HC Deb 25 March 1969 vol 780 cc1501-10

2.48 a.m.

Mr. R. H. Turton (Thirsk and Malton)

I want the House to move from the consideration of the teaching of the young to hospital treatment of the elderly in rural areas. The National Health Service has achieved a great deal, but the plain, blunt truth is that in the treatment of the elderly in hospital we are practising barbarism and cruelty far greater than was practised 30 years ago before the National Health Service started. All of us, without any question of party, are rather apt to draw a curtain of complacency over the problem until the curtain is roughly parted by incidents such as the fire at Shelton Hospital or the allegations regarding the Ely Hospital at Cardiff.

I want to concentrate on the problem of the treatment of the elderly in rural areas. This is not because there is not a problem in urban areas. There is similar cruelty there, but it arises in a different way. It Comes from congestion and overcrowding, whereas the cruelty I am speaking about comes from the ruthless separation from home and friends which is a main characteristic of the treatment of the elderly in rural areas.

When we are seriously ill, whether we are old or young we require the best treatment available, and for this to be provided nationally without astronomical costs patients will have to travel considerable distances. Therefore, no one quarrels with the present policy of centralising surgery and skilled medical treatment in district hospitals that draw their patients from very wide areas. This applies to both young and old patients.

But the problem is very different when the patient is recovering from an operation or illness, or is not seriously ill but is suffering from a deterioration in physical condition due to age. The siting of the hospital, the distance from home and neighbours, is vastly more important for the elderly patient than it is for the young. The young usually have a husband or wife, or a parent, sister or brother, earning a wage that enables them to afford to travel the long distances to the far off hospital on visiting days, and they have an urge to do so. But the contemporaries of the old do not have the means to travel those distances or the physical capacity to do so. Just because the greatest problem of the old is loneliness, there are very few who want to go to the trouble of visiting the old when they are in hospital some distance away.

There is, therefore, a need in rural areas for a pattern of hospitals, with large district hospitals that cater for serious operations and illnesses and a number of small hospitals that will nurse patients when they are convalescent, and in particular treat the elderly patient suffering from minor disorders. But under the Government's present policy such small hospitals are not being built, and many existing small hospitals are being closed.

This policy is as uneconomic as it is inhuman. The present cost of a patient in a district hospital is about £42 a week. In the small cottage hospitals, though it varies from region to region, it is below £30 a week. Therefore, by closing these small units and building large new units for elderly patients, we are wasting money as well as manufacturing suffering.

Let me illustrate the position from my constituency. In the area of Ryedale with a population of 32,000, there are no geriatric beds but patients have to be sent either to Scarborough or Whitby, which are from 25 to 35 miles away, or to York or Driffield, which are from 30 to 40 miles away. Fortunately there is in the centre of this area at Kirkbymoor-side an orthopaedic hospital which takes some elderly patients.

A fortnight ago there were 12 elderly patients who could be classed as geriatric patients. Sometimes the figure is as low as six. Under the Government's policy of closing small units, this hospital will be closed at the end of 1969. Every plea which has been made that the hospital should be kept open for elderly patients, closing the orthopaedic side, has been turned down.

Next year, the whole of this area, which has one of the highest proportions of elderly in the population, will have no geriatric bed within 25 miles and in the whole area only eight geriatric beds for 1,000 old people, whilst in the other areas of this country the figure is normally from 13 to 16 beds per 1,000 of the population.

Two consequences arise from this. Waiting lists build up at the district hospital and the elderly in rural areas that are remote are not on the waiting lists because they are reluctant to go to hospital and leave their homes for what they suspect will be for the last time. Last year, 57 people from this area died in hospital. Only one died in the orthopaedic hospital I have mentioned. All the remainder died in hospitals which were from 25 to 40 to 50 miles away from their homes.

It is this situation on which I believe historians in future will base their accusation of this generation of barbarism and inhumanity towards the elderly. What is preventing a change of policy to secure for old people hospitals near their homes where they can be visited by their relatives and friends and looked after and cared for by local nurses and doctors? I put this question to the Secretary of State for Social Services on 3rd March. I quoted the illustration I have given. I should like to read you his reply, Mr. Speaker. He said: The prime objective of hospital care of old people should be rehabilitation and return to the community. It is essential that such care should be supervised by experts and conducted by a qualified team working in properly developed centres with full facilities. An inevitable consequence of providing this level of care is that those living remote from these centres will not be near their homes when they are in hospital. This is very clearly put, and it is the whole fallacy in the present policy of the Ministry. These old people must be cared for by experts when they are ill. Good heavens, is not the local G.P., who spends his day working on his rounds, seeing these old people every hour, who has done that year after year, as great an expert as any in this country on how to treat these old people and their illnesses?

I remember that when I was Minister of Health I went to what was then the most up-to-date geriatric centre and watched the modern ideas of the expert. The old people were taken up parallel bars and exercised, and I was told that they never returned to that hospital. This is not really the most humane way of treating the normal geriatric case. The normal case of the elderly person in hospital can best be looked after by a G.P., working as a clinical assistant in a geriatric hospital.

On that day, when I questioned the Secretary of State, I went on to ask questions about hardship. I quoted figures, and he said: I think he has given the figures correctly for beds in geriatric wards of hospitals. I made a special study to see what the provision for old people's homes was in the area and found that there the accommodation was by no means inadequate by average."—[OFFICIAL REPORT, 3rd March, 1969; Vol. 779, c. 6.] One cannot, in dealing with sick old people, say that it is all right, we have not got enough hospital beds, but there are some good hostels for old people provided by the local authority. My local welfare authority has discharged its duties, but the Minister is failing to discharge his. I beg the Minister and the House to reconsider the whole of this policy towards old people. Let the Minister visualise the fears of old people, knowing that they ought to go to hospital, but thinking that if they do they will never come back; they will be wrenched away from their homes and friends, taken to a long ward in some distant hospital, to be cared for by strangers and never again have sight of anyone or anything that they have known in their 70 years of life. Is it any wonder that when old people go to these distant hospitals they deteriorate, crumble and die?

It is a sad reflection, even on the procedure of this House, that the only way to raise a question like this, which affects 20 per cent. of the population, is to do it at five minutes past three o'clock in the morning. While the Minister of State, who is to reply to the debate, has great talents and great humanity, he has got no responsibility for this problem. It is a sad reflection that this matter which intimately concerns the constituents of every one of us is not his responsibility. The Minister responsible is not in this House but is in the other place.

I thank the hon. Gentleman for coming to reply to this debate. I beg him to take this matter back to the Ministry and to discuss it with the Minister responsible. This is not a party matter. Both parties have been culpable. Let us try to achieve a better policy for the treatment in hospital of old people in rural areas.

3.5 a.m.

The Minister of State, Department of Health and Social Security (Mr. David Ennals)

rose—

Mr. Speaker

The hon. Gentleman needs the leave of the House to speak again.

Mr. Ennals

I was about to ask for leave to speak again, Mr. Speaker.

I am grateful to the right hon. Member for Thirsk and Malton (Mr. Turton) for raising this matter, though it be at this late hour. He has shown a great deal of knowledge and humanity in raising it. I know that he feels deeply about it on behalf of his constituents. He and I have discussed it previously. What he has said about old people naturally arouses the sympathy of hon. Members. I was sorry that on one or two occasions he perhaps over-stated the case when he talked about barbarism and cruelty in the National Health Service. Very much of the lack of care for old people in the past has been due to their neglect in geriatric hospitals. Certainly there is no complacency in my Department about the problem.

In view of our inheritance of very old hospitals which were inadequate to meet the needs of this generation or of a past generation, and in view of the very inadequate expenditure on hospital building when the right hon. Gentleman was in office, it does not come well from him to accuse the present Administration of barbarism and cruelty. We are seeking to tackle a chronic problem in the care of the elderly. We should not always generalise. When we talk about the care of old people, we are sometimes talking about those who through illness have come into hospital but who, we hope, will not spend the rest of their lives in hospital. The right hon. Gentleman's assumption that an old person admitted to hospital is ipso facto there for life may have been accepted by a previous generation. It may even have been accepted when he was in office. We certainly do not accept it today.

Increasingly the responsibility which falls on the hospital service, the doctors and nurses is, first, diagnosis and, secondly, active treatment. In many ways, improved treatment and equipment can ensure that a larger number of people admitted to hospital at an old age are restored to health so that they can return to life in the community. Too often in the past have we supposed that we are dealing with terminal cases, that it was simply a matter of a little kindliness, that specialties did not matter, and that the general practitioner could look after the continuing long-term needs of patients who would remain in hospital. There is such a category, but happily it represents a decreasing proportion of old people who will be admitted to geriatic hospitals.

Mr. Turton

The hon. Gentleman is right generally. But does not he realise that by taking the old person away from his locality and sending him to a distant hospital he is making his chances of recovery much less than they were in the old days when he was in a cottage hospital near his home?

Mr. Ennals

That is a problem we have to balance. We have to take into account the advantage that exists where we have the modern facilities of a district general hospital that has all the specialist care and ancillary services to enable patients to be restored to health and to return home. We have to set that against the disadvantage of patients having to travel a great distance. I recognise that we have to seek a balance in this respect.

If the right hon. Gentleman talks about the old days—and one can apply this to psychiatric and psycho-geriatric cases—the assumption then was that for an old person to be admitted to hospital was in a sense a conclusion of a problem, whereas today we are concerned that a patient, be he or she psychiatric or geriatric, should be returned to the community.

Mr. Eddie Griffiths (Sheffield, Bright side)

The point which my hon. Friend has missed—and I take up the point the right hon. Gentleman opposite made—is that people admitted to geriatric wards generally have no hope of being reclaimed to their normal domestic environment. I should like to speak about the particular example of my own father—

Mr. Speaker

Order. Interventions should be brief. They cannot be speeches.

Mr. Griffiths

One point which the right hon. Gentleman opposite made was that a lot of geriatric sections would not be in new modern buildings, but are like the workhouse which we knew in earlier days under a Tory administration. I do not wish to make political capital out of this.

Mr. Ennals

Of course, there is political capital to be made out of it, but I am not going to make it.

It is essential that we should get away from the concept that the geriatric hospital is the workhouse hospital and that the purpose of the geriatric wards is to provide for the last few years before death. This is not the concept of medicine today and increasingly the concept is that patients should be rehabilitated and that the maximum proportion of people should return to the life of the family and the community.

I accept that there will be a proportion, but a small proportion—increasingly small—of elderly patients for whom the highly developed resources of a geriatric unit can do little, but who are in need of nursing care. It is the second group about whom I am talking. Some may be admitted to hospital in the expectation and hope that they may return but they may not be in this position. Our concern is that, where possible, long-term geriatric patients should not be far removed from family and friends and there should be sufficient transport facilities for people to be able to visit them, and that they should not be cut off from the community.

This is especially so in rural areas and I am not arguing that all patients in a geriatric ward must be treated in the district general hospital. I am saying that it must be so for the majority. However, one must recognise that there will be a proportion of patients who will not be expected to be totally rehabilitated, but for whom it is important that there must be prolongation of a useful life in the community.

The right hon. Gentleman opposite referred especially to the Ryedale area of the North Riding, and this raises a number of issues which flowed from or led up to the issue of Adela Shaw Hospital in Kirkbymoorside. This hospital is a specialist hospital and has for some years been providing facilities for elective orthopaedic work for a large part of the Scarborough and North Riding area, as well as services for a number of long-stay children, most of whom come from outside the area.

The decision to remove these services to new accommodation in Scarborough and elsewhere was taken for good reasons, on which I need not enlarge in the present context, since the hospital has never provided a geriatric service. It is true, as the right hon. Gentleman said, that from time to time a number of elderly patients from the local area, who would be better described as geriatric patients rather than orthopaedic patients, have been accommodated at the hospital. But they have been only a small number, and that has not been the principal purpose of the hospital. It was done by local arrangement when there happened to be an orthopaedic bed available at the time. In no sense has the hospital ever offered a regular or substantive geriatric service.

The right hon. Gentleman gave the population of the area as 32,000. I think that that figure includes Malton and Norton, where there is a small general practitioner hospital. The figure of population which I have for the catchment area of Ryedale is only 19,000, though we need not argue that further now.

As the right hon. Gentleman knows, there has been long, careful and detailed consideration about the future of the Adela Shaw Hospital by the Leeds Regional Hospital Board and by my right hon. Friend the Secretary of State. The fact that the Leeds Regional Hospital Board, as the responsible body, finally decided to recommend the continuance of out-patient service at the hospital is an indication that it is ready to consider with great care local representations made to it in matters of this sort. It has been decided to continue the present level of hospital out-patient service there, and this will mean for old people that they will not have to travel greater distances away from Ryedale. They will be able to undergo out-patient treament there.

In a situation of that kind, the facilities of a health centre may well ease the difficulties. I am glad to say that the county council for the North Riding of' Yorkshire is considering the provision of a health centre in the Ryedale area and will be bringing the regional hospital board and other interested parties into its consultations on the matter. I imagine that that will be encouragement in the area.

Now, the question of in-patient services. The scale of provision of geriatric beds in hospitals in relation to the population served at present varies, for historical reasons, quite considerably from one area to another. The recommended national average is 10 beds per 1,000 of the population aged 65 and over. A major factor in judging whether this national standard reflects the need in a particular area is the extent to which the various community services for the elderly are developed—for example, residential homes, sheltered housing, home nurses, home helps, as well as day-hospital and other out-patient services.

Reverting to a point made by my hon. Friend the Member for Sheffield, Bright-side (Mr. Eddie Griffiths) as well as by the right hon. Gentleman, I believe that the very improvement in community services provided by local authorities will lessen the need for people to be taken into geriatric hospitals. I have no doubt that there are today a good many people occupying beds in geriatric hospitals who ought not to be in hospital and who would not be there if better services were provided in the community.

In the area with which we are here concerned, Scarborough, Ryedale, Mal-ton, Norton, Whitby, Bridlington and Driffield, with a population of about 180,000, the proportion of geriatric beds is 10 per 1,000 elderly people, which is the same as the national average.

As I said earlier, we have to strike a balance in meeting the need to provide the most modern diagnostic and treatment facilities in our district general hospitals, and particularly our improved hospitals. The Leeds Regional Hospital Board has plans for considerable developments for the geriatric hospital services in the area about which we are speaking, including considerable new accommodation in Scarborough and new units in Whitby and Bridlington. We have to balance this with the problems of transport and communications and the need of patients to maintain contact with their communities.

I assure the right hon. Gentleman that, when considering any proposals for closing geriatric hospitals, my right hon. Friend will certainly take due account of any increased difficulty there may be for visiting long-stage geriatric patients. As I said to him, I have great concern that old people who may not be able to return to health and return to their communities should, so far as possible, live in hospitals where they are in touch with their friends and relatives, in order that in their last days they are not out of touch with the communities of which they have been such an essential part.