HC Deb 12 February 1958 vol 582 cc529-38

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

10.17 p.m.

Mr. Anthony Kershaw (Stroud)

I wish to raise tonight a very important question which often occupies my attention, and rightly so—the question of the welfare of the old. This was last discussed here in a most fruitful debate last November, the debate started by my hon. Friend the Member for Canterbury (Mr. L. Thomas). That was a whole day's debate which ranged over a large number of subjects. Tonight I wish to take this opportunity of the Adjournment Motion to draw attention to only one aspect of the care of the old.

Care of the old is in the family. It is commonly said that in these days the family does not look after its old people in the way families used to in our grandfathers' time. I think that criticism is unjust. Furthermore, one must reflect that perhaps in days very long ago the alternative to old people being looked after in the family was their not being looked after at all and having to undergo extraordinary hardship entirely by themselves. Nevertheless, I do not admit the criticism that families today are any less mindful of their obligations to their old people than families used to be in the past. Indeed, the affection and good will in families is, I should think, greater now than in harder days of old.

Nevertheless, in this House and in local government we have been very much preoccupied with the necessity of providing accommodation, Part III accommodation, or hospitals and almshouses and so on, for old people, with accommodating them in institutions of various sorts, and I feel that there is a slight tendency to forget the rôle which the family still plays in the care of old people. After all, the family is the centre where most people today still grow old and where most people today still die. It has been calculated recently that only 3 per cent. of those who are retired are cared for in institutions of one sort or another, and there must be at least three or four times that number of people, and probably more than that, who are looked after by their families. Indeed, family ties become stronger as people get older. That is natural, because people are thrown together very much more. I know the House is well aware that retirement is for many people an absolute disaster, and especially for those who are the least well-off section of the population.

First, there is a remarkable fall in income, to perhaps half or even less than the amount the retired person formerly earned. Secondly, it is found especially by men who retire from work that they have no more friends. They discover that the only friends they had were the friends they made at work. They are no longer able to meet them in the day or to frequent the clubs which they used when they were at work. They drift apart from their former friends and then find that they have no others.

Thirdly, they find that their status in the home has fallen. The man used to be the breadwinner. He was able to put his hand in his pocket and hand out a tip to the children or put his wages on the table when he came home at the end of the week, and he earned the kudos that came from doing that. When a man retires he no longer has that status of breadwinner. The person who runs the family after retirement is generally the wife or mother, because she is in charge of the kitchen on which the family life centres. Therefore, retirement is a disaster and old people must necessarily turn more to the family than they did previously.

The criticism is frequently made that families do not shoulder the responsibility of looking after the old people in the way they used to do. I submit that that is a mistaken impression. It has been calculated that 2 per cent. of the old people in the country have the services of home helps. If that is true, it is a very low figure indeed. I should like to ask the Minister whether all things possible cannot be done to increase that percentage of old people who have some help in the home from organisations or local authorities.

In a recent sample which was taken in Bethnal Green, which is not a rich area, it was found that 6 per cent. of retired people had the services of some sort of home help and that more than 50 per cent. were looked after by the family or, in a small number of cases, by neighbours. That is the measure of the difference in responsibility which the community and family take for old people—that is 6 per cent. as opposed to 50 per cent. It was also found that between 10 per cent. and 15 per cent. of the old people were entitled to National Assistance but did not draw it. A few did not do so because they were not aware of their rights, and a few because they refused to do so out of pride. The vast majority, however, did not do so because they were helped by their families. In fact, their families were paying them the National Assistance which is the obligation of the State. Therefore, that demonstrates again how the family its shouldering its responsibilities.

I wish to make certain deductions from these facts and to ask the Minister some questions. In the first place, it is clear—though perhaps it is not a question for my hon. Friend the Parliamentary Secretary to the Ministry of Health—that when old pepole are rehoused they should be rehoused as closely as possible to their families. Secondly, I should like to know what is being done and will be done to improve and extend the domiciliary services which are available to old people. The visiting which is necessary to help these old people must start with the problem of finding them. It frequently happens that old people, and especially single people who have no families, are found in a state of poverty and neglect because nobody knew that they were there until the milk was not taken in several mornings running. Nobody knew the conditions under which they lived.

I do not believe that it is beyond the possibilities of organisation to have a regular visiting system to discover where, in any area, there are those who are housebound. Secondly, having found out who they are and where they live, it is necessary also to visit their families. If far more than half these people are being looked after by their families and have no desire, and there is no real necessity, to be taken to institutions, then the strain falls upon the families, and the families must be kept under observation just as much as the old people. I am sure that every hon. Member of this House will know from personal experience of cases where the daughter or the niece has finally collapsed under the strain of looking after the old person, and both have had to be taken away.

Something, therefore, might be done in advance to help the families who are looking after the older people by, for instance, the older ones paying visits to institutions for a short time as a rest as has been done in many cases. Would my hon. Friend consider asking his colleagues whether something would not be possible on the lines of the constant attendance allowance paid to war pensioners for families looking after housebound relations who are constantly in bed?

Lastly, there is the problem of visiting and looking after those who have no immediate families. It may be necessary to take these people ultimately to institutions, but it is essential to find out where they are so that people may be in a position to take them away when it is necessary.

My object in raising this subject in these few minutes is to concentrate for a short time on the service of the family to the old people of this country and to make sure that it is not forgotten. I believe that timely help to the family, and organisation which can help the family, may save the great expense to which the community is put by taking these old people into institutions to which, by and large, they do not wish to go. Thus, we may both save the country a certain amount of money and greatly increase the happiness of the old people concerned.

10.27 p.m.

Sir Keith Joseph (Leeds, North-East)

I am glad to have the chance to echo what my hon. Friend has said and emphasise the part played by the family in social life. It may seem trite to emphasise the family in this way, but the family is still the major influence in the lives of the majority of our fellow countrymen.

The author of the book on the study of Bethnal Green, to which my hon. Friend has referred, summed up his careful study of the situation thereby concluding that there is no justification for an attempt to supplant the family with State services. The job of the State services is to support the family and provide substitute help when the family can no longer manage on its own. All over the country there are imaginative schemes, often combining voluntary and local authority bodies who supply this kind of help to the family, ranging from light attendance, laundries, schemes for sitting With the dying, holiday relief; ranging from the extensive, almost comprehensive, scheme of a place like Salford, to the attempts of our 900 old people's welfare committees to co-ordinate all the activities for the care of the aged.

Most people have some help from their families supplemented by this kind of service. However, the poorest—the poorest not only financially—are those without active family life. Though it is a comfort that the proportion of unmarried in the community is falling, there is still a great burden upon those who have no family to help them. I am glad to see here the Joint Parliamentary Secretary to the Ministry of Pensions and National Insurance as well as the Parliamentary Secretary to the Ministry of Health, because this is a very fruitful field of research. It is true that 3 per cent. of the old are in institutions today and, but for the care of their families, a far larger number would obviously be in institutions. What we do not know is how many of those who are in institutions would never need to have gone there if there were more home helps available to succour them before they became housebound or unable to look after themselves.

It was the National Corporation for the Care of the Old which in its report in 1955 suggested that 50 per cent. of the people who received the services of home helps would be in institutions today but for the care of those home helps. It was the same Corporation which in its 1956 report drew attention to the fallacy of concluding inevitably that home help actually saves cost. I am sure that my hon. Friend the Parliamentary Secretary is well aware that in certain circumstances the keeping of a person at home, while much pleasanter for that person, might cost the State far more for home help, district nursing, and the like, compared with the relatively low cost of a bed in a hospital for the chronic sick. Therefore, I am not maintaining that domiciliary care must be cheaper than institutional care, but only that in many cases it is, and, particularly, that the domiciliary care may prevent a person from becoming an inmate in a hospital for the acute sick where the cost of a bed is so much higher.

May I conclude by suggesting to my hon. Friend that there is here a really genuine case for a survey, and perhaps for experiments in controlled areas, both to produce economy and to produce a humanitarian relief to the family on which the vast bulk of the citizens still depend for succour.

10.32 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Richard Thompson)

I am indebted to my hon. Friend the Member for Stroud (Mr. Kershaw) for raising this matter this evening. I only wish that limitations of time gave us more scope to debate the subject, which is a very large one, as fully as I am sure he would wish.

My hon. Friend is quite right in saying that we had a full discussion on this matter on 29th November last year but as he has narrowed the scope of his remarks to the particular aspect of the amount of care that we can give to elderly people in their own homes, I welcome the opportunity of giving a summary of what we are now doing and of our general thinking on the subject.

I am quite sure that no hon. Member of this House would look forward to spending his declining years in any kind of an institution, however well run and however humanely administered. I am sure that my hon. Friend is on absolutely the right lines when he pleads for more emphasis to be placed on the care of old people for as long as possible in their own family and in their own homes. I am sure that is what elderly people themselves want.

In answering my hon. Friend the Member for Leeds, North-East (Sir K. Joseph), I am not at all sure—when I say "economical" I do not use that word in the peculiarly pecuniary sense—that it is not the most sensible way of coping with the problem. I also think it is sound that the family today should still continue to recognise that it has some responsibility for elderly people when they have passed the age when they can do useful work and when they require considerable care.

This problem is very severe because of our ageing population; in other words, it becomes more severe every year. Hon. Members probably know that one person in every nine today is at least 65 years of age, and by 1975 it is expected that one in every seven will be 65 or more. Of these elderly people, about 95 per cent., roughly the figure my hon. Friend gave, live at home, and most of them certainly wish to retain their independence as long as possible. I should like to say that it is our wish that they should do so.

It might be helpful if I quickly ran over the specific health and welfare services which are available in the home. Reference has been made to health visitors. A local health authority is required to provide a service of health visitors to give advice about the care of persons suffering from illness and others. The total number of visits by general duty health service visitors in 1956 was about 11 million, and it is estimated that about 1 million of the visits were to the aged and chronic sick. The health visitor's advice on diet, hygiene and general care can, of course, be of the greatest value to the elderly and to those living with them and helping with their care.

The next important aid is the home nursing service. Under Section 25 of the National Health Service Act, 1946, local health authorities are required to provide a service of nursing to those needing it in their own homes. There has been encouraging growth here, and there is no doubt that it has met an increasing need on the part of the aged sick who might otherwise have had to go into hospital. The number of nurses employed has risen from 7,758 at 31st December, 1948, to 10,104 at 31st December, 1956, and during a roughly comparable period the number of patients attended has risen from 865,000 to 1,097,000. That is the measure of the growth of the problem which is on our hands. These cases involved more than 24,652,000 visits, of which more than half were to patients who were aged 65 or over at the time of the first visit during the year, and the increasing proportion of the demand by the aged is shown by the fact that only three years earlier, in 1953, the proportion of the cases in respect of those aged 65 and over attended was one-third of the total number.

The next important contributory service to which reference has been made tonight is home helps. They undoubtedly do a remarkable job. All local health authorities have made provision for such a service, and it is being increasingly used for old people who through a few hours' help each week may be enabled to continue to live in their homes. Old people often need such help for an indefinite period, but the extent of the help given may be limited—indeed, it often is—by the pressure of other demands on the service, some of which, maternity cases for instance, must be given priority.

The number of home helps employed has increased from 11,338 at 31st December, 1948, to 39,056 at 31st December, 1956. Sixty-eight per cent. of the applications for home help so provided during 1956 were from households needing help because of the presence of somebody who was elderly or chronically sick.

I should like to dwell in some detail upon the other services which contribute to this conception of care for elderly people in their own homes, but I cannot do very much more than mention them simply by name. There is the night attendance and evening service; the laundry service—which is a useful one, because laundry creates great problems for many elderly people, especially the bedridden and incontinent—and the meals on wheels service. In most areas this is provided by voluntary agencies, usually with a subsidy from the local authority, and it is doing a very fine job. Then there is the chiropody service, provided by a small number of local authorities and a large number of voluntary organisations either at clinics of their own or in conjunction with old peoples' clubs.

It is gratifying to think of the very great extent to which we have been able to draw upon the help of voluntary societies in providing this kind of help for elderly people. If we want to keep the service away from the strictly institutional it is important to maintain the co-operation of these voluntary societies whose work is beyond all praise.

I want to say a word about the problem of locating old people, to which my hon. Friend referred. I have looked at the book to which he referred—"The Family Life of Old People" by Peter Townsend. There was a suggestion in that book, which I think my hon. Friend had in mind, namely, that in each area a list should be compiled, in co-operation with the Ministry of Pensions and National Insurance, of all widowed or unmarried pensioners, and that each of these potentially isolated old persons should be visited regularly by the health visiting service in liaison with the home help service and with the aid of voluntary services.

That is an interesting idea, but it presents one or two difficulties when we try to work it out. The Ministry of Pensions has the material, but regards it as confidential. Moreover, the creation of such a list would involve a tremendous amount of work which when completed, would contain an immense number of entries which might not be helpful. The number of men and women of pensionable age—single, widowed or divorced—is over 3 million, and even one yearly visit to all these old people would place a very heavy burden on services which are already under very heavy strain.

It is true that a small proportion of these people need help or advice, but a good many others would not welcome visits from members of local health authority staffs or other forms of approach which carried the implication that they were of an age when they needed some sort of surveillance. We need to find a more acceptable way of identifying these elderly people, who at present seem to slip through our administrative net, and perhaps are discovered only when they are in extremis.

There is a good deal more that I could say upon the subject, but there is one matter upon which I should incur your displeasure, Mr. Speaker, if I embarked upon it, namely, the reference which my hon. Friend made to a scheme similar to the constant attendance allowance paid to war service pensioners and some industrial injury pensioners. My hon. Friend suggested that that scheme might be extended to cover elderly people and help their families maintain them. That would require legislation.

I approve the emphasis which my hon. Friend attaches to the domiciliary care of elderly people. His thinking in this matter is on the right lines and is entirely in accordance with what experts in these matters regard as the proper approach, and also with what the old people themselves would prefer. I agree with him that the less institutional we can make a great part of this care the better it will be.

We recognise that some people who are very elderly and ill have to go into a hospital or home of some kind, but there are many who do not. With a little help to them and their families, they could be kept in society and made useful members of it. They would be much happier, because they would not be out of the way in institutions but still leading reasonably active lives.

In considering the extent to which we can develop our services, there are all sorts of considerations to be taken into account, many of them financial; but I assure my hon. Friend that we recognise this is the right direction in which the services for the old should be extended, and it will be our intention to see that such resources as can be devoted to that task will be used in the most fruitful way.

Question put and agreed to.

Adjourned accordingly at fourteen minutes to Eleven o'clock.