HC Deb 27 June 1969 vol 785 cc1942-58

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

1.34 p.m.

Mr. John Farr (Harborough)

We are fortunate today in that there is the prospect of a goodly length of time for this very important Adjournment debate on the care of the younger chronic sick. I am glad to have the opportunity of raising this very urgent matter on the Floor of the House. I have had an exchange of correspondence on the subject with the Minister, and Questions have been raised in the House expressing the concern of hon. Members of all parties.

I want first to make it clear that I am discussing people in an age group which includes people of 15 to the fifties who are receiving long-term care for chronic disabilities or illnesses of a purely physical nature. They are not those with psychiatric or mental illnesses. They number many thousands, and their plight has received far too little attention so far. It is true that the Ministry has conducted two limited surveys and is currently engaged on another. However, apart from producing last year an excellent report and a summary of recommendations and circulating them to local hospital boards with plans of specimen units to house the younger chronic sick, the Ministry has taken no apparent action.

The report which the Ministry published 12 months ago said that the Minister would call for a progress report from hospital boards in about two years' time. In answer to a Question on 10th February of this year, the Parliamentary Secretary said that he was unable to give any forecasts of additional provision to be made for the younger chronic sick by the end of 1970 but would be calling for the progress report which I mentioned earlier in the course of that year. It is in the hope that I can persuade the Minister to take a more positive line that I have initiated this debate.

The cause of my concern is that the younger chronic sick, who by the severe physical nature of their complaints in any case demand the deepest sympathy of all hon. Members, by and large are quite unsuitably cared for at the moment. A survey published last year gave the figure of 4,223 as the total number suffering from a variety of complaints such as multiple sclerosis, muscular dystrophy, cerebro-vascular disease, polio, rheumatoid arthritis and others. They are all cared for under the auspices of the National Health Service and almost half of them are housed in geriatric wards.

I know that the Ministry is now conducting a fuller survey to try to obtain a truer picture. I understand that this time it will include those who are housed in private nursing homes or kept at home, despite the difficulties, because there is no suitable accommodation available. The report published last year showed that under one-eighth of the 4,223 people who were the subject of it are properly accommodated in younger chronic sick units.

It is depressing and dispiriting for these young people, some of whom are very alert mentally, to live with the old and the senile. Needless to say, I would not have initiated this debate without some concrete evidence, and I make no apology for giving one or two sample cases in the Midlands and elsewhere to illustrate the type of wrong which I am seeking to right.

Only the other day, an example came to my notice of a young man of 36 who is a spastic. He is living permanently on his stomach with one leg in the air and cannot feed himself. Until last week his mother, who is aged 70, was able to care for him at home by an immense struggle and sacrifice on her part. But the time has now come when the Worcestershire County Council, under whose auspices this person lives, has been told that the mother can no longer continue to bear this burden and care for her son in a satisfactory manner.

The only place that the Worcestershire County Council can find for this man is in a geriatric ward with old people. What makes it so tragic is that this person, in common with many others, is very alert mentally. He has been described to me as mentally above average. He accepts his plight in a cheerful manner. All he asks for in life is to share stimulating conversation with young people and to have young faces around him. He obviously will not get that in a geriatric ward in a hospital or in an old people's home, which is the only accommodation that the Worcestershire County Council can offer him. That person, who I think it right should be nameless, is a sample of many other cases which have been brought to my attention.

Coming nearer to my own constituency, a man, whom I will describe as Mr. A, aged 39 and suffering from multiple sclerosis, for some years lived with his married brother and sister-in-law who have now emigrated to New Zealand. Mr. A hoped that he would be able to go to New Zealand with his mother, together with his brother and sister-in-law, but unfortunately admission to New Zealand was forbidden to Mr. A. He is now living with his mother, who has arthritis, in a "prefab" bungalow.

Mr. A. is unable to walk and his manual control is very limited. The only reason he remains at home and is not put into a geriatric ward is because his mother so far has been able to continue to look after him adequately. But, in my view, the time is approaching when that position will no longer obtain.

Another instance concerns a lady whom I will call Miss P. She is a dwarf, aged 43, and suffering from muscular atrophy. She lived at home with her father and stepmother until her father died of leukaemia. Miss P sent a letter to the Leicestershire Association for the Disabled, which does a great deal of good work in Leicestershire, asking for a representative to call and see her. Her first words to the visitor who went to see her were that she wanted to get away from the house where she had been living.

She has now been put into a county home in Leicestershire among all elderly people. She happens to be a person of extreme intelligence. She wears calipers on both legs and walks with extreme difficulty. In my view, she should not be housed with a lot of old people who are in need of special attention according to their particular conditions of life.

Another case concerns a lady, to whom I will refer as Mrs. R. She is aged 50 years. I will not go into the details of her case at great length, because she has a long history. Suffice to say, she is in a nursing home now and feels that she is just sitting out her life in a room which she shares with two senile old ladies with little or no prospects of any alternative than eventual admission to a geriatric ward when the little money she has is exhausted, as it will be soon, and she has to be moved into county care.

A further tragic case concerns another Mrs. R who is aged 45. She, again, is suffering from multiple sclerosis. The disease had reached the stage where her husband and young family could no longer look after her at home. When she knew that the outcome was to be a geriatric ward, she attempted to commit suicide. Her home is at Market Harborough, but she is now in a county home elsewhere.

It is because of cases like this, which I think disturb the conscience of the whole House, that I have sought leave to raise this Adjournment debate today. I want action today by the Minister to set up a series of younger chronic sick units throughout the country.

In this Report which was circulated last year certain excellent recommendations were made, but, typically, it contains no mention of the necessary finance to put these excellent recommendations into effect. I want the Minister to undertake today to finance immediately the erection of a series of units specially designed for the younger chronic sick. I will remind the hon. Gentleman of the type of younger chronic sick unit which I and some of my hon. Friends on this side are seeking.

The Report recommends that units should contain from 25 to 50 beds. It states, in my view extremely wisely: Smaller units are difficult to staff and tend to be isolated. Unlike other hospital patients the younger chronic sick require occupation and activity at many levels of intellectual capacity and this has to be planned in a continuing and purposeful way. Unless units are of a suitable size, they find it more difficult to attract the interest of educational and other outside bodies and this is detrimental to the objective of ensuring an adequate diversity of interests and activities.… There is a danger that units accommodating more than about 50 may acquire too institutional an atmosphere. The Report recommends: These units will be best sited within the environment of a general hospital and ideally a unit should be associated with the district general hospital nearest the patient's home. As there are unlikely to be enough younger chronic sick patients to justify this, there will therefore only be need for a few units suitably distributed at or in association with district general hospitals in each Region. I am not asking for a whole range of new units for the younger chronic sick to be established. I am asking for the recommendations in the Report to be carried out; for a network of relatively isolated younger chronic sick units to be established with a start forthwith on construction.

The Report makes many other recommendations of which I am sure the Minister is aware. I understand that the Ministry sent to local hospital boards copies of plans of the type of unit it would like to see constructed. The type of unit to which I have been referring would, for instance, provide up to 25 per cent. of the accommodation in single rooms. The Report states: The aim should be to provide"— in these younger chronic sick units— as relaxed and permissive an atmosphere as possible within a hospital setting. A unit should include a number of day rooms, with its own occupational room or even a workshop. I especially call the Minister's attention to this point, because a number of these people that I know are quite capable of working physically in a limited way. Mentally, they are unimpaired and they are desirous of carrying out some form of part-time occupation.

The Report continues: 'but wherever practicable, arrangements should be made for these facilities to be shared with other patients and by both sexes. The ward should be subdivided into small units, with at least 25 per cent. of single rooms, and others with provision for mobile partitions. There is a need for a small private room for visiting. It goes on to say, and I can bear this out from what happens in the Midlands, that there is a real need for younger long-stay patients to have regular holidays, and for arrangements to be made whereby the people living in the chronic sick homes or units are not necessarily there permanently. They could perhaps go on a day basis or for two or three weeks to give their parents, husband or wife a little relief and rest from the burdens they so nobly bear in supporting their kith and kin.

I know that the Minister has a perfectly satisfactory reply. I am sure that he will confirm the recommendations in the Report, that he will say that as soon as money permits he hopes to make a start on the construction of the units. I remind him that many of those he houses in a special unit for the younger chronic sick will relieve urgently needed geriatric space in old people's homes, for which there are many on waiting lists in the Midlands.

1.51 p.m.

Mr. Tom Boardman (Leicester, South-West)

I support all that has been said by my hon. Friend the Member for Harborough (Mr. Farr). All hon. Members will have seen many hard cases of the kind to which my hon. Friend referred in the course of their work in their constituencies. We have examples of them all too painfully obvious when we visit old people's homes and see those of the younger chronic sick who are misplaced there. It is a strain on both sides. The home does not have the facilities which are needed and desirable—occupational therapy facilities and the like. It is also a strain on the older folk there who, whilst they may not be able to do any more than the younger chronic sick, have a different attitude. Their ways of living are somewhat incompatible. It is a real strain, which all hon. Members would regret.

There is also the strain, which is perhaps rather greater, in the homes where parents, often themselves becoming old and frail, are looking after the younger chronic sick. This causes the greatest concern. Hon. Members who have seen an old couple struggling to look after and provide for a chronic sick person of the type to which my hon. Friend referred will know only too well what I mean.

A survey in 1967 suggested that in the Sheffield Hospital Board area the type of special home for which we believe there is a requirement was not justified. But that survey was limited to the younger chronic sick then in hospital. It took no regard of the needs of those who should have been in a special home but, because no special home existed, were being looked after by their family. There is a need for a permanent home which will give the surroundings and opportunities to which my hon. Friend referred That is clearly one of the first priorities.

The other need is for somewhere where younger chronic sick can go for a short stay to relieve the strain on the parents or relatives looking after them. It is good for them to have a fortnight's break, to have some time when they know that those for whom they care and whom they love are being well and properly looked after, while they themselves can get away from the terrible responsibilities and burdens they carry.

There is also a case for somewhere where some of the younger chronic sick can go for day care, not being in permanent residence and not staying overnight. But they could be looked after there and given occupational therapy and interest during the day.

It is very much a question of social priorities and I place this very high, as I believe the Minister will. It is an anomalous and illogical gap, at a time when public money is being spent in substantial sums on the provision of abortions, centres for drug addiction, and when we read of large amounts spent in skin grafting to remove tattoos at £250 a time.

The Under-Secretary of State for the Department of Health and Social Security (Mr. Julian Snow)

Is the hon. Gentleman suggesting that those tattoo operations are for other than cosmetic reasons, or for cosmetic reasons?

Mr. Boardman

I should not like to develop an argument as to whether they are right or wrong. I would accept that normally this is done for psychological reasons.

On the question of priorities, this may be right or wrong. I should be ruled nut of order if I debated the justification of public funds being spent for abortions, curing drug addiction or the removal of tattooing.

Mr. Snow

The hon. Gentleman has introduced an emotive subject, because the popular Press has suggested that these cosmetic operations are not chargeable to the National Health Service. As the hon. Gentleman has just said, in many cases they are carried out for psychological reasons and it is very right and proper to carry out such operations under the National Health Service.

Mr. Boardman

I am sorry if I introduced an emotional tone. It was not my intention. I shall not pursue that point, but I would just stress that when we are assessing our social priorities it is right that we should see where money is spent and whether it might be better provided, or equally well provided, for the care of the younger chronic sick, a class of society largely passed by at present. I hope that we shall have some assurance as to what should be done.

I realise that it is a question of money, but I cannot believe that, in the debate going on privately among hon. Members opposite on the raising of money for the National Health Service, any hon. Member would object to the alteration of the social or health priorities, or to the raising of funds in the way suggested, to meet this need of a small but in many ways neglected section, of which my hon. Friend has given some graphic and typical examples.

There is an unanswerable case for the allocation of funds for the provision of a permanent home, a holiday home or a day care home to remove from the geriatric wards those aged 15 to 50, and to remove the strain from households up and down the country which face—I will not say that they are saddled by—because it is a responsibility the parents willingly bear—the responsibility of looking after these people who cannot look after themselves. The burden becomes increasingly heavy as the years go by.

I do not wish to put this in emotive terms, and I apologise to the Minister if, in introducing the other subjects, I have taken the debate out of the setting in which my hon. Friend had intended that it should be conducted. It is a case about which I feel deeply and passionately, as I am sure the Minister does. I give every support to what my hon. Friend has said.

2.0 p.m.

The Under-Secretary of State for the Department of Health and Social Security (Mr. Julian Snow)

I am personally appreciative of the opportunity that the hon. Member for Harborough (Mr. Farr) has taken to bring this matter before the House and of the moderate way in which he did it.

I do not take serious exception to the point made by the hon. Member for Leicester, South-West (Mr. Tom Boardman) about tattooing. He has emphasised that he did not want to bring in an emotive subject, but I know that he will agree that there is a psychological case for many of these operations. Had it not been for the popular Press building up this matter on one occasion, I should not have referred to it again. A young wife does not like to see the words "I Love Lucy" etched across her husband's chest as a reminder of what he had been doing before or where his affections lay before they married.

To address myself to the serious matter that the hon. Member for Harborough has introduced, I have been struck by the fact that the words "younger chronic sick" have different meanings for different people. I am concerned not with attaching labels, but with the kind of services that can be provided and for which my Department is responsible.

The term is used primarily to cover people suffering from conditions like multiple sclerosis, muscular dystrophy and paraplegia, but the designation covers a varied group, so much so that I shall not have time to deal with the special needs of all the people included in it. However, it does not mean that I am any less mindful of what those needs are. I do nevertheless want to make the point that the services to be given should depend always on the individual social and clinical needs of the person receiving them. Every person's needs differ from those of every other person, and nobody can lay down general rules about how he ought to be treated.

I can, however, be specific about our object in providing services for the younger chronic sick. It is simply this: to enable them to lead a life, whether at home, in residential care, or in hospital, which is as full of interest and satisfaction as their disabilities permit. For most of us the greatest satisfaction is to be found in a life centred not in institutions but in our own home. There seems no reason to doubt that in most cases the same is true of the younger chronic sick. Hence there is a wide range of services designed to help them remain in their own homes wherever possible. These include not only the general practitioner and local authority services which are available to everyone in the community but also many special services.

Local authority services may include the advice, guidance and support of social workers, the practical services of home nurses and health visitors, often working in conjunction with general practitioners, and home helps. Local authorities may assist with the adaptation of dwellings, and they may also provide aids and appliances—though here the provision is by no means limited to the relatively simple equipment available from local authorities. The items available through the National Health Service range from sophisticated electronic equipment such as POSSUM—the patient-operated selector mechanism—to wheelchairs and walking aids.

Local authorities also provide a number of services which, while given outside the home, may play an important part in enabling a person both to continue living there and to lead a life which is more satisfying. These services may include day centres, where it may be possible for a handicapped person not only to be cared for but to undertake some diversionary or even light industrial work; they may also include arrangements for caring for a handicapped person during a family holiday or at other times when it is desirable to relieve the family of this responsibility. The hon. Member for Harborough referred to this, and I take his point very seriously. Families are much to be sympathised with, in many cases.

I accept that at present we do not know enough about chronic sick and handicapped people who are living at home. That is why my Department, along with other interested Departments, sponsored the national survey of such people which the Government Social Survey Department has carried out for us. The results of this are now being analysed, and I expect that in the course of the next twelve months or so usable information will become increasingly available. This should help us to plan services better.

But, whatever may be done for people living at home, it is easy to imagine circumstances which would make it impossible for a chronic sick person to go on living at home. It might be, for example, that the necessary support could no longer be given by ageing parents. In these circumstances—and here I think I find myself in agreement with the hon. Member—it may be that a person can be best cared for in residential accommodation, where a more intensive form of welfare care can be provided. Local authorities may build their own homes for this purpose, or make use of voluntary or private homes. I take note of what the hon. Member has said, and I shall probably be writing to him about that point later.

I should not wish to convey the impression that I regard local authority provision of centres and residential accommodation for the younger chronic sick as widespread as we would wish or that services are evenly developed. The main emphasis in recent years has been on provision for the elderly, and in that field we have made a great deal of progress. On the other hand, I cannot accept the proposition that nothing has been done for younger people. There are now 15 local authority homes especially for the younger physically handicapped.

It is true that a number of younger handicapped people have to be accommodated in homes occupied mainly by elderly people. In some cases—although I think it is dangerous to over-emphasise this—because of their upbringing and their disabilities the people concerned may find it better to be with rather older people. I would not like to emphasise that too much, however. It is also true that this may in many cases provide the best answer to the problems of caring for them, by reason of their age or condition, or in order to enable them to remain near their friends and relatives. It is very easy to have the most ideal of hospital provisions or residential accommodation and to detach people from their family surroundings. There are also dangers in this.

For many years there has been a greater demand by local authorities for loan sanction for welfare projects than the resources available have been able to meet. Nevertheless, I want to assure the hon. Gentleman that we are well aware of the problems, and that they are carefully considered in the allocation of loan sanction money. I am sure that local authorities will wish to accelerate the rate of their building programme when circumstances permit and that they are seeking to improve the recruitment of qualified workers. When the hon. Member for Leicester, South-West mentioned the difficulty of finding money, I thought that it was not only a question of money; it is often a question of trained staff. That costs money, but we just cannot allocate so much money and have the trained staff available at once.

It is unfortunately but inevitably the case that some patients will need more intensive and continuous nursing care than can be provided in the community. Within the statutory health and welfare services, this can be provided only in the hospital service, which alone is organised to provide a twenty-four hour nursing service on an economic basis. I think it appropriate here to record the valuable contribution made by voluntary organisations, such as the Cheshire Homes, which bring their skills, dedication and compassion to bear so effectively in this field. Many of them provide beds on a contractual basis with hospital boards for the care of the younger chronic sick. People sometimes think that hospital boards on the one hand and voluntary efforts on the other are completely detached. This is not the case.

As the hon. Member for Harborough said, the memorandum issued by my Department last year to hospital boards has probably set a lot of new thinking going. I am sure that the House will agree that this shows that my Department attaches great importance to the provision of suitable accommodation for the younger chronic sick in hospital. The memorandum was endorsed by the Standing Medical Advisory Committee, and it gave detailed advice about different aspects in the provision of a specific service for these patients; it dealt with admission policy, including holiday admissions to afford patients' families some relief, with the size, location and equipping of units, staffing and training, and the use of voluntary help, and it enclosed a model plan of a unit, drawn up by my Department's professional staff, to help boards in their planning.

The attention of boards had been drawn to the problem of the care of the younger chronic sick in 1957 when they were given advice on the provision of hospital services for geriatric and chronic sick patients. Some progress in provision was made over the next years but it became clear that up-to-date information about the size and nature of the problem was desirable. A survey was mounted in 1967 of the existing hospital population of younger chronic sick. I must emphasise that this was never intended to show what unmet need there was in the community for admission to hospital, but rather was intended to discover the extent to which chronic sick patients in the younger age groups—for this purpose we used the age range of 15 to 59—were in hospital at that time and unsuitably accommodated.

Each hospital board, by reason of its participation in the survey, now knew exactly where its younger chronic sick patients were housed and the scale of provision needed to meet their special needs. It may be wondered why this information was not already available, but it must be remembered that we are dealing here with a relatively small number of patients—some 4,000—compared with half a million hospital patients in all. I accept that these people are important, but these figures show the ratio of this problem to the whole problem.

The House may welcome a few figures which illustrate the nature and extent of this problem. The survey showed that there were 4,223 chronic sick patients between the ages of 15 and 59 receiving hospital care. About one-fifth were in special units for the younger chronic sick or in contractual beds in voluntary homes. About half were in geriatric and chronic sick wards. I would emphasise that it would not be fair to regard all these as totally misplaced. Many are near the upper age limit of the group, and, sad as it may be, many have undergone such extensive mental and physical deterioration from the nature of their disease that the skills of the geriatric staff are most appropriate to their care. In fact, there are 299 in perfectly suitable voluntary homes instead of hospitals, and of the remainder not all are badly placed in some of the elderly homes. I have explained why geriatric care becomes rather more necessary at an earlier stage in the life of many of these patients.

The main point of the advice in the memorandum to which my hon. Friend referred is that the best possible standard of care can be given only in units specially designed and equipped for the purpose.

Boards have been considering, in the light of the results of the survey, in what ways they can implement the advice they were given in the memorandum. The main concern of hon. Members, which I share, is to ensure that progress is made on the ground. I would say, first, that boards were told by the then Minister of Health when the memorandum was issued in June, 1968, that he intended to call on them for reports on progress in about two years' time. My right hon. Friend the Secretary of State for Social Services fully intends to keep to this timetable.

But, having said that, I should be less than honest if I did not remind the House that boards have many and varied calls on the resources which are available to them. It is boards which have the task—and we should not underestimate the difficulty of that task—of determining priorities, and it would be idle of me to hold out to hon. Members the prospect of a massive implementation of these recommendations at once. I have no doubt, however, that boards will give the fullest consideration to finding a place in their programmes for these units, especially in order to iron out the unevenness of the present provision.

This brings me to the hon. Member's specific point about the position in Leicestershire. It is a fact that at the moment there is no special hospital unit in the county, although in the area of the Sheffield Regional Hospital Board, of which Leicestershire forms part, there are already two units. I know that the board is at present considering the needs of the region as a whole in the light of the memorandum, and I know that it will not have escaped its attention that the southern part of the region, especially Leciestershire, is without a unit at present. My Department will examine the two speeches made this afternoon and the board will be sent our observations on them. I hope that we shall be able to demonstrate our consciousness of the concern expressed today.

The House is indebted to both hon. Members for raising this matter, which is of a national character. Our survey, which was produced from 1967, will, of course, be amplified in due course through a survey on domiciliary cases. When we have all this information—perhaps some more work could have been done in the past—we shall be better able to try to allot priorities in this matter.

2.17 p.m.

Miss Mervyn Pike (Melton)

I apologise to the House and to the Under-Secretary for having arrived late, but the House will understand my difficulties, and why I came running in at the last moment. I was not able to hear the speech of my hon. Friend the Member for Harborough (Mr. Farr), although I know the facts very fully and I am sure that I completely endorse everything which he and my hon. Friend the Member for Leicester, South-West (Mr. Tom Boardman) have said.

I would thank the Parliamentary Secretary for the full and thoughtful reply which he has given, although I did not hear all of it, and would re-emphasise his point that the care of these people should be in special units. We in Leicestershire do not have that facility at this moment. Particularly now, when young people have so many advantages and such a full life, we need to be more compassionate and to take more care of these people and give more thought to their parents, who bear a tremendous burden.

I accept that, in many cases it is to their advantage to be in the geriatric part of a hospital, but in most cases, especially in our part of Leicestershire, this type of accommodation is urgently needed. So I add my voice, as a Member for Leicestershire and as the President of the National Society for Mentally Handicapped Children, not only to congratulating the Minister on the work which is being done, but also to urging him to ensure that every effort is made to see that these homes are provided and that the voluntary help is encouraged which also plays a tremendous part. Special compassion is needed not only for these people but for their parents and those involved in these problems. We must be grateful to my hon. Friend for bringing this forward and for all the work which he has done in this field in Leicestershire.

Mr. Snow

I pay due respect to the experience of the hon. Lady the Member for Melton (Miss Pike) in this matter. Although the House is sparsely attended, as is not uncommon on Friday, I hope that the debate will receive some publicity, because the care of the young chronic sick and other matters which are less glamourised and which are in the responsibility of the National Health Service are not so very popular among the great army of voluntary workers who help us so much. If the public can only be given to understand the size of the problem and the importance of becoming better acquainted to the tragedies which surround these cases, we might see an increase in voluntary aid, which we should welcome.

Question put and agreed to.

Adjourned accordingly at nineteen minutes past Two o'clock.