HC Deb 11 July 1967 vol 750 cc431-554

3.55 p.m.

Miss Mervyn Pike (Melton)

I should, first of all, apologise to the House in case my voice goes at some stage in the debate. I have been unable to withstand the severity of this hot weather and have a bad cold, but I will do my best.

We are to have today an important debate on the care of the elderly. We would all accept that the mark of a civilised society lies in the contribution which it makes for its old people and that the mark of a compassionate society lies not only in the quantity but in the quality of this service. I hope, therefore, that we can discuss this problem without too much party political self-justification. What is in question is our ability to plan ahead realistically and to use our already overstretched resources to provide adequate services for a section of the community which is growing both in numbers and requirements.

In any case, this is a question in which we must all declare an interest. Whether we like it or not, we will all grow more dependent—unless some of us die in the attempt—and most of us will reach this stage at a time when our provision for the elderly and infirm is bound to be under tremendous pressure.

There are now over 6 million people in the country over the age of 65. On present expectations, a man of 60 will live another 15 years, a woman normally a good deal longer, and medical science is constantly increasing our ability to keep people alive. Between 1966 and 1986, the population is likely to increase by over 6 million, although the working population will increase by only about 800,000.

In just over 30 years, therefore, by the year 2001, the elderly population will have increased by 30 per cent. to a little over 7,500,000, yet the fact which we must face is that, during the next 10 years, the total spending on the social services will have to rise by more than 60 per cent. to keep pace with current policies. Even if—at present, it seems a very big "if"—the economy grows by 3 per cent. a year, the total national wealth will grow in the same 10-year period by less than 40 per cent.

There has also been considerable change in the post-war years in people's attitude to their elderly relatives. I am afraid that we are all much more prone to take the attitude, especially when "dad" and "mum" can no longer manage for themselves, that it is high time that they went into an old people's home, where, we tell ourselves, they will probably be much happier and much better looked after. Also, the changing pattern of society has made it more difficult for families to look after their elderly relatives. Today, there are fewer single women. The maiden aunt—I am one—is a vanishing species and it is the maiden aunt who has borne the brunt of looking after elderly people.

Society is also becoming much more mobile and volatile, with all that that means in the break-up of family ties and neighbourhood responsibilities. We must also take into account the fact that old people have, in the past, tended to set their standard of requirements very low. They have, of course, applied the yardstick of their past experience and not that of what will be the future practice and, therefore, have, on the whole, asked for far less than, possibly, modern resources would facilitate.

But more and more a society such as ours, which has lived through very rapid change and rapid social progress, will inevitably demand higher standards and far better provision for old age. By present standards, we must all admit, our provision for the elderly is proving quite inadequate, and I think that most of us would admit that the desperate need at the moment is for more money, for more staff and for more buildings.

It is against this background that we must look at what hope there is for any dramatic improvement in the years that lie ahead. The problem falls into three main groups. First, there is the provision for those who, by reason of physical or mental infirmity, must be cared for in hospital. Secondly, there is provision for those who by reason of physical or mental frailty and family circumstances should be cared for in residential homes or in sheltered housing. Thirdly, and by far the largest group, there are those old people who, with the aid of supporting services and properly planned accommodation, are able to live independent lives in their own homes.

In the first group there are those who must be cared for in hospital. The aspect of this problem which at present is uppermost in our minds is probably that so vividly portrayed in the recent book by Mrs. Barbara Robb, "Sans Everything". A.; this book shows, all too often people are, existing in huge old-fashioned, overcrowded institutions, and that many people are in mental homes not because they are psychiatric cases, but because there is no room for them in old people's homes or in the geriatric units of general hospitals. On the other hand, some of those at present in the geriatric wards should be care for in mental homes. Many old people are enfeebled and incontinent, and the overcrowded accommodation, unsuitable buildings and staff shortages inevitably lead to intolerable conditions for both patients and nurses.

These circumstances are inevitably self-perpetuating, because bad working conditions are driving away staff, so that sometimes unsuitable and untrained staff are overworked in institutions which receive few visitors and become isolated from the rest of the community. It is in these circumstances that undoubtedly there are some cases in which old people are treated with callous inhumanity. If we turn our backs on those facts and try to pretend that they do not exist, we must bear the guilt not only of our own inhumanity, not only of the suffering of these who are being ill-treated, but, not least important, we are guilty of doing a grave disservice to the overwhelming majority of nurses and doctors, who are giving devoted and tireless service, often in impossible circumstances.

Our immediate reaction is to say, "It cannot be true". I know and appreciate the Minister's very great difficulties. In the post-war years there have been tremendous improvements in conditions in our mental homes and our institutions, and there lave been great advances in our treatment of mental illness and of age and infirmity. When I was studying for a degree in psychology I saw for myself conditions in institutions which personally I shall never forget—conditions and forms of treatment which would be quite unthinkable today. We all recognise that this steady improvement is still gaining momentum. But what is needed is not just a plausible reassurance or an apologia but, something on which I think we all agree, determined action probably on two fronts.

First, we must face the problem of setting up the proper machinery for hearing complaints. I have great sympathy with the views expressed by Professor Brian Abel-Smith, who suggested in the book which I have mentioned a hospital commission which would be responsible for investigating complaints. This Commission could be part and parcel of the Ombudsman procedure. We on this side of the House have long thought that if there were to be a Parliamentary Commissioner he should not be debarred from investigating complaints in the hospital and health service. I hope that the Government are prepared to reconsider this matter because it is this kind of impartial investigator which is needed.

I also agree with Professor Abel-Smith that we should again consider the idea of an inspectorate. I know that we do not like the name, but we can change the name and probably find a new one. We should consider an inspectorate on the lines of the school inspectorate, which would cover both hospitals and the health and welfare service. This type of inspectorate has worked pretty smoothly in education, and I see no reason why it should not be equally valuable in health and welfare.

I have been asked to put certain questions to the Minister and I believe that my hon. Friend will repeat them. They fall into three headings. First, will the chairman have the assistance of nurses and doctors in the inquiry which the Minister is to set up? Secondly, will the Minister ensure that the people he chooses have no connection with the regions and the hospitals in respect of which the complaint is made and that there is no question of intimidation? Those are important questions which I know the Minister will be anxious to answer in winding up the debate. Secondly, we must make a much more determined effort to deal with the present overcrowding and to cut down the long waiting lists for hospital beds.

I was glad to see that only last Thursday the Minister was urging a greater priority for geriatric beds—when he was opening a new geriatric wing. At the same time he was, as The Guardian put it on Friday, 7th July: indulging in some sustained slapping of his own back in the Ministry of Health Report for 1966. No doubt we shall hear more in the same vein today and we shall be told how much better he is doing in hospital building. I hope that some of my hon. Friends will take up this theme later in the debate. The fact remains, however, that when all the costs and statistics and the plans are analysed, his hospital building programme is substantially the same as our own building programme was. Perhaps I am not being quite fair. In any case, he shakes his head. But as an article in New Society on 2nd June shows, as a result of the Minister's present programme hospital building, as a proportion of total gross fixed investment, would grow more slowly in the next five years than it did in the last three years of Conservative Government.

However we look at the figures and analyse them, the truth is—as we all know—that we should be spending more on our hospitals. At the same time, the shortage of beds and pressure on resources is being aggravated by the fact that too many old people are having to be kept in hospital and mental home beds because they have nowhere else to go. No one will deny that we need many more homes for old people who, because of physical or mental frailty or family circumstances, need to be cared for in residential homes or sheltered housing but who do not require the highly skilled nursing attention which they are getting in hospitals.

The Minister no doubt will be able to quote statistics showing rising trends of expenditure on the care and welfare of the elderly. But we all know from our constituency experience that in far too many cases there are long waiting lists, inadequate and unsuitable buildings and untrained and overworked staff.

The Report just published by the National Council of Social Service, under the title "Caring for People," has a good deal to say about the Cinderella of the social services. This Committee, under Professor Lady Williams, which, for more than four years, has been studying the staffing of residential homes, has found that 80 per cent. of the staff in old people's homes are untrained and that the staff turnover is about one-quarter a year. This high turnover is not surprising when we find that a 70-hour week is fairly normal, a lack of personal privacy usual and salary rates little better than those of the domestic assistants who help them. We all recognise that residential care is a complex undertaking calling for people with special skill, understanding and training. Willingness and a warm heart are not in themselves a sufficient qualification—and I agree with the Report when it calls for a two-year training course and also for the provision of courses at university level.

The Report also poses another important question. Does the work for people whose circumstances require residence necessarily involve the employment of resident staff apart from the minimum of resident personnel for both safety and good care? Personally, I feel that the answer is that in most cases the staff are better to have a life away from the institution. I feel sure, also, that, as with teaching, there is considerable scope here for the employment on a part-time shift basis of married women whose children are at school all day. There is also much more scope for the use of voluntary help under the supervision of properly trained staff. Many of us know of the wonderful scheme at St. Thomas's Hospital where a great many volunteers are working under the supervision of trained staff. I think that this should be extended, particularly in our residential old people's homes.

Equally important as staff selection and training is the need for something to be done as quickly as possible about the depressing state of many of these homes. We all accept that proper care of the elderly requires a combination of tact and compassion, patience and understanding. Old people are not constantly grateful. Many of them in the homes undoubtedly feel neglected. Many even feel rejected by their families. They do not always look forward to being in a home for the rest of their lives, often a home not of their own choosing and amongst people they have not chosen to be with.

Therefore, it is all the more important to create decent, attractive surroundings so as to ensure that old people retain self-respect and do not feel that they are being a nuisance to anyone. This is not jug a question of devoting a larger proportion of our resources for the provision of homes and staff, but also of using a great deal more thought and imagination.

In the recent report by the Building Centre Trust on its excellent exhibition, "Building for Old People" Mr. Edward Mills stated: Few of the schemes appeared to offer potentially satisfactory social solutions to old people's needs; they were to institutional. In such homes there appears to be little provision for residents to determine how they will spend their days, and no allowance made for residents partly capable of caring for themselves to be independent if they wished.… Too many welfare authority schemes appear to be influenced by outdated conceptions of welfare … These solutions may have been aprropriate 50 years ago but they may be serious liabilities in 20 years time". It is worth noting that some of the best schemes were those of voluntary organisations and that there is great scope for voluntary private provision to supplement provision by local authorities. In your private capacity, Mr. Speaker, you are President of a Rotary Club and will be aware of the magnificent scheme which has been got going by Southampton Rotary Club for sheltered housing, where old people have their own flatlets. This is an example of a project initiated and cart led through by local people giving their time and their skills and it is something which could well be the prototype for voluntary participation in the care of old people.

But it is difficult to estimate how far residential facilities fall short of needs. On the one hand, waiting lists are long. On the other, part at least of the need is due to roverty, poor housing and inadequate domicilary services. Professor Townsend claims that over half of those newly admitted to residential homes are capable of leading independent lives and that, for a quarter of them, loss of accommodation was the main cause of admission. It is estimated that about 90 per cent. of elderly people live in their own homes and that more than 10 per cent. of this group is housebound because of illness or infirmity.

By far the largest part of this problem must always be concerned with those who are able to continue to lead useful lives in their own homes. Dorothy Wedderburn says in the December, 1966, Quarterly Bulletin of the National Old People's Welfare Council that her researches lead her to believe that … we could quite easily double our expenditure on domicilary services and on other services like special sheltered housing without there being any danger of over providing. What is the present position? The Government promised the expansion of virtually all health and welfare services and I am sure that this is what they would like to do. But as a result of last July's freeze they have brought in still more cuts in local health and welfare and amenity spending. The Daily Telegraph local government correspondent, writing on 30th December, 1966, said: Many authorities have already had to cut back on their original development plans because of this year's squeeze. Now some projects which survived this process are having to he looked at again. Especially hard hit are such plans as those affecting old people's homes, children in care, and rehabilitation centres. This is bound to have a serious effect on future expansion.

In the circumstances, one of our main aims must be to make the best possible use of our resources, inadequate though in many respects they are, and we are not always doing that. A report on community care cases referred by general practioners to local authorites which appeared in last month's edition of Social Work concluded that … the line of communication between the local authority and the G.P.s certainly merits more serious examination than it has hitherto received. The report noted the small number of cases in which the G.P. seems to refer his patients to make use of the community car services. Why is this so? Perhaps he is too busy. Perhaps he is just unaware of how he can get help.

Whatever the reasons, we must try to get this right. I think that it is partly due to the present separation of the three main branches of the services and partly to the fact that far too many doctors have still not joined group practices and as a result too many are overworked.

In fact, although we are short of doctors in proportion to our population, we are no more short of them than many other countries in Western Europe. But we need to give more encouragement to group practices and to health centres where doctors can have available all the ancillary aids to do their job. Secondly, we should move towards a Porritt solution, by which all the major branches of the services are brought under one authority on an area basis.

A recent article in the British Medical Journal argued that a unified health service should be fitted in with any reformed local government structure. I hope that both the Seebohm inquiry and the Royal Commission on Local Government have this idea very much in mind. Much can be done, also, to prevent overlapping in the local authority services. I have no doubt that the Seebohm Committee is considering the idea that there should be a social work department of the local authority to provide a wide range of social services including the provision of support and assistance to old people.

We also need to think increasingly of the need for what may be termed " day hospitals " for the elderly, where services such as physiotherapy, occupational and industrial therapy, hairdressing, chiropody and various recreational activities are available. This is the pattern at the psychogeriatric unit and Severalls Hospital, Colchester, where the majority of patients are transported to and from the hospital by the local authority ambulance services. The hospital also operates a system, I believe, whereby patients can board for a while so that their families can get a rest and go away for a holiday.

Very often it is the length of time of strain without a break or a holiday for those who are looking after old people in their own homes which forces them to allow the old people to go into care. By relieving strain on the family, many more old people could be kept in their own homes, in the community as a whole.

Sometimes, however, old people have to go to residential homes because of the sheer shortage of space in many modern houses. But in a number of cases families might be more prepared to look after their elderly relatives if they were given some encouragement and help from the Government to do so.

For example, if a young married couple are to take in an elderly parent the house may well need conversion in some form—perhaps to provide a separate kitchenette or an additional bedroom or lavatory, or perhaps certain aids to make it easier for an elderly person to get about the house—handles for getting out of the bath, etc. But all this is expensive, and even if these people undertake the conversion themselves, one result is that their rates go up, which is hardly an encouragement. What we should seriously consider is whether we could devise a system of grants to encourage people to adapt their houses for this purpose.

That, then, is the picture. It is that of a chain reaction which begins among the 90 per cent. or so of the elderly people who should be able to stay in their own homes. Because of inadequate family and housing provisions and insufficient domiciliary health and welfare services, pressure builds up on the already overburdened residential homes for old people. At this point, shortages of money, of buildings and of staff serve to increase the pressure at the next stage, thereby aggravating the shortages of geriatric and mental accommodation. This pressure again shifts the burden on the already overstrained hospital services.

This becomes a vicious circle, but, nevertheless, we all know that great progress has been made and is being planned. Much of our provision for the elderly is first-class and many more old people are enjoying the dignity and security of good community care.

As I have said, we need more encouragement and help for those families willing to make sacrifices to look after their elderly relatives, sensible spending priorities throughout the social services in a determined drive to rid the country of antiquated old people's homes and hospitals, an end to the separation of the different branches of the health services, a proper system whereby complaints can be impartially and objectively investigated without fear or favour, and a determined drive to make full use of the vast amount of good will and compassion that exists among all sections of the community.

We all know that there is much that can be done to improve matters, and I am sure that all in this House are anxious to see them done. We know that better research can lead to clearer understanding of the problems. Considerable savings can be made by adopting sensible spending and charging priorities, by closer coordination, and by employing a unified strategy of social security. Advances can be made by using new techniques and new methods. But, when all these things have been done, there will still remain a severe shortage of money, manpower and accommodation.

We are deluding ourselves if we imagine that we can meet the inevitably escalating demands of the future by relying on steeply rising taxation to pay the social welfare bill. This is a debt that can only be met if we have the courage and the imagination to reorganise ald reorientate our system of health and welfare provision. Professor Miller tells LB that an extra £500 million a year is needed to bring our National Health Service up to the best standards abroad.

The Minister of Health (Mr. Kenneth Robinson)

indicated dissent.

Miss Pike

I see that the Minister shakes his head, but, equally, I am sure that he will accept that a very large sum 431' money is needed if we are to have the sort of health service all of us in this country want.

In face of the present difficulties, the B.M.A. has decided to plan an alternative health service. Here, in Parliament, most of us on both sides of the House surely realise that the time has come to take a good hard look at the alternatives to our present system. Most of us would, I think, agree that charges on the lines advocated by the right hon. Gentleman the Member for Sowerby (Mr. Houghton) and his allies probably offer us the best hope for attracting the essential money and resources into the National Health Service without making the burden on public expenditure intolerable.

So much for the Health Service. But what about the social welfare field? Here, increasing numbers, acceptable design and building standards and higher requirements for staff, and the selection and training of staff, will inevitably lead to greatly increased costs. These costs can only be met if we plan to make use of what I am sure is our tremendous reservoir of voluntary participation and voluntary service.

There are already schemes in operation throughout the country that point the way to what can be achieved in this field. Hon. Members will know of schemes in their own constituencies, and other schemes in the country as a whole, but I think that very often not enough publicity is given to them. There is not enough, as it were, cross-fertilisation and knowledge of what is going on in this sphere. Every locality differs in its problems and in its opportunities. Every locality differs in its resources in terms of leadership and of people. The best must be encouraged, and the laggards must be helped. For myself, I am determined to stimulate discussion and action at local level so that local communities will be spurred on to make the effort to find the best ways of supplementing and extending the statutory provision.

Community service and good neighbourliness do not only serve to increase the quantity of the help that is given, essential though that is but, in themselves, enrich the quality of life. The dominant theme of all our policies and ideas must be care and compassion. But those are hackneyed words. Unfortunately, they have become trite, because very often we use them as pawns of our own prejudice, and sometimes as alibis for honest thought.

Care and compassion are words that have embodied different principles to different people and different generations, and if their interpretation is exhausted by one generaltion they become meaningless to the next. But with fresh attitudes of mind and new techniques of medicine and science we can charge those words with a richer, fuller meaning so that they remain the genuine expression of human aspiration at its most admirable.

Efficiency, political ideology and argument all have their place, but in this field we shall probably be judged by the quality of the care and compassion we show in dealing with this problem.

4.24 p.m.

The Minister of Health (Mr. Kenneth Robinson)

I welcome the opportunity that this debate affords to discuss the problems associated with the care of the elderly, and I would pay my tribute to the hon. Lady the Member for Melton (Miss Pike) for opening the debate in a way that was generally constructive and, if I may say so, unsensational.

This is a vast subject and, let us face it, it is a vast and growing problem, as the hon. Lady made clear. There is a sense in which it is almost a problem of our own creation collectively as a society, and it is also a problem that will demand more and ever more of our resources, particularly in the health and welfare services, at any rate as far as the end of this century.

It is a commonplace to repeat the statistical fact that the proportion of old people in our society has increased and will continue to increase. The advances of medical science have conquered many of the diseases which used to kill off large numbers of the population in infancy, in childhood and maturity. As a result, there has been an increase in life expectancy, though not to any very great extent measured in terms of years from birth. What is much more significant, and more relevant to our subject, is the greatly increased expectation of reaching old age.

The effects of this phenomenon can most easily be seen in any comparative study of the incidence of different kinds of disease or, indeed, of causes of death in the population as a whole today as against, say, 25 years ago. Gone, or dramatically reduced in their incidence and effect, are many of the killing diseases prevalent when I was a young man, but they have been replaced, inevitably, by the degenerative diseases of man, the diseases associated with old age. Thus, not only have we a steadily increasing proportion of the elderly in our midst, but this growing block of the population is by its very nature more in need of and makes more demands on medical health services of all kinds.

But, Mr. Deputy Speaker, this is more than a matter of demography. Increasingly, we as a society—and I think that the hon. Lady made this point—are looking to the State, to the public authorities, to provide residential accommodation of one kind or another for our old people. It is no doubt in part due to changing social habits, in part to our growing inability or, perhaps, unwillingness to cope within the family with our obligations to the older generation. But it is also a reflection of the improved standards we demand, and rightly demand, of institutional provision and residential care. As we raise the quality of accommodation—as, indeed, we have been doing—more old people are prepared to face the prospect of going into it, and more of us are prepared to see our parents and grandparents cared for in such an environment.

To put it simply, when we replace the grim ex-Public Assistance institution by the small and modern and friendly old people's home, designed and built to be a home in the proper sense; as we replace the cheerless, out-dated, long-stay hospital annexe with the modern geriatric unit, we ourselves stimulate the demand for such provision. The fact that everyone, whatever their social status, used to do everything in their power to avoid the stigma and misery of "ending up in the workhouse" itself acted as an effective limitation on demand.

This tragic restraint has, happily, gone, and gone for good, but it is in this sense, too, that I said at the beginning of my remarks that this vast and growing problem of caring for the elderly is largely one of our own creation. This development, let us not hesitate to assert, is to the credit of our society and of our generation. But let us not underestimate the demands it is making, and will increasingly make, on our manpower and other resources.

I should like to devote most of what I have to say to hospital provision for old people. This is, of course, only one facet of care, even if an important one, and my right hon. Friend the Minister without Portfolio will, in winding up the debate, direct more of his remarks to the community aspects of care for the elderly.

Hon. Members may recall that in 1965 I requested regional hospital boards, when reviewing their capital programmes, to give geriatric and psychiatric services what I called a due and early share of the additional resources being made available. In other words, I asked not only that boards should make certain that the proportion of available money spent on geriatrics in the next 10 years reflected realistically the importance of the care of the elderly among the many services provided by hospitals, but that the necesry money should be provided earlier rather than later in the 10-year period. Thus, I aimed to strike as quickly as possible, a position of balance which was not, in my view, struck in the earlier Hospital Plans.

There is already some evidence of progress in this direction. In 1966, there were 59,186 geriatric and chronic sick beds. Regional hospital boards estimate that in 1970 there will be 63,048, an increase of 7 per cent., which will keep pace with the very large rise expected in the elderly population.

This increase is coming about through the provision of new geriatric units in redeveloped district general hospitals and adaptations to existing hospitals. Existing geriatric wards are also being improved. With a good deal of imagination and ingenuity some of the old institutional buildings are being almost transformed so as to make them tolerable until such time as they can all be redeveloped or replaced.

Along with improvements in physical accommodation, geriatric medicine is developing very satisfactorily in many areas. This, I am sure, will be true of all areas as soon as more geriatric physicians are forthcoming. There has already been a considerable strengthening in the medical staffing of geriatric hospital departments and units. The number of consultants specialising in geriatrics has risen by nearly 40 per cent. from 115 in 1964 to 156 in 1966. Other hospital medical staff, including medical practitioners responsible for the treatment of the elderly, have also increased in numbers.

Geriatrics as a medical specialty is evolving all the time. The modern geriatric unit, with its assessment and rehabilitation wards, is designed to enable the elderly patient to receive the correct treatment for his condition. After further treatment in the rehabilitation ward many will return to the community where, supported by the domiciliary services, they will be able to spend happy and useful years. A small minority, of course, will fail to respond to treatment and will require long-term hospital care.

The day hospital plays a very important part in rehabilitation. Day hospitals provide for the elderly sick who are in need of hospital care, but who do not require to be in-patients. The pro- vision of day hospital facilities is increasing rapidly and it is clear that our hospital authorities are fully aware of its value. The number of attendances by elderly people at day hospitals increased from 61,450 in 1961 to 310,000 in 1966. Thus I think we can say that the concept of the elderly patient condemned, bed-ridden, to years of inactivity is fast disappearing. What one now sees more and more is the elderly person, albeit a little infirm, who with the aid of physiotherapy, occupational therapy and the help in some cases of simple appliances, can still play an active part in community life.

Geriatric medicine does not seem in the past to have been as attractive to the young doctor or nurse as most other specialties. This somewhat out-dated attitude is beginning to fade as the challenge of this specialty is more widely appreciated and this should be helped by a new development in the teaching hospital field. Most of the London undergraduate teaching hospitals have recently undertaken to provide—or propose to do so--full hospital services to their local communities, including provision for geriatric patients. This will mean that geriatric care will not only be part of an integrated hospital service, as it is elsewhere, but will benefit from the stimulus of a large teaching hospital. It will also mean that the medical students will have better opportunities to learn about the care of old people.

This will be of twofold benefit. Many of the students will become the family doctors of the future, and they will be that much more alive to the needs of their elderly patients and to the appropriate methods of meeting them. Other students will undoubtedly be attracted to this specialty and will provide the much-needed geriatricians of the future, without whom we shall be unable to make the most of many potentially excellent geriatric units. I am, incidentally, glad to note that the Royal College of Physicians has recently recognised the value of this important specialty by setting up a geriatric committee.

Similar considerations apply in geriatric nursing, which also calls for special skill. Much is being done, I am glad to say, to raise the prestige of geriatric nursing in the profession. For example, geriatric experience is being included in many of the educational programmes for student nurses. Attitudes change as the geriatric ward is seen to be a place where there is something to be learned both in theory and in practice. There is more satisfaction to be obtained from geriatric nursing now that successful rehabilitation enables the nurse to see the practical results of her efforts.

Gone are the days when nurses did no more than tend patients who would spend the rest of their days in bed. Geriatric nursing is now looked upon as a specialty requiring extra skills rather than as routine nursing requiring less skill. Geriatric units are now among the show pieces of the Health Service. They may not always be housed in new buildings, but much has been made to upgrade the old. Several geriatric units are run on the lines of progressive patient care and can in this respect give a lead to some general acute hospitals. The transition I have described has been taking place very rapidly and geriatric services are now included in the planning of new district general hospitals, as a matter of course.

I should like to say a word about a still more recent development, the psycho-geriatric assessment unit. Medically, it is often very difficult to separate mental from physical infirmity in old age. This is one of the facts which may lead to the situation described by the hon. Lady as misplacement of patients. It is essential, therefore, to find ways of assessing that minority of patients who cannot clearly be distinguished at the outset as suffering either from a predominantly geriatric or a psychiatric condition. Such an assessment should, ideally, be conducted in the patient's own home and the initial visit of the consultant could well reveal a number of social and medical defects that could, if properly remedied, obviate the need for hospital admission. When a domiciliary assessment is not possible, or fails, then the effective alternative is assessment in a psycho-geriatric assessment unit, in a general hospital.

The psycho-geriatric assessment unit prevents misplacement of patients, with all its consequences, and leads to more effective use of geriatric and psychiatric services. Its function is to enable a more precise diagnosis to be made, to initiate treatment, and to make the most suitable arrangements for further care when necessary.

Some patients will fail to respond to treatment started in the assessment unit and will need continuing institutional care. It may be provided, according to the patient's condition, in the wards of a psychiatric hospital, or the wards of a geriatric department, or in a residential home. Needless to say, to be effective this service calls for close links between the geriatric and psychiatric departments and between the hospitals and the local authority services.

Where both hospital and local authority services for the elderly and chronic sick are well developed there is little, if any, difficulty in ensuring that patients are cared for in the way that is best for them. But where services are deficient on either or both sides, it is inevitable that there are difficulties such as misplacement, blockage of hospital or welfare beds, waiting lists to both hospital and residential accommodation and delays over urgent cases which need transfer. My Department gave fresh guidance on the care of the elderly in hospitals and residential homes in a memorandum issued in September, 1965. It contained a section on joint planning and operation and emphasised that although the various health and welfare services for the elderly were not administered by one authority, their purpose was to provide what is essentially a single service for each individual needing it.

In most areas, hospitals, local authorities and general practitioners are making great efforts to establish on a firm basis that co-operation which is so essential for this purpose. One of the fruits which can be derived from this co-operation is the joint appointment of a geriatri, physician with his main responsibility in the hospital service, but with some of his duties lying in the local authority field. Extension of this area of co-operation should ensure that in future there can be less opportunity for any breaks in the continuity of care between the hospital and the local authority services. One doctor will be in a position to judge the possibilities of both services and to ensure, as far as physical facilities allow, that the most appropriate form of treatment and care is offered to elderly people at the time when they need it.

Although I have spoken at some length about modern hospital care for the elderly, the first objective of our complex of services for old people is, of course, to keep them out of hospital if possible and for as long as possible. Services in the community provided by local help and welfare authorities are themselves every bit as important. As I said, my right hon. Friend will say something about this in winding up the debate, but I should like meanwhile to say a word about residential accommodation in the community, the parallel provision, so to speak, to the hospital geriatric unit.

Mr. Nigel Fisher (Surbiton)

Does the right hon. Gentleman mean to refer to the "Sans Everything" issue, which has arisen so recently?

Mr. Robinson

I will not ask the hon. Gentleman to be patient for very much longer.

There has been a dramatic advance in recent years in both quantity and quality or residential accommodation which is not sufficiently known and appreciated. For example, during the last 20 years local authorities have provided 1,764 homes, of which 724 were purpose-built. Despite the limitations which had to be placed on the total loan sanctions in 1965, 130 new homes were opened in 1966, providing for nearly 5,800 residents, compared with 106 for only 5,000 people the year before and with 87 for 4,300 people in the last four years of government by the Party opposite. Local authorities were providing a total of 93,000 places for elderly people in March, 1965, and they plan to provide 152,000 by 1976.

These net figures do not wholly reflect the size of programme required, since, to their great credit, all but a few authorities plan to get rid of their remaining accommodation in old workhouses and other over-large and obsolescent buildings in which good welfare is difficult and often impossible. Replacement of this obsolete accommodation requires building for up to 20,000 more old people, but I am hopeful that the whole of the programme—both expansion and replacement—can be realised.

I have sometimes, however, to ask those authorities who are relatively well provided to hold back as patiently as they can while leeway is made up elsewhere, where the need is more clamant. We must recognise that replacement of outworn buildings is essential, if all those who spend their last years in residential homes are to do so decently. As I said in reply to a Parliamentary Question yesterday, I shall, for my part, not be content till all the old Public Assistance institutions are gone.

The part of the general practitioner in the care of the elderly is, of course, vital, and I should perhaps mention that the new scheme of remuneration for general practitioners now provides a higher capitation fee for patients over age 65–28s. a year instead of the normal 20s. in recognition of the additional medical care which may be necessary for the elderly. Furthermore, the strong incentives which we have introduced to form group practices or to practice in health centres and to employ supporting ancillary staff will do much to improve general practitioner care of the elderly.

However we improve our organisational arrangements—and I think that I have shown that we have done much in the last year or two—what matters, above all, is that our old people, under whatever form of care they find themselves, should be treated at all times with kindness and sympathetic understanding. The hon. Lady used the words "care and compassion". I have no doubt whatever that in general they are. The quality and dedication of our nurses is as high as can be found anywhere in the world.

I believe that the House would assent to this, and accept that nursing old people, many of whom are incontinent and confused, is one of the heaviest tasks the nurse can be asked to undertake. Hon. Members will, therefore, wish to put into perspective the sort of allegations of ill-treatment and gross neglect of elderly patients at the hands of nurses, which have received such eager publicity in the last few weeks.

These allegations, contained in a book called "Sans Everything", are for the most part made pseudonymously. I have made it clear in the House, in answer to Questions, and my Department has made it clear to the Press and to the editor of the book, that any specific complaint or evidence put forward in a way which makes inquiry possible would be investigated, and searchingly investigated; but that general unsubstantiated allegations cast unfair suspicion on large numbers of hospital staff who devote themselves to the care of elderly patients, and can only cause distress to patients' relatives.

I therefore wrote to AEGIS when I had seen the book, expressing the hope that, on reconsideration, they would agree to make available to me the identity of the complainants and the patients and staff involved, so that a full inquiry could be held; and that if they remained unwilling to do that, they would at least inform me in confidence of the identity of the hospitals. This would not enable full inquiries to be made into the allegations of ill-treatment of individual patients, but it would make it possible to carry out independent investigations into the situation at these hospitals.

I am glad to say that I have been given the names of the hospitals concerned and I have now asked for sufficient particulars to relate each hospital to a specific section of Chapter 3 of the book so that the hospital board chairmen can arrange for inquiries to be carried out by a legally qualified chairman from outside the National Health Service, assisted by other persons unconnected with the hospital concerned.

More generally, all chairmen of regional hospital boards and boards of governors are aware that if particular cases cannot be dealt with by investigation, everything possible must be done through management. I have asked the managers of all hospitals, through their senior staff, to make searching inquiries into the possibility that any form of inhumanity, particularly in the treatment of elderly patients, might exist in any of the hospitals for which they are responsible.

I am not, of course, attempting to prejudge the outcome of the investigations which are being undertaken. No one at this stage can say with certainty that any of the allegations is either true or untrue. Should it prove that even a single charge of brutality or inhumanity is substantiated then, of course, I welcome its exposure.

But the other side of the balance sheet should not be overlooked. The method of presentation of the case, in a series of anonymous charges against unidentifiable persons in unnamed hospitals, has also caused immeasurable distress and anxiety, not only to nursing and other staff, but, what is certainly no less important, to the relatives and friends of patients, both present and future, and, indeed, to those who themselves are likely to need geriatric or psychiatric care in hospital in the near future.

This type of generalised attack on the quality of care given to the elderly in hospital can hardly assist nurse recruitment, on which continued progress must depend. I sometimes wonder if the ready credence that seems to be given in so many quarters to allegations not yet proved, may not be a reflection of a deep collective guilt we feel at having transferred to public authority something we instinctively still regard as a private and family responsibility.

If malpractices of the kind alleged in this book exist, it is inconceivable that they are in any way widespread. To believe this would be to accept that there is in many of our hospitals not only a conspiracy of silence among the nursing staff of all grades, but, indeed, a conspiracy against the patients, and especially the weakest and most helpless patients. Does anyone, do the authors of "Sans Everything", does the editor of the Nursing Mirror, really believe this?

There have been suggestions that nursing staff and others are afraid to come forward with complaints for fear of reprisals against themselves or against the patients. My first reaction was to dismiss this possibility out of hand. I have, however, since seen the questionnaire on this subject in the Nursing Mirror of 16th June, and a selection of the replies has been published. They have convinced me that such fears do exist, at least among a small minority of nursing staff.

It is, as hon. Members will appreciate, extremely difficult to deal with apprehensions of this sort, but I am considering what may be done to dispel them. Senior officers of my Department have already discussed this with the President of the Royal College of Nursing, and we shall be considering what further action would be appropriate. We have discussed with the Royal College of Nursing the wider aspects of this whole subject, to explore what action the Royal College and we can take to encourage more widely the modern, positive approach to geriatric nursing and the care of the elderly generally.

Before leaving "Sans Everything", I should like to make one further point which may be not without significance. The gentleman who has the task in Chapter 4 of commenting on the anonymous nurses' allegations is said to have had 15 years of nursing experience, yet he states that he has never personally witnessed any case of ill treatment of patients.

To sum up, I have no evidence that any patients are deliberately ill-treated as alleged in "Sans Everything". I am ready and anxious to investigate anything which can be investigated, and I am determined that, if there are malpractices in any hospital, they shall be uncovered and eliminated. I know that there art difficult conditions in some psychiatric and geriatric hospitals, due to unsatisfactory buildings, overcrowding or shortage of staff. That is one reason the more for paying tribute again to the staff who give devoted care to patients while having to work in those conditions.

Mr. Fisher

I am sorry to interrupt again but there is one point which the Minister did not mention in talking about "Sans Everything". Could he categorically confirm that he will give the protection of complete anonymity to any nurses—he referred to the Nursing Mirror and the information which he had had on the point—who are, apparently, genuinely afraid to come forward without that protection?

Mr. Robinson

If they will come forward and give me their names, I shall, to the very best of my ability, give them all the protection that I possibly can.

I hope that I have left the House in no doubt of the scale of the effort being made by both hospital and local authorities to cope with this great problem not only of caring for our old people, but of enabling them to live as full and as useful lives as possible. We have not yet achieved all along the line the high standard which we have all set ourselves, but our best is as good as anything in the world. Of course, there is still antiquated provision, but we are fast getting rid of it There may well be personal failings here and there, and, if this be so, we must, as I said, make searching inquiry to identify and eliminate them.

In the meantime, whatever anxieties we may feel about a handful of them, let us pay our tribute to all those who devote themselves unstintingly, week in and week out, to the care and treatment of the older generation.

4.55 p.m.

Mr. Philip Goodhart (Beckenham)

I echo the warm tribute which the Minister has just paid to those who devote their lives in hospitals and homes to the care of the elderly. I am glad that he is taking seriously the allegations which have been made in the book "Sans Everything" and will investigate any specific allegations which are made. I hope that he will look carefully into the idea put forward by my hon. Friend the Member for Melton (Miss Pike), who opened the debate so ably, of an inspectorate on the lines of Her Majesty's inspectorate of schools.

I agree with my hon. Friend when she says that the problem of the care of elderly patients does not fit into a tidy or convenient shape, for, as everyone knows, some people preserve their full mental and physical powers until a late age. I think, for example, of my parents. They have a house outside Oxford, a little more than half a mile from the nearest post box, which is at the top of, to me, a fairly steep hill. I always drive up it to post my letters.

Last year, however, my father, at the age of 75, decided that he would make a practice of running up to the post box and back whenever he had a letter to post. I hope that, if I reach his age, I shall be at least half as vigorous. I think, also, of the right hon. Gentleman the Member for Easington (Mr. Shinwell), who so often entertains the House, but I know many constituents who have, regret-ably, sunk into senility 10 years or so earlier than his 82 years.

Most hon. Members agree with the general proposition that need increases with age. I have been one of those who have advocated over the years that the basic pension rates should go up as age increases. I am sure that social historians of the future will be staggered to note that 185,000 of the oldest inhabitants of this country are deliberately excluded from the pension system because they are too old, because they were past the contributory pension age by the time our present system was introduced.

If the Government are determined not to do anything about the pension rights of these 185,000 people, at an average age of 85—alas, there will soon be many fewer of them—I hope that they will at least consider a drastic transformation of the supplementary benefit limit on capital and income for those over 80.

Another group of the aged who have not received very good care in recent months comprises those who seek to remain at work in the community. A number of us have been pressing that employers of those of pensionable age should be relieved of liability to Selective Employment Tax. It is difficult to find out statistically the impact of the tax on those old people who wish to seek part-time employment, but we know that it must be great. A constituent, a grocer, has written to tell me that because of the tax he has had to sack his own father from part-time employment. I hope that in their approach to the care of the elderly the Government will give them a concession on this in the future.

But, meanwhile, I regret to say that they appear to be moving in the opposite direction. I am glad that there has been an improvement in the earnings rule, but, at the same time, there has been a particularly mean withdrawal of the Income Tax concession. A constituent of mine has lost the whole of the pension that was payable to him because of the removal of the concession. He writes: I have now received notification from the local office of the Ministry of Social Security that they have retained my order book as I no longer have any pension due. This supports my contention that the publicity attached to the announcement by the Government of the increased earning allowance was a gross misrepresentation of the facts. Up to the present I have received £1 4s. per week, but with the increase of the earning allowance I should have expected an increase in this amount, and not a decrease. My earnings per week after deduction of Income Tax of £4 8s. are £7 2s., which means that for a full-time job I get £7 2s. a week and the Government benefit by £8 8s. a week". It seems to me that the withdrawal of the concession will hit a small group of not very well off pensioners who are trying to make a contribution to the community and who I do not believe have received a fair deal from the Government.

The Minister said a great deal about the geriatric units and the work of the specialists in hospitals. But he did not tell us much about the work going on here on the development of drugs to combat senility. When I was in America recently, I had an opportunity of talking to the director of the Worcester Institute of Experimental Biology, which has done notable work in many fields. He told me of some of the exciting work being undertaken in the development of hormones to push back the onset of senility.

I hope that the Minister can say something about the work that is being done in this country when he replies, for this is a sphere in which we should not lag far behind the Americans.

5.5 p.m.

Mr. Gregor Mackenzie (Rutherglen)

I join the hon. Member for Beckenham (Mr. Goodhart) in congratulating the hon. Member for Melton (Miss Pike) on the way in which she opened the debate. I also congratulate my right hon. Friend the Minister on the very useful information he has given us today.

My right hon. Friend referred to the growing problem of old people in the community, which we all recognise. That recognition may not be reflected in the attendance here this afternoon, but perhaps last evening and the evening yet to come have something to do with the sparseness of our numbers. I am sure that it does not show that we are not interested in problems of this kind.

As my right hon. Friend said, the numbers of elderly are growing. It is also important to bear in mind that over the past decade or two we have lived a much more sophisticated life in what is known as the affluent society, and the break on retirement is now all the sharper for the elderly as they have enjoyed higher standards of living. These are the special problems that we must deal with in the 1960s and 1970s that we did not face in the 1920s or 1930s.

It is important that the House should consider how we can best channel the tremendous amount of good will on both sides and in the country into dealing with this very serious problem. I am sure that we are all impressed by the number of people who tell us how we should help old age pensioners. They say, "I do not mind paying an extra 2s. on my stamp or a little more in Income Tax". But, unhappily, when the day of reckoning comes, and the deductions are made at the end of the week or the month, we sometimes hear rather a different story. When we can release more resources for the important problems of the elderly it should not be just a question of increasing the country's wealth, the share remaining the same, but increasing the percentage available for the elderly from the increase that we hope to have over the next two or three years. This is the real test of our sincerity on the problem.

The first amount of extra money we think of spending should go automatically on the individual. Much has been done, which I am sure is appreciated, in the abolition of prescription charges, better allowances, rent rebates and so on, but a great deal more can be done.

My right hon. Friend is under a great deal of pressure at present from various pressure groups within the House and outside which suggest that more money should be spent on other needy groups. Some of them have a great deal to say for themselves, and I sometimes fear that in all the noise about a particular group the problem of some of the old people, although it will not be forgotten, might slip a place or two in the list of our priorities. I am sure that no matter what is said by some of our learned journals and newspapers and some of our sociologists the vast majority of the people in the community would want the care and maintenance of old people to be the Government's first priority.

Secondly, more of our resources should be spent not just on individuals—which we all want to see—but on the study of the problems involved in growing old. A great deal of gratuitous advice is given to Ministers and others concerned with the problem by a number of people, perhaps including myself, who know very little about the technical problems involved in growing old—loneliness, specialised hous- ing for old people and the work that they do in retirement. I was encouraged by my right hon. Friend's comment that there was a new interest by the Royal College of Physicians and some of the teaching hospitals, particularly in the South—I am sorry that it is not so in the North—in the problem of geriatric medicine. In the North, we have only one chair of geriatric medicine in one of our universities, and throughout the country we have no institute of geratology.

I hope that my right hon. Friend will think about these problems. Some very important work in this area was done by the Royal College of Physicians in Scotland a number of years ago. I referred to this in a debate two years ago. The Report of the Royal College began with the obvious comments. The first was that we should sustain people in independence, comfort and contentment in their own homes and that when independence begins to wane we should support them by all necessary means for as long as possible. The Royal College also dealt with the problem of alternative residential accommodation, particularly for those who because of age and infirmity lack a home. Thirdly, it talked about hospital provision for those who are either physically or mentally ill. I suggest that this is a document worthy of my right hon. Friend's attention.

As to the comment that people should continue to live in their own homes we take this to be axiomatic in the problem of dealing with the aged in our community. Most of us accept that it is something that they want to do. We also accept that the Minister of Health would want to keep these people in their own homes in contentment and comfort as long as possible if only to enable him to release hospital beds for more urgent cases. But it is not as simple as is sometimes made out by those who write on the subject. There are far too few old people with families who can help sustain them in their own homes. Many of us have been troubled by recently published statistics showing the number of single and widowed people who have no family assistance. So I hope that when we think of keeping people in their own homes we shall do what we can to coordinate the efforts of general practitioners, social workers and local authority officers.

If we want to keep people in contentment and comfort in their own homes we must provide them with decent houses. Unfortunately, this is something that we just do not do. There are far too many old people—I am not putting this on the shoulders of my right hon. Friend; it must lie on the shoulders of right hon. and hon. Gentlemen opposite—who are still living in near slum conditions. This is not because the local authority is not anxious about them, but perhaps because it has given priority to people with larger families, and so on.

A great many old people do not particularly want to leave the area in which they were born and have grown up and have reared their families. They may have lived in the centre of a community for a very long time. When redevelopment of slum areas occurs we push the old people out to the suburbs, to an area which they do not know, understand or like. Therefore, in our redevelopment schemes we should make a place for the aged in our midst.

A great many solutions of this kind have been offered, such as flats for single persons, the building of a group of old people's houses together, or dispersing them among people who have families. For a long time before I came to the House I served as a member of a corporation planning authority. While I think we meant very well in planning provision for old people's houses, frankly we did not know enough about the problem. Our local authority planning officers would have been well advised from time to time to consult people with special knowledge about how old people want to live, particularly in houses of this kind.

Another problem about old people living in their own homes is not just the sort of house that they have, but whether or not they are going to find sufficient occupation. In this respect, we pay tribute to the voluntary societies which try to relieve the boredom of people who find themselves cut off from work after a very long time. They have worked all their lives, and when the break of retirement comes it is very difficult for them to adjust themselves.

The hon. Member for Beckenham (Mr. Goodhart) said that the Selective Em- ployment Tax was depriving a number of old people of employment. I have noticed that while this may be true in some parts of the country it is not true in others. However, we have far too many advertisements appearing in newspapers suggesting that a particular type of part-time job is suited to an old-age pensioner. My father, who is nearly 70, is an old-age pensioner, and he applied for one such job. The job started at 9.30 in the morning and finished at 4.30 in the afternoon, for which he was to be given the princely sum of £4 10s. per week. Happily, he had a local authority pension and turned down the job because he could afford to have principles in the matter.

If one does not have a local authority pension, or some other form of assistance beyond one's old-age pension, one cannot afford principles of this kind and so takes such jobs. Perhaps what we need in 1967 is a Shaftesbury for old-age pensioners. The use of old-age pensioners in this way is a growing problem. I am sure that the old-age pensioners take the work because they want a little extra money and wish to relieve the boredom associated with retirement. Nevertheless, I hope that my right hon. Friends the Ministers of Health and Labour will keep an eye on the problem and cut out exploitation of this kind.

Further in connection with the problem of living at home, I wonder whether it is possible to extend the domestic help service. It is an excellent service in many parts of the country, but the difficulty seems to be that there is not enough of it and that there is insufficient weekend care particularly for single people.

Another problem is that of the consultative health centre. My right hon. Friend dealt with residential accommodation, as did the hon. Lady the Member for Melton (Miss Pike). I was encouraged to hear of the increase in the number of people specialising in geriatric medicine in hospitals. However, I suggest that we need some means of channelling the expertise of local authorities and that this can be done only through the centres that my right hon. Friend mentioned. In Rutherglen we have one of the few consultative health centres in the country. The work done there by the medical officer of health in co-operation with the Western Regional Hospital Board and the Departrment of Geriatric Medicine in Glasgow University is a model well worth being copied.

Unhappily, just not enough copying is being done and the point which the two doctors concerned have often made to mo—that we should as best we can, bring families and the old people into these centres in order to be given some education—is not given enough consideration. I do not want to detain the House further on this point, but I hope that my right hon. Friend will, in reply, refer to the problem of consultative health centres and whether or not we can expand them.

The Report of the Royal College of Physicians for Scotland emphasises that old age is not necessarily a time of ill health, disability and particularly of misery. I hope that this is the attitude we shall adopt and I trust that my right hon. Friends will give their attention.

5.21 p.m.

Mr. Maurice Macmillan (Farnham)

In taking part in this debate, we must all remember that we are not talking about old people generally, or about the elderly as a whole or even the great majority of old people. What we are really concerned with are those whom we can call the defeated, who, by themselves or with their families, are not, for one reason or another, able to cope with life after reaching retirement age and beyond.

That in a way meets the point put by the hon. Member for Rutherglen (Mr. Gregor Mackenzie) in considering the priorities that are given to old people and to other deprived the mentally or physically handicapped. We are dealing in each case with only one group of people—those who, through no fault of their own, can no longer cope by themselves and who therefore must be a charge to some extent upon their neighbours, whether those neighbours be the immediate family or the community as a whole.

It is in this context that Mrs. Robb's book has made such an impact. In discharging this collective responsibility, we may not yet have totally eliminated the workhouse and the workhouse mentality. Whilst bearing in mind what the Minister of Health has said, we should be grateful to Mrs. Robb because she has, as he himself suggested, perhaps pinpointed a sense of guilt in ourselves, inasmuch as that we are relying more on other people to discharge responsibilities in which, in our hearts, each one of us knows should be discharged by ourselves.

I am sure that all hon. Members will have shared my own experience of listening to a constituent deploring that the old-age pension is so low with a passion which probably stems from the fact that he is not using his own capacity to help the old person concerned. In other words, it is the sense of guilt at what he is not doing which motivates the venom with which such a person attacks what the State is doing.

I welcome what the hon. Member for Rutherglen said in suggesting that we should extend the study of gerontology. One of our most pressing needs in dealing with the care of the elderly is to prevent as many as possible from becoming defeated and to enable them to continue more or less normal lives. We should be doing a great disservice to Mrs. Robb and those who worked with her—who, I am sure, were sincere and compassionate and determined in their approach—if we assumed that what she has written about concerns only a few cases of scandal which require some sort of administrative clean-up and that we do not need to probe further into community services looking after old people.

I am convinced, like the Minister, that what Mrs. Robb found can only exist in a minority of cases and that the vast majority of those looking after the old do so with care and compassion and selfless devotion that is remarkable to see. But we should probe further into our Welfare State as an organised body as well as into the facts with which the book is concerned. If, as the right hon. Gentleman says—and I am prepared to believe him—this sort of conduct only affects a tiny minority of people, why are we so worried? We are right to be worried, as he said, if only one case of cruelty is discovered. But our sense of worry goes rather further. I think that we are worried in the same way that we are worried by a Welfare State which has produced family poverty and the terrible conditions under which some of the disabled are forced to live.

We should examine not only our care of the elderly but the mounting evidence that we are tending to weaken and control the strong without in any equivalent way helping the weak. Indeed, in some cases the reverse is true. We tend to claim for the State too large a proportion of the responsibility which should rightly be that of the individual and in doing so we are failing to enable the State to discharge all those responsibilities. At the same time we are preventing the individual from discharging fully his own resposibilities and are enabling him to salve his conscience by pretending that it is all nothing to do with him anyway because nowadays the Government do it.

The care of the elderly has been called a collective responsibility. I reject the idea that it is merely a collective responsibility. It is not. That is the kind of responsibility that one has towards animals on a farm or units of output in a factory. The responsibility is really much more what one might call a universal individual responsibility, in the sense that, if the individual cannot take care of the elderly himself, then it is at least his personal and individual responsibility to see that it is done for him in the community. After all, that sort of idea is a truism among more primitive people who know this sort of problem very well.

I do not think that this is even a question of "private affluence combined with public squalor"; because in the care of old people, even in public responsibility, there is essentially a private aspect, covering not only the relationship of old people with the apparatus of the community in which they live—the institutions, the local authority services and the government, national or local, in the many ways it impinges on the elderly—but also with the other people, individuals, who live in that community too.

Of course, in this House and in this debate, we are concerned with the public aspects. The statistics show that, whatever the possibility is of increasing private responsibility and of affluence, enabling people to do more themselves for their elderly relatives, the care of the elderly will make increasing demands upon the health and welfare services. In some ways, improved medical science cancels itself out, for, while it enables people to live longer, it does not necessarily keep them in better health. Moreover if we are to solve our economic problems, social and geographic mobility must in- crease, which again must put more on the health and welfare services for the retired and the elderly.

I want to make it plain that when I attack the Government in the course of this speech I am not referring to the right hon. Gentleman and his colleagues only, I am referring to the governmental machine and the tendencies which it demonstrates no matter which political party is in nominal charge of it.

There are four main types of institution which deal with elderly people: first, the ordinary acute wards in general hospitals; second, the psychiatric wards or mental hospitals; third, the geriatric wards in general hospitals; and, fourth, local authority and private homes.

The main tenor of the debate and of my hon. Friend's opening remarks is the danger, in the present complexity of methods of dealing with old people, of the wrong methods being used in individual cases. As the Minister said, old people change very fast, they become confused, they require psychiatric treatment, they require varying sorts of help relatively quickly and it is not easy to keep pace with their needs. However, there is no doubt that the wrong use of the facilities available is leading in some cases to waste of effort and the sort of abuses that "Sans Everything " described. Even if the accident is pardonable, leaving an ordinary elderly person in a mental ward for any length of time inevitably tends to make him more confused. Equally, it is sometimes difficult to get the right psychiatric treatment for people in ordinary geriatric or acute wards or local authority homes.

There is a genuine difficulty in the cooperation between the various authorities which are involved, although I would thank the Minister for the careful description he gave of the methods that he is proposing to constantly improve these techniques.

There is also genuine difficulty in getting people to come forward to undergo training for geriatric work. One must admit, in discussing this problem, that nursing old and incontinent people is not easy and is sometimes unpleasant. Old people themselves are frequently very difficult and even rather nasty. I do not wish to weaken my argument in any way, but this is something which has to be admitted in trying to cope with the institutional problems involved.

Most of all we need to look constantly and carefully at the capacity of the institutions which we now propose to develop to help elderly people remain in the community. This particular consideration demands the most flexible arrangements and the widest possible number of different sorts of treatment available in the same area, or at least close enough together, to avoid having to move old people far away from their habitual surroundings to get them into the right sort of home or get them the right sort of treatment.

I have one or two positive and constructive suggestions to make. There is a lot to be said for what might be called the three tier system; that is to say, an old people's home for those who cannot live outside an institution; with, nearby, and staffed from the old people's home, bungalows or flats with a certain amount of supervision and the possibility of communal meals, but with private kitchenettes available; with, roundabout, bungalows in the community for those who can live on their own, with a modicum of supervision from the centre. The hon. Lady the Member for Halifax (Dr. Summerskill) will probably recognise this as a description of institutions which are in existence in her constituency.

The second sort of unit which I would like to see developed further is the type developed at Colchester at the Severalls Hospital where regard is paid to relieving the relatives of old people from the burden of looking after them for at least some period of the year. The work done at that hospital, on the concept of "month in, month out", makes it much easier to make the transition between hospitalisation and living fully in the community, as does the concept of a day hospital and the other methods used to supplement home life.

There is a great deal more work to be done in considering the rôle of the family doctor, group practice, and the health centre in integrating geriatric care with the rest of the community care which is being developed. Incidentally, I think we are at the moment begging the whole question of whether we will move to- wards a family doctor service based on the individual or a family doctor service based on what might be called community care and a more public health or preventative aspect of medicine.

There are one or two other relatively minor acts which could be done which are relevant to this problem. I should like to see the whole level and incidence of tax relief given to people for dependent relatives looked at again. I should like consideration to be given to the question of whether grants could be paid to individuals on the lines of the proposals of the Disablement Income Group to enable old people, who might not otherwise be able to live at home, to continue to do so; grants which would therefore not be a net charge on the Exchequer. I should like consideration to be given to grants for conversion of housing to enable old people to live on their own or with their relatives.

In this matter and in the Welfare State as a whole we must consider the action of the State as enabling people to help themselves rather than merely as taking over responsibility for them. The tendency of the community to replace individual action and responsibility is inherent in our modern world with its complexity, technology, and in the increasing gap between those who are living on a normal average income and the poor —the poor getting poorer as the average gets higher. This increases the problem and in some ways the tendency to hand over more and more to the State is beginning to add to the problem which it is ostensibly solving.

I think it also partially explains the obduracy of institutions, the difficulty of getting complaints heard, and of getting those in authority to listen. When one comes forward with complaints of one sort and another, it is almost as if authority, anonymous and impersonal, was saying to each of us that by abandoning our individual responsibilities we have in some sense abandoned the right to complain about the treatment of those whom we have handed over to the State. We must ensure that that responsibility is accepted by us individually, even if we have to devise a mechanism for its discharge.

For these reasons, I should like to have the whole question of the accountability of our various institutions looked at again. Who is in ultimate control of hospitals? Can the Minister order or only advise? Will the sort of inquiry he is making actually get to the root of the matter? I could not help feeling, as he was speaking, that he showed in some sort the complacency of the machine—that here we had the brave new world solution to the future, but not much hope of getting matters deeply looked into in the present. He used the words "psychogeriatric assessment unit" as if it was a sort of old people's 11-plus. I have no doubt that he was right, but it did seem extremely dehumanised.

I am not really criticising what he said, nor the progressive and practical ideas which he put forward, but rather wondering whether we are not tinkering with the problem and whether it is a problem which is especially acute for old people only because they are especially weak. More and more in the modern State the individual's importance is lessened and shaken in face of the demands of the machine. More and more we are isolated in the society in which we live according to our category in the administrative machine—child of school age, student, productive worker, old person—seeming real to the machine only in so far as it acts on us as a member of such a group.

When the Minister was speaking I wondered why I almost automatically believed Mrs. Robb's allegations, and I came to the conclusion that it was because they were merely an extreme example of the harshness of the impact of the State on the individual. In housing cases, in child welfare cases and in other matters of which each of us has experience in handling constituency cases, authority as such is callous.

In considering the special problems of the old, we must bear in mind that callousness is becoming normal in our society and that it is an attitude of mind which is as important as any institutional change or plans for the future, an attitude of mind which it behoves each of us to eradicate in ourselves, not at some time in the future, but now.

5.43 p.m.

Mr. Alfred Morris (Manchester, Wythenshawe)

The hon. Member for Farnham (Mr. Maurice Macmillan) made in interesting speech. It is not my inten- tion to follow his arguments, except to say this about his reference to the occasional nastiness of some elderly people. Some of our elderly are people whose lives were soured by long years of unemployment in the 1930s and many of them now have to exist in institutions —I shall not call them welfare homes—which were called Bastilles when they were built in the 19th century as workhouses under the so-called New Poor Law. These are elderly people who can crave some indulgence for any occasional nastiness they may show.

My first concern in the debate is to emphasise the importance of a topic which has not yet been mentioned, but which I regard as fundamental in any discussion of the welfare and well-being of the elderly. This is the need for much more attention to be given to the problems of preparing to retire. It is a new experience for our community to face the fact that more than 12 per cent. of the population is fit and lively and yet over retiring age. Every month, active people are having to give up work and are losing status and being driven into loneliness and isolation because of our rules about compulsory retirement. Happy are those with money, outlets and interests to keep them occupied when they retire from full-time work, but for many life loses its meaning when they have to retire.

The problem is made worse by the current trend towards retirement at the age of 60. In the world of modern technology, many people, from management to machine tool operators, are unable to hold their own after the age of 55. The farewell handshake may come suddenly or according to schedule, but, unless it is planned for, it can be disastrous.

It is now being realised that retirement raises entirely new problems and responsibilities for individuals, for the firms for which they have worked, and for the community. We still know very little about the adjustments involved in moving from employment to retirement. If the social and economic stability of our community is to be maintained, much more detailed research into this problem is urgently needed. To prepare for other phases of life we go to primary schools, secondary schools, training colleges, technical colleges and universities. Advice is eagerly sought from many different sources. It is the duty of the House to create a climate of opinion in which it will be as natural to train for retirement as it now is to train to start work. This involves the Government, both sides of industry and the local education authorities, as well as the voluntary organisations.

How bad is the problem? My attention was drawn recently to an excellent statistical survey undertaken by the Workington College of Further Education. Its results show that of 149 men between the ages of 50 and 55, 93 did not know what their retirement income would be; 99 had not considered how they would manage on their retirement income; 104 did not know to what benefits they would be entitled in retirement; and 94—this is the figure in which I am particularly interested in this debate—had no new interests or activities to take up after retirement. The results obtained in the Workington inquiry would, I am sure, be repeated in similar inquiries in other areas throughout the country.

One may well ask what is being done to meet this very important problem? First, there is the Pre-Retirement Association, an organisation which is doing extremely valuable work in helping people to adjust from employment to retirement. It runs many advisory courses and has performed a most useful service in killing the idea that training for retirement should be regarded as old people's welfare. Many of those whom the Pre-Retirement Association is helping are people who just happen to be in their sixties and who want to enjoy life and to continue to make a useful contribution to society.

Moreover, keeping people happy in their own homes would certainly save some of the public resources now devoted to medical care. The Pre-Retirement Association recognises all this. It has set itself the task of making these points commonplace among all who are nearing retirement. Nationally, and through its regional committees, the Association is providing a remarkable service which I should like to be acknowledged by my right hon. Friend the Minister without Portfolio in his speech tonight.

Secondly, a great deal of useful work is being done by employers and trade unions in emphasising, to those who are nearing retirement, the difficulties that will have to be faced and the adjustments that will have to be made. I am particularly pleased that some of the nationalised industries have given the lead in this sphere. For some time I worked as a national officer with the electricity supply industry and had experience of courses organised by local joint consultative committees with the purpose of enabling people to take up new interests following retirement age.

I particularly recall courses which were organised in association with the University of Wales. Men who had lacked any previous opportunity to take an interest in arts and crafts became very good at some art or some craft as a direct result of these pre-retirement courses. I know that many private employers also help by paying fees for their elderly employees' attendance at educational courses and in phasing retirement from work. Thirdly, the local education authorities as well as the universities, are making an important contribution.

I am happy that in the City of Manchester, part of which I have the honour to represent, there are some of the best pre-retirement courses to be found anywhere in the country. Mr. Donald Garside, the Warden of Holly Royde College in South Manchester, has done particularly outstanding work, and much valuable work has also been done by the Lower Mosley Street Adult Education College.

The Pre-Retirement Association, employers, trade unions, the universities and the local authorities are doing excellent work. But it is for this House to emphasise that very much more needs to be done. My hon. Friend the Member for Rutherglen (Mr. Gregor Mackenzie) referred to the University of Glasgow. Some hon. Members will recall the speech made at last year's annual conference of the National Association for Mental Health by Professor W. Ferguson Anderson, the professor in geriatrics at the university. Professor Ferguson Anderson was in fact the first professor of geriatrics ever appointed anywhere in the world. He has carried out a very interesting study to which he referred at last year's conference. The paper convinced me that one important factor responsible for emotional disturbance in the elderly is compulsory retirement. He emphasised that if people are to be saved from mental ill-health, it is as essential to train them to retire as it is to train them to begin work.

We are not behind other countries in this connection. Much has been written about this in the United States, which may have the lead upon us in terms of precept. They have thought more than we have about the problem of adjustment from work to retirement, but in terms of practice we are doing as well as any other country. I would like to see us doing still more and leading the world because this involves something of the deepest possible human interest and importance. The ideal is that each person should have a genuinely free choice between working and retirement, within the limits of his ability and health, and that when retirement arrives it should be fully prepared for. What is this life, if full of care, We have no time to stand and stare? So said the poet, but he was writing for a generation other than ours. One of the problems today is not that people lack some opportunity to stand and stare and reflect. The problem too often now is that people are forced out of work even if they are lively, active and healthy people. My right hon. Friend the Member for Sowerby (Mr. Houghton) has emphasised the importance of this problem, and I hope to hear some reference to this in the Government's reply to the debate.

Some years ago the Co-operative Party published a document called "Care of the Aged" which included many recommendations which have awaited implementation for a very long time. I hope that the Minister, who will be aware of this important document, will give, as it were, a progress report on the recommendations it contained. The document said that in the view of the Co-operative Party: …the division of responsibility between the hospital board and the local authority in providing for old people can cause unnecessary hardship to some who are 'marginally' sick or who are convalescent. A problem also arises in providing for the chronic sick who are kept in special wards of hospitals or alternatively of welfare institutions because there is nowhere for them to go. If one authority were responsible for meeting the needs of old people who require care and attention of any kind, the many facilities that are available could be readily co-ordinated, transfers effected, and special provision made to meet any need, all with the minimum of inconvenience or delay. I am reminded by this recommendation of the reference in a book called "The Social Services of Modern England". Its author, Miss Hall, instanced the case of a Manchester firewood seller who, after being turned away from hospital because he was not sick, and from the local authority because he was, returned home to die… This question of co-ordination is one of widespread concern and is of the greatest importance. Another recommendation from the Co-operative Party's document says: Most old people suffer from foot ailments of varying degrees of severity. Mobility in old people is a condition of their happiness and comfort and keeps them from being cut off from their neighbours and much social activity. The document recommended that a chiropodist service be provided free to old people as part of the National Health Service. I hope that we shall hear of the progress being made in this direction.

I would now like to say something about the work done in the city of Manchester in many of the spheres referred to in this debate. This is a forward-looking and compassionate authority, which has given a lead to many other local authorities. In Manchester we have attacked with all our resources the problem of improving the quality of the lives of the city's elderly people. We have humanised large institutions by breaking them down into smaller ones and building welfare homes for small groups of elderly people in which they can live together as families.

I am pleased that in my constituency there are many of Manchester's new welfare homes which are the pride not only of Manchester but of the north of England generally in the facilities which they provide. I am particularly glad that we have a home called Weylands in the Baguley area of my constituency which is for those who have spent much of their lives in mental institutions. They are recovered mental patients but are unable to return to their families—in many cases because they have no families— and have been provided with a welfare home by the City Corporation. I should like my right hon. Friend the Minister to note the importance which we attach to Weylands and to hear from him how many other local authorities are being advised to follow Manchester's example in providing welfare homes for mentally recovered patients. What progress is being made in this respect?

I should like also to hear what is being done to help more the voluntary organisations which do so much to provide the meals-on-wheels service and in extending the facilities of luncheon clubs which we have in Manchester and in some other local authorities. One of our problems is to improve the quality of life of elderly people by treating them more as people and not forcing them into retirement when they are still fit to work, by helping them to train to retire and by providing the best social services whenever they need help from the community.

6.2 p.m.

Dr. M. P. Winstanley (Cheadle)

We seem to be enjoying an unaccustomed amount of agreement and unanimity today. I hope that we can preserve the same degree of accord in suggesting positive steps which should be taken on this important question rather than merely talking about it.

I join in the general congratulations given to the hon. Lady the Member for Melton (Miss Pike) for the way in which she introduced this subject and the responsible way in which she approached various aspects of the problem. I join, too, in the thanks which have been offered to the Minister of Health for the way in which he gave certain extremely important undertakings about the investigations arising from the "Sans Everything" document. I agree substantially with almost everything said by hon. Members.

I might quarrel briefly with the hon. Member for Rutherglen (Mr. Gregor Mackenzie), who appeared to place too much emphasis on further research into and further consideration of methods of dealing with the problem. We all know enough about quite a lot of things. I could take the hon. Gentleman, and I am sure that he could take me, to old people's homes which are entirely satisfactory. I could take him, and he could take me, to geriatric wards and units carrying on an extremely high standard of work and which cannot be faulted. Therefore, there is ample evidence that we have institutions which are satisfactory, but there is also evidence that we do not have enough of them and they are not always in the right places. I hope that we shall get on with doing what we have shown we can do rather than spend too much time thinking about other possibilities.

As has been said, this is an immense and growing problem. The fact that it is growing has particular relevance for the medical profession. Perhaps I can remind the House that the human body was never intended to endure for the length of time which it is now fortunately enduring. I do not wish to put the clock back; I am glad that we can look forward to a much greater expectation of life. But for a great many years the human body was expected to last for only about 35 years. It should therefore come as no surprise to hon. Members when they find that they are losing their teeth at that age and that the connective tissue begins to disintegrate and they develop various infirmities.

What this means to the medical profession is that it is becoming more monopolised by a growing section of the population, not for the treatment of active disease, but for measures to prevent or slow down degenerative processes. The Minister referred to this matter. It is of significance and we must consider it in any solution at which we arrive.

In this country we are very much dependent for our attitudes to the old on purely personal convictions—how we happen to feel as individuals about our relationships with others. When we turn our eyes to the Eastern and Oriental countries, we find that the care of the aged has become embedded in religious and social customs to such an extent that the force of tabus ensures effective care. That does not happen in this country. There is no doubt that in Eastern countries neglect of an old person would be regarded in something like the same light in which we in this country tend to regard aberrational sexual behaviour. I mention that, not because there is a connection, but to show how highly emotive a question care of the aged can be and how looking after one's parents or grandparents is deeply embedded in the culture pattern of some societies. In this country, it is not so embedded. We must therefore think very deeply about how we should deal with the problem.

I recall a quotation which made a great impression on me. It made such an impression that I regret that I cannot remember who said it, but I should still like to quote it: The care of the aged, irrespective of their medical, mental or social disability, is a measure of the dignity and culture of a country". Those are important words. We should consider what we have done so far and what we hope to do in the future with that kind of attitude in mind.

There are many aspects to this problem, but I prefer to concentrate on the health aspects with which I have more personal contact and merely to make passing reference to the more general matters. But it is important to emphasise that the care of the elderly is not specifically an urban problem. There is a tendency for people to think that difficulties regarding the aged arise only in what we generally look upon as slums and in heavily populated areas. There is a tendency too, particularly for urban dwellers, to regard conditions in the country as being inevitably satisfactory. Because there are cottages with roses round the door, it is presumed that everything within is similar.

May I remind hon. Members of a book called "The Ageing Countryman", produced by Dr. Miller, which points very sharply to some of the very special problems of the elderly in country districts. They are separated from the sources of help. Often they have a degree of loneliness which is much greater than that of people in the towns. Sometimes they are exposed to great dangers merely by being in the country. Often they do not have social services or even council services. The water supply and sanitation may not be of the same standard enjoyed by people in the towns. It is, therefore, worth remembering that this is not exclusively an urban problem.

I mention this in no spirit of criticism of the Minister, but he referred to his hopes for the development of community care, with the bringing in of local authority services to general practitioners and their combination in some kind of health centre arrangement. I agree with him entirely about this. But we must not forget that this could never solve the very special problems which cover large areas of the country and in which old people will always have to be the responsibility of an individual rather than an institution.

Of the other general aspects to which I would like to have referred, but will make only passing reference, the first is finance. We have to think again about our pensions policy, and we have in the end, I hope, to arrive at a situation in which retirement pensions are automatically linked to current earnings, so that there is not inevitably a delay before adjustment is made. This is relevant to the care of the aged.

I agree very much with what the hon. Member for Manchester Wythenshawe (Mr. Alfred Morris) said about the whole process of retirement. Many of our taxation and pension policies, and even our social attitudes, tend to create too much of a situation of sudden retirement whereby people go from full work to full rest in a highly traumatic fashion.

I remind the Minister who is to reply of the recent conference at the council of Europe at Strasbourg at which the British representative paid lip-service at least to the principle of trying to phase retirement and make it into a gradual process over a period of years rather than a sudden one. The hon. Member for Wythenshawe made this point and I will not elaborate it further, save to say that the earnings rule still has an unsatisfactory effect. Again, however, it would not be proper to go too far into that.

The various angles which should be examined concerning housing include the question of social attitudes. The tendency towards the philosophy of living in little boxes has produced special problems for elderly people and tended to have a divisive effect on families, because couples automatically assume that they must live in a little box, a very small one, which is only just the right size, and they do not have room for older relatives when the time arrives. I do not wish to see a return to the old clannish days when a family remained together almost always and the departure of one of them was regarded as regrettable. Nevertheless, we have, I think, gone a little too far in the other direction. This should be thought of when considering housing programmes and when local authorities and others consider the kind of housing which should be provided in a modern society.

I do not want to go into consideration of the size of the problem—we all know how big it is—but will go straight to what I regard as a more important or more relevant matter, namely, health considerations. In particular, one has to consider where the various old people should be cared for. Hon. Members have dealt with the question of their remaining at home. I agree that the more we can do to assist families to keep their elderly relatives at home, the better. There is no doubt about this.

Some of this depends upon housing. If the house is inadequate one cannot necessarily arrive at that kind of solution, but there are other things that we can do. I recommend to the Government, and to the Minister of Health in particular, the establishment of training courses for relatives of elderly people to assist them in looking after old people. I have seen many cases in which the difficulties appeared to be much greater than they were merely because those responsible for the old persons, who frequently might be people who were sick, had no kind of training or experience in how to handle and look after them. There would be great merit in the establishment here and now of courses for the training of relatives and friends in the care of the elderly and of the chronic sick. If that was done, it would take some of the load off the official sources—the district nursing service, home helps and the rest—and it might even take some of the load off the hospitals.

A further need is the availability of equipment of one kind or another. We all know of the many new gadgets and inventions to assist old people who may be partially handicapped to live at home, but the availability of these items in our society is patchy, to say the least. In some areas they may be readily available, but in others they are not.

A crucial point in the whole problem of the care of the elderly is the existing situation of divided responsibility. An individual doctor can find himself with an elderly patient for whom he is respon- sible. He has to provide the medicine and general care and make periodic visits. The same patient may be under the care of a hospital clinic for a specialised condition for which occasionally there is supervision. The patient may from time to time come under the care of the medical officer of health in dealing with hygiene problems or infections. There are many ways in which the medical officer of health or the divisional medical officer may be brought in. The patient may be getting meals on wheels through the R.W.V.S. and a clean linen service through an entirely different voluntary organisation.

There may be a loan scheme operated by the Red Cross to lend out bed pans or other items which may be necessary for the old person at home. Frequently, wheel chairs and items may be borrowed from hospitals. To borrow other appliances, the old person may have to go to a separate hospital or clinic from the original one. In addition, the health visitor or district nurse might be visiting the patient. When one adds to that the involvement, which is not inconsiderable, of the Ministry of Social Security, one finds that the elderly person may be getting help from a whole number of totally different sources.

It has always been my view that where so many people are responsible, there is a tendency for none fully to accept responsibility. There is, therefore, a fairly urgent need for the appointment in each local authority and local health authority area of a person or official who would be called an old persons' officer. We already have an appointment like this with the children's officer, so that there is precedent for it. The children's officer system is not necessarily wholly analogous, but we need some kind of official whose sole duty is to make himself or herself aware of the size of the problem in the area, to identify the people and to ensure that all the various sources of assistance and health are integrated.

In doing that, great assistance would be provided to the general practitioner. Even the most knowledgable G.P. frequently has difficulty in knowing where to get various things. He does not always know what is available, he sometimes does not even know that something is available and, therefore, he does not try to find out where it can be obtained. If we had somebody who was responsible for integrating all these services and for being aware of what was available in the area, this would be of help to all those working with the elderly and also to the elderly people themselves.

Next on this theme we must speed up the end of the tripartite system within the National Health Service and the nonsensical arrangement whereby people who all do the same work, and who should be working co-operatively in some kind of partnership, may be employed by entirely separate authorities—the general practitioner, for example, by the executive council and all the local authority services by the local health authority, in addition to all the various hospital services, and never the twain shall meet. If we persist in having these organisational divisions, we will never get the kind of integration that we want.

I think that the Minister of Health shares that view. I have heard him in this Chamber say that he was looking forward at least to experiments towards integration of the Health Service. I hope that he will speed them up, because while we continue these divided services we will tend to miss things out and not make economic use of our resources, which we do not have to excess.

There are a number of things to be thought about immediately concerning elderly people who live in homes on their own and not with relatives. First in importance is visitors. This has particular reference to what I have said about the ageing countryman. It is essential that elderly people should be visited. All sorts of systems of visiting are operated through the local authority, voluntary organisations and others, but unless we make one person responsible for seeing that it happens and finding out to whom it should happen, inevitably people will be missed out. The fact that they are missed out is amply evidenced by recent publications about deaths from hypothermia—the figures which Dr. Taylor has published showing that perhaps thousands of old people die merely because they are cold, and who would not die if they were visited by people who realised the situation and the importance of supplying help at the right time.

We have to supply better methods of keeping them living on their own, and at the same time keeping them in contact with other people, perhaps by the installation of the telephone and perhaps, if I may say so, the introduction of modern science and new methods—radio equipment, and so on. We have seen it done by the hostel type of arrangement, the settlement type of arrangement, whereby people living in little flatlets on an old people's estate are connected with the warden's flat by radio communication, so that an old person can, at least at night, when he or she goes to sleep, switch on and have the feeling of security that somebody will hear if he or she should call if something goes wrong. This is one way we should make much more progress, and we need, too, the establishment of more wardens to look after these people.

We ought to look, too, more and more at old people's transport problems. I agree that we have a concessionary fare system in so far as old people are living in an area which is served by local authority transport, but it is surely high time that we provided some arrangements in those areas which are served not by local authority transport but by private transport.

One could go on on these matters for a very long time, and I do not wish to do so, but I would emphasise once again the conditions of old people living on their own, and that brings us back again to the importance of increasing and integrating the services, and of speeding up, what I hope is not far away, the end of the tripartite structure of the National Health Service.

Much of the discussion so far has been about the old people in hostels or in hospitals, and I want to join in the general tributes which have been paid to the staffs and their dedication to their work in those hospitals and in those hostels. I have had intimate experience of many, of some local authority establishments, some private, and some joint, and I have seen the excellent work they do with skill, knowledge, compassion and good humour, and I, too, would regard it as very regrettable if the criticisms which have been made tend in any way to throw doubt on the standards of hostel accommodation in general. The fact remains that many of these hostels do operate under very great difficulties, and they are likely, I think, to operate under greater difficulties as staffing problems increase.

This applies to geriatric units as well. I think that sometimes, when we begin to congratulate ourselves on the provision of hostels, that we have provided geriatric beds, that we are doing better because we have got more, we should remember that we should not be wise to rely on the present demand as being necessarily a true indication of what is the actual demand, for the fact remains that the general practitioner does not seek accommodation in a geriatric ward for patients if he knows perfectly well he is not going to get it. I have myself visited patients whom I should have liked to get into a hospital, and I have known that I could not because I had two or three others whom I regarded as having a higher priority. What I am saying is that however much the Minister increases the amount of accommodation, the general practitioners will fill it, and they will keep on filling it till he increases it by very much more than he has in mind at the moment.

I want to come very briefly to these allegations regarding ill-treatment, cruelty and so on. I, too, have had discussions with Mrs. Cross, the editor of Nursing Mirror as, indeed, have other hon. Members, and I think there is some merit in her suggestion of some kind of an independent standing committee which could hear complaints from nurses, because I have been impressed myself—I think the Minister has himself been impressed—by the number of nurses who have written to her to say that if they were aware of conditions of this kind they would be in great difficulty in reporting this as they would feel they were, perhaps, in jeopardy of the possibility of recriminations. There is one thing which Mrs. Cross said which I should like to quote: I do not believe that witch hunts against junior personnel serve any lasting purpose. I entirely agree with her, and I would suggest that if anything valuable is to come out of this there must be a full investigation into all the conditions which can result in these sorts of things happening, or in the suspicion that they are happening, or in allegations that they are in fact happening.

I ask the House to believe that quite compassionate people can sometimes be cruel and be neglectful when they are subject to intense pressures—I saw it myself during the war years—perhaps in an understaffed hospital when there is a great deal of night duty and a nurse is looking after a very large number of patients and there is an inducement—not to ill-treat; there is no desire to do violence—but an inducement, perhaps, to behave in a way which she would not normally do. The inducement can in some circumstances be a very strong one.

I should like to mention in this connection that it should not be forgotten that many cases of cruelty to old people arise not through nurses, not through people who work in hospitals, but from the relatives themselves. I, too, have seen relatives—children who, perhaps, have been with their parents all their lives—and who are fond of them, but in conditions which are beyond their own control they have treated those patients cruelly, sometimes even dangerously. It is rather parallel to the battered baby syndrome, in which the parents do not wish to hurt the child but sometimes act in a way which causes injuries. These are people who need help and understanding, and the kind of help which they need is the kind of help which the staff in these geriatric wards and hospitals need in terms of beds, of additional staff, and resources generally.

I should like to quote a letter which I think important and which comes from a consultant geriatrician in my own constituency, Dr. Tweedy, who wrote to me about a constituent when he had certain difficulties in getting this patient into a geriatric ward. In his letter he says: I have made official representation to the regional board that I do not consider we can meet our obligations on the geriatric line until the Group has more beds. Last year, for instance, 190 patients died before we were able to admit them to hospital, and this was out of a total admission rate of about 1,130 in a year. Is this not serious? And it is confirmed by my own personal experience, that some 16 per cent. to 20 per cent. of old people die while on waiting lists, and they are only on waiting lists if there is a very good reason for them to go into hospital—if they have not got somebody to look after them at home, for instance. There is a percentage something like this of people who die while waiting to go into these places, and Dr. Tweedy refers to this point in this unfortunate case; he says that that patient needed nursing care but it was difficult to get her into hospital because there was someone in the house to provide for her bodily needs although she unfortunately has to be left alone all day long as the daughter has to earn her living. There is nothing special about that particular case; it is typical of cases all over the country: the facilities we have at the moment are just not adequate.

We can talk for a long time—perhaps I have talked for a long time—about all sorts of aspects of this problem, but it comes down to one thing and one thing only: money. We have got to spend more money on the provision of resources for the care of the elderly, and unless we do spend more money no amount of talking will do any good at all.

The hon. Lady quoted from the book prepared by the National Institute for Social Work, "Caring for People", and I should like to quote some of the conclusions there. For instance, on page 191 we read: We realise that the establishment of training courses, improved accommodation, shorter hours of work and the other changes in staff conditions which we have recommended will cost money. But unless this money is spent there is no hope of any significant improvement in the numbers and quality of the staff who enter and remain in residential work; and unless there is significant improvement in these respects it is not possible to provide the amount and quality of care that is needed The happiness and welfare of the hundreds of thousands who must be cared for in residential Homes depend on our willingness to spend this money. We do not consider the extra costs excessive in relation to the amount of human happiness involved. Nor do I consider the amount excessive, and I venture to say to the right hon. Gentleman that his job is not only to reply to this debate but to do what he can, in the face of many competitors, to obtain more resources for this section of our social activity. If he does that, I suggest that the care of the elderly will prove in time to be very much more relevant to the real needs of the people than many of the activities which at present get greater priority.

6.30 p.m.

Dr. Shirley Summerskill (Halifax)

The subject of health receives far too little prominence in this House and for that reason I welcome this debate.

It is significant that the Opposition have chosen their 25th Supply Day for a health debate. Presumably, they do not consider that the National Health Service is too badly run by this Government, having chosen it as their Supply Motion at the very end of the Session. In moving it, the hon. Member for Melton (Miss Pike) accused my right hon. Friend the Minister of sustained slapping of his own back. Certainly it seems to have had its effect, in that the general tone of the debate has not been highly critical of the Government, considering that it is a Supply debate.

Many of the lessons which we can learn from studying the care of the elderly can be applied to other branches of the National Health Service. There was a danger that today's debate would end in a series of generalisations and perhaps be based solely on the book "Sans Everything". But I am glad that it has developed into an occasion for a reappraisal of both domiciliary as well as hospital care of the elderly, at the same time examining the faults in the National Health Service as a whole.

All those hon. Members who have spoken so far have finished their speeches by asking where the money is to come from. I should like to start with that question, because we are all aware of the shortages, deficiencies and the various needs which are inherent in the Health Service, particularly in the care of the elderly. In my view, the money should come entirely out of the national income, and we should spend much more of the national income on health. It is quite clear that the Government do not give health a very high priority as a social service when it comes to spending money. They have admitted that housing is their top social priority. We are not here to argue the merits of schools, houses, hospitals, pensions, and so on, but anyone who is interested in the Health Service should keep up the representations to the Government that far more of the national income should be spent on it than at present, because every time that a National Health Service problem is raised, it comes back to the same point. We know what the problems are. The only solution is to find more money.

When he comes to reply to the debate, I hope that my right hon. Friend the Minister without Portfolio will say how he thinks the money can be found. Is it his view that it should come out of the national income? There has been a tendency on the part of hon. Members opposite in speeches and comments both in the House and outside and in newspaper articles to say that money for social benefits should come not from the tax payer but perhaps from the private individual. In the course of the debate, we have heard the word "State" used as if it is a rather impolite expression, and we have heard continual references to the responsibility of the private individual.

I should like hon. Members opposite to clarify their position. Do they really want people to pay for their National Health Service treatment at all and, if so, can they say for what aspects of it they wish them to pay? In this debate, when we are discussing retirement pensioners, we have heard it suggested that even they might make some contribution to their upkeep.

Do members of the Conservative Party support the latest British Medical Association proposals that we must tend towards payment in a National Health Service? Even more important, we should like to know whether the Government support those proposals, or whether they dissociate themselves completely from them. Everything which is said about the matter is exceedingly vague. The idea is put out as a suggestion or proposition, but I feel that it will prove to be the great issue of the coming year and perhaps even the great issue between the two political parties at the next General Election. How much of the Welfare State is to be provided by the taxpayer, or is any of it, and how much, to be provided by the individual? It is a volcano that is bubbling under the surface, and I should like the Government to come out and say what they feel about it.

When we are considering the care of the elderly, perhaps one of the reasons why we do not see a huge turn-out of hon. Members is that the subject has no glamour. If a miraculous cure for old age were discovered, geriatrics would achieve some sort of glamour in the eyes of the nurses who take it up and the doctors and other people who look after the aged.

I refute the suggestion that relatives are not caring for their old people as much as they used to. Last year, some research was carried out in Edinburgh. I will not go into detailed statistics, but it shows clearly that relatives still care for their old people as much as before. It has nothing to do with the Welfare State or with any other explanation. They are as keen as ever to see that old people are cared for as well as possible, be it in their own homes or in local authority homes.

It is not easy for relatives to get rid of old persons who are in their homes. According to some hon. Members, a relative can simply ask his family doctor to put his father or mother in a geriatric bed or in an old people's home. Everyone knows that family doctors themselves find it increasingly hard to obtain a geriatric bed or a place in a home for an old person. They have to persuade the authorities that perhaps there are no relatives to look after the old person, and the greatest chance of getting someone into one of these places is if he or she is living alone. Such a person comes at the top of the list.

We really should think more of the difficulties of the relatives themselves, and that is why I give my strong support to opportunities for relatives to go on holiday and take a rest from looking after old people by more beds or places in homes being made available for old people for two weeks in the summer.

The burden of this care is always on the woman. Except for the doctors who look after old people in hospitals, it is invariably the woman in the home who does this job. It is the female relative in the family who has this burden, and quite often it is a single woman. We have debated the problems of single women with dependent relatives, and, fortunately, the Chancellor of the Exchequer has been able to help. It is the women who are the home helps, the health visitors, and who, as members of the W.V.S., run meals-on-wheels services. In the hospitals, the job is carried out predominantly by female nurses.

Dr. David Kerr (Wandsworth, Central)

Would not my hon. Friend agree that she is doing a grave injustice to a large number of male nurses, in both geriatric and mental hospitals, who look after old people, and many men who, as devoted sons, make themselves responsible for their parents? I allow my hon. Friend 99 per cent. of her case, but I hope she will pay tribute to the remaining 1 per cent.

Dr. Summerskill

I still say that it is predominantly the women who wash their relatives, keep them clean, change the sheets, and do all the work in the home. I said that it was predominantly the women nurses who looked after old people in hospitals.

Here I put in a word for their pay and conditions of work to be improved. This is perhaps a matter for disagreement, but one tends to think that because they are women, they can be exploited in some way. The average wage of a woman is only just over half that of a man, and I ask my right hon. Friend to consider whether an increase in remuneration would not make a great difference to recruitment to all these services which care for the elderly.

I support my right hon. Friend's suggestion to set up psychogeriatric units, and I would like to mention a figure which perhaps he was not able to give to the House, namely, that 24 per cent. of old people were misplaced in mental hospitals in the sense that their illnesses were mainly or entirely physical, while 34 per cent. were misplaced in geriatric units because their illnesses were mainly or entirely mental. Here we have a situation in which, at the beginning of their treatment, they were put into the wrong category, and therefore an enormous difficulty was created at the beginning.

I have dealt shortly with the tremendous shortage of all the local authority services which old people so desperately need, but nobody during the debate has mentioned a great factor among old people, and that is loneliness. However many meals on wheels and home helps they have, however hard-working the health visitor, old people living alone, or even with relatives, can be exceedingly lonely, and only human company can overcome this. I am glad that there is a movement among young people nowadays to try to alleviate this loneliness. Many of them are making a point of visiting old people—and adults, too, are doing this—because this is a great problem among the elderly.

As my right hon. Friend, and also my predecessor, now the hon. Member for Farnham (Mr. Maurice Macmillan), told the House, many old people's homes have modern amenities unlike the institutions about which one reads in Dickens' books. In Halifax there are homes in which each old person has his or her own bed-sitting room. An old person can have complete independence and privacy when he requires it, and there are facilities for light cooking. When he wants company, he can go downstairs and sit in a general common room which is equipped with television, and there is a warden who runs the home. It is this sort of thing which has removed the fear of many people about old people's homes. If, even 10 years ago, it was suggested to a patient that he should go to a home, it was obvious he would almost prefer to die in his own home than go away. But now the whole atmosphere of these homes has altered.

There are growing up in the country many private homes for which the State has no responsibility, and, just as we are concerned about children in care, so we should be concerned about old people in care, because it is possible that these private homes are inflicting deprivations on, or neglecting old people without us knowing anything about it. Perhaps some registration or inspection of these homes should be enforced.

Mr. K. Robinson

I think my hon. Friend has overlooked the fact that two or three years ago the House passed legislation which gave local authorities the power of inspection in private nursing homes of this kind.

Dr. Summerskill

A further point to which I would like to draw my right hon. Friend's attention is that not every area in the country can be considered in the same way when one is trying to decide how many geriatric beds are required. For instance, in the West Riding of Yorkshire there is a far larger percentage of people of retirement age than there is in many other parts of the country, and this must be taken into account when deciding how many beds are necessary. Similarly, in the West Riding, of which I am speaking particularly, a far greater number of women go cut to work than do in many other parts of the country, and if we say to someone, "I want you to try to look after your relative yourself", we must remember that the factors involved vary from one part of the country to another.

I conclude by making a few recommendations which I hope will be considered. I think that there is a good case for a hospital Ombudsman. I do not regret that hospitals are not included among the duties of our present Ombudsman, because this would perhaps be too great a burden for him to carry along with his other duties, but a man, or woman, whose sole responsibility was to act as a hospital Ombudsman would I think, be a great help in settling the doubts, the fears, and the inquiries which so often arise when we are considering the National Health Service.

We all want to see an improvement in the status of nurses, doctors and everyone connected with geriatrics. I think that the Government will improve the situation by means of the recommendations which were made at the beginning of the debate. I do not at the moment support the idea of inspectors of hospitals, on the same lines as factory inspectors, who would just drop in at any hour of the day or night and presumably walk round inspecting the premises, but it may be that some other method of inspection can be found. A great deal of criticism has been levelled against the National Health Service, both in the Press and in speeches, and there has been a tendency to imply that because the Health Service is free, people take it for granted and try to exploit it. The Health Service should not be afraid of this criticism, but I would like to see more people patting themselves on the back because we have this Service, and giving more support to it than is the case at the moment.

Several Hon. Members rose

Mr. Speaker

I remind the House that we can call everybody who wishes to catch my eye in this debate if speeches are reasonably brief.

6.50 p.m.

Mr. Airey Neave (Abingdon)

The hon. Member for Halifax (Dr. Summerskill) accounted for the rather poor attendance in this debate by saying that the subject had not very much glamour. I agree, but it is one of the most important social subjects of our time. It is a difficult subject for hon. Members who have no practical experience of the problems of the old and do not have the professional qualifications for dealing with their medical problems. On the other hand, it is important for all hon. Members to know something about this matter and to be able to deal from time to time with cases in their constituencies.

I welcome the suggestion made by the hon. Member for Cheadle (Dr. Winstanley) that there should be old people's officers. In a large, mixed rural or industrial constituency like mine this would be very helpful. From time to time one hears complaints about old people living alone in circumstances which cause one a certain amount of anxiety, and it would be helpful to be able to contact an old people's officer in an emergency.

For example, as they gradually decline some old people become rather eccentric and even rather dangerous. Some are a danger to themselves and other people because they are apt to light fires. There are examples of old people throwing paraffin on fires, to the constant danger of other people in a row of cottages. These cases are difficult to deal with if someone is not present who specialises in them.

We might also compile a register of people over the age of 85 who have no pensions from the State. The right hon. Gentleman knows about this question, and he will also know that I shall take the opportunity to pursue it on every occasion. It is a disgrace to the country that there should be so many people who have no form of social benefit from the State.

In my view it is not merely a question of allowing old people to be sent to hospitals and homes because there is no other place for them. I support what has been said by other hon. Members, and especially what the hon. Member for Rutherglen (Mr. Gregor Mackenzie) said about the work of voluntary organisations. My constituency contains several voluntary organisations which run old people's homes. One of the problems facing them at the moment—and it seems to be a substantial problem—is that the buildings themselves are often placed in areas which present a certain amount of danger from traffic. In my constituency, near Wallingford, there is a dangerous corner which old people have to use in order to go to the post office to draw their pensions—if they are allowed to do so, being under the age of 85.

I spoke to the Ministry of Transport today and discovered that there are no regulations prescribing signs concerning old people. I hope that the right hon. Gentleman will draw the attention of the Minister of Transport to this fact, because we are reaching a stage at which something must be done about the problem. We have prescribed signs for racehorses and level crossings, but when very old people are crossing roads at what are known to be dangerous points it is very difficult for county councils to obtain permission from the Minister of Transport to erect any kind of sign, even a warning sign. We have signs for blind and crippled people crossing the road, and I should like to know whether it really is not possible for somebody to think up an eye-catching sign to warn motorists that there is an old people's home in the vicinity of a dangerous corner. This is not a constituency point; it must occur in many parts of the country. I hope that the right hon. Gentleman will consult the Minister of Transport about it.

I want to refer to the book, "Sans Everything". It is important that we should be objective about the statements made in the book. I want first to deal with the suggestion of an inspectorate of mental hospitals. We should be told a little more about this. The hon. Member for Halifax said that it would not be much good if we had inspectors going round at odd hours of the day, as factory inspectors do. The suggestion has been made in a letter to the Sunday Times that officials could go round disguised as patients and stay in these places for a month in order to discover what happens in them. I thought that that was a slightly frivolous suggestion, and that it is was not likely to provide very good results. But some form of investigation system is required in the event of information being supplied to the Minister which gives him reason to believe that there is cause for inquiry. I hope that the right hon. Gentleman will deal with that point.

I was pleased to hear the Minister's assurances with respect to nurses who had made complaints. I am glad that they will be protected. It is important that nurses should not inhibited from supplying the names of persons complained about. Apparently they have not been satisfied with the National Health Service inquiry procedure on this point. I wonder whether there is a need for reform. I should think there is. It is important that the Minister should be able to ensure that anybody who makes a complaint which is found to be justified should not suffer on that account.

I should like to know what form of inspection takes place at present. Under the Mental Health Act the commissioners used to go round. Perhaps the Minister can say something about that.

Mr. K. Robinson

The hon. Member may recall that it was his own Government who abolished the board of control which used to carry out this function before the passage of the Mental Health Act. The responsibility lies with the managers of hospitals, regional hospital boards and hospital management committees. The responsibility was transferred by this House under the hon. Member's Government.

Mr. Neave

Is that an answer to my questions? There are many old people's homes about which one could make no complaint. I hope that the effect which the Minister fears will not lead to any lessening in recruitment, because the provision of these services will be more important in the future. Much more emphasis should be placed on the independence of old people and the prevention of hospitalisation. In this connection I support the idea of the conversion of houses and the need for a system of grants and tax reliefs. It should be possible to convert houses for this purpose and to devise a system whereby relatives can apply for a grant for the purpose. This would be widely welcomed.

It is not true that all families want to drive out their elderly relatives. It is often a question of physical space, or family economics. In certain European countries it has always been the custom for the old people to live with their families. There again, any problem that has arisen has concerned the physical space available to the family. In our future house building programmes we should make serious provision for this.

In general, I agree that this will need a great deal more money, and there is no question that this extra money should be provided. The immediate problem is to investigate conditions in old people's homes and to deal with some of the constructive suggestions made from both sides today. This will lead to alleviation of conditions, but the long-term policy must be to help relatives to house old people and to provide hospital and home places on the basis of physical or mental need rather than simply providing accommodation.

7.1 p.m.

Mr. Laurence Pavitt (Willesden, West)

One of the disadvantages for hon. Members with a special interest in health matters is that we get few opportunities to discuss them, but one of the advantages is that whenever we do a lively sympathy and understanding is shown in all quarters of the House and this debate has been no exception.

The hon. Member for Abingdon (Mr. Neave) drew attention to the very important subject of the siting of residential homes for the elderly. Unfortunately, it is not always possible to retain the amenities even if one is selected which is convenient for those who will occupy it. In my constituency there is one of the first-class types of residential accommodation mentioned by my hon. and qualified Friend the Member for Halifax (Dr. Summerskill), called Ellerslie, which is in an ideal situation. It is in a quiet road but this very factor has encouraged driving instructors to use it for training learner drivers thus causing hazards for elderly people crossing the road and for traffic.

My right hon. Friend dealt with the question of inspection raised by the hon. Member, and I would underline the point he made. The hospital management committees have a responsibility not just to attend meetings but also to be fully aware of what happens in their hospitals. Nowhere is this more essential than in the geriatric wards. I would commend to hon. Members the Christmas visit to a geriatric ward as one of the heart-warming experiences which gives considerable pleasure, especially to elderly ladies, particularly if, like the hon. and qualified Member for Cheadle (Dr. Winstanley), one takes one's bedside manner and a little mistletoe. This can give comfort to the people there. May I say that the hon. Member's experience was reflected in his very constructive speech.

One of his points which the Minister should consider related to the training of people who have domiciliary care of their elderly parents. There is every facility through the local education authority, under the Further Education facilities, for such courses and there is no reason why that should not be done. The facilities and opportunities are there and I hope that, as a result of the hon. Gentleman's welcome suggestion, my right hon. Friend will discuss this with the Secretary of State for Education in order to plan this provision.

Another theme of the debate has been the problems created by tripartite administration of the National Health Service, which in this field and that of mental health is at its most awkward. The care of the elderly comes under three administrations, which means that one cannot consolidate or move freely from one sector to another in the way which we would like in this day and age. We all welcome my right hon. Friend's statement that it is now possible to appoint a geriatrician to the local health authority and the hospital service on a joint sharing arrangement, but this is not half enough.

At the last census, more than 4,000 elderly people in my borough each lived alone in one room. All these people are under the care of the general practitioner and there is, therefore, an urgent need to develop combined operations between the G.P., the local health authority and the hospital geriatric services, if there is to be effective coverage of the needs of the elderly. I would welcome a little experimentation by my right hon. Friend in this regard.

Surely it is possible to try out not just the co-ordinating and liaison services which already exist in many areas, but to have prototypes of a service for the elderly to which all three sectors would contribute, but with more freedom and autonomy, away from the controlling influence of each, to see whether a service for the elderly would be possible drawing comprehensively on all three, which at the moment are administered and financed separately.

I agree with my right hon. Friend that the new charter for general practitioners facilitates the provision of the necessary ancillary help for the family doctor. Under the present load of work, G.P.s cannot do all the visiting and give all the time that the elderly people on their lists need. Only with ancillary medical aides and social welfare workers attached to G.P.s can the necessary coverage be given. I urge my right hon. Friend to go further than the present provision which encourages a G.P. to employ ancillary service and ask him positively to promote the "extra pair of hands" which are so urgently needed to cope with the personal services of a family doctor to all his patients, the elderly as well as the young.

On the subject of loneliness, I would commend the system which exists in some towns but which was pioneered in Cambridge, known as "Fish", whereby people of good will are able to know, by means of a sign in the window, that the elderly need help perhaps to collect medicine, have errands run and even just to be talked to. People see the sign of the fish and knock on the door and ask if they can help. In Cambridge they have developed a large group of voluntary workers to do this. It is mainly elderly people who need to be visited because they are most in need of that kind of care. I would commend this scheme to people of good will who want to help and ask them to organise it.

The tragedy of the pockets of unhappiness and loneliness in our Welfare State is that no one knows. One hon. Member referred to the "little boxes" in which we live, and it is true that there may be more misery for one elderly person living alone in a road and about whom no one knows than in previous days when misery was more widespread. After the cold spell two or three years ago, an elderly lady was brought in to my local hospital after she had been dead for several days with a temperature of 72 degrees. This can happen not because people are heartless or unwilling to help, but because they just do not know. They pass by the house and the door is closed. I hope, therefore, that the attention given to this subject in the debate will result in a little more organisation of good will and voluntary service.

The excellent work of the meals on wheels service has been mentioned. I had the privilege of going out with the W.V.S. in my area and calling on the elderly people using that service. But still in my area we cannot give a comprehensive service. We give a service on so many days a week only. It should be possible today to give a comprehensive service so that at least one hot meal a day is provided for every elderly person living alone and needing it.

I pay tribute to the tremendous amount which has already been done. In the past year, an increase of 1 million more meals is recorded in the report to the nation for 1966 by the Ministry of Health. Last year, a total of 7,300,000 meals for elderly people living at home, and a further 1,400,000 meals were served in lunch clubs. A great job is being done.

I have every sympathy for my right hon. Friend in his task as Minister of Health. It always seems that good news is no news. But the moment that something comes up which gives an opportunity to have a slam at the Health Service, to have a slam at the hospitals, at the nurses or at anyone else, it makes headline news. The fact remains, however, that tremendous advances have been made—I commend to hon. Members the 1966 Report, which has only just been issued—and all manner of services have been stepped up and enlarged in spite of the financial difficulties which the nation has faced.

Last year, 128 new homes for elderly people were provided, giving accommodation for a further 5,777. It is not enough, of course, but at least we are making an inroad into the problem. Some commendation should be given for the tremendous work which is going on, and thanks should be offered to those who take part in it.

Through "senior citizens" clubs, the local health authorities are doing a great deal in giving a looking-forward approach to elderly people rather than living in the past. I have no doubt that this has made a tremendous difference in the lives of many people in my constituency. They look forward to going out and to meeting people next week instead of just dwelling on the past, and this gives a further lease of life to many elderly citizens. Perhaps I may tell the House, as an example, of the sort of incident which warms my heart. At my "surgery" a few weeks back, I had to listen to one of the usual marital problems about which Members of Parliament are consulted. Most hon. Members have to hear about these things. One listens. One cannot do very much, but at least one gives a sympathetic ear. After I had been listening for about twenty minutes, the lady who was telling me of her trouble said, "You must realise that we are not geting any younger. It is true that my husband is running after this other woman, but I am 69 and he is 72, so that it is a very difficult circumstance for me". I am delighted that, in 1967, we have reached a stage when people can look forward to a bit of "chasing"—even if it is not something in a mini-skirt—and at that sort of age people are not losing their interest in all that, perhaps, makes life a little attractive.

A great deal has been done for the hard-of-hearing, which is of particular benefit to the elderly. I pay tribute to my right hon. Friend for the provision last year of 48,224 more hearing aids. We are nearly reaching the million mark now in the provision of hearing aids free of charge to people who need them. Credit should be given to the Department for this. Incidentally, last year another 4½ million pairs of spectacles were issued under the National Health Service. This sort of news gets no headlines, but, when we recall how elderly people used to go to Woolworths to get their spectacles, we can appreciate how important the service is and take real pride in it.

I urge my right hon. Friend to take up with the Postmaster-General the question of providing elderly people who need them with transistorised telephones. You will know, Mr. Speaker, that I have managed to have installed in this building 12 transistorised telephones for the benefit of hon. Members who, like my- self, have a hearing disability. I am surprised to find how many of my elderly colleagues do not know where they are. But they are here. This simple provision in a home which has a telephone and where there is an elderly person who is hard of hearing can make all the difference to the contact which the elderly person can make and keep with the outside world. There is no point in elderly people having the telephone installed if all that they can get out of it are crackles and bangs every time they try to listen and to talk to their friends. This apparatus is available, and we could provide it.

The previous Government, under a certain amount of pressure from my right hon. Friend who is now the Minister and myself, brought down the extra charge for these telephones. I believe that it would be possible to bring the charge down even further, and I hope that my right hon. Friend will make representations to the Postmaster-General in that regard.

There has been some advance in the chiropody service, but it is still not wide enough. The idea of foot trouble always seems a little ludicrous—one remembers the jokes in Punch about old people and their corns—but, in fact, the chiropody service can make all the difference in whether a person goes out instead of staying indoors. If their feet are "killing" them, elderly people do not go out. The way in which the local health authorities have laid on the provision of this service and the way in which the chiropodists themselves, through their professional association, have raised standards has been a great help. I hope that the Ministry will give thought to expanding the service and giving more incentives to it in order that it may become comprehensive.

The hon. Member for Cheadle feels that there is no need for further research into the subject of care itself because we know the problems, we know the hazards, and we know the way in which the organisation can be improved in order to give our elderly citizens the best possible life in the community. Nevertheless, in my view, the Medical Research Council gives insufficient attention to the whole subject of gerontology. The more we can do in this field to prevent the ageing process, the more we shall be able to relieve my right hon. Friend of a great many of the problems he has to face in meeting and treating the conditions which develop after the ageing process sets in. Unfortunately, the Medical Research Council seems to concentrate on financing favourites. If it has a line of inquiry which seems likely to yield results, it gives priority of expenditure to that. So far, the subject of gerontology has not received the attention which it deserves, having regard to the large proportion of the community which can now be classed as senior and the way in which, over the next five or ten years, the number of people falling into that category will phenomenally increase.

The debate has docussed attention upon one of the problems which we all accept as our responsibility. This is not a job which we pass on to this or that Department, to the local health authority or to the medical officer of health. The problem is ours. We have done our duty today in all parts of the House in directing the maximum amount of constructive thought and attention to the problem and bringing the maximum pressure on the Government to provide the extras which are needed. But more must be done if the job is to be really effective. If we are to regard ourselves as a civilised nation at all, we must devote a greater proportion to our resources, our time and our effort not just in the institutions and organisations but in the streets and apartments in which we live. This is where care of the aged starts, where they are. This, I know, is the task to which hon. Members who have taken part in the debate today will give their best endeavours in order that it may have the attention which it deserves.

7.18 p.m.

Colonel Sir Harwood Harrison (Eye)

I wish to direct attention to this subject somewhat from a constituency standpoint, and to tell the House of a personal experience which has a great bearing on it. The House always appreciates personal experiences.

My interest in hospitals started when I was a member of the Ipswich Borough Council and when, in my twenties, I was chairman of the mental hospital committee. I speak here from experience in a large and scattered rural constituency. The great change I have seen in the post-war years has been in the way we have been able to make enormous improvements to old-fashioned buildings.

There are three old people's hospitals in my constituency, two of which would once have been called the Union or a Poor Law institution. When I first went round them 20 years ago they were very unpleasant-looking buildings, and one was very nearly condemned. If we have not built all the new general hospitals we need, we have certainly so modernised these old people's hospitals in my part of East Anglia that they are now very good. It is a joy and almost a pride to see them. Lifts have been installed, floors, ceilings and walls have been renovated from scratch, and a great deal of money has been spent. The hospitals' whole condition has changed out of all recognition.

Thanks to the science of geriatrics and the doctors, the average age of the old people in those hospitals has risen by seven to 10 years since I first went round them. Possibly we fell into a misconception when the National Health Service was introduced and our hospitals were taken over in thinking that the State would do everything. This has been proved entirely wrong. It has never been more necessary than to have Leagues of Friends, the W.V.S. and other voluntary help in our hospital service. Like the hon. Member for Willesden, West (Mr. Pavitt), I make visits to the hospitals at Christmas, when the wards are all decorated, and I should like to think that my visits have the same tonic effects as his.

The shops on wheels service may not matter so much in the towns, but to a hospital in the country a long way from shops it is very useful. Another problem when a hospital is some way from a town is that it is often very difficult for relatives to visit patients except by car. I often spend time in trying to get patients moved from a hospital in one part of my constituency to another, perhaps 30 miles away, so that they are nearer their relatives, because visiting is good in helping them to enjoy the remainder of their lives. In days gone by it would have been true to say that old people went into hospitals thinking that they could lie comfortably in bed until they were gathered to another life. But this is no longer so.

I too pay tribute to the male nurses in the hospitals. I am very impressed by what they do and their sympathetic attitude, as well as by the younger girl nurses. They carry out their work with great enthusiasm, but it is an additional strain to have to get the old people up and dress them.

When old people are looked after at home I try to encourage them to go into a hospital or old people's home for three or four weeks in the year to give their relatives a break. In East Suffolk we have now started three old people's homes for elderly people who are not sick enough to go into old people's hospitals. This is carrying out our duty to the elderly.

But I am not so satisfied on the private side. We have a long way to go, and there seems to be an enormous gap between what the State does and what the private nursing homes do. I believe that they relieve the State of the burden of a certain number of older people who would otherwise have to enter State hospitals when we are short of space. In the future we shall have to consider making some form of grant to private homes. Perhaps it should not be so much as the cost of keeping a patient in the State home, but it should perhaps be £5 a week where the total cost is £10, £12, £15 or £20 a week.

The personal experience about which I should like to tell the House concerns the will of an uncle of mine who was a clergyman in the Church of England with no children. He died in about 1930 and left £4,000, after various relatives had received a life interest. About three years ago I had to distribute that money among the poor of London and Northampton under the terms of the will. My uncle was once a curate at Northampton, but he spent a lot of time abroad.

The first problem was that poverty no longer existed in this country in the sense that he had known it early in the century. I therefore decided that roughly anyone who received what was then National Assistance would qualify to receive some of the money. Some societies tried to get me to give the £4,000 for a home, but I did not think that that was my uncle's intention. He wanted to help a large number of people. I had heard in the House of generals' widows living on National Assistance, but when I inquired from their societies about these wives and widows of clergymen in that position, I could not find any that were in real need.

Then I had what I thought was quite a bright idea. I wrote to the officers in charge of National Assistance in certain parts of London and in Northampton, and I received invaluable assistance from them. I asked if they could prepare for me a list of people who had been good citizens, craftsmen and so on, who were now retired, perhaps prematurely owing to sickness but largely because of old age, and who were now having a difficult time. They prepared the lists and I agreed with them what would be a worth-while sum that would not affect the amount the recipients drew under National Assistance. We came to the conclusion that it would be right to give £35 to a married couple and £20 to a single person.

I visited a large number of these people and there was no doubt, as hon. Members have said, that loneliness was their worst difficulty. They were not necessarily short of food, although perhaps their diet was a little dull. Most of them had a wireless, if not a television, and more often than not the television had been given by some of their children.

I learned a tremendous amount. It was a humbling experience to go to all their homes. Many of the people concerned were rather fearful when I knocked at the door. They did not get many visitors; some told me that they had not had a visitor for six months or longer. I explained most carefully, in order not to upset them, that I was trying to help. I had to ask them certain questions, such as whether they had lived in London or in Northampton most of their lives and could be called citizens of those places. Having established that, I found that the amount of money proposed was a real godsend to them.

I also came to the conclusion that a married couple who had lived together for years and had had their happy times and, perhaps, argued at least had each other to talk to or shout at if one was deaf, or read to if one was a little blind.

At least they had each other's company. The person for whom I was most sorry was the person living alone—the elderly widow or perhaps even more the elderly spinster. A man living alone seems more able to go out. I think particularly of elderly persons who are incapacitated and hardly able to move. They may have a help coming in to clean up and perhaps cook for them, but when the door shuts on that person no one else comes to talk to them.

I always felt after that experience that I might at some time be able to say in this House that we should do all we can in future for the person living alone. Married couples have larger pensions and supplements—not exactly double—but I feel that a person living alone needs a little extra spending money simply because he or she is alone and has no one visiting. This is where the meals-on-wheels service plays a part, because the old people like to see those bringing their meals. My wife is one of those engaged in this voluntary service, and I have heard her speak about it.

There are more lonely people in London and the bigger cities than perhaps in the rural parts of my constituency, and in respect of these people it is the voluntary side that matters so very much. In our legislation we must always think of the person who is alone. One of the things that strikes me these days is the kindness of people visiting old persons. One of the delights of the present age is the new spirit of the young, who give up a year or two years at the beginning of their career, perhaps after leaving university, to do voluntary service helping the old or sick in this country and other countries abroad.

I am grateful to have had the opportunity to say, as I have always wanted to say, what a great experience this was. I was very embarrassed at times as I was thanked, but it was my uncle and not me who deserved the thanks. I was also struck by the tremendous honesty of the old people. Many of them asked whether the grant would affect their National Assistance allowance; I was always able to reassure them. One might think that people getting a gift like that would not wonder whether they had to report it or not. But I was struck by the very great honesty of the old people, many of whom had perhaps been treated a bit hardly during their life in that they were earning at a time when wages were lower and their savings had been hit by inflation.

7.32 p.m.

Mr. A. H. Macdonald (Chislehurst)

I agree very much with the remarks by the hon. and gallant Member for Eye (Sir H. Harrison). I am sure that he is right in pointing to loneliness rather than poverty as one of the severest problems that we have to deal with. It is seldom that I find myself applauding remarks made on the other side of the House. So perhaps I may take this rare opportunity to say that I also agreed with some of the remarks in the earlier part of the speech by the hon. Lady the Member for Melton (Miss Pike) when she referred to our attitude towards the problem of the elderly. What she said was just and true.

I have two things to say about concessions to the elderly, and I am afraid that both of them are critical. First, I would refer to the relationship, or, as it seems to me, lack of relationship, between the basic pension granted to our senior citizens and the concessions of one kind and another available to them. There does not seem to be any just balance between them; from time to time when one goes up the other seems to go down.

The other day I had a letter from a constituent whose name is Wilson. I mention that because in a moment I shall be referring to something that my right hon. Friend the Prime Minister said, and, though my constituent has the same name, he does not have the same views. My constituent wrote a letter headed "This is a complaint." He noted with pleasure the Government's proposal to effect an increase in the pension that he is receiving, but he noted with a great deal of displeasure that at almost the same time he received a note saying that the charge made to him for home help service would be increased by 1s. an hour. The effect of this is that the forthcoming increase in pension will half disappear before he gets it. My constituent finds this sort of attitude inexplicable, and I do not well know how I can justify it to him.

Next, I question whether some of the concessions are entirely desirable. The Prime Minister and the Minister of Transport have made arrangements in some cases to provide travel concessions for elderly people, and there has been a great deal of applause for that. But I wonder whether they are aware that concessions are not always entirely well received by the old people for whom they are intended. In recent months, I have visited old people's clubs in my constituency and have always taken the occasion to ask as I move around what their reaction is to the concept of concessions for elderly people.

The reactions vary. Some old people certainly welcome concessions. But on the whole the reaction has been adverse. Statements made to me indicate that old people would rather have the value in cash than a concession made available to them on production of a pension book because it appears to them that there is some detraction from a man's dignity if he has to produce a pension book for a concession. They would rather be able to stand on their own feet and pay the full charges on equal terms with other people without any detraction from their dignity through having to appeal for a concession. After I had spoken on this subject at one club an old man told me that I was the first person he had heard who really understood what he felt about the concept of travel concessions.

I wonder why we are inclined to provide concessions for elderly people in this way as though our senior citizens were something separate from us. They are us and we are going to become them. What is this blindness that seems to afflict us and make us suppose that old age is something that will happen to somebody else and not us? We should do well to remember that we shall all become old. We shall become crotchety, frail, confused and incontinent. The people to whom these things happen are not a separate race; they are us.

I regret the increasing tendency to try to solve the problem of elderly people by packing them away in old people's homes. The Minister of Health referred to the feelings of guilt that we may have about putting people away in that fashion. He may have something there. But I do not think that the provision of these homes is enough.

Of course we need to provide them, and indeed, should go further and provide more. I am among those who think that greater and additional provision for our senior citizens is desirable and that those financial provisions should have a greater degree of priority than they do. But I do not think that money in itself is enough. My hon. Friend the Member for for Halifax (Dr. Summerskill) and the hon. Member for Cheadle (Dr. Winstanley) suggested that money was the problem. I agree that it is a problem but I am not sure that it is the major problem.

At present we are providing more and more funds for the police forces and yet it is no great exaggeration to say that we are encountering more and more lawlessness. I suspect the reason to be that the provision of police forces causes people, when they see hooliganism or vandalism, to turn aside and pretend that they do not see it because it is up to the police to deal with it. I submit that there is a parallel danger that, the more old people's homes we provide, the more callous our society may become by thinking that the problem of old people is something to be dealt with by the authorities or at any rate by someone else and not by us. I am not sure how it comes about that we have this society in which there seems to be no place for our senior citizens.

My hon. Friend the Member for Halifax, in rebutting the point of view I am putting forward, remarked that it is not easy to find a place for an old person in an old people's home. I think that is true. But the point is that, in many cases, old people are not living with their relatives but are living alone and, as the hon. and gallant Member for Eye said, the problem of loneliness is one that we must deal with.

It must be a condemnation of our kind of society that there seems to be no place for our senior citizens in it and that relatively little value is placed upon their lives when they reach retirement. In many cases they have nothing to do but to sit around waiting for the end. If I am not using too harsh a phrase, this is the problem of the "redundant grandmother". There are many laidies, not necessarily in poverty, who are living alone.

I wonder how far this may be due to the great emphasis placed nowadays on rights to the exclusion of duties. When I was small, my mother looked after me. It was her duty and my right. Now she is old, I should look after her. That is her right and my duty. Rights and duties go together, and we have a duty to look after our elderly people. I accept that rights are inherent in each of us but it should constantly be remembered that rights are meaningless without duties.

I believe that I am right in saying that this particular problem, which was referred to by the hon. Member for Abingdon (Mr. Neave), is not found to the same extent in other countries because, there, grandmother or grand- father is still a valued member of the family and is still found living with the family and not alone because the children have moved away.

I had the pleasure of visiting an old people's home on Christmas day. It is a purpose-built home, well built and with a friendly atmosphere. The old people living there each have their own little room with a small stove on which they can "brew up". There is a communal dining room and a communal living room. The warden and his wife are pleasant, friendly people and everything possible that could be done was clearly being done. Yet there was one old man whose grand-nephew was due to call for him at 1 p.m. to take him away to spend the rest of Christmas with the family. At noon the old gentleman was ready, fully dressed and with hat and coat on, waiting outside because, however nice the home, it could not compare with being with his own family. He could not wait inside. He had to be outside for his relatives when they came.

I am sorry that we seem to have a society where elderly people are no longer with their relatives, as they used to be. I wonder whether this is a problem not only for the Ministry of Health but also for the Ministry of Housing and Local Government. How nice it would be if houses were built in such a way that elderly people could live in a partly detached or semi-detached flat in the same building as their family so that they would be separate yet close to the family in case assistance was needed. I should like to see this sort of thing develop but we do not seem to build houses in that way.

Elderly people can be a great nuisance, but so can babies. It is accepted that babies are a nuisance and we do not feel it necessary to stash them away somewhere else. I regret that we seem to find it necessary, however, to put our old people away in old people's homes. I hope that it is not too harsh a phrase but I wonder whether this debate would not be better answered by the Department of Education and Science rather than by the Ministry of Health because, I wonder whether we have not a great deal to do in educating ourselves to accept the fact that old age is something that we must accept and which we cannot just shuffle off on to someone else to deal with; because it is something which will happen to us all.

7.47 p.m.

Sir John Eden (Bournemouth, West)

The hon. Member for Chislehurst (Mr. Macdonald) spoke with a great deal of feeling and, as he proceeded, I found myself agreeing in full with the philosophy he was expounding. When he ended by suggesting that perhaps education was called for and that the Department of Education and Science might be involved, I felt that he touched on a very valid point. But what I think is needed perhaps more than education is a development of consideration for others, and it is this lack of consideration, which is so manifest in the treatment of old people that one finds at almost every turn, which is one of the regrettable factors of the present day.

I do not know whether it is more so than it was before, but it is certainly so today. On almost every turn, people do not show enough consideration for other people's feelings, other people's particular whims or the situation in which they may happen to find themselves.

The Minister of Health was right to approach this question of the book "Sans Everything" with a great deal of objectivity. He is right to be cautious about the generalised nature of the charge. But I hope that he will not allow this caution to lead to a whitewashing operation. Perhaps I can emphasise, even overemphasise, the other side to this in drawing attention to my hope that he will not brush these charges under the carpet.

It is easy for all of us to say, "This sort of thing cannot happen. People are not as inhuman as all this", and because we cannot find a specific charge or have the evidence brought to us of a particular case, believe it cannot exist. I beg the Minister to treat these charges very seriously indeed, because I can well understand how this sort of situation can arise.

I know of no special case which I would wish to instance and which would warrant further detailed examination, but I understand the sort of circumstances which could lead to situations such as are described in this book. It often starts with the necessary firm handling in a nursing home or hospital where the staff are caring for elderly people. This firm handling is necessary, in the first instance, to give assurance to the people in the home, but it could sometimes so easily become bossy and unnecessarily harsh and, unless the person in the position of responsibility is extremely careful, it could become a considerable form of tyranny. I emphasise again that I do not know of instances where it has happened, but I believe it can happen. I take this book very seriously indeed and I hope that the Minister will, too.

It is very easy for people who live and have to work with it to become callous of any sort of human failing or physical ailment. For those of us who come to it from outside at the odd moment in our lives it is horrifying and upsetting and we are completely dismayed and put off our stroke by what we see, because we do not know how to deal with the situation. However, those who see this daily become acclimatised to the pain, grief and agony of particular situations and— I do not know—it is just possible that on occasions they may go over the boundary and become unnecessarily bar, callous and insensitive in their treatment.

This is something that needs to be examined. I do not know how the Minister will go about it. Sometimes when a great person, such as the Minister, visits a particular hospital or home he is given the red carpet treatment. I can 'quite understand that. I remember that when I was in the Army we went to the extreme of white washing lumps of coal to make them attractive and smart. Things used to be cleaned up which had never been touched for years.

Yesterday I went with the Minister of Transport on a very pleasant inaugural trip, which took rather longer than we expected, on the new electrified line to my own constituency, Bournemouth, West. That station was beautiful—the whole place was swept, there were pots of hydrangeas, and all the rest of it—and it was quite right that it should have been, because this was a great and special occasion. The visit of the Minister, apart from anything else, was an important event.

I am sure that the Minister is too old a hand at this game to allow that sort of thing to kid him. Therefore, I hope that a process of inspection will be arranged which will not be the much trumpeted and much heralded approach of the "big noise", but will be the unannounced, almost back door, visit of someone who knows what to look for, knows how to see through the veneer and facade, and will be attuned to the situation that he or she is examining.

I am glad that we are discussing the care of the elderly, as it is called, because the number of old and retired people is increasing annually. This is something that we have to face up to, and an increasingly serious matter is how we will be able to find sufficient resources in the years ahead to provide for the needs of the growing number of people who will become dependent upon that amount of wealth generated by the proportionately smaller band of productive workers.

In many respects this is a good debate to follow on the one which concluded in the early hours of this morning when, on the Prices and Incomes Bill, we were talking about the need for productivity and how to identify productivity wage increases; Only through increasing productivity will we get increasing national prosperity out of which we will be able to, finance the increasing, demands of services such as .those we are considering today.

I agree with the hon. Member for Chislehurst who said that money is not everything. How right he is. Money directly applied to the individual is not everything, but money spent sometimes in a different form—in the provision of central facilities—can be of considerable value. In this regard I refer to the establishment of a day centre in Bournemouth. This is a new event for my constituency, though it is by no means new for the country as a whole. There are other comparable centres in other parts of the country which have already been introduced, although not exactly identical.

Three weeks ago, at a cost of £25,000, Bournemouth introduced its first day centre. This is in addition to the 17 residential home for elderly people, which it already provides, giving a total of 700 beds. The Minister of Health was a very welcome visitor to Bournemouth not so very long ago and I know that he will endorse what I say about it, because I would not like it to be thought that this is a wholly biassed testimony on my part.

This day centre is a tremendously important advance, because people have gone out of their way to be imaginative in the provision which has been made for the needs of elderly people. Interestingly, it is designed primarily not for old people —this might sound like a contradiction—but with the needs of the younger families in mind. It is designed with the thought that there must be some means by which the working couple or the individual is enabled to carry on working in the sure knowledge that the elderly dependent relative is being properly cared for. This is a slightly different emphasis from that which has been given. So far we have been dealing with the laggard child, the son or daughter-in-law, who is not fulfilling his or her responsibilities, and, as a result, the elderly relative is neglected and lonely. For example, a school teacher may not feel happy about carrying on her job teaching in a school if, in doing so, she has to leave her elderly mother completely alone at home. The establishment of this centre gives her the opportunity to take her elderly mother, or whoever it may be, to this place for the daytime while she herself is at work. She can know that her relative will be properly cared for and looked after. It is interesting to see how much is being done.

The main thing is that proper meals are provided. Elderly people left on their own often cannot be bothered to go to all the trouble of making a meal, but with the establishment of this day centre meals are available for which old people pay half a crown a time for a full meal and less for snacks in the course of the day. This is an important factor in the avoidance of malnutrition, which is one of the dangers attendant upon old age.

The second most important thing is that the establishment of the day centre helps to keep some elderly people out of hospital and out of old people's homes. Were it not for the existence of a centre such as this, I have no doubt that some would have to go earlier to old people's homes or even to hospital than will now be the case.

The centre is a place not only to eat, but to meet. There is also entertainment, which meets the factor of loneliness, about which my hon. and gallant Friend the Member for Eye (Sir H. Harrison) spoke. I want to stress this aspect of entertainment. I have been around many homes outside as well as within my constituency and I have seen the difference of approach in some outside Bournemouth which have not made such progress because they have not studied the subject with such care.

One sometimes sees a roomful of elderly people seated in a semi-circle and almost immoveable and there is no doubt that there is colossal boredom. Many of the people to whom I spoke emphasised how desperately bored they were. There may be all kinds of medical reasons and I recognise that, because of advanced years, some people may find it difficult to provide their own forms of entertainment and to interest themselves sufficiently with books or other activities of that kind to escape from boredom. But the fact remains that boredom is one of the great drawbacks of old age, although it is not necessarily associated with loneliness, and it can often be found in homes and institutions. It is absolutely necessary that in places like this there should be not only the sort of activity in which the individual can indulge—dominoes, draughts, the use of a library and so on—but also communal entertainment.

This entertainment is valuable when it can be provided by other organisations in the town where the home is established. A great deal of encouragement is given to youth clubs to help in the provision of entertainment for elderly people who gather in the newly opened day centre in Bournemouth. This is a first-class and imaginative development which ought to be reflected throughout the country.

The test of this centre will come in the winter months. It is easy to talk about centres such as this in weather such as we are now having when it is gloriously warm and everybody wants to wander out and when it is a nice cosy trot across the street, but it is quite a different proposition in the bleak winter months when the wind is howling and it is raining or snowing or worse. I am glad to be able to say that the management of this project is already thinking of the provision of transport and will do its level best to ensure that those who wish to use the centre are not kept from it by fear of inclement weather.

This day centre offers a major opportunity for the future and there are already plans for opening another three in Bournemouth in the next six months and a further eight on top of that. The only snag is that they cost money and in these hard times money seems to be increasingly difficult to come by.

Much has been said about the difficulties in which people find themselves when they become old. One of their worries is that they are embarrassed by their own old age and by their own infirmity and by the condition in which they find themselves. As a result, they become nervous and confused and in their nervousness and confusion they say wholly idiotic things which they would not wish to say and do things which they do not wish to happen, so that the situation becomes worse and almost a vicious circle. This is when intolerance or impatience can make life an absolute misery for the individual.

There is also a feeling among many old people that when they reach a certain age they become something of a burden on the family and that they ought to hide themselves away. It is not always right to blame the family, which is sometimes quite ready to help, but the old person is not prepared to be helped, and I know all too well how obstinate old age can become.

One other problem is the difficulty of finding old people living by themselves, the problem of actual location. In Bournemouth the authorities have concentrated on this problem. The health, welfare and housing departments cooperate extremely closely and when a problem arises within the departmental influence of one, it is immediately reported to the others so that there is a joint operation to try to help. It is not only just the authorities, to call them that, but also the voluntary and religious organisations who work together.

I was extremely interested by the suggestion of the hon. Member for Willesden, West (Mr. Pavitt) about what could be achieved by visiting. I have not before heard of the fish symbol in the window, but there is no doubt that teams of visitors can be valuable in helping to discover where elderly people live.

There is here a major rôle for the younger members of the community. So often we hear, possibly to the point of nausea, certainly in my case, of the extravagances of youth, of its wildness and profligacy, how inconsiderate and how curiously dressed young people are, and so on, but, as hon. Members know, young people often form clubs of whatever description the primary purpose of which is to help others in the community, and to my certain knowledge they concentrate on the needs of the elderly.

My hon. and gallant Friend the Member for Eye quite rightly emphasised the voluntary factor in this way. No matter that there is a great and glorious State provision it is the voluntary organisations which can really identify individuals, which can be closely sensitive to the peculiar circumstances of the individual. It is this which should receive every positive and possible encouragement. Where there are teams of visitors, or whatever they may be called, working for this purpose in towns and boroughs, having visited a person they should make a habit of following it up. It should become a regular sequence of visits not just the occasional hit and miss affair, because once hope has been aroused it would be cruelty indeed to let it fall away.

8.10 p.m.

Dr. David Kerr (Wandsworth, Central)

I have remarked before, though not publicly, the difficulty of expressing in this Chamber new and rather technical ideas and problems, be they scientific or social, educational or foreign affairs. We tend always, and I apologise if I sound irritatingly condescending, to rehearse accepted ideas. Today has been no exception. Anyone listening to this debate, with any profound knowledge of the problems of the old, could be forgiven if they left the Chamber convinced that all that Members of Parliament knew about the care of the old was that they were lonely and had meals on wheels.

I am aware that this is a rather shorthand representation of what has been a good debate. None the less it has been a debate which has expressed more about our attitudes to growing old than about the relevant facts for the care of the old. We wrap the old up in euphemisms and expect them to stay warm in the winter. We call them senior citizens. With all respect to the hon. Member for Bournemouth, West (Sir J. Eden), he spent a long time describing an admirable provision, the day centre, which is nothing new. It has been going on in many other areas of the country and has been explored and examined and found to be valuable, as he said.

It is a pity that this House cannot throw up more exciting and adventurous ideas. I had better be a little iconoclastic and say that if we were really expressing what I believe so many of us feel it is that old age is a squalid nuisance. That is an idea that would be accepted by anyone below the age of 105. One the one hand, old age becomes a burden to the family at a time when the family is less able to bear it comfortably. The parent becomes old as the children become middle-aged, with the problems of their own children going through a rather critical age. This is the inevitable, predictable and axiomatic result with the problem of old age, and it does something to explain why today the family finds it so difficult to contain its older members.

Why have we to confine consideration of these problems to what we call for want of a better term "the elderly"? What do we mean by elderly? Does anyone here imagine that what is written on our birth certificate has any relevance to this? Does "old" mean the same to my right hon. Friend the Member for Easington (Mr. Shinwell) as it does to an inmate of some old people's home in my constituency? Of course it does not. To talk about the elderly is to omit to say, to forget, that we are dealing with a whole mass of problems which are generally applicable to the housebound and the dependent in a variety of ways; to the chronic sick, mentally or physically; to the mentally sick, be that due to a mental breakdown or to the mental illnesses which so often accompany old age.

We pay homage to old age, aware that we must either in the end submit to it or else face the other rotten alternative of dying young. These are some of the things that we ought to be saying about the care of the elderly. These are some of the things that we should have at the back of our mind. When we are talking about things like meals on wheels we should recognise that they represent the inadequate provision by the community, the inadequate sop to its conscience through services which fall sadly below what is needed.

My hon. Friend the Member for Willesden, West (Mr. Pavitt) talked glowingly of the provision of over 5,000 new places in old people's homes last year. He omitted to refer to the fact that the number of people aged 65 and over increased last year by more than 5,000 so that mathematically we are falling behind in the provision of places for old people. We are not winning this race.

Mr. K. Robinson

indicated dissent.

Dr. Kerr

My right hon. Friend shakes his head, but on the figures quoted by my hon. Friend the Member for Willesden, West this would appear to be the fact.

It is on community attitudes that there is so much more to say. The first thing is that if the community really bends itself to the care of its older members it is no use beginning once they have reached the age or state of dependency, because that comes at so many different ages. What we should direct our attention to is the fact that the care of the aged begins when the person reaches the age of 60, be he a Member of Parliament or a dustman. The whole problem of geriatrics has been touched upon by the hon. Member for Bournemouth, West and the hon. and gallant Member for Eye (Sir H. Harrison). The problem is that of case discovery. How does one discover a person who is in need of help, when inevitably the process of ageing leads to that very process which some have rather narrowly referred to as loneliness, but which, more specifically, should be regarded as the problem of isolation?

Loneliness can happen in a great crowd of people, but isolation is essentially a cutting off, which may result from the plain physical disability of arthritis, which prevents the old person leaving his [pine arid going shopping. We recognise too rarely the therapeutic value of being able to go shopping. So many people ho are house-bound become cut off from the community activity of going to the local supermarket. It is a very damaging experience indeed and results from sheer physical incapacity.

It is isolation that we should be talking about, and the problem which the community ought to be facing is that of discovering those who are isolated. The hon. Member for Abingdon (Mr. Neave) brought up a suggestion which we are too timorous to follow up. We should try to devise some way of registering a person with the local community services as they register for their retirement pension.

We do not think twice when we register babies and pass on the information to the local health visitor so that they can go round and check up that the babies are being properly looked after, fed, vaccinated and so on. Why do we not do the same for an even more helpless class of people, namely those over 65? Not all of them are helpless, but if we know who is over 65, if we were to organise our health visiting services to engage the attention and support of people over 65 in the same way as they engage the attention and support of mothers and young babies, we would go a long way to recognising and identifying, preventing the problems of isolation as they occur among older people. This is done in some parts, in my own constituency for example. But preventive geriatrics, to coin a phrase, involves a process of education.

It has been said that the relatives of old people should have some education. Already plenty of attempts are made—and some of them are successful—to create classes in local evening institutes for home nursing, but they are generally rather badly attended. They form precisely the sort of educative effort needed to equip the relatives of elderly people with the kind of information of which they could make most effective use in caring for elderly relatives, yet not much use is made of them. I hope that it is not proposed that such courses should be compulsory. That would be a new departure. It is not a question of creating them: they are in existence and advantage can be taken of them.

The process of education begins with the person growing older. One of the most interesting recent developments in places like Manchester and London is schemes for training for retirement so that people when they retire do not become vegetables and isolated. These training courses equip them with the opportunity to broaden their horizons and to accomplish some new creative activity.

The hon. Member for Bournemouth, West spoke about entertainment. I do not accept what he says. It is not entertainment but occupation which older people require. Perhaps one of our biggest failures is the difficulty which we put in the way of the man over 65 and the woman over 60, or perhaps even younger, in occupying themselves, not necessarily gainfully, but most advantageously gainfully. After all, this is the natural function of the human being —to do something creative, even though it may be repetitive and simple. The idea of a person producing something is an essential part of living. But we make it difficult for older people to do this.

We disadvantage the older people regarding their pensions and by making it more difficult for them to gain access to means of occupation. If the community is intent upon helping old people, it should make provision in the form of sheltered workshops and other forms of occupation rather than entertainment. I want people to enjoy the right to work but not to be forced to work because their incomes are low or their pensions inadequate. They should enjoy the right to work and be given the opportunity to create which we are busy denying to them. This is one respect in which we can go a long way to preventing the breakdown of individuals. Again it is a question of community attitudes, which we have been expressing today, to some extent.

Reference has inevitably been made to "Sans Everything" by Barbara Robb. It is a dramatic book which expresses a community attitude—a mixture of concern for things which go wrong and of hope and confidence that things may one day go right. I do not go along with the suggestion that there should be a hospital commissioner. The value of the book, if it has a value—and I believe that it has—lies in the message which is implicit throughout that the whole hospital system should be thrown open to public gaze. There is no better way of ensuring that the dreadful occurences described, I am sure with absolute accuracy, would not occur if the public have the sort of access to old people's institutions and the kind of interest which should be encouraged in old people's institutions which they have, for instance, in the more dramatic acute hospitals. Old people's institutions are a bit boring and forbidding.

That brings me to another point. If the community is to do anything useful for old people, it must learn to contain them and not extrude them into a new form of ghetto. Several hon. Members have referred to Christmas visits to old people's home. I go to visit old people at Christmas, and a more depressing experience it would be hard to find. I do not share this enthusiasm for such visits. One sees a group of old men sitting round in a situation which I can only say is characterised by the word "non-communication". They are all isolated from one another—why, I do not know. The women in the women's wards are all chirruping like magpies, but the men seem to be incapable of creating this kind of community.

Why do we have to shut up old people in one building simply because they are over 65? That is nonsensical. Local authorities which have responsibility for institutional provision should have the imagination to see that if they are to create a community it must be a mixed community. Local authorities, with very few exceptions, pay some kind of attention to this principle in their children's service. The provision of family units in the children's service whereby there are children of different ages in one group is almost axiomatic wherever one goes in the country. But when it comes to old people we are still back in the 19th century. The attitude is: "Over 65—in you go".

Instead, the imaginative local authority should be providing residential accommodation which houses not only old people but young people who need some kind of local authority provision—for example, the unmarried mother, the civil servant who has been moved from one part of the country to another and does not have his family to support with him, and perhaps even Members of Parliament in London who want accommodation, which would be eminently suitable to be provided by a local authority. It would be good for some of us to share with some of those lone individuals. It would provide a spread of age, interest and contact and would create in the institution a community.

That community cannot always house the incapacitated elderly person. Reference has been made to the tripartite nature of the service. I go a long way with what has been said about the division of provision. I do not like a tripartite service. Anybody who thinks about it, however, recognises sooner or later that one comes up against a boundary wherever it is drawn. If it is not drawn in the National Health Service dividing it into three, it is drawn between the National Health Service and the housing service, and sooner or later one trips over the boundary.

One of the difficulties is the conflict between the local health authority provision for old people and hospital provision for old people. On the one hand, the hospitals, and the mental hospitals particularly, are crowded with elderly people who occupy the beds and deny to the mental hospitals their proper function of caring for the mentally sick who are treatable and are subject to some kind of improvement as a result of treatment.

On the other hand, old people's homes are similarly overcrowded with people who require hospital care and who could benefit from hospital treatment. The local health authority or the welfare authorities are resentful that hospitals do not take their cases. On the other hand, the hospitals are resentful that they have cases which should be in local welfare authority accommodation.

There is an argument for much closer working and for a greater ironing out of boundaries. It is largely true that in many parts of the country those boundaries have been swept away by the sheer commitment of the local authorities concerned. We should see much more of this. I hope that my right hon. Fiend who replies to the debate will think carefully about ways of helping local welfare authorities to get their patients into the hospital service, where they could be rehabilitated, and help the hospital service to empty some of its mental hospital beds of patients who could well be in local health authority care and who simply need the kind of supervision or terminal care which is not properly the responsibility today of the mental hospital service.

I emphasise my ardent support for the view which my hon. Friend the Member for Halifax (Dr. Summerskill) expressed so cogently. It is clear that there is a growing ferment of demand for selectivity in the social welfare services. If ever a situation proved beyond peradventure that selectivity is out, it is the care of the elderly. We should make it plain from these benches that we do not accept the principle of selective care in our welfare services. Universality must be axiomatic, because without universality we cannot begin to plan the services, let alone all the other more humane and less pragmatic reasons for accepting universality as the basis for welfare.

In the care of the elderly, the introduction of some kind of payment would be unacceptable, not only to us on these benches, but to the electorate as a whole.

Mr. Bernard Braine (Essex, South-East)

Is the hon. Member aware that in our hospital arrangements the only people who have to pay for their hospital care are long-stay pensioners?

Dr. Kerr

I am, of course, aware that that wretched principle was introduced by a Conservative Administration, very much against my wishes at the time. It is my grave disappointment that we have not yet found it possible to remove it. I take it the hon. Gentleman is referring to the reduction in pensions which followed admission to hospital for more than eight: weeks. I do not accept that this is in fact a particularly fair or equitable way of dealing with them.

Mr. Braine

I am not disagreeing with the hon. Gentleman. On the contrary, I agree with him entirely. I think that where the elderly are concerned, this is a category of people in need and there should be no charges. I was merely remarking that it seemed somewhat odd that in our enlightened Welfare State these were the only people who suffered a diminution of income. For the rest of us, we get free hospital care.

Dr. Kerr

Yes, I accept entirely what the hon. Gentleman says, and I hope very much that in the course of time this, too, will disappear, in the way prescription charges have disappeared. I may add, in parenthesis, that if one group of people has benefited from the removal of prescription charges it is certainly the elderly, and if this Government make no other contribution to the care of the elderly this has been a most important one. I speak in a professional sense rather than a political one.

I wanted just to turn for a moment to a point made by the hon. and gallant Member for Eye when he was referring to the provision of private care for old people. I have spoken a great deal of community attitudes, and it is an unfortunate fact that the lack of community provision for the care of the elderly has provided a wonderful provision for the care of the elderly has provided a wonderful stamping ground for a number of —not all—nursing homes which are doing very well indeed out of the need of the community to find somewhere for elderly people to go who are incapacitated and cannot find hospital beds.

I do not want anybody to be under a misapprehension: there are a number of private nursing homes which are taking in old people and which are doing a marvellous job and not extracting from their families or the estates of the old people an extravagant amount of money, but I regret to say that there are a number of such homes which are doing a deplorable job, in which the conditions are disgusting, in which charges are extravagantly high, and which are a disgrace, and which, with all respect to my right hon. Friend, do not seem to have improved as a result of the Measure to which he referred earlier today, and which was passed through this House, giving inspection rights to local health authorities. The fact is that age is also a matter for exploitation.

I have spoken repeatedly about our attitudes, our own attitudes, towards approaching our own old age. I remember that many years ago, when I was a house physician, in charge of a geriatric ward, I stopped at one bed in which there was an elderly lady as I was going on my round, and the sister in charge of the ward said, "Dr. Kerr, this is Louisa. It is her birthday today." I said, "Many happy returns, Louisa. How old are you?" To which she replied in a quavering voice, "I am 92 today. I always wanted to live to a ripe old age, but I do not know whether I shall." This, I think, is something entirely characteristic of our own attitudes both to other people's ages and to our own. I venture to hope that we shall be able to approach that age in which—if I may for a brief second speak professionally—the idea that we have only three score years and ten, or proportionately less, it seems, if we are Members of Parliament, is seen as totally inadequate by any computation. We ought to be able to lead a productive and independent existence, certainly to well over 100 years of age. I would hope that my right hon. Friend's best endeavours will be directed to ensuring that before the Labour Government may be supplanted by any other Government at all they will at least have guaranteed to us this 100 years of productive life.

8.35 p.m.

Dame Joan Vickers (Plymouth, Devon-port)

I am very glad to have the opportunity of taking part in this debate, but first of all I want to apologise to the right hon. Gentleman for not being here when he made his contribution. I was attending a meeting of a Select Committee, of which I informed Mr. Speaker.

While I have not the great knowledge and experience of the hon. Member for Wandsworth, Central (Dr. David Kerr), he made one comment which I did not like when he said that we thought of old people as a squalid nuisance—

Dr. David Kerr

I would not like the hon. Lady to think that I said that about old people. I said that old age was squalid nuisance, not old people.

Dame Joan Vickers

Whether that is so or not, most people still revere the elderly.

In one part of his speech, the hon. Gentleman dealt with the training of old people, and I agree entirely with him that we should do all we can to prepare people for retirement. I understand that there are certain firms which run retirement courses, and one of them has a weekend course designed to bring husbands and wives together who, in many cases, live rather separate lives in their everyday work. It is an idea which has worked very well, and I should like to see it continued. Now that people have a shorter working week, they have more time to take up hobbies which will provide them with interests later on. We have an excellent example of this in Plymouth where every year we have an exhibition called "Skilled Hands". It is amazing what beautiful and useful pieces of work people produce, which obviously give them tremendous pleasure.

The hon. Gentleman told a story about an old lady of 92 who, despite her circumstances, was obviously enjoying life. I do not think that it matters about age as long as one is in fairly good health and still has one's mental faculties. We are thinking today mainly about the distressing cases of old people who lose their faculties.

I have just returned from a conference of the Council of Europe in Copenhagen. The hon. Gentleman will be pleased to hear that one of the subjects discussed there was that of retirement and provision for old age. Very many corn plimentary things were said about the United Kingdom, and I was amazed at the knowledge of some of the delegates and how they had studied what we do in Great Britain. They think that we have found a great many answers which they have not, which is rather cheering for us when we wonder whether our services are efficient.

On the other side of the picture, I have three constituents over 75 on retirement pensions who have gone abroad recently, one of whom had never even been to London. Her daughter sent her some money, and she has gone to Bermuda for three months, another has gone to Australia, and the third has gone to the Continent. I think that that underlines the fact that we have to bring people into the community before they retire so they do not age so quickly. A lot of them are not in the community when they are working but simply travel to and from work, but if we bring them into the community before they retire, there is far more chance of keeping them there. I want to pay tribute to the National Old People's Welfare Council and to the Salvation Army. They have done a tremendous amount to bring these matters to the notice of various local authorities and hon. Members of this House.

Hopes have been expressed about the likelihood of extending the expected life span, and perhaps the right hon. Gentleman could send some of his people who are engaged in research work to see the people in the centre of Russia who seem able to enjoy life at 110 years of age.

Recently, there has been much publicity given to the book "Sans Everything", and I hope that this book will stir up the consciences of people. However, one point about the book which worries me is that there is no attempt to compare conditions in good and bad hospitals. Neither the hospitals nor the contributors are named in the book, and it has had a disturbing effect. I dare say that other hon. Members as well as I have had letters from constituents wondering if their relations might be in one of the hospitals referred to in the book. I am glad that we are having this debate, because it provides the right hon. Gentleman with an opportunity to say how unfair the book is to the good hospitals, which I am sure are in the majority. An example of a good one is the Moorhaven Hospital, near Plymouth, which is open to visits by members of the public. One thing that I am sorry is happening in the West Country is that house committees are being closed down, because these were of great advantage both to the patients and to the staff.

During the last 10 years there has been a tremendous increase in the number of patents over 65 who have been admitted to Moorhaven Hospital. Ten years ago they represented 19 per cent. of the population of the hospital. The figure is now 23 per cent., and this makes matters more difficult.

I would like the right hon. Gentleman to tell us what powers the General Nursing Council has, because I believe that it has the right to inspect hospitals at least once every five years, and as its members are trained for this job and they have great knowledge of hospital management and might be able to advise the Minister concerning action in the future.

When someone visits a hospital, he can easily fall into the trap of feeling sorry for a patient after talking to him. This happened to me only last Saturday. A charming old boy came up to me and asked whether I could find his wife. It was a pathetic tale. He wanted her to come down from London, and I said that if he gave me her address I would see what could be done. On making inquiries, however, I found that he had been out in the car with his wife only that afternoon. They had been for a very pleasant drive, and she was proposing to return the following day to visit him, but he had forgotten all about it until reminded and this is what can happen to people who visit patients from time to time, I was not very impressed by "The Diary of a Nobody". I think that there are better ways of tackling these problems.

Having lived overseas for some time, I often had the mothers of friends of mine to stay with me, when they needed looking after, if they could not get back from leave. On one or two occasions I had to find homes for them. It is not easy to find such places, but there are many good ones, and I am glad that voluntary homes are on the increase. They usually cater for a fewer number of people, and I am pleased that the total number has increased by 50 since the last Ministry Report, but it will always be difficult to find the right home for elderly people because they are individuals and need a terrific amount of understanding.

What provision is there for patients or staff to make complaints if they wish to do so? I was a Member of the Committee which considered the Parliamentary Commissioner Bill, and one reason why hospitals were not included within the Parliamentary Commissioner's duties was stated to be the circular sent by the Ministry of Health to all hospital committees, which said: An independent lawyer or other competent person from outside the hospital should conduct an inquiry set up for the purpose whose membership shall be independent of the parties concerned and should include a person or persons to advise on professional and technical matters. The complainant or any other person who has such a complaint should have the opportunity of hearing and cross-examining the witnesses and should be allowed to make their own arrangements to be legally represented if they so wish. Are the details of this circular known to the nurses and to the matrons, and is a notice displayed in hospitals telling the relatives of patients what rights they have?

Mr. K. Robinson

Perhaps I can help the hon. Lady here. The circular sets out methods of dealing with complaints by, or on behalf of, patients. It details a number of suggested methods, if I may use the phrase, graded according to the seriousness, or apparent seriousness, of the complaint. The procedure which the hon. Lady has detailed is for the more serious type of complaint. I think it would be fair to say that the normal channel of complaint for a member of the nursing staff is through his or her superior officer. Clearly, if she or he did not get satisfaction in that way an approach to the chief administrator of the hospital management committee or the regional hospital board would be open.

Dame Joan Vickers

I am very grateful to the right hon. Gentleman for that information. These points should have been known but evidently could not have been known to the writers of this book, because they did not adopt what I would have considered the normal processes.

The hon. Member for Wandsworth, Central talked about the registration of people when they retire, and I agree that this is extremely important. I had hoped that this would have been done some time ago. If people on retirement were sent a form they could fill it in, voluntarily, and at the same time they could be told of the advantages of the Welfare system in their district and the machinery that exists to help them.

I was interested to find that in an excellent book on "The Social Needs of the Over-80's" it was said that 8 per cent. of men and 5.5 per cent. of women in the survey conducted had no knowledge of the various services available. Ten per cent. of the over-eighties did not know that there was a chiropody service. I would have thought that this system of registration was a very good way of bringing to the attention of the individuals concerned the facilities that exist. We would know where the old people were living and the old people would know what was available.

I do not want to say anything against the meals-on-wheels service, which is excellent, but I am worried about the nutritional value of some of the meals. I should like the Minister's assurance that the service is providing the right type of meals, especially in hot weather. I would have thought that it could have provided a better standard of diet. I should like to know whether the right hon. Gentleman issues guidance and advice to the R.W.V.S. and the Red Cross, who do this excellent work, as to the type of meal that is most advantageous. The question of malnutrition is very important in this respect, as it is not always caused through not having enough to eat; sometimes it is caused by not eating the right things to keep fit, especially if a person is unable to have much exercise.

I hope that the right hon. Gentleman will press his right hon. Friend the Minister of Housing to continue with what I think is one of the best forms of housing old persons, namely, little flatlets with their own kitchens, and with warders available to help the occupants. This enables them to be on their own but also to be secure in the knowledge that there is somebody to look after them.

Then there is the question of boarding out. Special arrangements for this are made by Exeter and Plymouth. These social security authorities pay £3 15s. to persons who are willing to take old people, in the same way that a child is fostered out. It is clear that the old people will go only to good homes, because nobody will take in somebody for that small sum of money if he is not anxious to take in that person. Over 100 people in Plymouth have been boarded out in this way.

At one time the idea was that old people should always live in mixed communities, and it is a great advantage if they can have their little flatlets in a block of flats. However, tremendous success has been obtained by Miles Mitchell Trust with villages for old people. We have a village in Plymouth where the people have their own hall and shop, and their own community centre. They have their own "get-togethers", and also where they can work at their various interests. They do their gardening. The scheme has proved to be an enormous success, and there is a long waiting list. This system goes against our previous ideas which proves there is room for all types of organisations and I should like consideration given to this type of scheme, because it has been going on now for about ten years and has proved very helpful.

I turn finally to the question of holidays. Many seaside towns give special off-season terms. Perhaps old people could register at a central place like the town hall to gain knowledge as to going on holiday and receive details from the local authority. A holiday away from home breaks the monotony for old people as they meet other people. We should encourage local authorities to show the various centres where these facilities exist, although they need not make all the arrangements. Married couples too should be kept together in old people's homes if possible and the two sexes should not be divided. Both should live together, as this is the natural way of living.

8.50 p.m.

Mr. Leslie Huckfield (Nuneaton)

We cannot dismiss the seriousness of this problem. By 1975, 10 million people will be over 65. At the moment, there are 6½ million, 90 per cent. of whom Lye with friends or relatives, which means that 10 per cent. are not wanted or cannot be looked after in this way. The debate has concentrated on this 10 per cent., but I am also concerned about part of the 90 per cent. Although older people, who have been euphemistically called "senior citizens" may be looked after by friends and relatives, here too there may be serious problems. When an old person lives with a younger family with different habits, customs and traditions, there may be difficulties, despite statistical evidence that they are well looked after.

We are told that only 50,000 beds are available for such cases. In Warwickshire, where my constituency is situated, the county council has had to say that only the very serious cases, with no immediate friends or relatives, can be admitted to such hospitals, which increases the percentage of families who have their relations living with them despite difficult problems. Although a large percentage may be looked after by their relatives, we must remember these problems of shortage of geriatric beds.

The publication "Sans Everything" goes about this in the wrong way, because it should not only give serious examples and quote speeches and comments to give a headline effect. One of the better methods is to propose action to improve matters. I would have liked more suggestions of this kind in the publication. We accept that there are serious difficulties, but want to know some of the ways of dealing with them.

Much depends upon where the particular senior citizen happens to live. My constituency of Nuneaton has a first-class record of care for the elderly. I pay tribute to the people who are responsible for this first-class record, and I shall tell the House of one or two things which my borough does which could, I feel, be copied with advantage by others.

The hon. Lady the Member for Plymouth, Devenport (Dame Joan Vickers) emphasised the need to have a wide choice of accommodation available to our senior citizens. It is no good thinking that, if we build an old people's home, that is enough. It is no good thinking that just one kind of provision is sufficient. Many people, after reaching retirement age, still want to live what is basically their own life they like to keep their own house and things together. This is why the flatlet schemes developed in my constituency are so valuable.

In such flatlet schemes, which are now being favoured by many of the more progressive local authorities, not only is there a warden but there is also a community hall and other facilities actually within the centre. This encourages old people to carry on living their independent lives, should they wish to do so, and it also permits them to get together of an evening to play dominoes, to watch television and so on, and, what is more, to have their relatives visit them not only in their individual dwellings but also in the communal accommodation.

A further and most enlightened development is the siting of flats and dwellings for younger couples either as part of the old people's centre or very near to it. Quite a few such developments are now going on in various parts of the country to make provision for individual and communal living by our senior citizens and younger citizens as well. In my view, this is a line of development which should be encouraged. One only has to compare the situation in an old people's home and in a flatlet scheme running side by side. Very often, the people have gone either into the flatlets or the home purely by choice, but what has struck me on my visits to these schemes is the comparison between the way of life of people living in the flatlets, where they are more often the independent and sturdy type of person, the person who takes pride in being allowed to carry on his or her own existence, whereas on the other hand, the people who have been put into the home very often become dependent and, as we have heard in this debate, they reach the point when they have difficulty in communicating and more and more has to be done for them. I urge, therefore, that we encourage the development of centres which permit senior citizens to pursue as much of an independent existence as they possibly can.

In spite of everything we may do through the local authorities, and in spite of everything which we may choose to do within the community, as society becomes more affluent, it becomes more callous. Although we may have a greater number of centres and a greater number of old people's homes, if there is not the right kind of attitude within the community itself, a lot of that will be not just wasted money but money that could be better spent if there were more community participation.

In this connection, I applaud the work of the old people's welfare committee in the Borough of Nuneaton, which not only provides the usual facilities provided by old people's welfare committees such as laundry, information services and the like, but, more important, has a visiting subcommittee composed of people willing to devote their mornings, afternoons or evenings, on a rota system, to going round to visit senior citizens wherever they happen to live. This is tremendously important. The greatest misfortune which old people have to combat is so often not physical ill health or the difficult conditions in which they live but sheer loneliness.

Many local authorities throughout the country still think that by providing old people with flatlets, bungalows or homes they have solved the problem of the elderly, but while old people still have loneliness and are without visitors that problem still very much exists. The old people's welfare committee at Nuneaton has managed very successfully to involve not only its own members and those who come to the occasional lecture and to see what the committee is doing but also many local clubs and societies, and particularly the schools. When I was at school we used to run a record evening at one of the local hospitals for the old patients over the "intercom" system. This is still being done in my constituency, and it is the kind of thing that should be encouraged. In many respects I am a very fortunate Members in that, if I have problems concerning those over 65, I know that apart from the centres, institutions, homes and local authority facilities which are freely provided for senior citizens in my constituency, the old people's welfare committee involves the rest of the community in its work.

I, too, wish that I had been here for the whole debate, and I apologise to my right hon. Friend for not having been here all the time. In forming conclusions on the debate we must bear in mind that whatever we do from the local authority and public expenditure point of view, if we do not have the involvement and participation of the local community and a very active background of voluntary activity from it, much of the money will not be spent as well as it could be.

9.2 p.m.

Mr. Bernard Braine (Essex, South-East)

The debate has been somewhat unusual in two respects. We have had a series of exceptionally thoughtful, sensitive, informed and constructive speeches, all of which have indicated a deep and lively concern for the more vulnerable of our old people. Unlike what happens in most of our discussions, and what will no doubt take place in our discussion later tonight, a very clear consensus has emerged.

Both my hon. Friend the Member for Melton (Miss Pike) and the Minister have reminded us that the problem of caring for the elderly is growing. It is a sobering thought that the number of those over the age of 65 is expected to increase by no less than 20 per cent. between 1965 and 1976, which I understand is about twice as fast as the rate of growth of the total population. But we need to keep this changing pattern in perspective. Thus I agree with my hon. Friend the Member for Farnham (Mr. Maurice Macmillan) and the hon. Member for Wandsworth, Central (Dr. David Kerr) that we do not help the elderly by treating old age itself as a problem. We have only to consider our colleague, the right hon. Member for Easington (Mr. Shinwell), to realise that age is a matter of attitude, a state of mind.

Indeed, it is one of the more encouraging features of our society that the age at which most people feel that they are getting old is tending to rise all the time. It is astonishing to me how youthful grandmothers seem to be these days—and grandfathers, too, but I take greater notice of the grandmothers. It is a good thing that they should be, because life is meant to be lived to the full. It has been my observation that very few old people seem to lament the passing of their middle years. Dean Swift was very near the mark when he said: No wise man ever wishes to be young. Moreover, most old people enjoy reasonable health. About half of them over the age of 65 are living with their spouses and normally are in contact with children or friends. About 96 per cent. live in their own homes. But this does not mean that all those living in their own homes are enjoying a comfortable, independent existence. Far from it. About a quarter have no surviving children, and about one-tenth—my figures are not up to date, but I think that must be at least 650,000—are housebound because of illness or infirmity. Many are desperately lonely. It does not matter very much whether one calls it "isolation" as the hon. Member for Wandsworth, Central did, or "loneliness". Many of them are desperately lonely and feel cut off, neglected and unwanted. For some, unhappily, help comes only when they have had a complete breadown in health, and often then it is too late.

Listening to the speeches, it seemed to ma that we were all agreed that if we are to ensure a decent and dignified existence for all our old people we must meet two basic requirements. The first requirement for all old people is a home of their own where they can lead, or be helped to lead, an independent existence for as long as humanly possible. The second is that our health and welfare services should be designed not merely to treat sickness and infirmity when these occur, but to promote positive health and welfare.

The truth is that by any test our present arrangements make it difficult to meet these requirements as we would wish. I have felt this for many years. I felt it when I was at the Ministry of Health, and I feel that it is still true today. Where the system works satisfactorily it is not because of its inherent virtues but despite them. It is not because the administrative structure of our health and welfare services is specially designed to meet the needs of the patient but because the kind of people engaged in the service—the family doctors, the geriatricians, the nurses, the hospital secretaries, the medical officers of health, the welfare officers and social workers, and one might add the lay people in hospital administration and local authorities—are trained, responsible and dedicated.

Where in any area there is a good consultant geriatrician, effective liaison between the family doctors, the hospitals and the local authority services, adequate home nursing and home help, domiciliary physiotherapy and a well organised meals on wheels service, although all these no doubt require a greater outlay of money in the first place, there is a quicker turn round of beds, a more economic use of resources and less danger of a patient after having been restored in health and discharged coming back to hospital because of neglect in the home. In such circumstances the system works very well indeed. All of us know areas where one can point to this happening with justifiable pride. But all too often the system does not work very well, and there are some areas where it hardly works at all.

The reason is that there are two basic defects in our social provision for the elderly. First, there is not enough of the various kinds of accommodation necessary to safeguard the health and preserve the independence of old people for as long as possible. Secondly, there is no one authority charged with the responsibility either for finding that accommodation or providing the care, and as a consequence there is imperfect co-ordination of services.

These two defects interact one upon the other. The outcome is often an administrative muddle, frustration of staff, damage to the best interests of the patient and a waste of resources. So we have far too many reasonably fit old people eating their hearts out in local authority welfare homes—admittedly, first class accommodation in many cases —simply because not enough small dwellings are provided by housing authorities.

So there are far too many frail old people needing care but still in their own homes for whom no welfare accommodation will be available until after their health has finally broken down and they have had to go into hospital. So there are far too many old people in hospitals who cannot be discharged because they have no home to go to or because there is no one at home to care for them. I have heard it suggested, and never denied, that there may be as many as 25,000 old people in psychiatric hospitals who could be discharged tomorrow if there were someone at home to care for them.

It is important to ask ourselves why these people are in psychiatric hospitals. Doctor Stephen Horsley, whom I have had the pleasure of meeting and who is quoted in "Sans Everything", believes that Perhaps 80 per cent. of elderly patients in mental hospitals have mental symptoms entirely attributable to untreated physical ailments. It is a serious indictment of the National Health Service that there is still much misplacement of elderly patients within the hospital service. Perhaps one quarter of the elderly in psychiatric hospitals should be in geriatric units and one-third of those in geriatric units should be in psychiatric hospitals. This situation is not new. I am not attacking the right hon. Gentleman. This has been going on for a long time and we are all seeking year by year to remedy it.

But such a situation has more serious consequences than the layman would suppose. During the investigation to which I am referring, which took place some years ago, Dr. Kidd found that the mortality of misplaced patients was significantly higher than among the correctly placed patients wherever they were and, secondly, that the discharge rate of medical patients was slightly higher if they were correctly placed in geriatric rather than in psychiatric wards. He concluded: It is difficult to imagine any more drastic consequences from admitting old people to the wrong hospital than that so high a proportion of them should die, and that of those who survive so few should be discharged. I would like to think that a lot of that has changed. No doubt there have been improvements but I have been told by consultant geriatricians that misplacement still exists. My first question, therefore, is what is being done about this? As the right hon. Gentleman told us in his very interesting speech, the ideal is, of course, the establishment of psycho-geriatric units under the joint care of a geriatrician and a psychiatrist, to which all old people would be admitted for short-term assessment, diagnosis and treatment and for decision as to further care. How many are there of these units?

As for these old people discharged from hospitals, their capacity to keep fit despite a functional disability depends very much on their general environment and the availability of the domiciliary services. It is not surprising that, while less than one-third of those who have someone to care for them at home go back to hospital, about half of those living alone return to hospital.

I come now to the first defect in our provision for the elderly—the insufficiency of the right kind of accommodation. Although great strides have been made in recent years in the provision of purpose-built welfare homes the recommended level of 20 beds per 1,000 population over the age of 65 is still inadequate in a good many areas. In any event, I suggest that the ratio is unrealistic unless it is related to the provision of special housing for the fit elderly, on the one hand, and to adequate geriatric beds, on the other. But we know that here the provision varies considerably from area to area.

Coming to the geriatric provision there does not appear to be much scientific basis for the recommended level of ten beds per 1,000 of the population over 65. That ratio is based on the decision that the Conservative Government took in 1962 in their long-term Hospital Plan. They looked at the existing provision, which was 10.8 per 1,000 persons over 65, and said, "This will be roughly right for the next ten years or so and we will base the plan on this, especially as we can expect improvements in active treatment in the hospitals and in the rehabilitation services outside".

We recognised in the Hospital Plan, however, that knowledge and experience would not stand still, and that the hospital authorities would be alert to modify the proposals and to bring forward new ones.

Since then five years have elapsed. Despite the glowing picture that was painted by the right hon. Gentleman the provision is still inadequate. In the group of hospitals serving my constituency and Southend-on-Sea there is provision for only five beds per 1,000. The proof that the provision is inadequate, whether it is 5 per 1,000 or 10 per 1,000, is seen in the waiting lists.

It is very difficult to get at the truth. On the same day last week that the British Medical Association warned the nation that the National Health Service was heading for disaster, the Minister issued his annual report saying that he did not accept the criticisms and that the past year had seen "a striking measure of success". There have been successes, there are strains and there are difficulties, and this is not the time and place to go into them. However, tucked into page 55 of his Report was the admission that the total number of persons awaiting admission to hospital was 536,000—an increase of 19,000 or 4 per cent. over 1965. I understand that the geriatric figures show a slight decrease since 1965, but nevertheless an increase of about 25 per cent. over the figures for 1964.

What are the explanations? Is it that there is a persistent overall shortage of geriatric beds or is it that some geriatric accommodation is being used for other purposes? We know that young chronic sick patients are often put in geriatric wards. That is a wrong and cruel thing to do, but we know that it happens.

Is it that the Ministry of Health's standard is now based on the wrong criteria? I think this is a serious question to put to the Minister. We know that it is not so much people between the ages of 65 and 70 who need care and attention as those over 70. It is over 70—of course I am generalising here—when old people are most likely to have lost their partners, are living on their own away from relatives and friends, and are getting frailer in body and spirit.

Is it that there is a shortage of geriatricians—the Minister told us that there had been an increase—or a shortage of geriatric social workers? If so, what is being done to give encouragement to a branch of medicine and social work which will become of increasing importance as the numbers of old people increase?

Is it that there is a shortage of physiotherapy facilities in hospitals? If so, why does the Minister discourage mobile physiotherapy units which make use of married women physiotherapists who are not available for full-time work in hospitals?

Is it that we still have an insufficiency of day hospitals? We had a glowing account from the hon. Member for Bournemouth, West (Sir J. Eden) about the new day hospital in Bournemouth. There is no doubt that these are very desirable institutions since they help to prevent old people deteriorating to the point where they must become inpatients.

May I now turn to Mrs. Barbara Robb's book "Sans Everything", which has figured in a number of speeches? Everyone who has read it has been affected by its terrifying indictment of conditions which it is alleged are endured by elderly patients in certain unnamed hospitals. One would hope that these allegations of cruelty and neglect are true of only a very small number of hospitals, but if they are true of only one, this must call for swift remedial action.

I agree with my hon. Friend the Member for Farnham that Mrs. Robb has performed a useful service in one respect —in warning us that we cannot shuffle off our responsibilities for the care of the old and the weak and, to use his term, the defeated, in the belief that now that the Welfare State exists, it will take care of them and we do not have to bother.

I want to say from this side of the House that we are very glad that the Minister has decided to arrange for an independent inquiry. His approach this afternoon to the whole matter was absolutely correct. At the same time, I am sure that he will agree that my hon. Friend the Member for Melton and my hon. Friend the Member for Bournemouth, West were right to insist that the inquiry should be conducted in a way which would give everyone, both in the hospital service and outside, the fullest confidence in its impartiality and its determination to establish the truth.

The right hon. Gentleman answered two of my hon. Friend's questions. He said that the person conducting the inquiry would have expert medical and nursing assistance and that care would be taken to ensure that the persons who are chosen have no connection with the hospital regions in which the hospitals complained of are located. I must press him for an answer to the third question, which was whether steps would be taken to ensure that no possible pressure could be put on junior hospital staff or patients about the evidence which they gave.

This is particularly important where nursing staff are involved. Because of their involvement and the narrow confines of their relevant experience, patients and their relatives are not necessarily the best witnesses to malpractice or poor conditions in hospitals—I think that we can understand that. Nursing staff, on the other hand, have better understanding of conditions and of their origins in the hospitals in which they serve and are therefore in a better position to make a true assessment of standards of care. I suggest that their evidence should be sought in circumstances which will permit them to speak freely and without risk. Moreover, their evidence should be considered in relation not only to particular abuses, but to the whole administration and atmosphere of the hospital concerned. I say that because my hon. Friend was absolutely right to say that there must be no whitewashing.

But the matter does not end there. Whatever is revealed by the inquiry, I hope that due note will be taken of a suggestion by Professor Brian Abel-Smith and urged by my hon. Friend the Member for Melton that effective machinery should be set up for investigating complaints about hospitals. The present arrangements for investigating complaints are not satisfactory—we all know this. The well-run hospitals have nothing to hide and the dedicated doctor or nurse or hospital secretary has nothing to fear. As every speech in the debate has shown, the rest of us have no right to shelve our responsibility for the sick and infirm in our care.

Mr. K. Robinson

The hon. Gentleman said that the present arrangements for investigating complaints were not at all satisfactory. He ought to substantiate that, because the present arrangements have been in force for only about a year and I know of no evidence whatever on which to base such a general assertion that they are not working satisfactorily.

Mr. Braine

It would probably be unfair to criticise the arrangements which have come into being since the right hon. Gentleman issued his circular. It would be fair to say that these must have time to work out. Nevertheless, most people who have addressed themselves to this question feel that even the new arrangements, like the old, are based on the hospital authorities being judge and jury in their own case. I am not saying that this leads to the suppression of material evidence, or anything of that kind. What I am saying is that it is not always what the facts are that matter, but what people believe them to be.

Just as this House has decided to establish a Parliamentary Commissioner, or Ombudsman, to consider complaints against administrative mismanagement and abuse, it seems that there is a strong case for doing something of a similar nature in respect of the health of the hospital service. All that I am asking is that due note be taken of the suggestions made.

Dame Irene Ward (Tynemouth)

Would my right hon. Friend press the right hon. Gentleman to give illustrations as to how the anonymity of those who give evidence will be preserved, because this is what is causing great anxiety in the nursing profession? I have had no opportunity of pressing this upon the right hon. Gentleman myself.

Mr. Braine

I have asked the right hon. Gentleman this, and I am sure that he has taken the point. I now turn to the second defect in the system, the fragmentation of the services for the old and the consequent failure to see the problem in the round. The hon. Member for Cheadle (Dr. Winstanley), in a very interesting speech, rightly drew attention to the unsatisfactory structure of the National Health Service, within the centralised political control and divided, tripartite local administration. I agree with every word that he has said.

Whatever one's view about this generally, nowhere does one see that tripartite administration at greater disadvantage, creaking at the seams, than in the care of old people. Talk to any family doctor, geriatrician, welfare officer, or housing manager, and all recognise that a serious problem exists. Each does his own job to the best of his ability, yet each feels frustrated by the lack of effective co-ordination. The family doctor may be driven to ask for admission of a patient to hospital because of the inadequacy of domiciliary services. Having got on the telephone he may then spend a considerable time trying to persuade the hospital to accept his patient because of the inefficiency of hospital admission procedure. This is well known. The geriatrician is often at his wit's end to fir d beds for old people in need of care. He knows, too, that his work may be undone by lack of supporting services in the community.

The basic difficulty is that no one is responsible for identifying the elderly in next of help until after that need has arisen. There is no central responsibility. This is split between four Ministries at central Government level, between county and district authorities and between social work departments within the county authorities. So often the result is lack of continuity in the help and support provided in particular cases. So often the result is the provision of a palliative only because the service providing it is not empowered to go to the root cause of the trouble. So often the result is failure to use social workers who are trained to see the problem in the whole in the most economic and effective way or failure to make the best use of voluntary agencies who are looking for leadership to the statutory services.

There is also the failure stemming from the natural human resistance to taking on unaccustomed responsibility. The Phillips Committee, for example, put the point very well some years ago. It said: There must be a natural temptation to try to place elsewhere the responsibility for cases which do not fit easily into any of the conventional statutory definitions, and the best interests of the individual old person may therefore not always be served. No doubt all this is being considered by the Seebohm Committee. But the Government alone can bring order out of this chaos; the Government alone can will the means.

I do not wish to be ungenerous. On this side we acknowledge that certain significant steps have been taken in the last year and we give support and encouragement to them. There is the proposal to set up a new local authority social work department in Scotland, which springs from the recommendations of the Killbrandon Committee set up under the Conservative Government. I shall be interested to know when this proposal will be implemented. There is the extremely valuable experiment in Livingstone New Town, where it has been decided to unify the three parts of the National Health Service, and to make tripartite appointments from the outset. This is excellent. This is real progress. But what is happening in England? Are there any similar experiments planned or under way?

Then there is the welcome trend in some areas towards the joint appointment of consultant geriatrician by hospital authorities and local health authorities. Clearly this ensures much more effective use of beds and welfare homes. This is, a splendid move and we welcome it.

The Minister's task is to co-ordinate all these activities. When my hon. Friend the Member for Somerset, North (Mr. Dean) asked the right hon. Gentleman on 26th June what he was doing about this, he gave a somewhat vague reply and admitted that he had no staff. I am aware—[Interruption.] The right hon. Gentleman will have the opportunity in a moment to explain how he uses other Ministers' staff. I am, however, aware that a great deal of inquiry and research is afoot.

I hope that the right hon. Gentleman will be able to say something about the studies taking place, for example, in the Nuffield Department of Industrial Health in Newcastle into the care of geriatric patients. I hope that he will be able to tell us something about Professor Peter Townsend's comparative study of the aged in Denmark and the United Kingdom, Professor Roth's study of psychiatric care needs of the aged, and the inquiry into the health and welfare services by Professor Chester at Manchester University.

All this sounds wonderful. I do not know for how long it has been going on. We should like to know when the results will be made known and when they will be fitted into a programme of action. The right hon. Gentleman possesses great qualities of heart and mind, as those of us who have known him for many years can testify, but I hope that he is seized of the fact that reshaping social provision for the elderly is now long overdue. I hope that if he is encountering difficulties about finance or from colleagues whose Departments are reluctant to lose part of their administrative empires, he will have been fortified and encouraged by the deep concern expressed by every speaker in this debate.

There is no escape from our moral responsibility for the old, any more than we can escape, apart from accident or illness, from getting old ourselves. If this debate has shown anything, it is that all of us agree that the real test of the worth of our society is our determination to care effectively for the old, the sick and the infirm.

9.32 p.m.

The Minister without Portfolio (Mr. Patrick Gordon Walker)

This has been a very careful, informed, serious and constructive debate. There has been no, or very little, attempt to make party points. I am grateful to the hon. Members for Melton (Miss Pike) and Essex, South-East (Mr. Braine), who opened and closed the debate, and to everyone who took part in it for their constructive and serious attitudes.

One of the results of debates such as this—we have had a number on this subject—is that it has become generally understood, and is almost a truism, how rapidly the elderly population is increasing and will continue to increase. It is probable that by the 1980s there will be about 10 million people over retirement age, and between now and the 1980s—this is a very serious problem for those who have to plan the development of the social services—the proportion of the dependent population—those under school-leaving age, on the one hand, and those over retirement age, on the other—will be rising much more rapidly than the working population, which has to produce the wealth from which we pay for social security.

However, in the 1980s—I do not know whether this is generally realised—as children grow up and enter the labour force this trend is expected to be reversed and from the 1980s the proportion of those in work will increase more rapidly than the dependent population, despite the rapid increase of people over retirement age. But, whatever happens, there will be a large number of people over retirement age as a permanent feature of our society.

I agree very much with what the hon. Member for Essex, South-East said about not treating old age as a problem. There is inevitably a slight tendency to do that in a debate like this because everybody concentrates on the problems, which is right and proper, but there is a very large number of people—and we should never forget it—who can and do look after themselves very well. As my hon. Friend the Member for Halifax (Dr. Summerskill) said, it is also true—much more true than is often realised—that many younger people look after their elderly parents and relatives.

There are, however, problems. As the hon. Member for Essex, South-East pointed out, 25 per cent. of retired people do not have children or relatives who can look after them. We have some idea of the proportion of the total number of the retired and elderly who need special care, although we must remember when talking about percentages and categories that the individual people are moving from one class to another all the time. We must not lose sight of the particular problems when talking about general percentages.

I agree with the hon. Member's figures, that about 95 or 96 per cent. of elderly people live at home, perhaps one in 10 is housebound through frailty or sickness, 4 per cent. are in residential accommodation, some of it very old and inadequate, and about 2 per cent.—this is a varying figure—are at times in mental hospitals. Although the proportion of those with special claims for care is not therefore as great as is sometimes thought, the absolute number is very great because a small percentage of a very great number still leaves a large number of people. For instance, 2 per cent. of the 8 million or so who are now over pension age is 160,000. So, although the percentages an not great, the absolute figures make al extremely serious problem.

As the hon. Member pointed out, we have both a self-centred and a moral obligation towards the elderly who need special care. We have a self-centred obligation because we all hope to become old ourselves. Even though my hon. Friend the Member for Chislehurst (Mr. Macdonald) spoke about the horrible problem of decay which will overcome us, the alternative, as someone once said, is somewhat less attractive. Some of us, I regret to say, are nearer to retirement than others, but we all look forward to retirement in the sense that it is the best alternative before w. The treatment we can expect from society must be conditioned by the amount of provision we in our own time make for the elderly with whom we have to deal.

Of course, the most powerful motive must be—and it was clear from the debate that it is—the moral obligation and the duty to solace those who suffer and do our utmost to assuage pain, sickness and infirmity. The extent to which we do these things is the measure of the worth of our civilisation. We have to tackle this, as has been made clear by many hon. Members who have spoken, from many angles.

The maintenance of income is, of course, one very vital factor. If affects all on retirement pension and undoubtedly helps large numbers to look after themselves more adequately than they could if they had less income. The recently announced increases in retirement pension, to commence next October, will raise the incomes of retired people by about £160 million. This is not to be ignored as a contribution towards a partial solution of the problems we have been talking about.

We are working on the complex problerns of a new and revolutionary wage-linked superannuation scheme, which we intend to pass into law before the end of this Parliament, and which will help to solve the problem mentioned by my hon. Friend the Member for Rutherglen (Mr. Gregor Mackenzie) of the sudden drop of income on retirement which creates relative poverty—though not necessarily absolute poverty—often of a very serious kind. I agree with my hon. Friend the Member for Chislehurst that cash alone, however generous—and it can never be generous enough—leaves much of the problem untouched.

In approaching these problems we have naturally been very much concerned about the allegations made in the book "Sans Everything." I assure the hon. Baronet the Member for Bournemouth, West (Sir J. Eden) that there is not going to be any kind of whitewashing attempted over that. It is slightly insulting to my right hon. Friend the Minister to suggest that there could be any hint, thought or possibility of a whitewash operation.

I was very glad to hear what the hon. Gentleman the Member for Essex, South-East said about my right hon. Friend's remarks on this point. Searching inquiries are being made into these allegations, in so far as it is possible from information which is supplied. The nature and kind of the inquiry must depend upon the nature of the evidence which is produced. The names of the hospitals which are involved may in some cases be enough; in others not nearly enough to enable a searching inquiry to be made. Of course, every step will be taken to see that the witnesses, whether patients, nurses, or anyone else, can speak freely and safely. The report will be published when it is finished, though I think it would probably not be desirable, and I think the House would agree, that all the evidence in these cases should be published. But the finding and the conclusions of the report will be published.

There is one thing I do not like about this book and that is the reiterated implication that my right hon. Friend is a callous and indifferent Minister who tends to put the hospital services before the patients. This is a wholly unjustified calumny of his conduct in this instance or, indeed, in his whole political life. Those of us who were in the House sufficiently long ago to remember it recall that my right hon. Friend, who was then a young back bencher, almost single-handed made it his job to draw to our attention the state of our mental hospitals—and it was not then nearly so popular to do that as it is today. In office, he has been a most active, sympathetic, resourceful and fair Minister, and I am sure that everybody in the House, regardless of party, resents the slurs which have been passed upon his integrity.

Apart from the particular allegations, which, of course, must and will be looked into as far as that is made possible by the provision of evidence, we must remember, as many speakers have said, that there is an underlying problem, namely, that some of our mental hospitals are still so overcrowded that it is really very difficult—or not always easy, shall I say?—to give patients the special care and treatment to which they are entitled.

The numbers in mental hospitals are decreasing. They have been decreasing for a long time, under the Government of the Conservatives and under ours, and, indeed, in other countries, and that is a good thing. It is partly because of less misplacement, and so on, that the numbers are decreasing, and I think we can expect that they will continue to decrease. We have to carry this further. We have got to do everything we possibly can to keep out of mental hospitals and geriatric hospitals elderly people who should never go there at all, which is a misplacement problem, and we have to get out of hospital those who should not be there, so far as this can be done humanely—for there is a great variety of cases.

I listened with interest to the confident figures mentioned by the hon. Member for Essex, South-East. I do not know how true or not they are as to how many can be got out, how many are misplaced, and so on, but if he has any statistical basis for those confident figures I shall be very glad indeed to see it in due course and do my best, with my right hon. Friend, to take it up.

If we are to get this misplacement problem right we have to tackle it simultaneously from very many angles. We have to press on with new ideas and methods, which are springing up in differ- ent parts of the country, and which are designed to ensure re-entry into the community and return to their own homes, of elderly people in hospital. Very great medical progress is being made in this field. There are many examples up and down the country of the excellent work being done by the geriatric hospitals to keep the sick and disabled people to the greatest possible extent in the community.

The example I know best is of a geriatric hospital in my own constituency, Langthorne Hospital, which is a very old Poor Law hospital built about a hundred years ago. Dr. Delargy, who is in charge of it, has introduced many new ideas, some of which he pioneered and some, no doubt, which he borrowed from other people—and which are spreading throughout the country. One of the ideas to which he attaches the greatest possible importance is the visiting of patients before they are admitted, partly to explain to them in their homes what to expect in hospital so that it will not come as a great shock to them, and partly to prepare their relatives to accept them back after they have been in hospital. He calls this. "arranging, discharge before admission." It is a very good approach to the problem. Patients are moved as quickly as possible out of the acute wards.

Then there is another scheme which he has, and which the hon. Member for Melton mentioned in connection with a hospital in Colchester, for elderly people who have incurable disabilities and whose care imposes a great strain on their relatives. Under this scheme they spend alternatively six weeks in the hospital and six weeks at home. By this and other means in Langthorne hospital, a discharge rate of about 130 a month out of a total of 640 patients has been achieved, providing a rapid turnover and availability of beds.

We must do all that we can to find accommodation for the elderly when they grow more feeble outside these various kinds of hospitals. One of the needs is the building of new residential homes and the closure of old and outworn institutions. To some extent, one does not make as rapid progress as one might statistically because these old places are being closed. In the three years 1964–66, 342 homes for the elderly and handicapped people were opened for 16,000 residents and, in that same period, 30 former public assistance institutions were closed. One never makes rapid enough progress, but this is quite substantial.

Another need for which my right hon. Friend the Minister of Housing is particularly responsible is to provide within our house building programme special dwellings designed to enable old people to continue to look after themselves. Since the war, something like 400,000 one-bedroom and bedsitting room dwellings have been built by local authorities and new town corporations in England and Wales. The vast majority of them have been designed for the needs of the elderly and are in fact occupied by old people. At present, about 25 per cent. of our housing programme is devoted to this end, so that we are making a very vigorous effort to catch up with this part of the problem, which saves us a considerable amount of money in other fields of activity, though it is more expensive than ordinary housing. In addition, many local authorities have produced a number of two-bedroomed dwellings for this purpose.

My right hon. Friend the Minister of Housing has been giving a great deal of thought to the problems involved in the design of housing for the elderly. We are not yet sure what the answers are. We have to experiment and learn from what we do. I know that my right hon. Friend is only too conscious that we are still a long way from knowing all the answers. It is easy to make speeches about these matters, but it is not so easy to get things right. My right hon. Friend has issued a large number of design bulletins for the guidance of housing authorities, and his research and development group has built an experimental block of 24 old people's flatlets on behalf of Stevenage Development Corporation, details of which are set out in a pamphlet. Anyone who is interested and has not seen it will find it an extremely valuable document. It is an experiment, and we want views and judgments upon it.

As my hon. Friend the Member for Rutherglen and the hon. Member for Farnham (Mr. Maurice Macmillan) said, perhaps the highest need of all is to help those elderly people who make up the vast majority of those with whom we are dealing. They are the people who live at home and need help to continue living at home. We have been talking a great deal about services in our hospitals, but services at home concern overwhelmingly the largest proportion of elderly people.

Reference has been made to the meals service. This is spreading. It is an example of a service which was voluntarily pioneered by the W.R.V.S. and which is now being developed by the local authorities. I think that about 12 million meals will be delivered this year, and about 5½ million meals will be served in lunch clubs. Local authority services, which are rapidly developing, cover about 30 per cent. of the field at the moment, and are going forward without the work of the W.R.V.S. falling off.

My hon. Friend the Member for Rutherglen asked about home helps. They are of tremendous importance, and although their work is not concerned only with helping old people, it is heavily concentrated on this group. The numbers are increasing, but there are never enough. In 1964 there were 61,800. In 1966 there were 65,300, about 4,000 more. It is not always easy to recruit home helps, and so this rate of progress, if it is continued, will make a considerable contribution.

Many hon. Members have spoken about the problem of loneliness, which concerns particularly those who are living in their own homes, or in houses with other people. To this one must add ignorance of the services, benefits, supplements, concessions, and so on, to which they are entitled. Many agencies help to solve this problem. Where it is in contact with elderly people, the Supplementary Benefits Commission does magnificent work in seeing that they are aware of their rights, and in bringing elderly people into touch with the organisations and authorities which can help them. But the main task naturally falls on local authority welfare services which do indispensable work, and I need not detail it, as everybody knows it.

I come now to one of the points raised by the hon. Member for Essex, South-East about the co-ordination and harmonisation of these services. We have to await the Seebohm Report, and I cannot therefore anticipate it. I can, however, tell the hon. Gentleman that I am very much in favour of the creation of what is sometimes called a family service. How it is to be done, how wide it is to go, and so on, are matters in respect of which we have to await the Seebohm Report. I hope that it will come this year, and that it will give us great assistance in trying to solve this problem.

We are not sure about the integration of the tripartite system, because we do not know exactly how the Seebohm Committee will interpret its terms of reference, but in any case this must, in the first place, be a matter for local authorities. We are watching with great interest and care—the hon. Gentleman gave one example, but there are one or two others—the work that is being done by local authorities to integrate these services, and it may be that when progress has been made, and experiments have been carried out, we can begin to generalise more. But I think it is a difficult problem of organisation. The various experiments that are being tried are still a bit tentative, and it is better that this should be done by forward looking local authorities. We can then learn from what they do, and consider generalising it.

We are increasing the number of trained social workers. It is not only a question of harmonising them, but of increasing their numbers. The number of certificated social workers in training has increased by 350, and the rate is increasing. We hope that this will soon rise to an increase of 500 in training each year. As the hon. Lady said, and I would like to endorse it, voluntary organisations have an enormously important rôle to play in this and other cognate fields. They play a very important rôle in helping to combat loneliness among the elderly, and in helping them with their housework, repairs to their homes, and that kind of thing. It needs to be very carefully organised and co-ordinated.

One of the most encouraging things is the way in which young people are helping, on a really encouraging scale, in classes from schools, and also what are called unattached people, those who are not in schools. It is a rather striking development that whereas attendance at youth clubs, places where they go and amuse themselves, is falling, the number of young people ready to help others is rapidly increasing. This is shown by such bodies as Task Force in London which concentrates on helping elderly people, and there are similar bodies in other parts of the country. We are seeking ways of stimulating this kind of voluntary work. We shall have to find a way of giving help while maintaining the full independence and usefulness of these kind of bodies.

Day centres are a valuable new development. Bournemouth is not the only town that has one, although Bournemouth has a fine one, about which I was happy to read in The Guardian, and to hear described today. These centres make an extraordinary contribution towards combating loneliness among the elderly and making it easier for relatives to keep their old people at home. Often the elderly do not know what to do with themselves during the day, and they do not want to move from their homes if they are a little frail. Day centres contribute to solving many of the problems. Last year there were about 115 day centres—that is the latest available figure—and they are expected and planned to grow in number to about 430 by 1973.

The hon. Member asked what I did about co-ordination. Inevitably many Departments are involved in this work. Unless we have one vast Department we must have the work divided up into matters concerning the Departments of Health, Housing, Social Security, Public Building and Works, in some aspects, Transport and the Scottish Office. It has fallen to my lot to try to combine and co-ordinate the work of these bodies and not to try—as I do not, in any way—to become an overlord. Naturally, proper independence must be allowed to all these Departments. On that their answerability to Parliament depends, and it is important that they should be responsible in their own fields.

Co-ordination proceeds sometimes by consultation on specific points. Sometimes I consult a specific Department or a group of Departments. Often we meet together. I am proud of the fact that I have a minute staff, and I would have thought that hon. Members opposite would have applauded this. I have a staff of three, although I have access to the staffs of other Departments, and of the Cabinet Office. Nevertheless, I am still staffed without having added to the number of civil servants. In my view we manage this co-ordinating fairly well. It is not always an easy job.

On the whole we can claim that we are making progress along the whole front, and that we will advance further. We are not complacent, and cannot be. However much we do there will always be more to do. Indeed, the chief motive power of progress in this field is always to be raising our standards, so that we are always behind what we set ourselves to do. Each time we advance and solve problems we must set new standards and create new problems. This is essential.

That is why we welcome criticism, if we do not always regard it as well-informed. We particularly welcome the pioneering work which is done by independent and voluntary bodies, who think up things that we have not thought of. Sometimes we may be shocked by disclosures. The capacity to be shocked is a measure of our moral obligation in this field. However much progress we make I hope that we shall always be capable of being shocked, as a country, by disclosures. However high standards are raised there will always be some people who are below them, and we must buckle down to the never-ending task of raising our social standards ever higher.

Mr. Walter Harrison (Wakefield)

I beg to ask leave to withdraw the Motion.

Motion, by leave, withdrawn.

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