HC Deb 29 July 1964 vol 699 cc1541-54

9.26 p.m.

Mr. E. L. Mallalieu (Brigg)

I wish to take the opportunity which all hon. Members have of raising points for discussion on the Bill. The point to which I wish to draw attention is the provision for mentally handicapped persons.

We may put these people into any sort of category, but for those who are less interested in categories and more interested in persons it is enough to say that I am talking about persons who, by reason of subnormal mentality, are unable to take their full economic place in the activities of the nation. They are also people who, to a greater or lesser extent, are a burden, a burden which has to be seen to be known and understood, on their parents or families who have to look after them. I am thinking not only of children, but more of those who have gone beyond school-leaving age.

It is not very long since the only public provision for these people was the madhouse. I do not think that it is any use for us at this time to look back and blame our forefathers for their inability to treat these people, because so much less was known then of the ways in which it was possible to help them than is known now. The same certainly cannot be said of us. We ought to blame ourselves to a very large extent having regard to what we now know of the ways in which these people can be helped. We ought to blame ourselves for what I can only call the extreme paucity of the provision which is made for them.

When there occurs in a family the tragedy of a subnormal child it very often happens that the whole of the energies of that family are devoted to the help of that child; and, in particular, the mother can become worn out partly because, more than anyone else, she feels the sense of tragedy and also because on her falls the burden of looking after the child physically. I do not suppose that there is any hon. Member who, in his constituency, has not come across a family which is completely ruined by the presence of one of these burdens, if I may so describe them, upon the family.

It is not only a question of the physical burden and the expense, but also the fact that holidays may become impossible for such a family. The parents, perhaps, do not wish to be seen taking about a child of mental sub-normality, and there are few places which will receive such a child with the sympathy and care which it needs. All this falls upon the family through no fault of their own, as far as is known; as far as we can tell, it is completely by chance.

I know that there are schools for these children, but in April the Minister of State for Education and Science said in public that there had been a constant waiting list of 10,000 for places in these schools in the last ten years—and 10,000 overburdened, perhaps wrecked families is a terrible sum of tragedy in this generation.

It is not that the families, into which these children are born, want to get rid of them. The most poignant part of the tragedy is that the members of the family who have the care of these children feel that they may well break down under the strain. Generally, they are completely devoted to the subnormal person and willing to make any sacrifices to look after him, but how much more able they would be to give the necessary care and supervision if, from time to time, they felt that there was some respite for them from the burden. I feel that the sympathy of the House should go out more to the parents and members of the family than to the sufferers themselves, who often have a gay and happy disposition.

Without doubt, the schools work wonders, and sometimes save these children from becoming the hopeless wrecks which they might otherwise become without the help of the schools. I am glad to say that in my constituency, in North Lincolnshire, the progressive Borough Council of Scunthorpe has been in the lead since the war in providing places of education and of training for those people. But when they are adults what happens to those who leave these schools and this training? Some of them may be able nearly to stand on their own feet. Perhaps they have sheltered employment in Remploy, or elsewhere, and they may have homes in which they can shelter and where some care and supervision is exercised.

But parents grow old and die and brothers and sisters, however willing they may be, have families of their own to look after and, perhaps, cannot accept the burdens that the parents have carried. Then the tragedy enters into its final phase, and the unfortunates go from lodging to lodging, perhaps losing their sheltered employment, and, finally, they come through misery into crime, prison, or hospital. That is the situation in which, at present, virtually nothing is being done. If the Joint Parliamentary Secretary can show that I am wrong in this, I shall be very glad to hear it. I am talking not of the children, but of the adults who are at the stage when they no longer have a home to shelter in.

The National Society for Mentally Handicapped Children is doing wonderful work. It has brought out a scheme whereby the parents contribute to insurance to look after these unfortunates when the parents themselves have gone. The Society has established an experimental hostel for training at Slough. This is a mere fleabite, and it is non-governmental. So far as I know, nothing is being done by the Government in this respect. I simply do not see how the community can any longer evade the responsibility of providing for this flotsam on the ocean of our so-called civilisation.

Mr. Kenneth Robinson (St. Pancras, North)

I hope that my hon. Friend will not overlook the fact that hospitals for the subnormal cater for precisely the group he is describing. The subnormal person who has lived with a family, whose family has died, and who is then as an adult no longer able to live on his own resources is the commonest source of admission to hospitals for the subnormal amongst the adult population.

Mr. Mallalieu

I know. I am very glad indeed to acknowledge that there is that provision; but it is nothing like what I am talking about. I am talking about something which can take the place of the home and be a permanent umbrella, while making the most use of the capacities, which are often considerable, of subnormal persons. I know that I said that nothing was being done. I did not mean that absolutely literally. It is, as I said also, a mere fleabite compared with what could be done for the benefit of the nation as a whole.

A publication was issued this year by Her Majesty's Stationery Office called, "Health and Welfare: The Development of Community Care". It is stated on page 112 that in 1963 in the London County area, which, I imagine, is as progressive as most, only 0.23 per 1,000 of population were in adult training centres, only 0.24 per 1,000 of population in junior centres, and none in an adult or junior hostel. As for the capital programme for the future for the mentally ill, in 1968–69 £63,000 will be spent on workshops and occupational centres and only £800 on social centres and clubs. How many clubs and social centres could be built or bought for £800? In 10 years the figures will apparently rise to only £189,000 and £1,500 respectively.

I submit that something must be done. We must have more hostels where these people can live and from which they can go to work. We must have more day hospitals of the excellent kind we have so near here in Westminster Hospital, in Vincent Square, where these people can go in and spend a happy day doing useful work and receiving useful training. This is the main burden of my remarks.

Apart from these provisions, we must at least begin to accept the idea that we must have communities for these people, communities in which they may live and work, apart from places like hostels where they live and, in favourable cases, go out to work in sheltered employment. If we do these things we will be saving thousands of families from ruin, and making the most use of the powers and skills of subnormal people.

I have been in contact with three Departments over this matter, Labour, Education and Health. I pay tribute to the Ministry of Labour for what it is doing under its sheltered workshops provisions and to the Department of Education for its provision of schools, and so on. I also pay tribute to the Parliamentary Secretary, who has been kind enough to write me several letters on this issue. I have detected increasing sympathy in successive letters from him and I believe that he understands the need fairly well. I also believe that Parliament will approve of bold measures by the Minister of Health, so long as the needs are known and that the little that is being done is realised.

Just before the war fugitives from Hitler's tyranny came to these shores from Austria and elsewhere. One group comprised followers of Rudolph Steiner. They had to make their way here, a completely new life for themselves, and they decided that the best way to do this and, at the same time, return the hospitality they had received as refugees was to use the skill and knowledge they had gained from their leader and his teachings, and to care for the subnormal.

They begged, cajoled, preached and worked until they had gathered together sufficient good will and promised capital to acquire a small property. They lived in it as a community, having no money individually. The doctors among them practised, the writers wrote, the builders built, the carpenters made their furniture, the gardeners and farmers produced the food they needed and the teachers taught. Gradually, their community took shape. As it was taking shape they began to take in the mentally handicapped. These people managed to instil into the minds of the subnormal the feeling that they had a niche in that community. The skill they had or could be taught was used and these young handicapped people—young, but no longer of school age—were given the idea that they had a purpose in life.

The former Prime Minister's family was by no means unconnected with this good work and it was in one of the Macmillan Homes that the first village, as these communities are called, was started. There are now four such villages and they receive a deficiency grant under the provisions of the Ministry of Labour. In them trades are practised and the very highest quality of goods produced and sold on the open market. The young people feel that they are at home there, and they are doing useful work—no more burden on the State than is represented by the per capita deficiency grant.

This is what a band of devoted men and women refugees have done to show us one possible way of dealing with this great problem in our midst. I do not say that it is the only way, but I feel that the Government would be very well advised indeed to study what has been done inside this community; to see what are the lessons that we can learn from it in order to deal with the problem ourselves.

I have the honour to serve on the council of the trust that tries to look after the activities of these people. I believe that it is doing a tremendous work of great usefulness to the country, and one that may very well have to be expanded and adopted by the country if we are fully to cope with the situation and make use of the potential there is in these subnormal people, who otherwise so often tend to rot.

From the letters of the Parliamentary Secretary I make so bold as to hope that he will set in train studies that will result in governmental action leading in a not-too-distant future to the removal of this blot upon the conscience of the nation—a blot which is hinted at in those terrible figures from that Government publication with the rather hopeful title—"Health and Welfare: The Development of Community Care". I hope that Government action will lead to the true development of community care.

9.47 p.m.

The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)

The hon. and learned Member for Brigg (Mr. E. L. Mallalieu) and I have recently exchanged correspondence on the subject of services for the mentally subnormal, and I have been well aware for some time of the keen interest he takes in this question. I know that he appreciates the nature of the problem he has raised tonight and that he is as anxious as I am, and as my Department is, to do whatever is best for those suffering from the misfortune of mental handicap.

I think we can take a modest pride in what is being done by the statutory and voluntary services for the handicapped generally. I noticed only yesterday in The Guardian that Dr. Jack Tizard, a New Zealander who has become the first Professor of Child Development in the Institute of Education—thanks to the Spastics Society-had said that he preferred to work in this country because he thinks it is the most advanced in the world in helping the handicapped though, even here, there are immense tasks ahead.

Let me say at once that we, too, fully appreciate that there is still a long way to go before the services provided for the mentally subnormal are adequate throughout the country, but I know that the hon. and learned Gentleman will not mind if I say that I cannot possibly accept his charge that virtually nothing is being done for the group of handicapped people to whom he has made reference.

Indeed, it is interesting to note how much has been done in recent years. The number of people in local authority training centres for subnormal adults rose from 10,600 at the end of 1961 to 15,000 last year, and by 1974 the number of places will almost have doubled. The number of children in local authority junior training centres has risen from 13,000 in 1961 to 14,000 in 1963, and by 1974 the number will have increased to about 25,000.

The hon. and learned Member also referred to the distressing problem, which I think most hon. Members have encountered, of parents who have the care of a subnormal child, a heavy burden at the best of times and from which now and again they need relief. For this purpose, last year over 5,000 short-stay admissions to hospitals or local authority hostels were arranged. The best way of judging this is to bear in mind that we have to go back only a decade to find that the provision in these fields was very small.

In short, this is a developing service and a good deal is now being done in a number of different ways to meet the need of this particularly unfortunate group. The approach of the Camphill Village Trust settlements, to which the hon. and learned Member referred, is an interesting one and I can assure him that my Department will follow the progress of this and similar ventures very closely.

I am sure that the hon. Member for St. Pancras, North (Mr. K. Robinson) will agree that we have still much to learn about the best ways of providing for the needs of the mentally subnormal and that there is undoubtedly room for experiment. I readily acknowledge the useful work which is being done by the Camphill Village Trust, and I am gratified to learn that my right hon. Friend the Minister of Labour has been able to approve the three establishments of the Trust as sheltered workshops under the Disabled Persons (Employment) Acts. I understand that his Department has already paid £85,000 in deficiency grants and expects to increase its financial support as the number of workers in the three establishments increases.

I should make it clear, however, that we are not convinced that the need is best met through units which are separated from the community as a whole. This is where the hon. and learned Member for Brigg and I may part company. I fully appreciate the work that is being done in the Trust's settlements and I take the opportunity to acknowledge the devotion and single-mindedness of those who have made possible such an experiment in community life for the handicapped, but I ought to say that we cannot see the self-contained community as a blue-print for services for the mentally subnormal.

The aim of the statutory services is to ensure that as far as possible the mentally subnormal are able to live happy and, to the full extent of their abilities, useful lives as part of the general community. I agree with the hon. and learned Member that in the past, and not so many years ago, certain subnormal people, and especially those whose families could not or would not support them, would have found themselves drifting eventually into isolated institutions and there they would have remained for the rest of their lives. We are realising more and more the extent to which such people can enjoy and profit from contact with the wider world, a process which of course has been made easier by the welcome change which has taken place in public attitudes. Indeed, there are several hon. Members here tonight who have played a notable part in the education of public opinion in this respect in recent years.

Here I should like to pay tribute to the National Society for Mentally Handicapped Children and its local branches for the influence it has had on public opinion generally. To secure the aim which I have mentioned of enabling the mentally subnormal to live lives as normal as their capacities permit within the community, local health authorities, in addition to their services for children, already provide training in their training centres for about 14,000 mentally subnormal adults, and in their plans for the development of their health services they aim to increase the number of places to about 29,000 in the next ten years. In spite of the obvious difficulties, training centres are provided in rural as well as in urban areas. I have visited quite a number of these centres in different parts of the country since I have been at the Ministry of Health, although, of course, I had some knowledge of the problem long before I arrived at the Ministry. I think most hon. Members at some time or other have come into contact with this problem and have been moved by it, and have sought in their limited ways to do something about it.

I have been greatly impressed by the work that I have seen done and the results achieved by people working in these centres, who bring such a remarkably high degree of skill, patience and devotion to their tasks. There is much talk nowadays about the selfishness and materialism of the age in which we live. Certainly the people who give their services in these centres are some of the most unselfish and dedicated people I have even encountered. It is a moving experience to visit them and talk to them, and I gladly pay my tribute to all who give of their time and energy to service in this challenging field.

The general aim in all these centres is to adjust the tempo to meet the needs and abilities of each individual. The House will appreciate that this does not mean that each person should be able to dictate his own speed; the object is to improve his performance but to achieve this at the pace which his abilities allow. When I talk about improving performance here, I am using the phrase in its wider social sense, not merely in the context of work output which is of secondary importance. The essence of the task is to enable the individual to live as satisfying and useful a life as his abilities allow.

I can tell the House from my observations that the atmosphere and the approach in the adult training centres are always sympathetic. The needs as well as the limitations of individual trainees are taken fully into account. There is no question of trying to create in these centres the precise conditions of industrial workshops. Indeed, the centres deliberately reject those types of work which, while they could be performed by the trainees, would not contribute to the basic objective of developing their potential to the maximum possible extent.

Another facility which local authorities are developing is the provision of residential accommodation for those who may need it. At present accommodation is provided for almost 1,400 adults either in local authority hostels or in other homes or in private houses. Here again, I have seen up and down the country some quite remarkable experiments. It would be invidious to mention authorities by name, but these are experiments being carried out by what I would call enlightened local authorities. I can assure the hon. and learned Gentleman that a considerable expansion of local authority hostel accommodation is planned with a view to providing over 7,000 places by 1974. Many of these places will be for those who do not need to be in a hospital but who have no relative and no friend willing to look after them—precisely the category of person whom the hon. and learned Gentleman has in mind. Some of them, those who need more sheltered conditions of employment, may attend local authority training centres while others may be in normal employment.

Nothing is more satisfying in this context than to find someone who has been through a training centre, who has been placed in normal employment in a factory or firm outside, who has been accepted by his workmates, and who is settling down happily and leading a useful life. This is one of the triumphs. It is not always possible to achieve, but we are aiming all the time to encourage that sort of result.

Mr. Tam Dalyell (West Lothian)

Is not the Minister slightly disturbed at the discrepancies between authority and authority? Of course, the good authorities are very good. Others, on the other hand, leave much to be desired.

Mr. Braine

The hon. Gentleman has put his finger on a point which should cause us all concern. There is a discrepancy not only in this field but in other aspects of health and welfare, but one of the objects of the Blue Book on "The Development of Community Care" was to place in juxtaposition—it had never been done before—the long-term provision being made by all local health and welfare authorities over a decade. The essence of that plan was that it should be revised—we have just published the first revision—and that local authorities should be able to see what other authorities of comparable size were doing.

This is a matter of local government. There is, after all, a limit to the extent to which the central Government can dictate to local democracy. Although I agree with the hon. Gentleman that there are regrettable discrepancies, he will find, I think, that these will tend to disappear as public opinion becomes more and more mobilised, as, indeed, it is becoming on these matters. Many local authorities, having seen in the plan the provision made by others, have started to revise their own ideas. Nevertheless, I agree that it is a matter of some concern that there are still discrepancies between authorities.

What I wanted to say about the hostel provision which is being made is that, whether a subnormal person is working in a training centre or is sufficiently advanced to be able to work in a normal place of employment, the availability of hostel accommodation means that he can remain within and have contact with the wider community.

My experience is that the dearest wish of many relatives of the mentally subnormal is to keep the family together. One very rarely comes across parents who are ashamed to take a subnormal child about. This is one of the most touching features of the whole subject. The fact is that the reverse is generally true, and the desire of the relatives of a mentally subnormal person is to keep him within the family circle. A great many families do succeed in keeping their mentally subnormal relatives in their own homes.

Mrs. E. M. Braddock (Liverpool, Exchange)

The Mental Health Act, 1959, lays down that there should be special facilities arranged so that every child over the age of 5 who cannot take in the ordinary educational curriculum can be taught to the extent that its mind will allow. Very little has been done in this direction throughout the country. Is the Ministry now looking at this matter? It is one of the problems about which parents of handicapped children are very concerned. The law now lays down that a child between the age of 5 and 15 who is unable to accept a normal education must attend for training to the extent of its limited mental ability, and if the parents do not send the child for such training they are in the same difficulty as parents of a normal child, but parents of such children cannot send them for training if the local authority has done nothing to meet the situation. What is happening about it?

Mr. Braine

The hon. Lady has raised a very important point. I cannot answer her question in detail without notice. Perhaps I should be able to do so, but I cannot. I know that in my county, for example, this has been a problem for some time, but the position is improving. Since the hon. Lady has asked me a specific question, I should like to go into the matter in a little more detail and, perhaps, to write to her about it. I am sorry that I cannot answer her question now. However, I know that quite a lot is being done and that enlightened local authorities are fully aware of the need in this regard.

I was speaking about keeping the subnormal member of the family within the family circle. Various local authority services are designed to make this possible and at the same time to give the families a degree of support in caring for their handicapped relatives. The advice and support of local authority welfare officers is available to such families and they can benefit from other local authority services such as home helps. These are services, of course, which are in an early and formative stage.

The value of a debate such as this is that it focuses attention on the need to improve these services. I know that it is not always possible to give help in the right way at the right time. Sometimes the strain on the family is too great. When it is no longer possible to keep the mentally subnormal person in his own home, local authorities aim to provide homes in their hostels so that the sub- normal person can still remain in the ordinary stream of life in the general community.

We must also remember that some trainees at adult training centres are able to progress to open employment. Many who make such progress would surely prefer to do so and to remain with their families in the community with which they are familiar, indeed of which they are part, rather than to live a life somewhat away from the world, however protective and sympathetic the environment may be.

From what I have said, I hope that the House will see that my Department and local authorities are fully alive to the needs of the mentally subnormal and are making good progress in providing the necessary services for them.

On balance, we maintain our view that the lines of development of the local authority services are right, though there is scope for experiment in methods in a service which is still in a very formative stage. We want to see an increase in the provision of training centres; an increase in the number of places in these centres; the replacement of make-shift premises with purpose-built ones; and the separation of junior training centres from those for adults. We are also anxious to increase the provision of training courses for the staffs of training centres. The Training Council for Teachers of the Mentally Handicapped, which started work six months ago, is actively promoting the necessary training courses. For those mentally subnormal people who no longer have a home of their own, we intend to increase substantially the provision of hostel accommodation where they can find, not only a home, but also the support and guidance of experienced social workers.

Mr. E. L. Mallalieu

Can the hon. Gentleman indicate what he means by "substantially" increasing the provision of hostels?

Mr. Braine

I cannot be precise, but if the hon. and learned Member looks again at the figures which I have given tonight, he will see that the expansion is considerable. At the present rate of progress, I see no reason why he should not achieve these figures, because they are based upon what has been achieved in the last year or two. This is not an unattainable rate of progress when one bears in mind what has been done in the last year or two.

In these various ways, we are determined to do all we can to improve the lot of the mentally subnormal. I should like to think that in helping the weaker members of the community to overcome their disabilities and to find a useful niche in society, we are in a small way helping society to become more purposeful, more wholesome and more worthwhile. It is for this reason that I am grateful to the hon. and learned Member for drawing our attention to this problem tonight and for the way in which he did so. I know what a generous person he is and I am sure that he will readily recognise that my Department shares his determination to continue to develop this extremely important sector of our social services.