HC Deb 27 February 1959 vol 600 cc1465-91

Order for Second Reading read.

11.19 a.m.

Sir Gerald Wills (Bridgwater)

I beg to move, That the Bill be now read a Second time.

This is a small and, I hope, non-controversial Bill. It has a comparatively limited purpose. It aims to do two things. First, it adds a new subsection to Section 24 of the National Assistance Act, 1948, relating to the provision by local authorities of residential accommodation, and, secondly, it substitutes words in Section 29 (7) of the 1948 Act which extend the protection given under the Act to local authorities who provide sheltered workshops for the training of disabled people.

If I may, I should like to explain Clause 1 (1) of the Bill. Under Section 21 of the National Assistance Act, 1948, local authorities—and local authorities in this context mean a county council or county borough in England or Wales or the council of a county or large burgh in Scotland—have a duty to provide residential accommodation for people who because of age or infirmity or other such circumstances need care and attention which would not otherwise be available to them. Section 24 of the same Act defines the authority responsible for providing this residential accommodation as the authority of the area in which the person normally lives. It occasionally happens that, in circumstances of urgency, accommodation is provided by the authority of the area in which a person does not normally live, and then the cost of providing the accommodation becomes recoverable from the authority of the area in which the person does normally reside.

An example is the case where an elderly person enters a hospital away from home for treatment and, on discharge, needs to be given accommodation in a local authority home. But the hospital in which he has been receiving treatment may not be in the area in which he has been living. Or it may be that an elderly person in a hospital away from his home would have the natural wish, upon discharge, to return to a local authority home in the area where he used to live. Until a year or so ago, local authorities in general were willing, wherever possible, to arrange this on the basis that, normally, a person in hospital retained his original place of residence, But difficulties have arisen between certain local authorities about what could be deemed the ordinary residence of persons requiring residential accommodation.

Under Sections 32 and 35 of the National Assistance Act, 1948, these cases of dispute must be determined by the Minister of Health in England and Wales and by the Secretary of State for Scotland when they occur in Scotland. In a number of cases submitted to the Minister for determination of what was the ordinary residence of the person concerned, it has been held on legal grounds that a per son's stay in hospital has severed his link with the area from which he went into hospital. Perhaps the tenancy which he had in that area has been given up because of his long stay in hospital, or perhaps, because of having been in hospital, the person has become incapable of living alone. In such cases the tenancy has been severed and the patient can no longer be regarded as ordinarily resident in the original place where he lived. Other cases would be determined the other way round. They would be cases where the link with the area has not been severed and the former place of residence still exists.

Nevertheless, doubts remain, and many local authorities are not now prepared to accept in their homes people whose ordinary residence in their area may have been lost. It follows that a local authority where there are a number of hospitals may have an undue burden imposed upon it to provide accommodation for elderly people who have lost their original place of residence and this may cause hardship to those people. On discharge from hospital they find themselves placed in a home away from the area in which they normally lived and far from their relatives and friends.

As I have said, under Section 24 (5) of the National Assistance Act a person who enters a local authority home is deemed, while in the home, to continue to be ordinarily resident in the area in which he lived before he went into it. The purpose of Clause 1 (1) of the Bill is to apply the same rule to persons entering hospitals under the National Health Service. The term "hospital" would include mental hospitals and convalescent homes. That is to say, persons who leave hospital and require local authority accommodation will be regarded as living in the area from which they came before they entered hospital and the local authority of that area will be responsible for meeting the cost.

Clause 1 (2) further defines the liability of local authorities when they provide workshops for the training of disabled people. Under Section 29 of the National Assistance Act, 1948, local authorities have power to make arrangements to provide workshops where blind, deaf, dumb or other substantially handicapped people may engage in work which is suitable for them. These authorities can provide hostels for such people and make money payments to them for the work they do. Any expenditure incurred by the local authority in the provision of these welfare services for a person who ordinarily lives in the area of another local authority is recoverable from that other authority.

By Section 29 of the National Assistance Act, a person who works in a "sheltered workshop," as they are termed, is deemed to be ordinarily resident in the area in which he normally lived. The object of this is clear. It is to give some degree of protection to a local authority from the liability to meet the cost of services to disabled people coming to live in its area for the reason that there is a sheltered workshop within the area of that local authority.

As it stands, this Section of the Act does not cover the period in which a disabled person is training in the workshop. Because of this, some local authorities have been reluctant to admit disabled people from outside its area to its workshops to undergo training. Clause 1 (2) of this Bill is designed to extend the protection given to local authorities by Section 29 of the National Assistance Act to authorities providing workshops, to cover the period during which a person is training and also to cover the period between the time when a person is accepted for work or training and the time when he actually starts.

It will be seen that the object of the Bill is to make quite clear the position of local authorities in regard to the two matters to which I have referred. I do not in any way wish to exaggerate the number of cases which would be affected by the operation of the provisions of this Bill. But I think it fair to say that in the last few years a number of local authorities, whenever there has been a doubt about the ordinary place of residence of a person, have been disinclined to accept responsibility for providing the residential accommodation which they could provide under the National Assistance Act, 1948; or, in certain cases, to provide the services to disabled persons which they might be able to provide.

I feel it a good thing that these doubts should be resolved. I think it a good thing for the convenience of local authorities and, what is much more important, for the benefit of the unfortunate people concerned. I hope that the House will agree with me, and will give a Second Reading to this Bill.

11.28 a.m.

Colonel Richard H. Glyn (Dorset, North)

I wish to congratulate my hon. Friend the Member for Bridgwater (Sir G. Wills) first on his good fortune in the Ballot; secondly, on his judgment in putting forward such a useful Bill; and, thirdly, on the lucid and helpful way in which he has presented it to the House. It was hard for hon. Members to realise as they listened to my hon. Friend explaining the intricacies of this Bill that this is the first opportunity of addressing the House which my hon. Friend has had for about seven years.

I am concerned with the question of hardship which may arise under the present position, and perhaps I may be allowed to give an example. It is a standard practice for patients in part of my constituency of North Dorset to be taken to hospital in Wiltshire because that is more convenient, and they go to Salisbury Hospital. I do not say that this has happened, but it might be that while such a person—perhaps an elderly and infirm person—was in hospital in Wiltshire some change in the home where he had lived in my constituency would have the effect of losing for him what is ordinarily called his residential qualification in Dorset. As I say, so far as I know, this has not yet happened, but should it happen—and it could happen— such a person would have the greatest difficulty in coming again into the county of Dorset upon discharge from the hospital in Salisbury, and in getting the help he needed in finding a residence in Dorset under the county council scheme. This would impose very great hardship on such a person.

In my constituency I have old folks' homes where there are very happy, thriving communities. A patient taken from such homes to hospital for some months can, after discharge, have lost his residential qualification and be unable to return home to the place where he or she had been happy and where they wish, naturally, to spend the remainder of their life.

I believe there is not a very great number of cases in which this hardship has operated, but that fact does not alter the extremely acute nature of the hardship when an unfortunate elderly person is so affected. The Bill will clarify the position and serve a useful purpose by preventing the risk of acute hardship to elderly people in the sort of case to which I have referred.

11.31 a.m.

Mr. Tom Brown (Ince)

I, too, congratulate the hon. Member for Bridgwater (Sir G. Wills) upon promoting the Bill. Any Bill or regulation that has for its purpose the relief of hardship has my wholehearted support, whether it comes from the Government side of the House or from this side.

The Bill will do a lot of good, and I do not think it will be controversial. I do not think we could advance any argument against a Measure making provision for the relief of hardship. As the hon. Member for Bridgwater truly said, within the last three quarters of a century a great deal has been done, but a lot more still remains to be done before we have a perfect system. As a nation we are supposed to be pioneers in this branch of legislation, but when one analyses what is being done by other countries that came into the field of social insurance, social security and provision for the aged and disabled, we realise that we fall very much behind them.

When we have had under consideration provision for assistance to people who have been unfortunate in life, I do not know why we have not gone what we in Lancashire call the "whole hog" I am not underestimating the attempts that have been made, but we are still far behind other nations in the provision we make for the disabled and the unfortunate. In my constituency we have no workshop for the disabled, but provision has been made by the local authority, which has greater powers and much more brass—by which I mean money—to deal with that aspect of communal life. I hope that the Bill will do something in that direction.

I hope that the hon. Member for Bridgwater will understand me when I say that I am a little surprised that the Bill has come from the hon. Member for that constituency. The last time I was in that beautiful spot it had no poor and disabled people. There must be width of vision on the part of the hon. Gentleman behind his decision to bring forward the Measure, and I admire him for so doing. When the hospital or workshop has made provision for a person, it may be difficult for the person to get back again into the area in which he was formerly resident. I agree wholeheartedly with the seconder of the Motion, the hon. and gallant Member for Dorset, North (Colonel R. H. Glyn), that that difficulty has created real hardship, which the Bill seeks to remove. We shall be prepared on this side of the House to support the Bill.

The Bill refers to National Assistance, and I intended to refer to the operations of the National Assistance Board, but I do not want to be ruled out of order. I have had one or two remarkable experiences this week, but that does not matter. Time is revealing with great impetus that more and more people who have been unfortunate in life have to seek assistance of the kind which the Bill provides. That is regrettable, but it is not the fault of this House. Our fault lies in the fact 'that thirty or forty years ago we did not tackle this problem in the correct way. We were not far reaching enough.

Looking at the legislation on the Statute Book, we find that every now and again something has reared its head which has commanded our attention and has aroused the sympathy of hon. and right hon. Gentlemen and of people in the districts. I travel about the country and visit old people, and I have always wondered why we should expect so much to be done for them by voluntary organisations. I welcome those organisations because they are good, but all the kindness and sympathy which they manifest for the disabled and the unfortunate only brings out the truth that the work ought to be done by the State. I am not blaming the voluntary organisations. They do a grand Job of work, and we should encourage them in every direction.

My main point is that the responsibility for making provision for the disabled and unfortunate lies upon the legislators of this nation and on this House. If the Bill will do nothing else but relieve the hardship which is encountered by our unfortunate fellow-citizens it will do a good job. I welcome it with open arms, and I hope that the hon. Member for Bridgwater will have success in getting the Bill through its further stages.

Let us go forward until the day dawns, as I have said before, when this legislative assembly will tackle the problem of the unfortunates and the disabled, who have a call not only upon our sympathy but upon our money. Then we can do away with the patchwork quilt which is now covering us and put in its place something commensurate with the intense human need.

11.39 a.m.

Mr. Leslie Hale (Oldham, West)

It would be ungenerous, on a Friday morning, to criticise the hon. Member for Bridgwater (Sir G. Wills) and the hon. and gallant Member for Dorset, North (Colonel R. H. Glyn), who respectively moved and seconded the Second Reading of the Bill, for the brevity of their speeches. That fact is normally welcomed, but I hoped to elicit information from them on the extent to which the Bill will affect the powers now used by local authorities under the National Health Service and the National Assistance Acts.

I sincerely congratulate the hon. Members upon introducing the Bill. I wish it went further, but that, again, is unfair criticism, because I have a great deal of sympathy with the point of view that the best use of private Members' time is to introduce small, useful and as far as possible non-controversial Measures. I say that, realising that my words may in future be quoted against me, because I have for long contemplated the introduction of a one-Clause Bill dealing with the nationalisation of land and National Debt redemption which would be effective for ninety-nine years by reform of the leasehold law. I still reserve the right to reject my own argument and to introduce it one day under the Ten Minutes Rule.

While welcoming the Measure, I am not quite sure precisely to what extent it will affect the law. As the Parliamentary Secretary to the Ministry of Health knows, in a Committee room upstairs we are at present discussing the mental health services, which are singularly important in this connection and will become much more important because some of the problems to which this Bill refers fall to be dealt with under the Mental Health Bill. I do not know what assurances of support the hon. Member for Bridgwater has had. He has had some assurances today of absence of opposition, but that alone is not enough. Sometimes a Bill may fall not because of what is contains, but because of what it does not contain. That is undesirable, but we know that it can happen.

It might be a matter for consideration how far the principle now enunciated in this Bill could be incorporated in the Mental Health Bill. It could be pointed out that the short Title may not be wide enough to cover that, but it would seem conceivably possible to do it. That would give a chance of enabling the Measure to reach the Statute Book by one means if it failed to reach it by another.

One of our major problems in this limited connection is the failure of the Government to do anything about local government reform. That is a failure which affects this Measure directly and it continually affects us in the North in almost every problem. I do not want to be almost the apostle of the parish pump, although Oldham has had a singularly creditable record in this matter, but I believe that hon. Members should quote from examples they know and which they have seen in constituencies. Oldham is a county borough and did a great deal of pioneering in connection with accommodation for old people. We built some of the first hostels for the aged that were built since the war, but Lancashire County Council had a hostel in Oldham before the war.

The Lancashire County Council hostel is actually in the borough of Oldham. People living in the county of Lancaster and going into a county hostel may reside in the borough, although they have never come under the financial control or aegis of the borough. That seems to make a point which might be dealt with in Committee, because conceivably it might require special provision. We built these homes and I regard them as a major measure of social life. It is not possible to visit these homes without realising—I use these words quite advisedly—that, without selecting people on any class or education basis, we can have people in them who are capable of a social life, temperamentally and mentally capable, gathered together in one small hostel. A dozen aged people can gather and talk about their experiences in the Matabele or the Boer War and live a social life together.

I am speaking rather "off the cuff" this morning and I have not the figures at my disposal, but I think that I am right in saying that this proves a cheaper method. The study of the optimum unit in local government affairs is a matter of great importance. The Parliamentary Secretary will agree that in mental health we are moving away from the conception of the mass hospital which gets too big to manage and that we are also moving from the optimum in penal reform. Most penal reformers know that a prison with 200 to 400 occupants is better than a great caravanserai like Wormwood Scrubs, although Wormwood Scrubs is perhaps the best run prison in England. I make no criticism of its control, but nevertheless, it is too big effectively to manage.

I gather that I was perhaps approaching the bounds of the territory which is laid down for me to confine myself to today, so I shall try to limit my remarks very largely to one special example of the problem which I think is of importance and also of interest. I do not know, and I should like to ask the hon. Member for Bridgwater, how many of these industrial institutions are in existence. One knows that there is a great variety in most progressive towns. Some are run by one authority and some by another. Some are financed partly out of the rates. In Oldham, we have a very wonderful institution called the Inskip League in which four or five disabled men decided themselves to do something for the disabled. They did it rather on the principle that only disabled men could really understand the problems of the disabled and that only disabled men could really make the approach to the disabled which was the effective approach.

In view of your warning, Sir, I could not get near to discussing penal reform again, although I remember an institution in Utrecht where the prisoners themselves were asked to lay down the routine and to apply all the discipline. Something is to be said for that point of view. These disabled men in Oldham managed to get extraordinarily cheaply—although the price was some thousands of pounds—a great hut which was used in the construction of the railway tunnel on the Manchester-Sheffield line and they brought it to the centre of the town. They there established it as a place to which disabled people could go in their bath chairs.

A grant was made by Oldham Corporation, which has shown great kindness and understanding and given great co-operation to the scheme. It is a very progressive corporation that we have in Oldham and it has helped considerably, but, of course, there is in no sense officially rated support for this institution, nor is it an institution maintained out of local government expenditure and I do not think that it would be affected by this Bill.

The organisers are very anxious to encourage disabled persons anywhere to use their services. They maintain a visiting service to all disabled persons in the district. It is of interest in relation with this Measure to know that in the early days they visited men who were so walled into their homes that they were reluctant ever to emerge from the renunciation of life which their disability had imposed on them. They had come to accept it so much that they had achieved a sort of immobility of their own. The neighbours did their little shopping for them and they spent the time just looking at the ceiling, or out of the window on to the mills or—if they were lucky—to the hills. That is one of our problems.

It is right to emphasise the very great importance of this Measure in one way in particular. We are facing the problems of mental health which are particularly affected by this Bill, because it is especially in connection with the industrial training of mentally suffering patients that a great deal of local authority work is likely to be done in the immediate future. The problem there is very great indeed and it will also be a problem of the ageing man who becomes incapacitated by senile decay, or even more aggressive forms of mental trouble.

The problem which confronts the local authority in this way is very serious. If we accept an aged person into a mental hospital, that person is likely to remain there for seven, eight, nine, ten years, or for the rest of his life. That bed will be occupied by one person, whereas the normal turnover in the hospital is nine months and the result is that eight or nine people are kept out by that one aged person. Here the progress of chemico-therapy and the use of antibiotics, and so on, is a very considerable boon when we are approaching the stage at which it might be possible to apply the use of large hostels to people not so fit but who can use them under slightly different conditions under medical supervision.

It may well be that this is the precise problem of the Bill, which, in relation to county boroughs, is a singularly important one. The problem arises in this way. Each of these county boroughs is the centre of a rural area. Most rural areas have neither the money, nor the facilities, to implement proposals of this kind. Nor have they sufficient people in their areas to need those facilities to justify the construction of a single home. I do not want to stray beyond the bounds of order, but this is the precise and limited problem of the Bill, and it is well that on Second Reading we should understand what it means.

Adjacent to the county borough of Oldham is the urban district of Chadderton, with a population of about 30,000, which is quite capable of running its own affairs, and would be extremely indignant if I suggested that it was part of or associated with Oldham except in very limited connections. Then there is the much smaller urban district of Lees, which has much more limited facilities. There is a wide rural area stretching over the hills in the direction of Yorkshire and the North. Many of these authorities cannot contemplate the construction of an industrial rehabilitation centre for the reasons which I have given.

As a county borough we have tried to help anyone who needs our help in this particular sphere. But it is limited. The particular example which I should like to draw to the attention of the House is the Mental Health Industrial Rehabilitation Centre in Oldham, which, perhaps, has many claims to be regarded as a pioneer centre in this respect. Thanks to the Medical Officer of Health, Dr. Keddie, and his assistant, Mr. MacNiff, this centre has a record which should earn the respect of the whole country. It has demonstrated solutions to problems which have puzzled many people for a very long time. A singularly unpleasant piece of undulating land was taken over by a county borough with little money for the purpose which already faces the miserable situation that the rate product, however high it be, can never meet a tithe of the urgent problems confronting the vast conglomerations of housing in the North.

Priority becomes a very bitter word in the administration of a bounty borough. So many things need to be done. There are streets to be made that should have been made seventy and eighty years ago and there are houses which should have been pulled down scores of years ago. So it may well be perhaps that this misfortune was singularly fortunate. We found that if we were to conduct an experiment of this kind it had to be done with very little money. Houses were bought at about £50 a piece, and were painted. With a lot of voluntary and some paid labour a centre was constructed at which there are now 110 people working.

Army huts were taken over, and 50 men and 60 women are now employed at normal hours on a five-day week at the centre. All of them have some form of mental ailment. Some are children from the special schools—a very acute problem. Some are people who are being rehabilitated after a stay in the mental hospital, but some—I do not want to particularise cases—are people who were put in the mental hospital twenty and thirty years ago and who probably should not have been put there at all.

As I say, I am speaking "off the cuff", and I will not guarantee my figures, but I think I am right in saying that, of those 110 people, 90 are normal residents in Oldham and about 20 came from outside. Some came from outside to the special school and some to our mental hospital and some who were recommended to this treatment have not been inmates of the hospital at all and may have been under out-patient treatment or under observation. We have found, in this work, that it is a very astonishing thing that on the repetitive task, the more acutely mentally sick persons becomes a more efficient worker than even the ordinary person, for a well-understood medical reason, namely, that the isolation of mind makes it impossible to have distractions. The modern medical theory about fatigue is that distraction is much more the cause of fatigue than the actual operative task itself. So it is possible to get them working on a repetitive task and performing useful commercial services.

I do not want to labour this point, but the man who was at the mental hospital for twenty-seven years at a cost to the community of several pounds a week, with the family, perhaps, being supported from outside, and who is now earning £8 a week in industry, is a classic example of what a progressive authority can do in one of the most difficult spheres of work. We have been taking some risks. I hope that the Minister will not start making too many regulations about these places while they are in the experimental and difficult stage.

I could have wished that the hon. Member for Bridgwater had given us a few more figures. I do not say this discourteously. I thought that he moved the Second Reading very ably, briefly, and effectively and made the purport of the Bill perfectly clearer. One of the tragedies of political life is that we go on passing Bills to provide facilities, but that all too often the facilities are not used. This is the sphere of the relationship between Parliament and local government in which one can well understand the difficulty of Ministers. All of us would protest if Ministers imposed their will too often upon local authorities. But the facilities provided for mental health, old people and industrial rehabilitation under the National Health Service and National Assistance Acts were very wide and very full and were subject to a full Government grant.

All our information shows that far too little has been done and that we are reaching the stage when the will of the Minister must be made known and when he should be calling for reports from local authorities. The time is rapidly approaching when he must impose a time limit and say, "Your proposals for developing these essential measures in the interests of the community must be put before the Minister and must be submitted within a reasonable time." If he fails to do so, these Bills become very largely nugatory and we are spending our time, earning sometimes, perhaps, a little self-contempt, in purporting to do things which, in fact, will not be done.

I said in my opening remarks— and I want to be quite fair about it—that there is much to be said for a Bill introduced as a Private Member's Measure which is limited in its objective and which seeks to correct some anomalies in the law. On the other hand, it is a pity that today, when we are discussing the growing problems of aged people, it would be out of order for us to mention some of the pressing problems of the aged which are weighing ever more heavily upon us.

I have referred to the problems in Oldham, and I know that it would be out of order to develop that subject, except perhaps in a single sentence—because it is relevant in the general connection— to say that, given widespread unemployment, each and every social service becomes the victim. Given 7,414 unemployed in one county borough, it affects the operation of every social service, affects many homes and creates many problems. It also makes life singularly difficult for the hon. Member who has to bear the burden of the mass of correspondence which results from that situation and the additional problems which arise.

The Bill is a useful Measure and I do not want it to appear for one moment that I have been denigratory in my remarks. No doubt the Minister will give us the advice of the Government on this matter. I ask him to consider one or two technical problems which I have put to him and which I do not want to recapitulate. They arise in the interrelationship between a county borough and a county council—particularly a county council which, necessarily and properly, has some of its services centred within the area of the borough.

We have another and quite separate problem in Oldham. I hope that I am betraying no secrets when I say that plans have already been drawn up, thanks to a very generous donation from a very generous trust, for the building of residential homes in connection with the Mental Health Industrial Rehabilitation Centre. Twenty people—only 20, but, still, an interesting and very useful experiment, because most of them have been acutely ill and are now on their way to recovery and rehabilitation—will live in those homes.

What will be our position if we accept patients from outside Oldham? I know that it would be the wish of the authorities, and, indeed, of the House, that in the administration of those centres we should accept people on the basis of need and that we should not be limited by a geographical boundary in the financial administration of the service of that kind. Naturally, from the point of view of studying the effect of rehabilitation we ought to select cases most likely to profit rather than cases in which the person happens to have been born within the borough.

That is a problem on its own. What are the financial implications of that policy and how far will the Bill affect them? I hope that under existing legislation the county borough is entitled to the maximum assistance from the Government in a venture of this kind, and I hope that the Minister will clear up any doubts in this respect, because that would be to the advantage of the House and would help us all.

I do not want to delay the House, and I will conclude by hoping that we shall have an early opportunity of considering some of the matters which are left out of the Bill and are inherent in the problems of the aged. It may be that in a limited way we shall be able to consider some of them in Committee, but there are others, too, which are of very urgent concern. I have in mind the diminution in the standards of living of the aged and the widespread increase in unemployment. These problems are affecting the lives of aged people, whose allowances are still inadequate for an independent life and who, because of the failure to provide an adequate standard of life for them, are still affected to some extent by the change in the standards of the rest of the community.

I beg the Government to think again on the whole policy in relation to these institutions. Festina lenteis a very good policy in some spheres and no one suggests that in mental or penal reform we should advance with a reckless speed. Certainly, in proceeding slowly we have learned a great deal from experience. I wish it were possible for me to show the Minister not only what has been done in Oldham in mental health matters, but also what we have done for the aged in the erection of small homes for this part of the community. There, again, we have exactly the same problems as are specifically dealt with in the Bill. On the small housing estates for the aged in Oldham we have built excellent, small houses.

I hope that the hon. Member for Lanark (Mr. Patrick Maitland), who is smiling, is smiling appreciatively of this point. I would tell him that I have seen a deaf and dumb aged lady living on her own and looking after herself. All that is provided is a superintendent and his wife, living in one of the houses and ready to give such limited help as is necessary and to provide a little skilled assistance—for instance, helping with a little gardening in the centre. I do not know why the hon. Member for Lanark is amused. I find it difficult to translate his expression, and I certainly should not like to try to translate it into words.

Mr. Patrick Maitland (Lanark)

I was smiling at the hon. Member's expertise in spinning the matter out.

Mr. Hale

I represent the greatest spinning town in the world. Nevertheless, I had not thought that I was spinning it out. I should be distressed to think that I was imposing myself upon the time of the House, and after the hon. Member's comment I almost find it difficult to continue. Perhaps the House will allow me to conclude what I was saying, in spite of the hon. Member's opinion.

It would be a bad thing if all these matters were wholly decided by geographical location. Indeed, it is a bad thing for them to be wholly decided by a priority list, although priority is an extremely important element. In this sphere, in particular, we ought to try to provide services for people in need and for people who can most profit from them.

We are very proud of what we have done, but we believe that we ought to be doing more and that the Government are not giving us enough help here. We believe that the last seven or eight years have shown a definite retarding of the work for the aged which we began and which we are anxious to continue to the fullest extent. If the Bill will help, I welcome it. If the Minister makes a statement which will help, I shall listen to it with the greatest pleasure. If, in my interest and enthusiasm for the subject, I have spoken longer than I had contemplated, I regret that I have postponed the possibility of the House rising early on a Friday.

12.9 p.m.

Mr. H. A. Marquand (Middlesbrough, East)

Like my hon. Friend the Member for Oldham, West (Mr. Hale) and my hon. Friend the Member for Ince (Mr. T. Brown), I welcome the introduction of this Bill and hope that the House will accept it and pass it quite rapidly. I would not have risen at this time to try to catch your eye, Mr. Speaker, if I had thought that some of the hon. Friends of the hon. Member for Bridgwater (Sir G. Wills), the sponsor of the Bill, would wish to support it. Indeed, I look forward to hearing something about the state of accommodation for old people in the town of Lanark. It would be quite interesting to know about that.

We have many opportunities in this House of discussing National Assistance, but they are almost always opportunities confined to discussing the sums of money provided by the National Assistance Board to help old people and disabled people and unemployed people to make ends meet. We are sometimes inclined in consequence to forget that the National Assistance Act does contain a number of provisions for helping the disabled and the aged in very practical ways. It is, of course, absolutely essential to provide a minimum income on which such people can live—I do not propose to go into that because it is not mentioned in the Bill—but that would not by itself be enough. Experience has shown us that if we are to help the disabled and the elderly in our population we need to do a great deal more for them than merely provide them with sufficient money on which to live.

What the disabled and the elderly welcome more than anything, in my experience—and I have had some experience of this, as the House knows—is opportunity to live as much as possible of their lives in the normal life of the community. The disabled person derives an enormous satisfaction, his life is undoubtedly lengthened, if he can take part in the normal life of the community, particularly if he can do a job. This was proved very strongly in our experience with war pensions, and we took the opportunity in the National Assistance Act, 1946, to try to make that opportunity available to other disabled persons and to empower the local authorities to provide among other things the sheltered workshops which are referred to in the Bill.

There, disabled persons who are not able to do a full job in ordinary factory work have the opportunity none the less of contributing something towards the national product and of engaging their minds and their bodies in useful work. They can go away at night from one of those workshops and back to their own homes feeling that they matter, that they, too, are dignified and useful citizens taking part in the general activities of the community. One can hardly exaggerate the value of work of this kind. Therefore, anything that can be done to facilitate the use of the workshops should be done, and the proposal in Clause 1 (2) of the Bill will undoubtedly help to facilitate the expansion, I hope, of the disabled workshop services.

It will certainly facilitate the use of those workshops in the way which was intended, and it will remove a little administrative obstacle which has been discovered, which arose without any deliberate intention at all on the part of those who drafted the original Measure. A piece of drafting which seemed at the time to be entirely reasonable has turned out to create an obstacle and to prevent certain people who ought to have the opportunity of doing so from working in those workshops.

I hope that the Parliamentary Secretary to the Ministry of Health will take the opportunity, because, as I say, it is a very rare opportunity that the House of Commons gets, in explaining the Government's attitude to the Bill, which, I am sure, is bound to be friendly, to give us at least a little information about the general background, some account of the present situation of the disabled workshops. We are entitled to ask how many there are and what progress is being made in increasing the number.

I believe I am right in saying that the last time that an official report was made, though I must confess I have not had an opportunity to check my recollection, it was found that progress was somewhat disappointing. The provisions in the Act are permissive and not obligatory, if I remember aright, on the local authorities, and some of them may have held back because they were afraid that the present block grant system of financing their activities may have meant that in order to construct a new workshop for the help of the disabled they would have to do without some other useful activity which they may have liked to start. I hope the hon. Gentleman will take advantage of this opportunity to bring us up to date at any rate in this matter.

The Bill seeks to deal also with a similar administrative difficulty arising in the care of the elderly, a difficulty arising, as the hon. Member for Bridgwater has very clearly explained, where an elderly person has to spend a considerable amount of time in a hospital which is not in the area where he normally lives and finds at the end of that period of hospitalisation, to use an American word, that he cannot get into an old people's home in his own district, because he is now legally resident in the area in which the hospital and not his home is situated. This, of course, is an absurdity and ought to be corrected.

Nobody thinking of the welfare of the elderly or the disabled can deny that it is a great advantage to them to live in their familiar environment. We find all the time that old people, even though it is extremely difficult and awkward, even though it means they encounter risk of serious accident, will persist, even if they have to live entirely alone, in living if possible in their own homes to which they have been accustomed over the years and which carry for them memories of their family life and all the rest of it. That being so, that being the frame of mind of the elderly who desire to live in their home environment, we should remove that obstacle in the way of an old person's getting back to the village or the town or the street in which he used to live, or as near to it as possible. If he is to go to live in a local authority home, he should get back to his neighbours, to the place where his relatives can go to visit him, and where he feels at home.

The hon. Member for Bridgwater mentioned that some local authorities are now very reluctant to accept persons coming back from hospital in this way. He almost suggested that perhaps local authorities were glad of a reason not to accept a person of this kind, who spent some time in a hospital outside the area, and lost his residence qualification, and that, although no doubt they were sorry for him personally, they were not sorry they could not admit him because, of course, they had not sufficient local authority Part III accommodation available to take care of all the people who needed it. The real difficulty behind this Bill arises, I suggest, from an overall lack of accommodation. The problem would not be there if there were a sufficient number of local authority homes to take care of all who need them.

We are, fortunately, in the position that we have made a great advance on the state of things which used to prevail. When the great Royal Commission on the Poor Law studied these matters at the beginning of this century, no less than one-third of people over seventy were living in poor law accommodation. It is no longer true that large numbers of old people need to resort to poor law accommodation. In some cases, that accommodation is still being used, but it has been transformed out of all recognition and turned as far as it is possible with these old-fashioned buildings into modest modern hotel accommodation. But the number of old people is increasing so much that, although local authorities have transformed their poor law accommodation in this way and they have been able to build or to buy buildings, as they are empowered to do under the Act, there is still a considerable lag in making this provision.

Our attention has been drawn to all these matters in the recent Report of the National Corporation for the Care of Old People, which contains this sentence, with which I am sure every hon. Member is bound to agree: The experience of almost every individual who has endeavoured to find a home at a reasonable cost for an elderly relative is that local authorities can seldom promise an early vacancy. That is the situation today, despite the advance that we have made.

Another part of the Report refers to the type of person with whom we are particularly concerned today. It says that among the large number who fail to get admission easily and quickly to local authority homes are this special group, and that in the survey carried out by the Ministry of Health, published in 1957, it is stated that in five counties in Wales there was a total of 877 beds in homes, of which only 76 were on the ground floor. Elsewhere a report has been noted of a county council which had a waiting list of 313 for its old peoples' homes, and of this number 128, or 41 per cent., were unable to manage stairs and only 13 were under 80 years of age. These are precisely the kind of persons for whom the hon. Member for Bridgwater is trying to make provision. They are the elderly people in failing health who may have needed hospital treatment for a time and who come out no longer so weak and infirm that they need to stay in hospital but—and I do not want to use an emotive word—decrepit. They are unable to move about easily and freely. The Bill wants to help these people who really need accommodation in a home for those needing care and attention. They need accommodation in homes where there is ground-floor accommodation, for it is difficult for them to get upstairs and dangerous to get down. These people ought to be accommodated in properly constructed special accommodation, but unfortunately that does not exist to the extent that is needed.

These problems will be increased by the operation of what we hope will shortly become the Mental Health Act, 1959. That Bill is now in Committee and my hon. Friend the Member for Oldham, West has reminded us that it will increase the numbers of afflicted persons who will need this kind of accommodation. When that Bill comes into operation there will be an accentuation of the problem, with which the present Bill seeks to deal, of people who have been in hospital—this time in a mental hospital—and who on coming out should be cared for by the local authority.

The National Corporation for the Care of Old People, in a reference to it, says in its Report: This would involve, amongst other things, the discharge from mental hospitals—probably in most cases to Homes—of a large number of old people who though no longer in need of hospital treatment would probably need a considerable amount of care and attention. This is a measure which makes even more necessary the most careful assessment of future need for residential Homes by local authorities. I hope that the Parliamentary Secretary will take this opportunity to tell us what plans the Government have in this respect.

So far, there seems to be no doubt at all that the accommodation is not satisfactory in quantity, though it is in quality. The National Corporation says, on page 7 of its Report: While the number has increased considerably, demand, in most places, exceeds supply and this situation seems likely to continue unless it becomes possible for local authorities to spend large capital sums on building in the immediate future. From the tables … it will be seen that out of the 145 local authority administrative areas in England and Wales, there were still 90 in March, 1958 which had provided under one bed in small Homes per 1,000 of the total population which may well be less than half the potential demand. This evidently is a serious problem. The Bill deals with a small aspect of it. Perhaps the most deplorable finding of this valuable Report by the National Corporation is to be found on page 8, where it says: Comparison of the 1956 and 1958 figures indicates that not a great deal of progress has been made in the period. It is really deplorable that between 1956 and 1958 there should have been a slowing down in this provision. It can be attributed only to the restriction of building, for which Her Majesty's Government are generally responsible. It is a deliberate restriction which was adopted as a positive policy round about 1956. Local authorities, in this as in other of their housing activities have not been able to meet the peoples needs and, because of high interest rates and the reduction of subsidy, have not been allowed to provide the total accommodation which they have wanted to provide.

The National Corporation sums up this general situation by telling us that there is a lack not merely of local authority homes, specially built for groups of old people, but there is a considerable lag in the building of smaller homes for couples or single old people. The Corporation says that the proportion of dwellings suitable for the aged reached 18.8 per cent. of all houses built by local authorities during the quarter ended 30th September, 1958, but over the period since the last war the proportion has been only 8.3 per cent., which is not within striking distance of the total estimated to be required. The Corporation estimates that to reach a proper proportion and to make up within a reasonable space of time the lack of numbers of dwellings built in the past, it might be necessary to continue to provide for the aged over a considerable period at least 20 per cent. of all houses built during that time. The Corporation concludes: There seems little doubt that the provision of enough suitable housing for old people is one of the keys to the solution of the general lack of accommodation for the old, whether in housing, Homes or hospital and this being so it is the more strange that little effort has been made to assess requirements for the present and the future on a national scale. We are dealing here with the administrative problem of overlap and that, in turn, should lead us to a consideration of the administrative problem of co-ordination because so many different services care for the disabled and the old. The Minister of Labour is responsible in part for the work provided for the disabled, so is the Minister of Health and so are the local authorities. Similarly with the aged there is a responsibility on the local authority, on the Minister of Health, on the National Assistance Board, and so on. A multitude of organisations are involved in the care of these people and we have a right to ask this morning whether the Government feel that the Bill goes for enough. Useful Measure though it is, dealing though it does with a problem of overlapping and therefore of necessary co-ordination, should it not be expanded? Should not the opportunity provided by the introduction of this Bill now be taken to deal with the matter on a wider basis?

The National Corporation says further: To bring about a properly integrated system of social services it is necessary for all who are engaged therein at every level to work in close co-operation; and to enable them to do this they must first make the effort to discover, not only their own problems and how they can best be overcome, but also what is being done by other social workers in fields which are adjacent to, and even overlapping, their own. It is, unfortunately, all too common to find that different departments or services work in isolation. Therefore, we have a right to ask the Minister to tell us whether he is satisfied that the hospital authorities and the local authorities are sufficiently in touch with one another? Do they know what is going on? Have they adequate information services available to guide the old people coming out of hospital in respect of these problems? The National Corporation states quite rightly: Every Government department is a large and complex organisation in itself but, while making allowance for the difficulties which are inherent in a system of central government, there would still seem to be a need for closer working together whether this is done by a co-ordinating committee, a Minister for Social Welfare or by any other means. The whole burden of the Report is the need for more information. We really need a survey of the needs of the old people. Fortunately the University of Cambridge, by the aid of an outside body, is now conducting a large-scale survey of the conditions in which old people live and what their needs really are. I wish that an even larger survey had been made by Her Majesty's Government. At any rate I hope they are closely in touch with, and assisting, the survey now on foot, and that they will try to work out and present to the House of Commons at some time a more close, a more accurate and a more informative survey of the needs and provisions than we now have.

12.33 p.m.

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

We have had a useful and wide-ranging debate on some of the thoughts engendered in the minds of hon. Members by the rather evocative Title of this Bill. The best news I can give the House at once—and I was particularly asked for this by those who, on both sides of it, have welcomed the Bill—is that Her Majesty's Government welcome the Measure and will certainly give it any support it may need while passing through what I hope will be its further stages in the capable hands of my hon. Friend the Member for Bridgwater (Sir G. Wills). It is a modest and useful Bill and although it has given rise to a wide debate, it is strictly a machinery Measure. It does not aim to provide fresh accommodation as such, but to establish beyond doubt the respective responsibilities of local authorities in this matter.

My right hon. and learned Friend the Minister of Health has received a great deal of evidence in recent years that Section 24 of the National Assistance Act, 1948, which it is the purpose of the Bill to amend, as at present worded, has had the effect of putting an unfair burden of responsibility on certain local authorities, particularly those who have in their area hospitals which receive patients from a very much wider area. During a stay in hospital, especially if it happens to be a long stay, an elderly patient may give up his former home or otherwise break his ties with the area from which he was admitted to hospital, so that he becomes a person not ordinarily resident in the area of any local authority.

If this happens, the responsibility for providing residential accommodation, if he needs it on discharge from hospital, falls on the authority of the area in which the hospital is situated. The effect of Clause 1 of the Bill is that in such circumstances a stay in hospital would be ignored and the person would still be deemed to be ordinarily resident in the area where he normally lived before he entered hospital. The authority of the area where he had previously lived would thus have responsibility for providing him with residential accommodation if he needed it on his discharge. The local authorities, who have been in a certain amount of difficulty in cases which have arisen of assigning this precise responsibility, certainly welcome the Bill.

Subsection (2) of Clause 1 makes a small amendment to Section 29 of the National Assistance Act to prevent an unfair burden falling on local authorities who provide sheltered workshops. At present, the authority in whose area a disabled person was ordinarily resident immediately before taking up work in a sheltered workshop is responsible for meeting the cost of any welfare services provided for him. This does not apply, however, if the disabled person, knowing that he has been accepted for work or training in a sheltered workshop, gives up his home and moves to a new one in the area of the authority providing the workshop before he actually commences work there.

In such circumstances, the financial responsibility for providing him with welfare services falls on the authority owning the workshop. The effect of subsection (2) is to leave the financial responsibility with the authority in whose area the disabled person was ordinarily resident before he was accepted for work or training at the workshop.

Mr. Hale

Could the Minister say precisely what financial responsibility there is? For instance, how would it work in Oldham at the Mental Health Industrial Rehabilitation Centre? Supposing a man who normally lives outside the borough comes in either as a resident or on a five-day week, what is the contribution? How does any financial responsibility while he is there rest on the local authority? I appreciate the importance of the measures taken when he goes back to them after treatment.

Mr. Thompson

What is at issue is the responsibility for the welfare service provided for him while he is at a sheltered workshop.

As the hon. Member for Oldham, West (Mr. Hale) said earlier, this is a private Member's day, and I have no doubt that my hon. Friend the Member for Bridgwater will have listened to the debate and have noted, perhaps, some of the implications which may be involved when, as I hope, the Bill goes to its Committee stage.

I was asked one or two questions which arose out of what I think is perhaps a misapprehension that the Bill actually does anything to provide fresh accommodation. It does not do that; it is administrative, a quite limited but very useful tidying-up Measure which apportions the responsibility as between local authorities in cases where our experience at the Ministry of Health has shown that there is a good deal of doubt as to which authority ought to bear the cost of providing for a person who is discharged from hospital, outside the area where he normally lives, into Part III accommodation in the area of the second authority, and it has become something of a problem as to who should pay for it.

Therefore, I think that the general welcome which this Bill has received is well deserved. It does not seek to go very far into all the problems to which, for instance, the right hon. Member for Middlesbrough, East (Mr. Marquand) referred. It is strictly a machinery Bill, but it is none the worse for that, and I hope that after the useful debate which we have had, and seeing that the House generally has given it a welcome, we can now pass on to give it a Second Reading, and wish my hon. Friend the Member for Bridgwater well in the subsequent work which he will have to do in connection with this matter.

Mr. Marquand

Before the hon. Gentleman sits down, may I ask him whether he could say how many cases have arisen and in how many instances have old people failed altogether to get into Part III accommodation after discharge from hospital, because of this impediment?

Mr. Thompson

It is not so much a question of failing to get into Part III accommodation as of cases in which the Minister has been approached by the local authority concerned to determine to whose account, so to speak, the old person should be charged. The number of such cases is approximately 300.

Question put and agreed to.

Bill accordingly read a Second time.

Bill committed to a Committee of the whole House.—[Sir G. Wills.]

Committee upon Friday next.