enthusiasm. Let us start from the circular of my right hon. Friend call a campaign and make it a national one.

11.32 a.m.

Dr. Donald Johnson (Carlisle)

I beg to second the Motion.

My hon. Friend the Member for Canterbury (Mr. L. Thomas) referred to this circular as a departure from custom. I would comment that it is a welcome departure. I am tempted to comment also that it comes under the heading of that well-worn phrase, "too little and too late." I do not wish to be harsh, but I think that it errs to some extent in mildness of tone and has appeared somewhat late in the day, inasmuch as it was three years ago, in 1954, that in the Report of the Chief Medical Officer of the Ministry reference was made to the problem in terms similar to those contained in the circular. It has taken three years to get into action and to circulate the local authorities, but now it has started I trust that the campaign will go forward in the way recommended by my hon. Friend.

We have to be quite frank about this. Our local authorities do not have a good record in the matter of the care of old people. We must face some very uncomfortable facts on this question and the most uncomfortable of them that too many old people, for want of anything else to do with them and because there is nowhere else to dispose of them are being certified and sent to mental hospitals. One does not wish to make statements of that kind without quoting a real authority and I will quote the address of Dr. Cosin to the Royal Society of Medicine in which he states that Far the last one hundred years various committees have drawn attention to the general undesirability of certifying very old people, and vet today more old people are being certified than ever before. I hope that as a result of this circular that trend will go into reverse.

We must look for the reason for this and there is one which I was about to say was a good reason, but, of course, it is a very bad reason. It is that a doctor and relatives get stranded with a seedy, old person whose mind is perhaps wandering a little owing to physical causes and who becomes trying to look after and there is nowhere to dispose of him. That is the case in so many localities. There is nowhere to dispose of these people unless they are put on a certificate and sent to a mental hospital. That is the only method by which admission to hospital becomes compulsory. It is a feature of mental certification under the present law that an old person or anybody certified as being of unsound mind has to be admitted to hospital, whatever view the hospital authorities may take of the matter.

When one talks of the question of improper certification in this House automatically a denial springs to the lips of the Minister. In this case I am thinking, of course, of my right hon. Friend's predecessors. One is also interrupted and accused of bringing forward the evidence of deluded, paranoiac and hallucinated people. In order to prevent that happening on this occasion, I will quote from the evidence given to the Select Committee on Estimates on the Running Costs of Hospitals which reported as recently as July. A number of questions were asked of Dr. Beccle, the Medical Superintendent of Springfield Hospital who was giving evidence, and this point in particular came out. The Chairman of the Committee asked Dr. Beccle: Do you think people are too open—? Dr. Beccle said, "To certify?"

The Chairman asked again: I was thinking of getting rid of aged relatives? The answer to that question was, "Undoubtedly, unquestionably," and that is the evidence of a medical superintendent.

The Chairman of the Committee then asked: Decent people would look after them? The answer to that question was: The ceaseless spate of old people in various states of moribundity and senescence rather than psychosis who flood into the place I report each month regularly in detail. Should my right hon. Friend wish any confirmation of that, I can send to him a letter—I will quote from it now—which I received from another superintendent of a large hospital in the provinces. The relevant extracts of the letter state: Another most improper thing to my mind is the bringing in of old people whose only fault is that they have some intellectual impairment and are not able to look after themselves. Time after time these people are brought in on an order and once they are in hospital it is quite impossible to discharge them whereas if they had been taken, as they should have been taken, to a Geriatric Unit in the first place, within a few weeks they would have got over their acute phase and would probably, with the means at the Geriatric Unit's disposal, have been able to go back to their own homes. It frequently happens all over the country that people who are physically ill are brought in on an Order by duly authorised officers and once they are in, it is obvious that their physical condition is so grave that it would be improper to subject them to the hazards of another ambulance journey. An example can be given of two old patients who died within a few hours of admission, for whom it was clear that their psychiatric symptoms were only the result of their physical illness and they could quite adequately have been cared for in a general hospital. Local health authorities often seem quite disinterested and make no effort to remedy these matters. These are complaints from men who know and who have to deal with these problems, medical superintendents who find that they are unable to run mental hospitals properly with this load of sick and elderly people who are being pushed on to them in this rough and ready fashion. It is their specific point of view which I am quoting. I think that the point of view of any ordinary decent person is that it is a shocking thing, and that we have nothing whatever to be proud of in our National Health Service while this sort of thing is happening throughout the community at the present time.

Mr. R. J. Mellish (Bermondsey)

The hon. Gentleman realises, of course, that what he is saying will make tremendous news outside—news to the effect that hundreds of thousands of people have been certified and sent to mental asylums when, in fact, they should have been treated in hospital. I think it ought to be made quite clear that this is not the position generally. The hon. Gentleman may have individual examples to quote, but that sort of thing could not happen in the area which I represent. It is very important to get the record straight on the matter because, in my view, the hon. Gentleman has overstated the position.

Dr. Johnson

I am pleased to hear the hon. Gentleman say that it does not happen in his area, and I readily admit that there are areas where it does not happen. On the other hand, there are wide areas, I can assure the hon. Gentleman—I will show him the evidence I have quoted to the House and other evidence which has accumulated—where it does happen.

Mr. Norman Dodds (Erith and Crayford)

Is the hon. Gentleman aware that in the evidence before the Royal Commission the British Psychological Society of Medical Officers of Health gave evidence that 80 per cent. of the old people in mental institutions should not he there? That evidence was given by one of the most authentic bodies in the country. The figure of 80 per cent. covers the whole country, not only one area.

Dr. Johnson

I thank the hon. Gentleman for his support of what I am saying. There is really no question about it whatsoever in view of the evidence that has been adduced and which I produce to the House today. I should not dream of making statements of this character unless I had been able to produce the evidence and was satisfied that it was correct. I only hope that something will be done about it, not only in the hon. Gentleman's area, but throughout the country.

Passing to more constructive arguments, I am the first to admit that, of course, we need money. None the less, we have also to make quite certain that such money as we have is used to the best of advantage. But we not only need money; we also need good administration and good organisation. I thoroughly support the remarks in this Report. In page 5 it says: In other words, the need generally is for a better use of existing beds, supplemented by better domiciliary and welfare services, rather than for more beds, although in some areas there is a definite shortage of beds also. I am in full agreement with those remarks.

I will try in the remaining part of my speech, and to the best of my ability, to give some sort of pointer from my limited experience as to what I think should be done. I feel that I cannot do better than give an account of the experiments which I have seen over recent months in geriatric treatment.

The first is the work of Dr. Cosin at Oxford. For the benefit of hon. Members who have not heard of him, I think it would be fair to describe Dr. Cosin as the foremost expert in the country today on the practical care of elderly people. I can recommend hon. Members who are interested in the matter to go to see for themselves what Dr. Cosin is doing at Oxford. The fundamental basis on which he works is that old people's illnesses are like other diseases. They are dynamic rather than static, that an old person, whether suffering from mental or physical illness, has no need to be kept in bed continuously. If the illness is not fatal the old person will improve, and the patient should be got on his feet and rehabilitated in a comparatively short space of time. That is the fundamental thing to realise in the matter.

Dr. Cosin has a graduated scheme spread over three or four establishments. First, in what was originally the old workhouse in Cowley Road he treats the acute cases, and here I am pleased to mention the endorsement of what my hon. Friend says, that the essential thing in old people's illnesses is early action before the household gets too hot and bothered, alarmist, and so on. It is essential for some early action to be taken. The other thing, of course, is to have an institution where a completely informal admission can be arranged without the necessity of certification whether the illness is a physical or, apparently, a mental one. The question of mental symptoms is something which can be sorted out after rather than before the person is removed to hospital.

The next thing which Dr. Cosin has is a country hostel for ambulant cases from where they can be moved on to the next stage of the journey. Finally, Dr. Cosins has taken over the former fever hospital in Oxford where the people live while they are rehabilitated into the community.

One of the interesting features about Dr. Cosin's scheme is that there is a nissen but where these people, though allegedly in hospital, are, in fact, costing only £2 a week to keep. An old lady has to be very ill indeed to be unable to pour out a cup of tea. All that is necessary for people at that stage is to supply them with their rations and let them get on with it. Of course they can look after themselves in these circumstances as a final stage before being completely rehabilitated into the community. That is frequently a difficult matter, but it is relieved by having a day hospital where they can be parked for two or three days a week. It is by the extension of these day hospitals, as much as anything else, that the problem will be solved.

The second experiment which I have seen—it has really graduated beyond the stage of an experiment—is that of the Hill Homes in North London where Mrs. Hill has been doing excellent work among old people for many years. There is a series of these homes in the district; and recently one was started for mentally ill people. This latter project, I understand, encountered a considerable amount of opposition. It has, however, been found that even confirmed mental cases can be looked after in such circumstances with very little trouble and at a comparatively small expense.

One of the objections to the extension of local authority schemes, half-way houses, and so on, is that they will drain the hospitals of their nursing staffs. They do nothing of the kind. It has been found that a home for 30 people can be run by one trained nurse on the premises—[An HON. MEMBER: "Quite right."]—and that the rest of the service can be carried on by lay and part-time help. The argument therefore that halfway homes will drain hospitals of staff is not a valid argument. In fact, by getting people from hospitals into these homes we shall relieve the nursing situation considerably rather than make it worse.

Let me try to pinpoint this question. The fundamental cause of the evil to which I have referred—"evil" is not too strong a word to describe it—is the division of powers between local authorities and hospitals. It haunts this problem as it haunts so many problems throughout the health service. It is obvious that the local authorities have this easy way of putting their responsibilities on to the hospitals. I am using blunt words because they are needed here. It is like a rat trap; there is no easy way back, once the people are in the hospitals. This applies not only to elderly people but to others as well in mental hospitals. The hospitals cannot get the local authorities to take their full share in rehabilitation.

I would ask my right hon. Friend to address himself to this aspect of the problem of increasing the collaboration between the two authorities. They should work together on this matter in a sphere where the patients essentially need this kind of co-operation.

Mr. Mellish

Let us be fair to the local authorities. They are not allowed by law to do many of the things which the hon. Gentleman is now suggesting they ought to do. The first step is for this House of Commons to take sensible action and give authority, power and money to the local authorities to do some of the things which the hon. Gentleman has suggested. Without that, the rest of his argument is day-dreaming, pipe-dreaming. We shall not get round to it until local authorities get those powers.

Dr. Johnson

I am sorry to disagree with the hon. Gentleman. The local authorities have those powers.

Mr. Mellish

They have not.

Dr. Johnson

They have permissive powers under, I think it is, Section 20 of the National Health Service Act, to set up exactly this kind of service. I am quoting the Act from memory and I am open to correction on the exact Section. The powers are there, but they are permissive powers. It is a regrettable fact that whereas some local authorities have used those powers the majority have not, but there is no question that the powers are there if local authorities care to use them.

I have endeavoured to point out how these changes can be made without placing an extra financial load on the community. The great difficulty is that local authorities, under the provisions of the Act, have to spend money in order to save money for the hospital boards. There is no inducement for one authority to spend money merely to save it for another. We have to take a practical view of these things in appreciating this. This is why I appeal to my right hon. Friend to bend his energies to integrating not only the actual service but the finances as well. That is one of the basic essentials.

We cannot be satisfied with our welfare services at present until we have ensured that the weakest and the most defenceless members of the community are given the care which they deserve in the evening of their lives. It is for these reasons that I second the Motion.

11.55 a.m.

Mr. Frank Allaun (Salford, East)

I hope that the hon. Member for Carlisle (Dr. D. Johnson) will forgive me if I do not follow him on the aspect of the case which he developed. I want to deal with other matters. I very much regret to say that my right hon. Friend the Member for Warrington (Dr. Summerskill), who was eager to attend, is prevented from doing so by the sadden illness of her daughter. In her absence, I have been asked by Labour Members to summarise their views on a new chiropody service. The points are:

1. 1. The Government should give very serious consideration to the fact that the health of the feet is essential to the nation, and that treatment of the feet is not included in the National Health Service.
2. 2. This treatment should continue in the hospitals as a free service, but only for cases referred there by consultants.
3. 3. A national scheme should be instituted to provide a chiropody service based upon medical need, but it should be limited to cases in such categories as sepsis and infection, medical or surgical disorders which substantially affect the feet, and gross deformities.
4. 4. These cases would only be acceptable under the National Health Service if referred to the chiropodist by the general medical practitioner.
5. 5. Cases which need hospital service should be referred back by the chiropodist, with his recommendation, to the general practitioner, who will decide upon the disposal of the case.
6. 6. All cases falling within the categories in para. 3 should be enabled to have treatment on prescribed charges, the objects of the charge being to lessen the risk of abuse of the service, and consideration for public funds. People in receipt of National Assistance should be exempted from this charge.
7. 7. The central organisation of the Ministry should exercise control to ensure the orderly implementation of a chiropody service.
8. 8. The services of chiropodists in private practice should be utilised for cases which do not merit hospital treatment.
9. 9. Wherever practical, treatment should be given in a chiropodist's own surgery, and he should bear all the cost of treatment, being reimbursed partly by the patient and partly by the Government.
10. 10. The Ministry should accept responsibility only for cases which are referred to a chiropodist by a medical practitioner. Hon. Members will be glad to know that I am near the end now.
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11. 11. Patients should have the right to select their own chiropodists from an approved list which would be in the possession of the general medical practitioners.
12. 12. Should it be found that the full scheme cannot be implemented, special consideration should be given to its implementation for those in receipt of retirement pensions and National Assistance grants.

One of the most important ways of helping the old people is to defeat the modern scourge of loneliness which is eating into their lives. I wish to describe to the House a new and highly successful experiment now being undertaken in Salford which is aimed at defeating that scourge. I want first to refer to four pieces of pioneering work being undertaken by Salford to help people in a more material way. First, I want to pay my personal tribute to the devotion, thought and self-sacrifice which is being put into this work, and secondly, to express the hope that other local authorities will follow the example that has been set.

Loneliness is a curse, but when to loneliness is added poverty, it becomes a double tragedy. These old people want friends, but they also want a proper pension and, for all the friendship we can give them, they still need at least the £3 a week which the Labour Party is pledged to as a new minimum. Few of us look forward to growing old, because there are not many men or women who can grow old gracefully, but when there are added to the natural problems of old age the unnatural problems of poverty and loneliness, old age is turned into tragedy.

Secondly, there has been a striking growth in the number and activity of old people's clubs. At a time when most voluntary associations are unfortunately in decline, this is an indication of the desire of old people for companionship.

Thirdly, far greater help is required from the Government if we are successfully to do all the things which are in the minds of hon. Members this morning. One imaginative development which has taken place in Salford is the buying by the local authority of a number of big houses. Those houses have been divided into bed-sitting rooms for elderly widows, with bathrooms and cooking facilities on each floor to serve the people living on those floors. Regular visits are provided by members of the W.V.S., who are responsible for managing the homes. The rents are very low—10s. to 15s. a week—and include lighting, heating and cooking facilities. I am glad that this example by Salford is now being followed by a number of other cities.

A second example of Salford's initiative is that a bus has been converted and provided with a ramp for the entry of wheeled or invalid chairs so that old people can get in and out of the bus without difficulty. Another idea which emanates from the Corporation's Civic Welfare Department and its indefatigable director is a twenty-page booklet, written in very simple language, which tells elderly folk of all the welfare provisions which exist. It gives information about Government assistance in the form of pensions, National Insurance, National Health Service, and so on. Then it gives details of such local government services as home helps, health visitors and laundry services. Finally, it lists the voluntary clubs and associations available in the city.

This booklet is being given to the 20,000 pensioners in the city, and also to doctors, dentists, clergymen, milk rounds-men, coalmen, grocers and people who come into daily contact with old people. Thanks to the co-operation of the local officers of the Ministry of Pensions, when the first pension book is issued to an old-age pensioner on reaching pensionable age, with it is enclosed a message from the Civic Welfare Department entitled, "Are you lonely? Are you in need?" That contains a prepaid postcard which an old person can post to the department asking for the booklet so that all of them may be aware of facilities which exist. In addition to the 20,000 who originally received the booklet, no fewer than 600 of those postcards have been sent to the department in the last eighteen months.

Yet another achievement in Salford is the first complete survey by any large local authority in the country of all old-age pensioners in its area. One result has been the building up of a complete register of pensioners living alone. Following that, it has been arranged that those living alone shall be visited at least once every six weeks. For the other pensioners, there is a visit once every six months. The blind, the deaf and the crippled have been placed on special registers for those categories. In making this survey, some striking cases of old people who needed help were brought to light. For instance, we—I should say they, for I am not claiming any part of this but am paying tribute to those who did the work—came across old people living on their pensions who did not know that there was such a thing as National Assistance and that they were entitled to receive it. In other cases, such help was given as the provision of a handrail to very steep stairs in small houses and also facilities for chiropody treatment.

Most clearly of all, this survey reveals the terrible poverty which exists. We hear a lot of nonsense about workers being pampered by the Welfare State. If we go into the back streets of our towns and cities, we find that the Welfare State has a mighty long way to go yet. Some of the pages in this survey make pitiful reading. For instance, there is the case of a 78-year old widower whose budget included 2s. for meat once weekly, a 69-year old widower saving up for a new bucket costing 6s. 9d., and a 74-year old pensioner who has 18s. 3d. a week left for food after paying his rent and for coal, heating and other necessities.

Lastly, I come to what I consider the biggest achievement of all. It tells the story of a whole community trying to help the poor and needy. There has been set up what is called a companionship circle for the elderly. It involves the local offices of Government Departments, the local authority and voluntary associations—37 voluntary associations and 27 old people's clubs. That body can now provide 4,000 volunteers who visit people in their own homes, particularly those living alone. The names and addresses of the old people are supplied by the Corporation's Civic Welfare Department. The visitors come from nursing, trade union, co-operative, religious, women's and similar organisations. In addition, even the senior children from the secondary schools are volunteering to help.

I would like to give the House one or two examples of the kind of assistance and service provided by this new set-up. For instance, last Christmas first-class concerts were provided with refreshment for 5,000 elderly people. A boon to the old folk has been the provision by this circle of large numbers of reconditioned wireless sets to men and women who could not afford to buy them. That has gone some way to relieve the weariness of life on one's own. Free car transport has been provided for the aged and infirm to enable them to enjoy a few weeks' holiday with relatives and subsequently to return to their own homes. Pen friendships have been arranged between elderly people and children still at school. A striking case is that of young people going to the homes of old people to read to them.

A chiropodist service has been started at three convenient centres, also a mobile chiropody service. This is completely free of charge to those on pension or National Assistance. Then there is the service known as meals-on-wheels whereby a hot meal is provided for 10d., which is half the total real cost. Special arrangements have been made for over 800 pensioners to attend the first night of local dramatic presentations either free of charge or at a charge of 1s. Young volunteers have been pushing old people out in wheel chairs who have not perhaps for years at a time been outside their own front doors. There has been regular bathing for home-bound pensioners who are frail but not ill or otherwise entitled to such service. Gifts have been provided of such things as hot water bottles, walking sticks, clothes, bedding, and so on. Pensioners have had a holiday, which is something many have not had for years. It is planned to build a holiday home probably at Southport or somewhere on the coast.

This summer the circle ran a carnival at which 60,000 Salfordians lined the streets as the procession went by. They heard Dave King and other artists, and the proceeds went to help build the home. Another example is members of a trade union branch rolling up at an old couple's home to decorate the house from top to bottom because they were incapable of doing it themselves, for monetary or other reasons.

It may be asked why Salford has been go-ahead in this direction. First, it is partly due to the fact that the need is very great, and secondly, because the members of the council involved in doing this are working men who themselves live in the back streets and who know the needs of the poor and the old. For instance, the chairman of the Civic Welfare Department is a docker. Thirdly, we have an extremely able and thoughtful man, Mr. James Roberts, as our Director of the Civic Welfare Department.

I would like to conclude by saying that this kind of activity illustrates the theme of the tremendous French film now showing in London entitled "He Who Must Die"—that when the needs of men and women are so biting, quite ordinary people acquire greatness in satisfying those needs.

12.16 p.m.

Mr. R. J. Mellish (Bermondsey)

The problem which has been discussed by the hon. Member for Canterbury (Mr. L. Thomas) is one that interests most of us in the House. We congratulate him on his luck in the Ballot, and we owe him a great debt for submitting such an excellent Motion. The Minister will welcome the opportunity of replying to the debate. I am sure he will agree that there are justifiable criticisms to be made of the present set-up.

You quite rightly said, Mr. Speaker, that our Amendment was out of order because we wanted to call attention to the national position. We wanted to go into the heart of the problem and to see what the causes were. If we on this side of the House are dissatisfied with the reply we receive from the Minister, we can still divide the House on the Motion. That would be no reflection on the hon. Member for Canterbury nor upon the Motion he moved.

The hon. Member for Carlisle (Dr. D. Johnson), who seconded the Motion, referred to the large number of old people who are being certified and placed in mental hospitals. I interrupted him because it terrified me to think that it might go out from the House that generally when a person became aged and, if I may use the word, senile he was automatically put into a mental home. I can speak only from my own knowledge, but the statement which the hon. Member made is not true. I am not suggesting that there are not patients in mental homes who ought not to be there. I can understand that and concede it. I am not an expert and I do not know the facts of this matter. Probably one of the biggest problems facing us—I understand the hon. Member for Erith and Crayford (Mr. Dodds) wants to speak about it—is that many old people in mental homes who ought not to be there cannot be discharged because there is no place for them to go. This is one of the fundamental problems that we want the Minister to discuss.

It is no good talking about day hospitals and similar provision for old folk if money is not provided for the purpose. Purely in a lay capacity, I have been associated with the hospital world since 1948. If I make what appears to be a constituency speech, it is only because I call on local experience to help my argument. I cannot hope to compete with my hon. Friend the Member for Salford, East (Mr. Frank Allaun) who talked at great length about the city he represents. He talked about a city which has powers which my local authority does not possess.

The population of my constituency in 1939 was 120,000. Today the population is 62,000. The other half has gone mainly as a result of the war, during which nearly one-third of my constituency was destroyed. There has been a great deal of rehousing which has affected the young folk. I represent a constituency in which the problem of aged people is larger than in most others. One person in five in my constituency is over the age of 65, and it is difficult to deal with many of their needs.

I had a problem in my constituency a few years ago. I was asked to attend a meeting of spinsters. I went to the meeting wondering what sort of meeting it would be. I had not been there very long when I found that there was a very tragic problem in my constituency, because Bermondsey is a place where we have employed women labour for many years. Some of the largest firms in the country, with famous names, which I will not mention, are in my constituency, and for many years they have employed female labour.

In the old days Bermondsey attracted many women into the area for this work. In the 1914–18 war, which we have all forgotten, the country lost over a million men. Many women lost their future husbands or at least possible husbands. In addition, there is always the case of the one person in the family who stayed behind to look after an aged mother or father while the remaining brothers and sisters married and left the one spinster behind. In my constituency we have an enormous problem of elderly women living on their own, with no families and very few relatives. To hear about the plight of these people and the conditions in which many of them are living today is heartbreaking.

I think I ought to put on record that these people have had the worst of life. They worked in factories when 60 hours a week was common, when wages were disgracefully bad and full employment was only a dream. The vicious employment conditions in an area such as Bermondsey have left behind scars which can never be healed. We have an overwhelming problem in trying to deal with our aged population.

May I say a few words about what we are trying to do through the hospitals? When the National Health Service came into effect in 1948 we inherited St. Olave's Hospital, which is a very old hospital, part dating back to 1730. Of course, parts of that hospital ought to have been pulled down a long time ago. That was the major hospital. In addition, we inherited another place in New Cross which had been an old fever hospital but where, in 1948, not a single ward was open. The local hospital management committee has built up the New Cross Hospital to the best of its ability and extended St. Olave's, but the maintenance problem is enormous.

One of the biggest problems was to deal with the chronic sick in an area where one in five was over the age of 65 and where many became sick through lack of attention. The hospital committee decided to make this task a first priority and to devote as much resources as possible to providing hospital beds for these old people. The more we try, the bigger the problem becomes. I cannot describe the frustration which we have encountered. Five years ago we allocated 120 beds to this purpose and at that time we had, in addition, a waiting list of 57. In other words, after they had been medically checked and rechecked, there were 57 cases which ought to have been taken into the hospital at that moment.

That in itself created a problem, because the nursing of these beds in a general hospital is not an easy matter. The last thing I want to do is to make any criticisms about this, but I want to bring out some facts. To ask a fully trained nurse to spend nearly all her time looking after these very aged people is to ask a great deal. It is not fair to a young nurse. It is the most difficult job, I believe, in the nursing profession. Speaking as a layman, I think that looking after old people who, in the main, cannot even get out of bed is the hardest task in the profession. It is an appalling problem and we have had to consider tremendous staffing difficulties. Nevertheless, that was the situation five years ago; 120 beds were available and there was a waiting list of 57.

We tried to do what we could. We have increased the number of beds available to 235, but in spite of this, at this very moment we have 84 cases on the waiting list of old people in the constituency, in the main living alone, who ought to be in hospital but whom we cannot take. I am thoroughly ashamed of the fact. I have seen some of these people and it is an appalling situation.

May I emphasise some of our other problems in trying to co-ordinate with other people? We have had our own survey within the constituency, which is a small borough in London. At the moment we have 640 old people who are home-bound and cannot go out at all. It is no good hon. Members talking to me about Darby and Joan clubs in this respect, because these people cannot get outside their houses at all. Most of them ought to have almost hourly attention. Many of them are without relatives and have to rely upon what voluntary services can be provided for them.

Within their limits, the local authorities do a magnificent job with home helps, but we are very short of home helps because we cannot get enough people to undertake this kind of work. As a result, these old people who should be visited every day are in fact being visited only two or three times a week. The doctors cannot be there all the time; they can be available only when they are called. We have a first-class mission in the constituency, the Bermondsey Medical Mission, and without it I do not know how we should manage to look after these old people, but the mission can do no more than it does at the moment with the limited staff available.

In my view, the local authority would be the key and the answer to the problem if it were given the power to do the sort of job which I visualise. Compliments have been paid to the voluntary workers, but I am bound to say that to a large extent we must ignore the voluntary workers because by and large their day has passed. We shall not get the work for the old people done on a continuing basis unless we pay for it.

Mr. Somerville Hastings (Barking)

And pay well.

Mr. Mellish

If we think that we shall get volunteers to go round a constituency such as mine day in and day out to deal with this sort of problem, we make a big mistake. We shall not get them. It may be a sad thing to say, but it is a fact. We must have a trained and properly paid staff.

In the kind of set-up which I visualise, the town hall ought to be the hub of the activity for the old people. What is the position at the moment? Local authorities have to use all sorts of devious ways in order to do anything at all for the old people. They have to establish a committee outside the auspices of the local authority called the Council of Social Welfare. They can donate money to that committee for that committee to do a certain job, but it is not a statutory body. Let us consider the meals on wheels service. My hon. Friend the Member for Salford, East lightly touched on this. I should like to ask him a straight question. Does every old person in Salford get a meal from the meals on wheels service?

Mr. Allaun

No. Very few.

Mr. Mellish

The fact is that in nearly every constituency we are very lucky if a small number of old people can be provided with a meal on five days a week. There seems to be some theory that they do not eat on Saturdays and Sundays. The fact is that if we are to run an efficient meals on wheels service it needs to be run by the local authority with suitable vans in which to run it and a well-paid full-time staff to do the job on a day-to-day basis.

The whole project needs to be nationally controlled. Local authorities cannot do it properly in the piecemeal way in which it is done at the moment. Suppose a local authority provided the van and the driver for the service. As the law stands, the authority would get into serious trouble with the auditors. Indeed, it would not be allowed to do it. There would be a shocking row. The authority would be going beyond its powers. It would have to make donations to this body outside the council in order for it to look after these old people.

Local authorities are restricted again and again by existing legislation. There is no party politics about this argument; Conservative councils are in the same position as Socialist councils. I ask that that we be given more power to do locally what we want to do for the old people. We ought to be doing a much bigger job for the rehabilitation of old people, but because of lack of finance not much of that work is going on.

My constituency is largely a poor constituency. The incomes of the people whom I represent are very low. Already their rates are appallingly high. There is no room for the local authority to manoeuvre. Time and again I have said to my local authority, "Why do you not do this work?", referring to some work which it seemed to be natural for the authority to do; and in reply it has posed the question to me, "How can we do it? Where can we get the money?" If we continue with high interest rates for house building and so on, then a terribly difficult problem will continue to remain unresolved.

The real answer for old people rests at the door of the Government. They should give power to deal with the problem nationally and not merely have a survey to find out what the problems are or what follows from that. The Motion calls upon …those responsible authorities who are not doing so to implement the Minister's advice. That is impudent. Many local authorities want to do many more things than are contained in the survey, but they do not have the necessary resources. How does the Minister propose to help? That is the sort of question which we want answered today.

Some hon. Members have referred to local efforts being made in their own constituencies, and I want to refer to one which has shown great imagination in my constituency. We have a man who recently discharged himself from the Army, a man named Cargomm, who has had some publicity and who came to my constituency to start a scheme of buying one or two old houses, settling some old people in them and getting housekeepers to look after them.

When he first started the scheme, some of us were very interested and went to see whether he could be backed up in any way. Of course, he immediately ran into financial problems, particularly with pay for the housekeepers. He started from the basis that a housekeeper would be a good person doing a good job of work, but that sort of principle cannot last and he had to pay housekeepers reasonable rates. Fortunately, in this case the Assistance Board supported Major Cargomm's efforts with remarkable success, and today he has live or six houses of this sort in my constituency. That is the sort of scheme which should be taken over by local authorities who should be able to provide the money. However, what happens is that local authorities find that they cannot get the money. How does the Minister propose to help?

It costs £17 a week to look after an old person in one of our hospitals. Is there any other way to deal with such people? We are not in a position to find the capital to build a first-class geriatric unit and to take such people out of hospital, but such a unit would be a great help to the old people themselves and to those who want to visit them and would be much preferable to a general hospital with all the problems associated with it.

In the sort of area which I represent we have the land available. I have asked for money, but I have been told that I cannot have it, that it is quite impossible to provide it. All we can hope to do is to maintain the present position and continue to use a general hospital for the old people. It is no good saying that we ought to introduce a rehabilitation scheme and try to get the old people up and then let them go home. Most of them are over 80 years of age and are infirm and feeble. We cannot get them out of bed, far from getting them home.

The whole problem of the aged and the sick in hospitals should be taken out of the hospital service. Special units should be designed for them with people to help them and money should be given to regional boards for the purpose. In the long run, the capital which would be spent would be saved as a result of lower maintenance costs. We should not need a fully-trained staff, provided we had a sister in charge of the ward and medical attention available if required. The nursing could be undertaken by assistant nurses, or by people who came in to help.

If we used some imagination and saw this as a dynamic and national problem which we had to face now, we could ensure that local authorities were given the resources to deal with it and that they were given the statutory rights to deal with it so that they were not held up by legal questions. I should like people to be invited, "Vote Labour because we do more for old people than the Tories do", or, "Vote Tory because we do more for old people than Labour does". I should like to see an election fought on those lines with each party saying that it would provide better facilities for the old people.

I am ashamed to see authority after authority with only limited means having to try to do its best for old people. Without getting too emotional about it, I would point out that these are the people who have suffered two world wars and the sort of poverty which I experienced even in my young days. I have seen these people blindly groping their way through poverty to get a decent standard of living and now they have come near the end of their lives they see others getting a better standard of living, but once again they have the worst end of the stick, once again they are hard up, once again they have to suffer. Not once in their lifetime will they have had first-class standards, and yet all we have had from the Government is a survey to show what facilities are available. I am not so much concerned with old people who can get up and go out and who can join Darby and Joan clubs. I am more worried about those who cannot get out.

There are some things which nauseate me. This week the Minister of Housing and Local Government sent a circular to all local authorities—my local authority has received its copy—saying that next year many old people will probably be evicted under the Rent Act which the Minister himself introduced. In the circular he asks local authorities to show some humanity and to rehouse these people. Was there ever such impudence? The Minister introduced a Measure which will result in many of these old people being thrown on the streets and then he has to tell local authorities to be humane and rehouse them. Let us get our principles right. It is deplorable that the Government should have done this. If they are so concerned and worried about old people, why did not they exempt them from the provisions of the Rent Act? The Government should consider some of the problems which the Rent Act is creating in my constituency.

Little imagination is shown in approaches to this problem. Flats are often suggested as a solution, but flats for old people are a curse. Once one begins to put people into flats, one begins to break up families and there is no doubt that the community spirit which used to exist has now gone. We need special accommodation for old folk at cheap and subsidised rents. They should be given priority and local authorities should be given the money to enable them to put those priorities into effect.

I have referred to decent housing and to home helps where the shortage can be overcome by paying more money. Home helps are an integral part of local authority work and are doing a magnificent job. I have said that we want legislation to enable borough councils to undertake the meals on wheels service themselves instead of having to go through legal gymnastics to be able to provide that sort of service.

What about a supplementary diet? We used to do something about that and we used to worry about children. We have stopped that now. We have cut out cod liver oil and orange juice because of expense. I wish that we would get our priorities right. What about the old people? Is it not possible for us, the greatest nation in the world, to find ways and means to avoid malnutrition in old people? I should like to see a supplementary diet given free to old people in need of it. The manner in which many old people live is terrifying. They frequently have a diet of bread and margarine and cups of tea. We have heard about 2s. for meat, but I know of some old people who do not even get that. We have heard all the stuff and nonsense about spending the money in "pubs", but the publicans in my constituency rarely see old people in their premises.

I want to refer to welfare assistants. They do a great job of work, but they are regulated by certain restrictions. They are controlled by the county council, but they ought to be controlled by the local authority. Too frequently the work which welfare assistants could do is frustrated by legal restrictions—things cannot be done because the case does not fit into the right category in the terms of reference of the welfare service.

We want an end of this jungle of legal restrictions and of this ridiculous distinction between county authorities and local authorities. That jungle should be cleared away by giving local authorities the power to deal at local level with these cases. My own local authority knows far more about its own problems than does the London County Council. I do not deny that the London County Council does a good job of work, but it is remote.

The L.C.C. does good work with its Part III accommodation and it would do the Minister good to visit the famous Ladywell Lodge. I warn the right hon. Gentleman that if he goes there he will come out very upset. It is the sort of place where about half the inmates are children who have been abandoned by their parents or who are illegitimate, and the other half are elderly people waiting to die. If the right hon. Gentleman is not thoroughly unhappy by the time he comes out, there must be something wrong with him.

The L.C.C. has done all it can within the limits, and I pay tribute to the L.C.C.; but the problem is too big. I do not know how many hundreds of old people are there. All the beds are crowded together. If a married couple is living there, the man has to live in a different part of the building from the woman, and they meet only at meal times. We need a much smaller and more intimate place, but to do that we need money and imagination from the present Government. We are not likely to get either. We are merely going through the motions of debating the problem. We need the sort of legislation which will allow the local authorities to do a first-class job.

My constituency gets into the news because of two young men who have achieved fame—Mr. Bygraves and Mr. Steele. I am sick to death of reading about the pair of them. Of course, I wish them well, but there are much more important matters in Bermondsey. One in every five of the people there is in trouble. Some people are trying to help them. Voluntary workers are running clubs within their limited means, and local authorities are also trying to help, but the problem is a vast one. The problem cannot be solved only by voluntary help. The job can be done if we can get the cash, but every reason is given why we should not have the money.

If imagination could be shown, for example, in the use of hospital beds, and in the contribution which local authorities could make, the country would be paid a great dividend in the future. In any case, we have a debt which we must repay to these old people, and I am delighted to know that the House of Commons is for once in a while discussing this problem.

12.43 p.m.

Mr. Somerville Hastings (Barking)

It is gratifying when this House turns its attention to the health and other needs of special classes of the population, and it is especially desirable when we have a new Minister of Health whose mind is, as we hope, open to suggestion and who is good enough to come here personally and listen to the views of the House on matters which concern him.

The first thing I want to say to the right hon. Gentleman is that he really must do more for the foot needs of the old people. Figures show that of old people generally, and particularly those over 60 years of age, some 70 per cent. have something wrong with their feet which needs treatment, and of those who are living alone the percentage is 90 per cent. or even higher. I will deal with the latter figure in a little more detail later.

First I should like to deal with the problem from the medical standpoint. It is inevitable that old people should have foot troubles, for two reasons. First, with old age, the epithelial structures—skin, nails and so on—tend to hypertrophy. I have seen the toe nails of old men and women thickened and curved like horns and growing into the skin as the dewclaws of dogs sometimes do.

There is another reason. People over 55 years of age generally take to glasses. As they get older, the glasses have to be strengthened, and that means not only that the glasses have to be more powerful but that whatever they are looking at has to be brought nearer. These poor old people very often have a certain amount of arthritis. Their joints are stiff and, much as they would like to look after their own foot troubles, they cannot do so. If there are two of them living together they can help one another, but as many as 90 per cent. of people living alone have foot troubles.

I appeal to the Minister to do something to help these old people, so many of whom have to be looked after in institutions in fact because of foot troubles which prevent them from getting out to buy their own food and looking after themselves when they are living alone.

The other class to which I wish to call the Minister's attention in particular is that of the young chronic sick. Fortunately, there are not many young people with disseminated sclerosis, progressive muscular atrophy and other nervous diseases. But there are others with chronic arthritis and some who have suffered from poliomyelitis. It is the cruellest thing possible to put these people in wards where they have to spend their lives with old incontinent people, many of whom are dying and who have ceased to take any interest in their surroundings. Many of these young people live for many years; in many cases their mental condition is not impaired and they therefore want to take an interest in their surroundings.

In the case of the young chronic sick I suggest that the psychological needs are all-important. They want to feel wanted. They want to feel of some use in the world, and for that reason, if they can do some useful work, so much the better. But a time may come when they have to be taken into an institution, as a rule some form of hospital, because they have special needs which have to be cared for and which cannot be dealt with efficiently in an institution.

There are three possibilities. They can be dealt with in the ordinary acute wards of a hospital, but this is expensive, and in such wards there are constant changes as people get well and go out and others come in. I do not think the psychological atmosphere is particularly good for the chronic sick. Alternatively, they can be dealt with in some form of convalescent institution. A few weeks ago I went to Queen Mary's Hospital, Sidcup. This is now a general hospital. When I was Chairman of the Hospitals and Medical Services Committee of the London County Council I visited that hospital pretty often. We had convalescent wards mostly for young people, and we also had wards for early and non-infectious cases of tuberculosis, which we called pleural-effusion wards. There we took in a certain number of these young chronic sick people. They were able to take part in the activities of the hospital, and were treated rather differently from the other patients. They were very happy and comfortable there, for the other occupants of the wards soon appreciated the true position.

The third method is small wards for the young chronic sick in hospital. Probably this is the best method, because it may be possible for the patients to be near their homes. It is very important for the mental condition of these young chronic sick that they should be able to keep in touch with their homes and with the world outside, and if they have no friends that kindly people should visit them.

In certain hospitals they have these small wards, which are very useful for several chronic sick patients, and where, I think, they are best cared for. In some areas the very valuable system is adopted that where patients remain in hospital for year after year they have a sort of annual holiday. If they are well enough and have homes they go home, which is a good thing. Otherwise, they are sent to a nursing home or some other institution, perhaps by the seaside, for a few weeks in the year. At any rate, it gives them a change and keeps them in contact with the world at large.

I want to speak next about a subject which was introduced by the hon. Member for Canterbury (Mr. L. Thomas), in opening this discussion, and to ask the Minister what he is now doing for the chronic sick in welfare institutions and in hospitals to which reference is made in Circular 14/57. That circular deals with three classes of people who can best be looked after in welfare homes, and three classes of people who are best attended to in hospital. I have no objection generally to that. There are, however, two points which I should like to stress, particularly as regards those in welfare institutions. The circular says: Care of those elderly persons in a welfare home who have to take to bed and are not expected to live more than a few weeks… As a doctor, I know that it is very difficult to say which persons are not likely to live more than a few weeks. In many cases, particularly among old people, when they go into these welfare homes they are suffering, particularly if they have been living alone, from inevitable neglect. They have often been unable to get proper food for themselves and to look after themselves as they should. Some of these people recover unexpectedly. In any case, we doctors have learned to be very slow to say that a person is not likely to recover because, if he does, he is sure to hear of what has been said and both he and his friends will regard the doctor who said it as a mortal enemy for the rest of their lives.

The Minister's classification of patients would be all very well if they were static: but they change. Old people in a welfare home are liable to get sick. I know that the Minister says in this circular that the welfare homes should have some nurses available and that it would be a good thing if geriatric physicians, who look after geriatric cases in hospital, were also to attend these cases in the welfare homes.

I suggest to the Minister that this must be extended. I know of a great many cases of old people who get ill, in a welfare home or elsewhere, where they cannot be treated and must be removed to hospital for first-class treatment. There are others who could be treated at home, if the services were provided. I know that legislation may be necessary, but I feel that somehow the Minister should arrange that hospital services should be available to those old people in the welfare homes; indeed, I suggest to him further that we shall not get a proper liaison, which I know he wishes for and hopes for in this circular which he has recently issued, until we have a single health authority which deals with welfare as well.

I want to say a few words about hospital facilities for the chronic sick. Perhaps I am better able to speak on this subject, because I have had much more experience of it. For years I was Chairman of the Hammersmith Group Teaching Hospital. There we got many applications for the admission of old people who were thought to need hospital treatment. The acute cases we had, of course, to take in at once, but where the cases were less acute we adopted this system, which has been adopted elsewhere, that a geriatric physician or a geriatric registrar would go and see the patient with his general practitioner in the patient's home. He could then assess the patient's need and also assess it against the availability of beds in hospitals. He very often took with him one of the almoners, or some other social worker, so that if the patient could not be admitted to hospital at once something could he done meanwhile, and indeed in some cases it was found possible to provide what was necessary for the patient in his home—bringing the hospital to him without taking him into the hospital at all.

I feel very strongly that when an old patient has to go into hospital he should be admitted as a general rule first into one of the general wards and not into the geriatric ward. He can then be tested and examined carefully. If the patient is a medical case, he goes into the medical ward, and if a surgical case into the surgical ward. If it is a neurological case, as many of these cases are, he can go into the neurological ward, and then his needs can be assessed. Only after they have been determined should he be removed to what is often called the recovery ward or rehabilitation ward under the special care of the geriatric specialist. There can be given the special treatment for completing the recovery of old people after their stay in hospital. These wards have special facilities. There has to be physiotherapy and the patients have to be kept occupied, so occupational therapy may also be needed. The wards must have non-slippery floors and handrails to help the patients and special facilities for bathing and for lavatory accommodation.

I believe that the geriatric physician is a real specialist who can best look after these people. In many cases, after treatment in the recovery wards, even the chronic sick are able to return to their homes and to their ordinary conditions of life. Unfortunately, there are some who cannot, and so there have to be long-stay annexes in which people spend the remaining years of their life and from which they rarely return to normal conditions.

I have seen many long-stay annexes. The best I have seen was in Hackney Hospital, and I saw it before the appointed day. There the old people were happy and splendidly looked after. Except for the sister in charge, all those attending the old people were assistant nurses. It is very important to keep student nurses out of long-stay annexes. Otherwise they practise upon the old patients all the nonsense that they have had to learn to get through their examinations. A student nurse will make the bed by turning up the bottom of the upper sheet. This means that the patient's feet come into contact with the blanket and catch on the lower sheet when he moves. The student nurse will turn the bedclothes down to about the middle of the patient and then tuck them in so firmly that the patient is unable to move.

I am talking about something that I know, because I was in hospital last February. I was in for only a few days, however, and, fortunately, I was not very ill and was strong enough to be able to loosen the bedclothes after the interference with the bed had taken place. Thus, I was not held fast and was able to pull up the clothes to make myself comfortable again. This is a digression, but I would emphasise that it is essential to keep the old people in the long-stay annexes happy and comfortable. They should not be used as models upon which student nurses can practise what is called their "art".

There were many more things that I should have liked to say. However, I will conclude by saying that, in my humble opinion, we shall not get the service for the old people and chronic sick that I want, and which I believe the Minister wants, until we have a unified Health Service embracing all branches and including the welfare service as well.

1.4 p.m.

Mr. J. A. Leavey (Heywood and Royton)

I apologise that I was unable to be present at the beginning of the debate. I am conscious that hon. Members are anxious to hear my right hon. Friend the Minister of Health; therefore, I shall occupy the time of the House for only a few moments.

I wish to follow what was said by the hon. Member for Barking (Mr. Hastings) in his concluding remarks, and then make a plea to my right hon. Friend on the same lines. I am satisfied that, as a people, we have become aware of a growing responsibility to the elderly. We are an ageing nation, and, in a sense, we are also a "nervy" nation. When young men and women reach the age at which they will start to benefit from their education and make a constructive and productive contribution to the wealth of the nation, they will be faced not only with potential family responsibilities and moral obligations to sustain their elderly kith and kin but, as the years roll by, with the moral and material responsibility of sustaining the elderly kith and kin of others. To put it colloquially, our young people in the years ahead will have to face the problems of looking after not only granny but half somebody else's granny.

In taking up what the hon. Member for Barking said in his concluding remarks, which I support in general terms, I feel it is vital that we should, as far as possible in co-operation, face the problem of meeting not only the material needs of old age but the more nebulous needs to which he referred. My right hon. Friend the Minister of Pensions and National Insurance told us recently that in his Ministry there was a continuing study of the problem of old age. I am sure that we are all aware, from our personal experiences in our private lives and our public lives, of the unhappy coincidence of old age with doubtful health and loneliness.

While it may be the responsibility of my right hon. Friend, within certain limits, to see what can be done in the context of this debate to meet the needs of ailing old folk, and while it may in another sphere be the responsibility of my right hon. Friend the Minister of Pensions and National Insurance to lead the nation in meeting its material obligations, I would plead that in both spheres we might have the humanity to which reference has been made in earlier speeches.

Something more is needed than the facilities—they are, perhaps, not adequate today, but they are improving all the time—provided by the hospital service. I think we shall quarrel in the House for many years about pensions and that aspect of our responsibilities to the elderly. Sometimes I wonder whether realistically we can ever expect that pensions will be adequate judged by the standards that all of us would like to see. Whether we master the problems of inflation or not, I wonder whether the word "enough" is ever applicable in that context.

However, whatever may be the difficulties and problems, I hope that my right hon. Friend, in meeting his many heavy responsibilities in this matter, will see fit to co-operate, so far as he can, with the Ministry of Pensions and National Insurance and bear in mind the added, and almost more difficult, responsibility in respect of the humanities of the service as distinct from the more practical matters which are the subject of this debate. If only that obligation can be realised throughout the nation and we can combine these two needs, I believe we shall feel that the problem, which we as a nation of old people cannot sidestep, will be one about which we need not have any sense of shame in the years ahead. It is on that basis that I have sought to intervene in the debate.

1.10 p.m.

Mr. Maurice Orbach (Willesden, East)

I make no political point here, but it is interesting, and germane to the arguments that I shall advance, that from the hon. Member for Heywood and Royton (Mr. Leavey) we have just had the first speech from the opposite side of the House from someone who did not necessarily have to be here. I make that point because I want to draw attention to this very grave national problem, and to place it, as I believe it should be placed, in its right perspective.

In the 'twenties and 'thirties we were judged by our attitude to the grave social and economic problems created by unemployment. Today, we are being judged by our attitude to a host of problems that have arisen as a result of a distortion of values, one of which is the problem that we are discussing now. We pride ourselves on the achievements of our scientists, and ask them for more. We ourselves enjoy a never-ending stream of comforts made available in this new machine age.

Some of us look with some satisfaction on the orderliness of the Welfare State. If we have any philosophy at all, it is that we judge the grimness of the past by the horizons open to our children in the future. One of the happiest things that we very frequently do in this House is to call attention to the health of Britain's children. We are on common ground in proclaiming the activities of politicians and Parliament in regard to what has been accomplished in the past few years by medical science and clinical experimentation in defeating those illnesses of childhood which for so many years had marred adult life.

The provision of full employment served to fill the larders. It provided children with warm or suitable clothing and, since the end of the last war until recently, successive Governments recognised that cod liver oil, orange juice, maternity benefits, children's allowances and good schools all had a part to play in making the nation of today and tomorrow healthier than it was yesterday.

I am always thrilled when I hear that, because of a lack of patients, another children's hospital has been closed. I was very happy some five years ago to be able to close a children's hospital in my own district which had been built and cared for by the loving devotion of two elderly ladies, and to transform it into a hospital for what we call geriatrics. Ask nine people out of ten what that word means and they will say that they do not know. I wonder whether it is that we use a scientific term in order to hide what I think is a disgrace to the nation.

The closing of children's hospitals has been happening all over the country. Despite the immediate cost of all the necessary services that I have enumerated, we had the courage to approach nationally the problem of our children. Of course, some of us today are not very disturbed about the angry young men who make a good deal of noise, but it will be to our lasting discredit if we refuse to acknowledge the challenge of the hopeless old men and the lonely old women whose wretchedness is the shame of our society.

I doubt whether we can even begin to think of what should be done to deal with this problem in which millions are concerned, until we know more about it. Hundreds of thousands of those concerned will never know, because of their poverty and consequent inability to buy a newspaper or to listen to a radio, that this debate, which we hope will affect their future, is taking place today.

When the Minister addresses the House, he will no doubt give a series of statistics. He will tell us about the number of beds available, the homes being opened, the clubs, the societies and all the services that are established. We shall be—or so he thinks—blinded by statistics; but for the geriatric, the old and the sick there will not even be a soporific. This problem will not be solved by mere statistical abstractions. It is a great human problem. Hon. Members have already spoken of the dreadful individual cases that have come to their attention, but I should like to spend my time in attempting to give answers—which I do not say are correct—to those questions left unanswered by the Boucher Report, and to assess some of the theories therein propounded.

I join with the mover of the Motion, the hon. Member for Canterbury (Mr. L. Thomas), whom I congratulate on his speech, in saying that the first essential is to ascertain the number of old, sick people in each particular local authority catchment area. I have in mind the last report of the medical officer for health for my own district. He described one illuminating case. It was that of a woman of 78 living in a house containing seven rooms, a scullery and a bathroom—and living there alone. She was found to be living like that—dressed in filthy, ragged clothes, her face and arms grimy, surrounded by dirty crockery, pots and pans, and food in various stages of decay—only because someone in the local authority had the imagination to realise that the house was distinguishable from others because of its neglected state and the collection of dirty milk bottles in the porch. Otherwise, no one would have known that she was there—no one cared that she was there. What we have first to find out is not what services are available but what the problem is. Having found out that, it is easy to see whether the available services need adapting or changing in a great number of respects. I want to deal with this question not primarily from the point of view of the geriatric but from that of preventing people becoming geriatrics. I want to devote the major portion of my time now to dealing with the question of those who, at the moment, may become claimants for hospital beds. We are fully aware that hospitals are already bogged down, not only with the cases they already have but with the claims upon them.

In my own group there are two geriatric hospitals and a number of wards in other hospitals devoted to these people. In the hospital that was converted from a children's hospital to a geriatric unit with 39 female patients, one of whom is aged 106, the average age is 91. Not one of those patients can be expected to benefit from the skilled geriatric care, attention and equipment which the hospital management committee has provided. They are, in fact, only in a three-quarters home, awaiting the time when they will be carried out.

I want, therefore, to devote my time not to the dreadful long waiting lists or to the hospitals which are not hospitalising today, but to the postponement for as long as possible of the onset of infirmity and ill-health. I suggest that the question to which we have to devote ourselves is not concerned only with the physical deterioration of the individual, but that there are very grave social causes that we should examine. I hope to deal with both these factors.

As a result of my reading and study of the subject, I suggest that there are four main trends in our social pattern which produce the sense of loneliness, boredom, hopelessness and uselessness and the feeling in old people of not being wanted. The first—I hope I do not shock the House by mentioning it—is the present accepted retirement age. Some day, this matter must be closely examined.

When, in fact, is a man or a woman old and elderly? Is my hon. Friend the Member for Barking (Mr. Hastings), who today delivered one of the most interesting and illuminating addresses, to be considered old? Was the right hon. Member for Woodford (Sir W. Churchill) more feeble in the conduct of the nation's affairs at the age of 80 than is the present incumbent of the same office? Is the Father of the House, my right hon. Friend the Member for Gower (Mr. Grenfell), who is a frequent debater here or my hon. Friend the Member for the Scotland Division of Liverpool (Mr. Logan), who is a sprightly mere 84, an old man? I am reminded that my own mother-in-law is 87 and lives with two sisters, one of whom is 92 and the "baby" is 83. Every other year, she flies over from the United States to visit her daughter and goes back hale and hearty, only wishing that she had more children to see in other parts of the world.

In the Report dealing with the different services available to old people, I notice there is continued complaint that while the services are available, the manpower is not. Surely, we could solve some part of the problem of manpower if we could urge people to remain at work longer and employers to continue to employ them, if necessary on lighter work. There are, of course, real health reasons why people should remain occupied as long as they can; but I have other aspects to cover and I will not develop that theme at length.

The second factor in our modern pattern of society is the development away from overcrowded cities into satellite towns. When persons who have had their names on waiting lists and who finally find a job in a new town are invited to take residence there, they frequently leave their aged parents behind. These aged parents, without the warmth of a home with a family, going from one set of furnished rooms 'to another, generally end up in a squalid attic room. I know that something is being done in the new towns to provide old people's homes, but not enough is being done; and the running down of the housing scheme by the Minister of Housing and Local Government and the impossibility of financing housing forces me to the conclusion that the Government intend to do little to ensure that old people live with or near their relatives and friends.

The third trend is the increasing employment of married women. Even when there is a desire by the children to give care and attention to the parent who needs as much help and sympathetic understanding as a child, the married woman is too often forced to work because of the rising cost of living. I am not suggesting that we should change this by Act of Parliament, and perhaps it is a good thing that when the children are released from the home the wife should have other interests than simply shopping, cooking and sewing.

If we cannot reverse that trend, perhaps we can deal with the fourth important factor—that is, the whole housing shortage. Hon. Members hive already pointed out how the Rent Act has made life much more difficult for older people. In my constituency, not only does the town hall give advice to those hardship cases who have suffered from demands made by landlords, but we in the Labour Party have in two and a half months had 480 hardship cases brought to our attention. One person, after receiving notice to quit and being told that it was legitimate and within the confines of the Act, went home and committed suicide. Another who was given notice to quit was a woman aged 80 suffering from angina. The Minister cannot pride himself that on this occasion that the notice has been withdrawn.

I wish to turn to the question of housing the old folk and perhaps to make some suggestion to the Minister. Anybody who has studied this problem seriously will agree that it is advisable that the old folk who are to be rehoused should be rehoused in the same area as that in which they have spent their lives or, at least, with familiar surroundings, and that they should not be isolated from other members of the community, but integrated with them, so that a whole community may be formed.

Our elderly people are still independent and they are reluctant to accept many of the offers of help given to them by organisations which are well-meaning but have little understanding of the man or woman whom they are approaching. They are reluctant to accept offers of rehousing distant from their present surroundings, where they have done their marketing and where they know their neighbours, because they feel they will become a burden and troublesome to the new people, amongst whom they are alien. At the same time, one of the outrages of this century is to put up big institutions to get them away from the public gaze, where they wait day after day, listening, perhaps, to the radio, which is all that is provided for them, in an enforced idleness which creates an attitude of hopelessness and apathy.

I could not follow my hon. Friend when he started castigating blocks of flats and saying that they were not wanted anywhere. I welcome blocks of flats. The ground floors should be reserved for old people, where they can be together with their families, who are living upstairs in a separate household, but close enough to them to know them and to feel the warmth of the family.

The Minister should exhort local authorities to build blocks of flats on that basis. But what is the good of exhorting them unless the Minister provides the money and directs the workers and the materials so that the job might be done? A real sense of purpose has to be shown. In Germany, which I hate to quote as a country that we should emulate, I notice that there is an interesting experiment in the building of family houses, where there are small flatlets for the aged parents and the rest of the house is devoted to the family. There are two households under one roof where, on the demise of the aged person, there is room for the growing family. It is an idea which might be considered in this country. It continues the suggestion which I made about integration.

One of the happiest things which rather denies my story about institutions is the old people's town in Copenhagen. If the Minister or his Parliamentary Secretary has not seen it, they ought to go and look at it. It is much more interesting than the Tivoli. There in small hostels old people live in single or double rooms, not with institutional furniture, but with their own furniture. They can entertain their families and guests to a meal. They have very limited cooking facilities because one hot meal a day is provided for them. They have their own cinema, their houses of worship, their library, their laundry, shops, work-rooms and a club which is open all day long. Doctors and nurses are also available to them.

If we could empty some of our so-called welfare institutions, many of which are rather grim places, and the so-called half-way houses, and if we had some imagination and recognised the independence of those of advanced age, we should be taking a great step forward. I hope, therefore, that the Government will look at the problem from the point of view that I have stressed because these are the preventive measures which could be taken.

There is frequent reference in the Boucher Report to the absence of coordination between the services and to the lack of co-operation among those operating them. Something ought to be done about that. I hope that the Minister will take strong action to see that there is the necessary co-operation.

I now turn from the preventive to the remedial. The existing services are blocked by the unknown. I do not accept the figures given in the Report that there are enough beds for geriatrics in view of the case which I have quoted and the dozens of others which other hon. Members could quote. I believe that an increase of beds is necessary in geriatric hospitals in areas where there are considerable numbers of aged people.

Owing to the very nature of the problem, too many old people do not seek medical advice until the illness from which they are suffering is too advanced. Others are never brought to the notice of the authorities. I suggest that every local authority should create an old people's health clinic. Such a clinic would need three classifications of staff—a medical officer, a health visitor and an almoner. The clinic should not be responsible for treatment, but should just carry out general examinations. It might have, as so many hon. Members have suggested, a chiropody service. It should give advice on diet and on the general precautions to be taken to maintain health. It should refer to the local general practitioners any cases which demand investigation and treatment as, otherwise, it will become bogged down by the number of patients coming to it.

The almoner should be there to advise on social problems, and to tell the old people that there is a National Assistance Board, about the services run by the local authority, whether there is a laundry or library service and whether a meals on wheels service is provided by any charity. The health visitor ought to follow up with reasonably frequent domiciliary visits. Provided that there was wide publicity through brochures, as was suggested by one hon. Member, and in the Press as to where such a service was being carried out, I think it could prove an effective means for dealing with people who are not feeling on top of their form, but who should not be considered as geriatrics or chronic sick and whom we can prevent from becoming chronic sick and help to maintain a normal life.

To return for a moment to the Boucher Report and to the question of the number of beds, whether there are sufficient beds or not there are certainly insufficient nurses. I do not agree with all that has been said by some hon. Members about nursing staffs in geriatric wards. There is an absence of glamour and nothing very pleasant about nursing an old incontinent person. Every entrant into the nursing profession realises the heavy, exhausting and unpleasant duties that attach to the nursing of old people.

Even if we had a sufficient number of beds, I doubt whether we should attract sufficient nurses. Therefore, I suggest that we should ask or instruct local authorities, through the medical officer for health, to give lectures to men and women on the care of the aged. If the family knew exactly how to look after the aged father or mother and were told what simple nursing precautions they should take, I think it would be of some value. I have found it extremely valuable in my own constituency of Willesden.

All the suggestions which I have made would, of course, cost money, some of them a lot of money. But the cost per patient for a geriatric case in my hospitals, where I keep the cost down as much as possible, is £12 1s. 8d. and £10 12s. 3d. respectively, with an occupancy of 97 per cent. If these geriatric cases had been getting not £12 or even £10 a week, but £6 a week over the last few years I am sure that they would not have landed in the hospitals of which I am chairman.

These suggestions, of course, call for a knowledge of the facts. We must survey all the ugliness and despair which lies hidden under the surface. We must take our old people out of their isolation. People who are unable to attend to their wants degenerate from bedfastness into a state of squalor. We should try to tackle the matter as a great human problem, as a problem as important as that of the victims of the 1920s and 1930s. The children with whom we are so delighted today were a problem 20 or 30 years ago. We must instil in the old people the joy of living. This problem is a challenge to our own maturity as a nation. If we fail to tackle the problem it will be to our everlasting shame.

1.39 p.m.

Mr. A. E. Hunter (Feltham)

I am very pleased to follow my hon. Friend the Member for Willesden, East (Mr. Orbach), whom I have known for so many years. I know the great interest he takes in this subject and the great service he has rendered hospitals in Middlesex.

In the recent National Insurance debates we discussed the very human subject of elderly and sick people. In addition to pensions, sickness benefits and welfare services, which are so important to sick and old people, we are today discussing the subject from another angle. The hon. Member for Canterbury (Mr. L. Thomas) has performed a great human service in raising this matter, and I wish, briefly, to deal with three of the very important points he made.

The hon. Member referred to the question of housing for the elderly people, a matter which was also referred to by my hon. Friend the Member for Willesden, East and other hon. Members. Convalescent homes, holiday homes and meals on wheels were dealt with by the hon. Gentleman, and those three services are important to old, sick and infirm people. A great deal of work is done today by voluntary organisations in that connection, and I wish to pay tribute to the Local Council of Social Services in my own constituency. I am certain that other hon. Members could pay a similar tribute to the work done in their constituencies. We want the Minister to complete the survey, to give the local authorities powers to extend their activities and to co-operate with the Ministry of Health and Local Government in the important question of the housing of old people.

Today, there are 7 million retired people and people of retirement age. It has been estimated that that figure represents one in five of the population, and therefore housing for them is a very important matter. A balanced policy will relieve the housing situation as well as make provision for old people's dwellings. In Hounslow and Feltham, we have bungalows and flats for old people. In these are rehoused old people who may be occupying three-bedroom council houses, which makes available that accommodation for families who need it. By catering for elderly people in that way, we are also able to relieve the housing difficulties of other people.

Another welcome provision for the old people in my constituency is the David Waring Home, which was formerly a large country house. It has been divided into self-contained flats each with its own kitchen. There is a caretaker to give any help that is required. A large billiard room has been turned into a comfortable lounge and sitting room, where television is provided and the old people can enjoy a pleasant communal evening. That is the kind of thing which many hon. Members wish to see done to help the old people, and I trust that schemes like this will be extended to all parts of the country.

There is also the matter of providing S.O.S. cards for old people. That system is to be developed in Feltham and can be linked up with the voluntary organisations. The Scouts and Guides can help. Old people, especially if they are living alone and have no telephone, can make good use of S.O.S. cards. If they are in trouble, a card placed in the window will result in a visitor being sent right away by the voluntary organisations. We all know of cases where old people have died under tragic circumstances because no medical help was provided in time; and their death was discovered only because of milk bottles being left outside the door, or newspapers in the letterbox or because tradesmen could not obtain an answer to their inquiries. I do not think the provision of these cards would cost a great deal. I am certain they would be of enormous assistance to old people especially the infirm and chronic sick.

I wish to impress upon the Minister the importance of the meals on wheels service. In Feltham, voluntary organisations and other bodies have worked to raise money to provide such a service. A grant has been made by the local authority and the local Round Table has helped a good deal. Soon we hope to have a meals on wheels service in Feltham so that we may ensure that old people get hot meals on at least one day a week. In Hounslow, another part of my constituency, a meals on wheels service operates.

The hon. Member for Canterbury referred to seaside homes and holidays for the old people. Convalescent homes are provided through the National Health scheme and arrangements for old-age pensioners could be made by grants from the National Assistance Board to help pay for fares to holiday resorts. I know that a number of Darby and Joan Clubs and the Federation arrange to send old people away for holidays by the sea in May or June. Hon. Members who represent seaside towns will know that the towns are full up with visitors in July and August, but arrangements could be made to cater for the old people in June and July when there is accommodation available and the railways are not so crowded. That would help the seaside towns, and I know that the proprietors of many boarding houses in towns on the South Coast provide special terms for old-age pensioners and give them a warm welcome.

My hon. Friend the Member for Barking (Mr. Hastings) emphasised the importance of chiropody for old people. I appeal to the Minister to extend that service and, if possible, to provide clinics which old people might attend. Hon. Members, particularly those on this side of the House, have shown that they possess detailed knowledge of these questions. At least two of my hon. Friends have been or are chairmen of large hospitals so that the matter is constantly brought to their attention.

Today we have 7 million people of retirement age, and by 1980 the number will have increased to 9,500,000. That is a large proportion of the population, and therefore we must plan our services now. It is a matter which should not be left to chance. The Minister must give attention to extending the powers of local authorities and linking the work of voluntary organisations with the local authorities to ensure that this generation of old people, and the next, will have every care and consideration in the evening of their lives. 1.50 p.m.

Mr. Norman Dodds (Erith and Crayford)

I would add my congratulations to the hon. Member for Canterbury (Mr. L. Thomas) for having introduced this Motion. He has done a very good service in bringing to the attention of the House the needs of the elderly people. It was left to some of my hon. Friends to put down an Amendment pointing out the limitations of the Motion. I am pleased that has been done. I am sorry, on the other hand, that my hon. Friend the Member for Bermondsey (Mr. Mellish) is not in his place because of what I propose to say. I hope that he will read my speech.

I cannot but give credit to my hon. Friend the Member for Bermondsey as one of the greatest humanitarians in this House, but I would draw attention to his criticisms of the hon. Member for Carlisle (Dr. D. Johnson), who introduced into this debate the fact that on a very big scale under the National Health Service old people who are not insane are, because of expediency, being certified in a terrifying way and are being committed to mental institutions or hospitals because we have failed to provide other treatment or accommodation for them. The hon. Member for Carlisle was speaking of the matter in general and not as it affected one particular place, but my hon. Friend spoke of his experience in Bermondsey.

I drew the attention of my hon. Friend to the concluding words of the Amendment— national approach to this problem". That was the way the hon. Member for Carlisle approached the matter. I hope that I can make an equally useful contribution.

A few weeks ago the country was startled by the report of a mental health conference in London at which a magistrate gave an account of an incident which she deeply regretted. She said that she had been called in to certify an old lady of ninety years of age whose doctor admitted that she was not insane and was likely to live another ten years. The old lady could answer all the questions. She was, however, being looked after by a daughter of seventy, and it was vital to do something for the old lady of ninety. As is done in so many cases she was certified as insane. Within a few weeks she died. This recalls the evidence which was given before the Royal Commission on Mental Illness and Deficiency which sat for nearly four years. The evidence, based on wide experience, was that elderly people often died quickly after being admitted as insane to mental hospitals. They died of broken heart. What a blot that is on the people of this country that in 1957 we should allow that to happen. It is worse now; the tendency is for the position to get worse as the population gets older and something drastic must be done.

Speaking with a good deal of experience, my hon. Friend the Member for Willesden. East (Mr. Orbach) said that to tackle this problem we needed knowledge of the facts. We must know what is happening. It was rather a coincidence that yesterday morning I was able to be called into a case of an old lady who was to be certified. Because I got there the old lady was not certified, and I do not believe that she ever will be. There is no need for her to be. It is vital that before such a terrible step is taken old people should have the opportunity of legal opinion.

Most of this action is taken because we have not provided enough facilities for old people. My hon. Friend the Member for Bermondsey rightly said that more money was needed. It is amazing how plentiful money is for some things and how scarce it is for such great problems as the one about which I am talking, yet I always tell my hon. Friends and others who ask for more money that by itself money is not the whole of the picture. Certainly, if old people are taken into a mental home public money is spent to keep them, but I often feel that the money is not spent in the best way. A habit has grown up of taking the line of least resistance and using certification as an expedient for getting rid of a difficult problem.

In reporting about the old lady of ninety, the magistrate wound up by saying, "I now feel that I am guilty of manslaugher". If that had been an occasional case I would not have mentioned it. What appals me is the lack of knowledge of the facts, even among hon. Members. Therefore, I want to put forward evidence in this connection. I have here a copy of The Lancet, in which Dr. J. A. R. Bickford, on 29th October, 1955, said: If relieved of the burden of those old people who are at present admitted or retained for social rather than medical reasons, any mental hospital ought to be able to reduce each year, for a long time to come, the number of beds in occupation. He is the medical superintendent at a mental hospital. How much better it would be for our national health and for those who really need mental hospital treatment and could benefit by it if accommodation was not taken up by those who should not be in mental hospitals at all. I intervened in the speech of my hon. Friend the Member for Bermondsey when he was pulling up the hon. Member for Carlisle to mention that the picture at Bermondsey was not a fair one for the country as a whole, and I quoted from evidence given to the Royal Commission by the British Psychological Society of Medical Officers of Health. While I could give my own experience, I am only too well aware that that would not cut any ice.

Those who disbelieve what I say cannot challenge one piece of evidence given before the Royal Commission, where the most knowledgeable people in Britain on this aspect of the problem gave evidence. I have probably an advantage over most other hon. Members in that I took the trouble to read every line of the evidence, which is terrifying, about the expediency of certifying old people. I am therefore very pleased of having the opportunity to get on record some of the evidence. Those who say that I am overstating my case should produce their own evidence sufficient to offset it.

The Society of Medical Officers of Health makes it clear in its report that 80 per cent. of people over 65 years of age who are certified should never have been certified at all, and that only 20 per cent. of them should be in a mental hospital. It is easy to see that there are thousands—not hundreds, and I will not go as far as saying "hundreds of thousands," which is fantastic, because there are only 200,000 altogether in mental hospitals—of people who have been wrongfully certified and are now passing the remainder of their days in mental institutions.

Another thing that is ignored is the effect upon their sons, daughters and grandchildren. With many insurance companies the fact of insanity in the family prevents business being done. Many Government Departments will not take as employees the relatives of certified people, and if such relatives want to emigrate, it dams them. I ask that this expediency should be altered at the earliest possible moment.

This morning I received in my post the annual report of the Medical Officer of Health for Kent. In that report, on page 32, he refers to the residential accommodation for elderly and disabled persons. He mentions that the reports over the past few years have referred to the lack of accommodation and goes on to say that in 1956 the waiting list was greater than in the year before. So it will go on and, in the end, he suggests what is badly needed now. He makes three suggestions: type 1, homes for old infirm people needing constant attention at night; type 2, infirm people who need only intermittent attention at night; and type 3, homes for reasonably active old people.

This is at a time when this Government have done all they can to stop the building of homes in any situation. My hon. Friend the Member for Bermondsey spoke about the circular sent by the Minister asking local authorities to tackle in a humane way the problem of old people who would be evicted by the Rent Act. There is much more to be done in that respect. My hon. Friend has now returned to the Chamber, but he will be able to read what I said earlier. In giving this evidence, I speak not only for Erith and Crayford, but for Kent. Evidence relating to Kent was given before the Royal Commission by the National Association of Local Government Health and Welfare Officers. The spokesman referred to the Scarborough Conference in 1953, and said that it was a blot on the National Health Service, that 75 per cent. of the old people now in mental hospitals should not be in them at all but in chronic sick hospitals. He said that 20 per cent. should be in senile dementia hospitals and that altogether 95 per cent. should not be certified.

Today, many thousands have the stigma of certification because it has been expedient to certify them and put them into hospitals. The spokesman went on to say that only 5 per cent. of old people in mental hospitals were qualified to be there. What a terrible thing it is that 95 per cent. have to be certified with all the ill effects that result for their relatives. The spokesman went on to give his experience: In Kent I have dealt with 450 cases in the last five years and 30 per cent. have been in the over-65 age group. There has been no alternative but the mental hospital for them with the consequence that the hospital which serves our area is overcrowded with senile dementia cases, many of whom could be adequately dealt with in other accommodation if it was available and if there were statutory provision for it. We think it is dreadful having to certify people of 65, 70, 80, 90 and, as I did in one case, 100 years of age. What a shocking thing for a person whose only crime is that he has lived too long. If such people are insane it is all right, but the evidence and experience shows that only 5 per cent. should be certified. I do not blame the medical profession, because they have to do something and this is the only opening for these old people. My hon. Friend the Member for Bermondsey referred to his district, but I will quote evidence given by London County Council for the Royal Commission. That is one of the most humane local authorities in the country. If this can happen there, what can happen in the less progressive authorities? This is the testimony which was given after deliberation: Owing to the increasing number of old people needing hospital treatment, however, the accommodation at these hospitals. which are named— is not sufficient and many old people are now being certified and admitted to mental hospitals. Provision should be made in other ways, and the evidence went on to state: Such provision would save many patients and their relatives the pain and distress caused by certification and admission to a mental hospital. These people are being dealt with by the State. It is costing money to deal with them even in mental hospitals. I suggest this is not the best way to do it, and it is a terrible indictment of our system that that sort of thing is not only done but is increasing.

Mr. Mellish

The whole point of my previous interruption, as of this one, is to put on record, as I am sure my hon. Friend understands, that I speak for my constituency. I can give him the assurance, and I know that he will accept it from me, that whatever may happen elsewhere this does not happen in my constituency. There may be reasons for that, but I beg him so to believe me.

Mr. Dodds

I appreciate that, but I would draw the attention of my hon. Friend to the Amendment to which he has put his name, the last words of which refer to "a…national approach to this problem."

It is not a local question about which the hon. Member for Carlisle or I have been speaking, but a national one. We have not been speaking solely of our own experience, but of the experience of people more qualified than we are. I will take this into a wider ambit. In its evidence to the Royal Commission, the County Councils Association said: The Association understand that, quite apart from any question of 'certification', it can be a great shock to any old person who recovers his mental stability… as many do— …to find that he has been admitted to a mental hospital and the fact that he has been so admitted may also cause embarrassment and difficulty to his relatives. Because of the indecent haste practised today and because there are no other outlets, many people are certified, probably only temporarily, because they are confused or deranged, but when they come back to stability they find they are certified as mental defectives. As the evidence shows, these people do not live very long after they have been admitted to these institutions. Can anyone wonder at that? The Association has made that quite clear. I bring in support of my argument the British Medical Association. These are not hare-brained organisations to which I am referring, and I do not see that there can be anything to refute the evidence they have given. They were invited to appear before the Royal Commission and when one reads the evidence one finds that they all speak about old people on exactly the same lines. It is terrifying to read on page 1080: In 1947 and 1948 some reference was made to this problem. It is one which is going to be of increasing importance as the years go by and the population gets older and older. It is one giving me… that is, the spokesman— great anxiety and concern. It is a shame that these old people should go into any kind of mental hospital… There is testimony after testimony. The evidence goes on: …I am speaking of people who at the age of 75 are sensible but old people, because they have been unfortunate enough to be able to live to 78 they have become addle-minded, foolish, silly, unfit to be left to their own devices. It seems rather a shame, when a person has been of great use to the community for many years, that the fact that he or she lives to a ripe old age should mean that he has to end his days in a mental hospital under some kind of order, just because there is not the kind of personnel available to be with him the whole time. That is the only reason, and personally I do not like it. It leaves a nasty taste in the mouth every time I have to send some of these old people into a mental hospital. I could go on giving more and more of this evidence, which makes it clear beyond dispute that there are at present thousands of old people who are not insane but who have been certified as insane, who in the last days of their lives have to associate with those who are insane. It can be a very big embarrassment and handicap to their relatives. In being certified they have been deprived of their necessary liberty.

I quote from an article in the Manchester Guardian, which sums up the position: It is shocking that some people should be detained unlawfully. But it is wrong too, if one comes to think of it, that people should lose their liberty because the rest of us have not gone to enough trouble to make it possible for them to live at liberty. I hope that through my revealing the facts, giving evidence of what is happening under the surface and reading evidence that has been brought forward by the greatest experts in the country, not only the conscience of this House but the conscience of the public will demand that something shall be done and done quickly.

If people cannot think of it in a humanitarian way, I hope that all men and women will consider it from the very important point of view that, unless this system is changed quickly, no one in this country today, if he lives long enough, can claim he will never fall foul of this system. I hope that the Minister in replying to this debate will have that in mind. I have nothing personally against him at all. I doubt whether in the time he has been in the Department he can have read this evidence. The Minister has the Royal Commission Report on his knee. He can read the Report. But in the Report we do not find the evidence which was responsible for the Royal Commission's views. The evidence says, "Let us scrap the old laws and start afresh." If the people want to know what is happening, they have to read the evidence given before the Royal Commission.

2.13 p.m.

Mr. B. T. Parkin (Paddington, North)

In joining in the congratulations of the hon. Member for Canterbury (Mr. L. Thomas) for raising this matter today, I should like to thank him, not only for the content of his speech, but for its complete freedom from complacency and the energy with which he pressed a number of positive proposals. This has been a debate in which many hon. Members have put forward their concern regarding the problem of the old people. The difficulties that have been set out today, and many others of which the Minister is aware, should not cause us to be despondent. The fundamental reason for the urgency of this problem—it is a problem which will become more intense as the years go by—is something in which we can all rejoice.

It is because medical science is conquering the killer diseases one by one that more and more people are dying of old age. We are therefore faced nationally with the problem—which we hope, will increase—of helping people to grow old gracefully, and old people can do this when they live in comfortable circumstances. If there is one point which we want to get over to the Minister it is that attention for the old people does not start early enough. It is often too late when old people are brought to the attention of the many organisations willing to help them. Therefore, our argument on this side of the House that there is no co-ordination and no national plan in this matter has some validity.

One wants to visualise not just permissive powers but an organisation throughout the country, worked probably through the local authorities, but with the active support and drive of the Minister and also financial support, to co-ordinate the work of the voluntary associations and to make sure that the old people at the point of retirement, or even before it, come under the sort of watchful care children receive in the welfare clinics and other people receive in the T.B. clinics, and so on.

Time is short so I will let my speech make itself by quoting one of the many cases which I might bring to the attention of the Minister. It is the case of an old gentleman who caused me a great deal of worry, because whatever I tried to do to help him I found that the bureaucrats were right. The difficulty many of us are in is that it is too late when a case comes to our notice to do anything useful. Let me start by reading a sentence from a letter I received from the former Parliamentary Secretary to the Ministry of Health in reply to a second attempt by me to raise this case. She said: Nevertheless, I think that your criticisms are unfair. Mr.…was evicted from his address in Willesden in August, 1951, apparently at the instance, as I have said of solicitors acting for his landlord". I intervene to say that Mr. X was 84 years old at that time. The first intimation that the authorities had or could have had,"— I emphasise, "or could have had"— of his undeniable distress was the discovery of him sitting on the edge of the pavement. Mr. X was evicted from his dwelling, as the Parliamentary Secretary said, at the instance of solicitors acting for his landlord. Will the Under-Secretary note that and talk to his right hon. Friend about it? How many people are terrified that they will be evicted next year in similar circumstances? Will he do something to make certain that such people can be evicted only by a court bailiff and not by a private bailiff? It is a terrible thing that the Welfare State should admit that the first time the case is brought to the notice of the authorities the old gentleman is sitting on the pavement weeping. One has the greatest suspicion of landlords who try to evict old people in order to get vacant possession. I believe what the old gentleman told me, but I cannot raise the matter now. Neither the Lord Chancellor nor anyone else can put it right.

I will read the certificate which was issued when the old chap was taken off in an ambulance in a state of complete collapse. His few pitiful possessions had been thrown into the road and he never found them again. The certificate reads: Name of patient with Christian name at length, surname first. will refer to him as "Mr. X." Sex and age; male, 84 years: rank, profession or previous occupation no occupation; religious persuasion; Protestant; resident at or immediately previous to the date hereof; no fixed abode. It is a terrible thing that he should be stated to have no fixed abode. It appears to have been nobody's business to find out how he came to be there. Whether first attack; yes: age on first attack; 84 years: where and when previously under care and treatment as of unsound mind or idiot; nowhere as far as known: duration of existing attack; indefinite: supposed cause; unknown whether subject to epilepsy; no: whether suicidal; yes: whether dangerous to others; no: whether any near relatives; none known: brief description of any property owned by patient if over £100 in value; not known: names, Christian names and full postal addresses of one or more relations; none known: name of person to whom notice of death to be sent………… ;the Medical Officer of Health, the County It is a terrible thing that on those particulars a man should be certified insane and sent to Horton Hospital.

I would like to think that at his age I would have the courage to do what he did. He got over the wall because he knew that if he could escape—and he slept rough for fourteen days—they would then not be able to recapture him and send him back.

I wonder whether anyone can imagine a man of that age living for a fortnight in London like a hunted animal, not daring to speak to anyone because they would pick him up and knowing that he had to last fourteen days before he could escape re-certification—and could escape only then by keeping his mind off his troubles and remembering not to cry, because one of the grounds on which they put him away was that they said he had weeping fits and said he wanted justice and truth and talked about the Lord Chancellor.

After fourteen days he came into the open and was given support from the National Assistance Board. After that, of course, every welfare organisation said, "You are getting on now. We will find you a place in an old folks' home". Unfortunately, that first experience had been enough to terrify him and to make him unwilling to accept any kind of assistance which involved going into a home.

This raises the point on which some of us are insisting today. My hon. Friend the Member for Erith and Crayford (Mr. Dodds) and the hon. Member for Carlisle (Dr. D. Johnson) spoke of their very great concern about this question of certification. We ought to bring this question out and to insist upon it being discussed, but I am afraid that by giving publicity to these evils and making speeches about the inadequacy of the treatment, we make things very difficult for the old people, who will expect to be taken there and nowhere else. We shall frighten some of them into being more mentally ill than they are now. That is why I insist that care for the aged should begin much earlier, before there are any difficulties, and should be progressive.

After he was free this old gentleman went to the Stationery Office and purchased a copy of an Act, which he brought to me which said that the Minister of Housing and Local Government was responsible for seeing that he was housed. There is such a Clause in the Act. He asked whether I could not raise the matter in Parliament. I hope that it will not be regarded as a reflection on his intelligence or my powers of exposition if I say that I could not persuade him that Mr. Speaker's ruling was right that matters connected with permissive powers could not be raised in Parliament and that the Minister could not be challenged if he failed to compel a local authority to carry out a Clause which said that the old gentleman ought to be housed.

It is not good enough to say that there are permissive powers. We want consolidated powers, with the Ministry responsible. In the end, of course, the old gentleman went to Loughborough Lodge. He was there when he was about 90 years of age. I suppose that if we bear in mind the total cost of all that was spent on him from the time that he was found on the pavement to the end of his life, then even on grounds of expense we are making inefficient use of the money which is available. When we hear of these difficult cases too late in life it is very expensive to deal with them, and it would be very much cheaper in the long run if we could start the task early.

It is the simple task of helping people to understand that they are still wanted, that they still belong and that there is still a job for them somewhere in the community as long as they feel able to tackle it, even part time. It is this sense of belonging to the community which is most important. Our biggest task is to prevent there being a feeling that at a certain date one becomes an old person and useless. There is no such thing as an "old person"; there is no definition, no group, no homogeneity. We are now reaching the stage in the march of time when we recognise that people will live longer and that our job is to enable them to live complete lives from birth to death. We must see that they do not have this terrible feeling of going through a door, at a certain age, through which there is no return.

2.25 p.m.

Mr. Niall MacDermot (Lewisham, North)

I should like to develop briefly one of the main points mentioned by the hon. Member for Canterbury (Mr. L. Thomas) in proposing the Motion. He rightly said that one of the basic problems in the question of dealing with the old people today is that of housing. It underlies everything else.

May I call attention to the very grave accentuation of that problem which will take place at or about 6th October, 1958? That day is eviction day under the Rent Act. That is the day on which the tenants of properties which have a rateable value of over £40 in London and £30 elsewhere will lose their security of tenure. Do not let us be under any misapprehension about this. There will be a great number of evictions at that time. I am told that in the Borough of Lewisham, part of which I represent, over 100 tenants have registered their names with the local authority as being in need of accommodation on that date because they have received their eviction notices.

These, of course, are for the most part cases in which the landlord has given no alternative to the tenant in terms of an offer of a new tenancy. Where such offers are being made, for the most part people are entering into new tenancies and new agreements for three years on any terms that they can get, many of them hoping that by the time the three years are over there will have been a change of Government and that the new Government will again give them security of tenure and the opportunity to live at a reasonable rent.

Those who have already registered their names have not been given that alternative. In my experience a very high proportion of them are elderly people. The reasons for that are not far to seek. Do not let us think that because we are dealing with properties with a rateable value of over £40 in London—and let us stick to London for the moment—we are dealing with a well-to-do type of tenant. That does not follow at all. In many of these properties the tenant, more often than not an elderly person, has been sub-letting rooms to other people, also often elderly people. In one of these properties there may be five or six different units of accommodation.

Nor should we think that those subtenants will be protected. A great number are not. Most of the tenancies have clauses forbidding sub-letting, and anyone with experience in these matters knows how difficult it is for a sub-tenant in those circumstances to prove that there was a lawful sub-letting and to prove that the landlord had waived that clause and had knowledge of the subletting. Mere knowledge by a rent collector is not knowledge for this purpose. Many of these sub-tenants will be unable to claim protection. In any event, the tenant himself is quite unprotected in those circumstances.

Many of those who will not be given protection are those who cannot afford to take on the responsibility of a new tenancy, and many of them are people who are already on National Assistance and whom the National Assistance Board is prepared to help. The Board is even prepared to say to many of them, "If you enter into a new tenancy we are prepared to advance to you the additional rent which will be required by your landlord under the new tenancy which he is offering you." Even so, the tenant is unable to accept the offer for the simple reason that landlords are holding out for most onerous covenants from these tenants for repairs to property, requiring them not only to keep the main structure in a proper state of repair but also to keep the internal decorations and the whole structure in a proper state of repair.

Many of these houses, of course, are in a lamentable state of repair and that is not a covenant that many tenants—certainly not my constituents—can possibly undertake, nor is there any provision whereby National Assistance can help them there. These are the people who are to be the victims, and the landlords have until April to serve on them their eviction notices. Neither we nor the local authorities will know until April the size of the problem next October.

What do the Government do about it? As has been said, they have just issued a circular to local authorities. When the Rent Bill was being debated we were told that these would be no problem. We were told that it would sort itself out. The Minister of Housing said that he was quite confident that as soon as the Bill was passed an enormous amount of property would be available for letting. We ridiculed that idea then, and we now know that it has not happened.

Now, in the circular, the Minister of Housing recognises that there is a very real problem, and it is one that he is now trying to foist on to local authorities. The private landlord system simply cannot cope with this question. Most of the tenants who are to be evicted cannot afford to pay the type of rent that will be demanded from them by private landlords. That is why they are to be evicted. If they could pay, they would enter into new agreements.

How can the local authorities possibly cope with this matter in present circumstances and labouring under their present difficulties? As one of my hon. Friends has said, they are in a hopeless situation. There are two basic reasons for it. The first is the level of interest rates which local authorities have to pay on money they borrow. In view of the difficulties that will arise in October, it is simply no good the Government saying to local authorities that they must give priority to the provision of housing for old people. It is because private landlords and developers are economically unable, at the current market rates of interest, to provide the special kind of housing that is required for old people, that this problem exists at all.

But, even so, we still had the Financial Secretary saying last night on the Public Works Loans Bill that the local authorities must pay the market rate, otherwise there will be a subsidy. Surely the principle of subsidising housing for old people is one that is realised and accepted. When the Government removed housing subsidies for local authorities they made an exception of single-room dwellings for old people. If that principle is valid for that purpose, why should not it be valid for the purpose of making loans to local authorities through the Public Works Loan Board?

The first practical solution that I offer is that if the Government want to hand over this problem to the local authorities they must give them the means, by making special arrangements for them to obtain loans at special rates—at subsidised rates of interest, if the Government like the term—for old people's housing.

The second reason the local authorities cannot deal with the matter is that, because of their existing commitments for rehousing people to deal not only with priority cases but with slum clearance, they are unable to make any progress at all in the areas where the problem is worst. We are all familiar with the kind of cases that crop up, particularly in London, and with which local authorities are quite unable to deal. They are quite heartrending.

A fortnight ago, two people came in succession to my advice bureau. The first was a young mother with three children. She, her husband and the children all slept in one bedroom. That is the housing accommodation they have. That case has been taken up with the local authority, but although she has been on the Lewisham waiting list for ten years the local authority can hold out no prospect of offering any kind of housing for years to come.

My next caller was a man in his eighties, a widower, who was occupying accommodation consisting of five rooms. He would have been delighted to change it for smaller accommodation, but could not. He was also being asked to pay a rent that he is quite unable to afford and is at his wits' end to know what to do. The obvious, sensible thing would be an exchange between those two families, but that cannot be arranged because the landlords will not agree to continue the protection of the Rent Act to either family. It is, of course, only where the landlords will agree to the protection remaining under the Rent Act that these exchanges are possible.

Therefore, my second concrete proposal is that the Government should reconsider the Rent Act provision about exchanges. The only kind of human solution to under-occupation is properly organised exchange. The effect of the Rent Act provisions has been to bring exchange to a standstill. I urge the Government to look into these two matters, and not just to think that they can rely on the local authorities to cope. The local authorities' responsibilities are so great at present that, even with the very best will in the world, they will not be able to manage.

2.36 p.m.

Mr. E. C. Redhead (Walthamstow, West)

The Minister has had a number of very excellent suggestions from the constructive speeches made today, and there are certain aspects of those suggestions to which I hope he will address his attention. Otherwise, I fear that this debate may simply drift into the expression of platitudes, when what we want from the Government is that positive encouragement which will give us hope of the fulfilment of some of those excellent suggestions.

I should like to join in the chorus of praise and appreciation of the hon. Gentleman the Member for Canterbury (Mr. L. Thomas) for putting down this Motion. It has focussed attention on an undoubted social problem of increasing difficulty and perplexity. It is a problem not only of official administration, but of very real human needs. In many families old people have become a very serious burden and responsibility upon the younger members.

I join with the mover of the Motion in welcoming the Minister's action in undertaking this national survey of the existing services for the chronic sick and the old people, and in the encouragement that he has offered to local authorities—by advice and exhortation, at least—to examine their existing services in the light of that survey and to determine whether they can be improved. I want, however, to underline what has already beer, said—that advice and exhortation from the Minister is not enough, and that there is no ground for complacency in the present situation, excellent as is the work of many hospital and local authorities in this sphere.

Let me quote one or two instances of the difficulties about which the Minister's advice appears just a little too complacent. In his Circular No. 14/57 paragraph 5, he refers to having advised the hospital authorities to give high priority in the allocation of their resources to the establishment of further geriatric departments, both for assessment of cases and for active treatment. He draws attention to the value of units providing for the convalescent care of those no longer requiring full-scale hospital services. He says that it is not thought that there is a general shortage of chronic sick and geriatric beds although in some places, especially in London, there is a definite shortage. I am not competent to judge how far that may be true in respect of other parts of the country, but I do know that there is a positive shortage in the London area.

I want to enjoin upon the Minister that he should not be content merely to count the number of beds and to be satisfied if that comes up to a requisite standard. It is not only the number of beds that matter in this context; what also matters is the condition in which those beds are and what sort of hospital facilities there are where those beds are located.

Let me give one example. The right hon. Gentleman suggests in paragraph 13 of Circular H.M. (57) 86 to the hospital management authorities that while it is impossible to lay down a rigid standard for application throughout the country, nevertheless something like 1.2 beds per 1,000 population appears to be the requirement for this purpose.

Let me instance the hospital which serves my own constituency, one which is embraced within the south-west Essex area That hospital, covering the needs of a population of 700,000, has 700 beds. That is somewhere below the suggestion of the Minister in his own circular, but it certainly is not by any means the whole picture. What is this hospital? It is an old building, constructed in 1840 originally as a workhouse and bearing now all the old marks of the workhouse, despite the excellent work which the authority has done in seeking to adapt it.

The beds in which old folk are accommodated are in overcrowded wards, dull and dreary in their character, where the old folk have nothing else to do in the daytime if they are out of bed but to line the walls in sitting positions, dull and dreary with no bright aspect or comfort whatsoever. If the old folk in some of these wards have occasion to use the lavatory in the middle of the night, they have to go down iron staircases outside the building and cross a yard to an external lavatory. There is a constant, pressing need for the kind of service which we are discussing today.

The Minister urges elsewhere in his circular the desirability of authorities considering what is called the in-and-out system, whereby for a time such old folk may be taken for a period of rehabilitative treatment and then, having given a holiday or a rest to the younger members of the family who hitherto have been caring for them, can be returned home.

I can see that that proposal in certain eases has its merits, but when pressure upon hospital authorities is of the character which is experienced in my own constituency, the assistance and encouragement given by that system lends itself not primarily to the aid of the aged sick but to relieving the hard-pressed hospital authorities who on that pretext will push these old people out for further periods of care by the younger members of their families.

Mr. Mellish

May I interrupt my hon. Friend, because he is developing a point that I was trying to make? The Minister refers to geriatric units in Circular H.M. (57) 86, but the fact is that we have asked for such a unit. We want to have the sort of thing, which is envisaged in this circular, but we are denied the money which would provide it. There is so much that we want to do and we have not got the cash to do it.

Mr. Redhead

My hon. Friend's observation aligns his experience with mine. The hospital authority has done everything possible, but its complaints of inadequacy are met by the simple explanation that the financial resources are not available to enable these things to be done.

I have had a recent example of this in-and-out system utilised by a hospital in order to relieve the pressure upon it, involving an old lady 80 years of age who spends six weeks in and six weeks out. She is bedridden, hopelessly incontinent and a real burden to her daughter who is not a young woman and who finds it increasingly difficult to bear the burden of looking after an old lady who, in any case, does not want to go out but prefers to have the care of an institution and to be free of the constant apprehension that she is being a burden upon her married daughter.

While I should be the last to say in any circumstances that there is not a moral obligation and duty upon children to do what they can for their aged parents, I would add that it is all very well lecturing the children as a means of overcoming the community's responsibility. Let us bear in mind that many of these so-called children upon whom the burden falls are women in their fifties called upon to look after old people of 80, women who themselves are no longer in the prime of life, who have brought up their own families and have reached the stage where often enough they are entitled to some measure of indulgence and comfort instead of being saddled with heavy burdens of this character.

In many cases the preference of old people is not so much to be a burden upon their families, as a preference which is dictated by the uncongenial hospital conditions which they would otherwise have to suffer. What does the Minister propose to do to deal with the admitted shortage of beds and with the inadequate hospitals where beds are located? What responsibilities does he accept in the matter? I know that in parts of the circular he quotes selected extracts from the Guillebaud Report with evident approval. But I remember that Guillebaud also made a recommendation about the urgent need of increased capital expenditure upon our hospital services, and I have not yet heard a Government pronouncement that would lead us to any hope of encouragement of implementation in that regard.

I do not want to traverse the whole ground, which has been well covered in this debate, of the services for those who do not need hospital attention and whose needs can be met by the domiciliary services—home nursing and domestic help. In particular, I would commend the suggestion made by the hon. Member for Canterbury who said that there is room and justification for a wide extension of the domestic help service. Why put upon this service the deterrent of making it a cost service, to provide home nursing as a free service but to apply the means test for domestic help? The domestic help service should be made a free service at the earliest possible moment. The meals service is a boon to the old people, but it ought to be a rate-borne undertaking.

Where these services are inadequate, what is the reason? The reason surely is not a lack of desire but the financial restrictions which are placed upon local authorities in present circumstances of increasing difficulty. The hon. Member for Canterbury referred to his own county, Kent, in this connection. I do not know whether he has seen a report relating to his county in today's Evening Standard. It says: The outlook for Kent—and probably other Home Counties—ratepayers is a bleak one, according to Alderman E. V. Mills, Chairman of the Finance Committee of Kent County Council. It says that the county is facing a steep increase in the rates. There is an ominous concluding paragraph in the report: During the next couple of months Alderman Mills will be having talks with the heads of the main spending departments, to see if any extensions of services can be cut out or postponed. In that sort of atmosphere, with all the apprehensions of local authorities about the need for further economies as a result of the Government's proposals relating to the block grant system, what earthly hope is there of carrying into effect so many of the excellent suggestions which have been made in this debate or, indeed, of carrying out the advice and exhortation contained in the Ministry's circular?

It is not only the question of power or of financial resources; none of these services can operate without the human agents to undertake the requisite work. Just as in every other sphere of the National Health Service, so here the experience of the authorities is of an acute shortage of the requisite people with the right training and qualifications to undertake this very difficult work. I beg the Minister to direct his attention to that matter, and I suggest that, if he will examine the question of financial inducement to people to enter these important social services, he will find in the National Health Service a level of remuneration which is now well below the general level of remuneration in the public services, and which commands urgent attention if we get the people necessary to carry out these services.

I know that the Minister has hitherto been able to shelter behind the statement that all these matters of staff remuneration and conditions are governed by Whitley Councils, that these councils are pieces of joint machinery, and that it is not proper for him to intervene. I do not want to traverse some recent controversies, but I feel that even he is hardly likely to shelter behind that particular alibi any longer.

He has, I suggest, a responsibility in the public interest to look at the whole conception of conditions and remuneration in this connection, as well as in the rest of the National Health Service, if he is really to see any prospect of having the means to make these services the real and effective services that they should be. I beg the Minister not to continue on the line that advice and exhortation is enough. I beg him indeed, as suggested to him by implication in this debate, to have a good heart-to-heart talk with his right hon. Friends the Minister of Housing and Local Government and the Chancellor of the Exchequer, and to give us some encouragement, when he speaks this afternoon, to feel that he will put up a real fight for the health services, particularly this section of the health services. If he does that, I assure him he has some chance of rehabilitating his somewhat damaged record in the office of Minister of Health.

2.53 p.m.

The Minister of Health (Mr. Derek Walker-Smith)

I, too, should like to congratulate my hon. Friend the Member for Canterbury (Mr. L. Thomas) on his initiative in moving this Motion today. It is a Motion which raises a subject of great human interest and of much social and, indeed, economic importance. I have listened with great interest to the speeches made in the debate, and I have been fortunate enough to hear the whole of all the speeches, with the exception of the speech by the hon. Gentleman the Member for Willesden, East (Mr. Orbach), which I shall, of course, read with care in the OFFICIAL REPORT.

Reference has been made by my hon. Friend the Member for Heywood and Royton (Mr. Leavey) and the hon. Gentleman the Member for Feltham (Mr. Hunter) and other hon. Members of the fact that we are an ageing population, though, as the hon. Gentleman the Member for Paddington, North (Mr. Parkin) well said, this is a matter which, although it has created problems for us, is one in which as a people we can take some gratification because it measures the advances of science and medical care in the prolongation of human life.

The hon. Gentleman the Member for Bermondsey (Mr. Mellish) referred to the fact that in his constituency one in five of the people resident there are over 65. This is a figure appreciably, as he will recognise, above the national average, which is today 1 in 9. But, of course, even that figure illustrates very vividly the nature of the trend, since in 1901 it was only 1 in 21, and by 1975 it will be 1 in 7. Today we have well over 5 million people in England and Wales over 65 and not far short of 2 million over 75.

This debate has naturally covered a very wide range, and it may not be possible for me, in the limited time, to deal in detail or as fully as I would wish with all the interesting and often constructive points which have been raised; not all of them, of course, within the ambit of my Departmental duties. I will start with a general word about the services which the House is primarily discussing today, and about the survey which is referred to in the Motion of my hon. Friend.

Of course, the elderly and the chronic sick share in the general services available in the health field, but there are some which are of particular value and interest to them, mainly in the category of services in the home provided by local authorities, such as home nursing, domestic help and health visitors, which have been referred to in the speeches of various hon. Members, and in the category of residential accommodation—Part III accommodation, as it is called—provided by welfare authorities for persons requiring attention not otherwise available to them. The third main category is the hospital accommodation for those in need of hospital care, again referred to by various hon. Members, in particular by the hon. Member for Bermondsey and the hon. Member for Walthamstow, West (Mr. Redhead).

I will seek to deal, at any rate in general, with these various categories of services in relation particularly to the points of view which hon. Members have been good enough to express in regard to them. I should perhaps preface by saying this in regard to the economic factors. Several hon. Members have referred to the economic context, would, of course, be very agreeable to me as Minister of Health to be able to say that in services so deserving and necessary as health we could ignore the economic factor and proceed regardless of cost or the financial aspect, but, as the House will appreciate, it would be unrealistic, untrue and, indeed, unhelpful to make a proposition such as that.

The resources which we can devote to health and welfare are necessarily not unlimited, and that makes it more important that we should seek to get the best deployment of the resources we have in order to get the best value out of them in terms of the health and well being of the community. It was with this object of the best deployment of the resources in view that we undertook the survey which was designed to discover the size and nature of the need and how well it was being met; and also to consider whether changes in emphasis are required to make the best use of the resources that we have.

As the House knows, after the reports of the survey had been assessed and considered, I sent out the circulars to which frequent reference has been made in the course of the debate. I think that two fundamental points emerge from the consideration of the survey, and they are these. First, more effective liaison is required between the various agencies providing the services; secondly, the key to problems stemming from an ageing population lies with the preventive and home services, for the extension of communal accommodation can never of itself be enough.

Therefore, for a few minutes I should like to deal with what is being done within this category of services, and also with what, in the light of the survey and subject to the resources which can be made available, can be done to improve the value that we get from them.

There has been a good deal of reference at various stages of the debate to the general problem of the housing of the elderly. My hon. Friend the Member for Canterbury made some reference to it, and the hon. Member for Lewisham, North (Mr. MacDermot) devoted virtually the whole of his speech to the subject. I will deal with it only very shortly because it does not fall within my sphere of departmental responsibility. Housing authorities, as such, do not have welfare duties; they provide accommodation for the relatively able-bodied old people, but that is not the subject of the survey referred to in the Motion.

My right hon. Friend the Minister of Housing and Local Government has recently issued a circular, to which reference has been made, advising local housing authorities to provide as many one-bedroomed dwellings as possible and to encourage the conversions of which the hon. Member for Salford, East (Mr. Frank Allaun) and other hon. Members spoke. It is a fact that if one measures the progress in the general accommodation provided for old people by the provision of one-bedroomed dwellings, which is the nearest index one can get, the proportion has increased annually from 7½ per cent. in 1952 to just over 13½ per cent. in the third quarter of this year. I do not want to take up in detail the points made about the general housing position. I should prefer to devote such time as I have to matters arising more directly out of the survey and the circulars which I have sent out.

I would refer first to the question of home services, which take the form, primarily, of home nurses, home helps and health visitors, together with all the services which are rendered voluntarily by organisations of various kinds. Several hon. Members have referred to these voluntary services. The hon. Member for Bermondsey said that the day of the voluntary worker was done. I think that when he reflects upon the very wide range of service done on this basis, including the regular visiting referred to by the hon. Member for Salford, East, the "meals on wheels" scheme referred to by the hon. Member for Feltham and others, the social clubs, laundries and so on, and the seaside holidays, also referred to by the hon. Member for Feltham, he will agree that voluntary work constitutes a significant and effective contribution to what is being done in this field. Indeed, at the end of last year there were no fewer than 1,280 old people's welfare committees operating in England and Wales.

Mr. Mellish

I congratulate the right hon. Gentleman upon the very courteous way in which he is replying to the debate and upon the tone of his reply. I probably used a stupid way of expressing myself, and should like to explain what I wanted to put on record. I do not think that, in dealing with matters of this sort, we can rely on the voluntary services as such. I still believe that the day of the voluntary workers, in the sense of leaving it all to them, has gone, and that we must have full-time, paid, experienced workers to do the job.

Mr. Walker-Smith

I am much obliged for the hon. Gentleman's explanation, and also for what he said at the beginning of his intervention. We cannot, of course, rely exclusively on voluntary workers—that would be quite wrong—but we should, I think, first of all recognise the great contribution which they are making and express our appreciation of it. But there is more work that could be done even now in the voluntary field if more workers came forward, and it was with that end in view that my circular asked local authorities to consider whether the time is not now ripe for renewed contact between themselves and the various voluntary bodies in their areas in order to encourage further voluntary help.

I will say a word in a moment about one or two of those matters, but I should first like to refer to the subject of home nurses, which was mentioned by my hon. Friend the Member for Canterbury. Here we have a very important aspect of the home services because of its value in enabling people who might otherwise have to go into hospital to continue living in their own homes, which, generally speaking, they prefer to do in any case.

There has been a gratifying increase in respect of the number of nurses employed, the number of patients attended and the number of visits made. The number of nurses has increased from 7,750 in 1948 to 10,100 in 1956, the number of patients attended was 865,000 in 1949 and just under 1,100,000 in 1956, and in that year nearly 25 million visits were made by home nurses, of which about half were to patients of 65 and over.

Mr. Mellish

Do not the district nurses visit most of those people?

Mr. Walker-Smith

Yes.

Mr. Mellish

They are paid.

Mr. Walker-Smith

Yes. I have left the voluntary organisations now. I am dealing with the main category of the local authority services. I agree that these people are paid, and—

Mr. Mellish

They are doing magnificent work.

Mr. Walker-Smith

They are, indeed, doing magnificent work, and there has been a very substantial increase in it in the last few years.

Health visitors are perhaps not quite so important in this context because their primary statutory function is in relation to mothers and young children, in respect of whom 85 per cent. of their visits are made, and it would be wrong to seek to divert them from that primary duty. Nevertheless, they make a significant contribution in this sphere, because last year about 1 million visits were made to the old people by health visitors.

Now, I should like to turn to another aspect of the local authority services to which there has been a good deal of reference in this debate—that is, home helps. Local health authorities have power to provide home help under Section 29 of the National Health Service Act when help is required owing, amongst other things, to the presence of an aged person. Although this is a permissive power, it is universally exercised, because all local health authorities have made such provision.

We have had a really gratifying increase in the number of home helps, in which I am including both whole-time and part-time. At the end of 1948, there were just under 11,400. At the end of last year, there were just over 39,000. It is still true to say that that is not enough—as the hon. Member for Bermondsey pointed out, his area has difficulty in getting sufficient numbers—and there are recruiting difficulties. In my circular, I have expressed the hope that areas with deficiencies in this service will make them good as far as they can.

As for finances, I would remind the hon. Member for Walthamstow, West that the provision in regard to charges and the taking into account of means is, of course, a basic provision under Section 29 (2) of the original National Health Service Act, 1946.

Mr. Mellish

The Minister should not imagine that because it was introduced by the Labour Government we do not have criticisms.

Mr. Walker-Smith

I appreciate the hon. Member's point that that reason is not necessarily a stamp of perfection. I was merely pointing out that this was not something which had happened recently. Indeed, the whole history of this service has been on the same pattern.

I was asked about chiropody, not only by the hon. Member for Salford, East, but also by the hon. Member for Barking (Mr. Hastings), whose great experience and authority I am happy to recognise. So far as chiropody is concerned, these services are at present available for hospital patients, for old persons resident in old people's homes and otherwise only in the areas of a relatively few local authorities who operate a scheme under Section 28 of the National Health Service Act.

I shall be quite frank with the House. The difficulty at present about extending the chiropody service is one of money. That applies to some extent to the general operation of Section 28 of the National Health Service Act, about which there has been some discussion today. My hon. Friend the Member for Carlisle (Dr. D. Johnson), who has indicated to me that unfortunately he is not able to stay to the end of the debate, referred to it as Section 20, but it was, I think, Section 28 which he had in mind. It gives wide powers to local authorities for care and aftercare, but they are permissive powers and the only duty at present imposed is one relating to tuberculosis. There is, of course, a financial limitation in some of these matters arising in both the health authority and the hospital context.

Reference has been made to Section 31 of the National Assistance Act, but a Private Member's Bill is to be introduced to amend it and perhaps I should not anticipate any discussion which the House may then have.

Mr. Mellish

I should like the Minister to continue.

Mr. Walker-Smith

I am anxious not to be too long so that my hon. Friend the Member for Wembley, South (Mr. Russell) may have an opportunity to move his Motion concerning the Commonwealth.

In regard to that part of welfare accommodation with which the survey is concerned—the Part III accommodation under the 1948 Act—at the beginning of this year there were over 74,000 people in such accommodation, or 60 per cent. more than at the beginning of 1949. Fifty-four thousand of these were old people. In the post-war years, 976 new welfare homes have been opened by local authorities, providing 30,000 places for old and handicapped people. Ninety-eight of them are new purpose-built buildings. I quite appreciate that some of them are old buildings, but there are also some good new purpose-built buildings.

Again, there is a marked shortage of this type of accommodation and there is, obviously, some financial limitation, especially at present, on possible expansion. I certainly assure the House that I feel no complacency on this score; but there is a good deal of work in the pipeline at the present time. One hundred and three welfare homes, including 53 new buildings, are at present in course of erection and 100 other schemes are in various stages of planning.

This is not, of course, a debate on the mental health services and I do not intend to go into all the points raised by the hon. Member for Erith and Crayford (Mr. Dodds) and by my hon. Friend—

Mr. Mellish

We do not often have an opportunity to discuss the chronic sick, but we often discuss the Commonwealth. Before the Minister talks about mental health, in which I am not directly concerned today, will he please say a little more about the possibilities of local authorities being given licence to do more in this matter? I beg of him not to leave it simply on the basis that there is a Private Member's Bill whistling about somewhere. It is much more important than that. Is there any hope of local authorities being able to do a lot more than they are doing at the moment?

Mr. Walker-Smith

On the general point of the widening of the powers of local authorities, the hon. Gentleman will, of course, be familiar with that part of the Local Government Bill which is designed to deal with the matter and which, no doubt, will be discussed in detail by the House.

In the narrower context of Section 31 of the National Assistance Act, that Section at present gives power to local authorities to make financial contributions to voluntary organisations doing various things. The Private Member's Bill to which I referred would give direct power to the local authorities to do them themselves, but I do not think, as that Measure is coming before the House, that it would be appropriate for me to say more on the point at the moment.

So far as mental health is concerned, this, as I say, is really not the occasion on which to enter into debate on such matters. However, I think it would be wrong if I left uncommented on and uncorrected what has been said by my hon. Friend and by the hon. Member for Erith and Crayford. The hon. Gentlemen referred a good deal to the evidence heard by the Royal Commission, but I think that the House should have in mind the conclusion expressed in paragraph 320 of the Report of the Royal Commission. The paragraph states: We have received no evidence to show that old people admitted to mental hospitals are not in fact suffering from mental disturbance or deterioration which makes them of 'unsound mind' within the meaning of the present Lunacy and Mental Treatment Acts. Nor do we subscribe to the view that elderly patients should never be sent to mental hospitals. What the Commission agreed to, as I do, is that more accommodation in welfare homes and hospitals for the chronic sick would make it possible to discharge some old people sooner from mental hospitals.

Mr. Dodds

The Minister cannot get away with that. It is an important matter. Is he denying that there is overwhelming evidence to indicate that large numbers of old people are certified and taken to mental instituions? That is what I am complaining about.

Mr. Walker-Smith

The hon. Gentleman will be aware of what has been said by the Royal Commission and that it did not accept the allegations of wrong certification. What it said was the point that I have just made.

I find it very difficult to understand the percentage of 80 per cent. which the hon. Gentleman suggested as representing people in mental institutions who should not be there, because in 1954 a survey that was made suggested that there were some 10,000 old people in mental hospitals all over the country who might be capable of being treated elsewhere. The total number of people over 65 years of age in designated mental hospitals is about 45,000 so that the percentage is, of course, something very different from that suggested by the hon. Gentleman.

Mr. Dodds

The Minister mentioned a different thing.

Mr. Walker-Smith

I hope that the hon. Gentleman will let me finish, because I do not want to debate the matter at length today.

Mr. Dodds

The right hon. and learned Gentleman is saying incorrect things.

Mr. Walker-Smith

With respect, I do not think so. The hon. Gentleman may be addressing himself to different considerations, but what I am telling him are the facts.

Mr. Dodds

Eighty per cent. of the old people.

Mr. Walker-Smith

I also am addressing myself to that. The two figures which I have given of 45,000 and 10,000 are both in respect of old people. I want to put the record straight by giving the House this information, but I really do not think that this is the appropriate occasion on which to say more. No doubt there will be opportunities for debating the matter in detail.

The House and the hon. Gentleman are aware that we have the Report of the Royal Commission, and I am now studying it in the context of the advice received from the various bodies with which, very properly, we have had consultations. These matters include the procedures for admission and certification and so on. As the hon. Gentleman knows, I am always happy to discuss these matters with him and aim to proceed with this consideration.

Mr. Dodds

I thank the Minister for that.

Mr. Walker-Smith

Regarding the hospital services as such—which was a matter raised by the hon. Member for Walthamstow, West and the hon. Member for Bermondsey—it is not right to say that there has been no expansion in the capital moneys available for hospital building. The amount has been increased from £10 million in 1954–55 and 1955–56 to £13 million in 1956–57; £18 million for next year, 1957–58, and £20 million for the year after, 1958–59. That, in my view, and especially in the context of our present difficulties, is a gratifying upward trend.

Mr. Redhead

The Minister will agree that it is still falling short of the recommendations of the Guillebaud Report.

Mr. Walker-Smith

In many respects we fall short of what we would like to do and what it would be useful and rewarding to do were the money available, but no Government would ever be free from the economic limitations imposed by our national economy.

The hon. Member for Walthamstow, West referred to the recommended average allocation of 1.2 beds per thousand of population to the chronic sick. That is an average figure dependent on various local factors and it assumes that there is a fully effective geriatric service and adequate home and welfare services. Our task is to ensure that, within the resources which can be spared, a higher priority is given to the organisation of these things.

Mr. Mellish

That is the crux of this whole matter. How is that to be done? We say that within our limited resources there should be a national plan to deal with the geriatrics, as they are called. Somehow the money should be found within the regions for a geriatric unit, because that would mean a saving of money on a long-term basis. Why do we not have a policy of spending capital in such a way that in the long-term we save money? We have no national plan proposed by the Government. There is no question of party politics about this, it is true.

Mr. Walker-Smith

The hon. Gentleman talks about a national plan. The first thing is to ensure by national action and a nation-wide survey—which we have done—that there is effective co-ordination and liaison between the various agencies providing these services. That is precisely what we are seeking to do, and that is the main subject of the Circulars which have sent out.

Mr. Orbach

The right hon. Gentleman has not dealt with any part of the short speech which I delivered, but surely the first thing to do is to find out what is the problem and the extent of it, not what services we might have available. It is a question of what services we should have available in view of the extended nature of the problem.

Mr. Walker-Smith

I did say at the beginning of my speech that the speech of the hon. Member for Willesden, East was unfortunately the only one which I had not the pleasure of hearing because I was out of the House at the time. I did say also, when the hon. Member was not here, that the object of the survey was to see what was the need and how we could best link our resources with it. I deal in the circulars with the question of what the geriatric department can do to ensure that we improve the use of the beds in our hospitals and develop supporting services.

I will come in a moment to the vital question of co-ordination, but first I would say a word on the question of waiting lists of chronic sick. These waiting lists have been shown by the survey to be, in fact, unrealistic in many cases because of their tendency to include people who are dead, or gone away, or who refuse admission when they have the chance, or sometimes who have been put down by their relatives for admission but do not want it themselves.

Now I come to the question—

Mr. Mellish

This is a very important point. I do not know whence the Minister obtained his information about the waiting lists, but he has just made a very serious statement. I produced a waiting list of 84 and one of my hon. Friends who is chairman of a committee can produce another waiting list. If I had had any impression that the waiting lists were "phoney," I give the Minister my assurance that they would have been dealt with, but that is not so. There is no justification for saying it. Our waiting list is genuine and I think most of the others are.

Mr. Walker-Smith

I am not specifying any particular hospital; but this is the information which I have.

Mr. Mellish

It is incorrect.

Mr. Walker-Smith

The hon. Gentleman must not say that. The survey was made by expert teams of very responsible people, and that is one of the conclusions which have emerged from it.

On the subject of co-operation and liaison, the survey brought to light very clearly examples of insufficient co-operation between local health and welfare authorities on the one hand and hospital authorities on the other, and even of unsatisfactory liaison between different departments of a single local authority.

The need for better liaison is particularly marked in relation to the use made of chronic sick beds in hospitals and of welfare homes. The survey shows that there were 4,500 patients in chronic sick wards who no longer needed hospital care and treatment, but that at the same time there were 1,900 residents in welfare accommodation who were considered by the welfare authorities to be in need of hospital care. That is an unsatisfactory state of affairs. So my circulars have stressed the need for close and constant liaison in order that accommodation can be used for the people for whom it is most suitable and for a quick and easy interchange, as far as possible, between the welfare home and the hospital ward to take account of the changes in the physical condition of the people concerned. As well, there must be first-class liaison between the various departments of the local authorities, particularly where the health and welfare departments are separate.

This has been a long debate full of points of interest. I am conscious that I have not been able to reply as fully as I should wish to do, but even so we have left very little time to my hon. Friend the Member for Wembley, South whose contributions on the Commonwealth and other subjects are always of such interest to the House. I said earlier that our resources were not unlimited and that we had to have the economic aspects in mind. At the same time, it is wrong to suppose that all progress is a matter of money. The survey has shown that much can be done within our existing resources by co-ordinating action and linking resources to needs. Our services, which have been discussed today, concerned with the health and welfare of the elderly and chronic sick, have a great fund of good will and constructive energy. I am confident that, with the effective employment and deployment of these, good progress can be made within our national capacity.

Mr. A. G. Bottomley (Rochester and Chatham)

Before the Minister concludes, may I say that he will be aware that not many of us expected that the Second Motion on the Order Paper could he reached today and it is within your knowledge, Mr. Deputy-Speaker, that two of my hon. Friends have willingly sacrificed themselves in order that the hon. Member for Wembley, South (Mr. Russell) may have an opportunity of moving the second Motion. As the Minister has acknowledged, not all the questions which have been put in this debate have been answered. I presume that the usual practice will be followed whereby he will send a written answer to hon. Members whose questions he has not answered in his winding-up speech.

Mr. Walker-Smith

I propose to read with great care all the speeches made in this debate, on any points I find outstanding I shall be glad to communicate individually with the hon. Members concerned.

Question put and agreed to.

Resolved, That this House welcomes the initiative of Her Majesty's Government in organising a nation-wide survey of services available to the chronic sick and elderly; approves the steps taken by the Minister of Health to make known to hospitals and local health authorities the best and most effective practice in services for old people as revealed by the survey; and calls upon those responsible authorities who are not doing so to implement the Minister's advice.