§ 3.59 p.m.
§ Mr. James Kilfedder (Down, North)
Having left this House at a few minutes after 6 o'clock this morning, I may not display the fervour that I have for the cause about which I am speaking in this debate. By means of the debate, I hope to draw attention to the great sacrifices being made by countless women throughout the United Kingdom who care for elderly or infirm relatives. The national conscience must be made aware of the contribution which the dedication of this group of single women makes to the community, and the economic and social deprivations which they suffer as a consequence.
It is particularly appropriate at this time to call attention to their plight in the last debate before the House rises for the Summer Recess, because two weeks ago—
§ It being Four o'clock, the Motion for the Adjournment of the House lapsed, without Question put.
§ Motion made, and Question proposed. That this House do now adjourn.—[Mr. Weatherill]
§ Mr. Kilfedder
A worthy organisation, the National Council for the Single Woman and her Dependants, published a fortnight ago a report on the cost to a single woman of caring for elderly or disabled relatives. The report is merely a summary of a study carried out by the organisation amongst some of its members, and it is only a preliminary survey giving the first indications of the nature of the problems facing single women who look after dependants in their homes.
I earnestly hope that this report will reach the notice of all those who show a concern for social welfare and community well being. It is bound to strike a chord of sympathy with anybody who reads it.
I know that my right hon. Friend the Secretary of State for Social Services has over the years displayed a deep interest in the work of this organisation, but I fear to mix my metaphors, that the financial watchdogs will keep a tight rein on 1117 him now that he is in a position to do something for these worthy people.
I and my hon. Friend the Member for Lancaster (Mrs. Kellett) know of poignant examples of hardships endured by single women who care for elderly or disabled relatives. I know of them in my constituency, I know of many cases throughout Northern Ireland, and I know of cases here in London, cases which I came across when doing voluntary work with a citizens' advice bureau.
Unfortunately, unless one knows directly of actual cases it is difficult to appreciate the trials and tribulations which the single woman endures who cares for a dependent relative. Regrettably, most people, if they think of the situation at all, conjure up in their minds a picture of a spinster daughter sitting comfortably at her fireside with her dependant in another armchair, both basking in the warmth of the fire, basking in the enjoyment of each other's company and feasting on that sort of contentment, a contentment which other people do not enjoy. This may be true in some cases, but it is true in only a small percentage of cases, The comparison is drawn between the single woman looking after a dependent relative at home and a woman going out to work, giving the impression that the working woman has to strive harder to earn her money.
The comparison has been drawn with the married woman. It has been pointed out that the married woman must rear a family, feed it, clothe it, and bring up a noisy family of children. Despite all the work involved in that for the married woman, the work of the single woman looking after and caring for a dependent relative is far greater.
The single woman with that responsibility faces a bleak future at this time. The reality of the single woman with dependants is harsh and sad. No working woman would, knowing the conditions that the single woman looking after a dependent must suffer, give up her weekly wage packet to work long hours for a mere pittance. Nor would a married woman exchange her situation for that of the single woman who had charge of a dependent relative.
1118 According to the report of the National Council for the Single Woman and her Dependants, the majority of single women questioned have given up work to look after infirm relatives when they themselves were between 40 and 50 years of age. Not only do they surrender a reasonable income, thereby suffering a substantial fall in income, but they sacrifice the prospect of promotion and bonuses and they undergo a reduction in pension, if not loss of pension rights altogether. They resign from their job, with its daily contacts with people, annual holidays and the rest, and they have little prospect of returning to work because, by the time their dependant dies, they are often too old for work or, perhaps, are living in an area where it is impossible for them to find work suitable for their age. A great number of the women questioned by the National Council had to give up not only their own career but a great deal, or all, of their social life as well.
Financial worry presents, perhaps, the greatest problem of all. With a much reduced income, there is no chance of putting money aside for the future, and many found that they were forced to spend their small savings to keep their dependants and to meet expenses for the maintenance of the home. It is not surprising, therefore, to find that 31 per cent. of those questioned stated that their health was deteriorating through strain, anxiety and sleepless nights. As the report states, these single women with dependants are subjected to a general lowering of standard of living in all respects, and their long-term future is bleak.
These women face a tax discrimination, too. I do not wish to deal with it at length, for time is short, but, briefly, unlike widows with young children, the single woman with an elderly dependant cannot claim the benefit of the housekeeper allowance. Looking at the position as a whole, I consider that an effective case could be made out for the incorporation in the national insurance scheme of a new category of unemployed, that is, those who have voluntarily given up employment in order to look after a relative at home, a relative in need of constant care and attention who might otherwise have to go to hospital, there 1119 to be a charge on public funds. I understand from the Ministry that the average cost of a hospital bed in a long-stay hospital is £23 a week, and in a geriatric hospital £21 3s. 6d.
The single woman who takes care of an elderly relative rather than put him or her into an old person's home or a hospital is thereby saving the social services a considerable amount of money. There is a strong case for making a payment towards these single women who give up their employment to look after the elderly or the disabled.
The unemployed are ordinarily able and willing to work and are looking for work. The single woman who has to give up her employment in order to look after an elderly or infirm relative is not looking for work, She would like to be free to do so, but she is voluntarily unemployed, yet working harder and for far longer hours than many who are in well paid employment. Those who have lost employment as a result of economic factors have expectations of finding another job. The single woman in these circumstances, however, has no such hope. She would not be able to seek outside employment until death has released her from her charge, and at that stage, as I said, she may well not be of an age which would enable her to find work. Therefore, a single woman who gives up her work should receive the same amount of money as a single woman who is unemployed—£5 a week.
I should like my hon. Friend to ask the National Insurance Advisory Committee to examine the problem and perhaps consider the suggestion I have made that the National Insurance Scheme and the National Insurance Fund might be expanded to include a suitable payment for a single woman who cares for an elderly or disabled relative at home.
I know that hon. Members on both sides have a great feeling for this dedicated group of women. It is not just a case of their escorting their relatives to the lavatory occasionally during the day. The person looking after a bedridden relative has to change the bed constantly and lift the relative and take him or her to the lavatory. She must constantly be in attendance and engage in heavy physical labour. Therefore, there is a strong case for the Minister's agree 1120 ing to my suggestion that such people, who have a bleak future, should receive from the social services a figure—I have mentioned £5 a week—which would not even recompense them for the work involved and would not match our feelings about the sacrifices they make.
§ 4.12 p.m.
§ Mrs. Elaine Kellett (Lancaster)
I, too, pay tribute to that very unselfish band of women who devote their lives to caring for the elderly. Many men do likewise, but they are outside the scope of the debate.
All such women run the risk of ending their lives in a more bitter loneliness than any of us is ever likely to face. My hon. Friend the Member for Down, North (Mr. Kilfedder) has spoken of the cost in hospital beds that they save. In December 1968 there were nearly 100,000 people over 65 in local authority homes. The average cost then to the nation and the ratepayer combined was £11 2s. a week. It may well be much nearer £14 today, quite apart from the vast capital sums involved.
The sample survey to which my hon. Friend referred revealed that about 200,000 women are looking after elderly dependants, or have done so during their lives. If those women were to throw down that burden the numbers in local authority homes would treble overnight.
My hon. Friend also used the word "countless", and as in so many social problems this is the crux of the matter. We do not know how much bigger the problem may be in reality. We must have an accurate picture, and we can only get it at the forthcoming census. I know that some of the questions may already have been prepared, and that printing may have begun, but it should not be beyond the wit of our civil servants to add a question to the census asking how many people are looking after elderly dependants, so that we can get a true picture of the position today.
My hon. Friend dealt very kindly and fully with the position of the woman who has given up her job to look after elderly relatives. They may well be helped by the Bill, which has happily gone through both Houses, to give pensions to the over-80s and a constant attendance allowance. But the woman who still works is also in a difficult position, because her relatives may well not 1121 qualify for the attendance allowance and yet need much more during the day. These women, too, need help. They face a lowering standard of living throughout their lives, because so often they must take only part-time and poorly-paid work.
I believe that it is possible when we have the information to set up boards to go through individual cases, boards arranged on an area basis and composed partly of medical people and partly of lay people, with a sprinkling of social workers, to work out a proper category for these women and to give them the help that the nation so rightly owes them.
§ 4.16 p.m.
§ The Under-Secretary of State for the Department of Health and Social Security (Mr. Michael Alison)
I am obliged to my hon. Friend the Member for Down, North (Mr. Kilfedder) and my hon. Friend the Member for Lancaster (Mrs. Kellett) for giving the House the opportunity to have this short debate, although I must say that half an hour is scarcely sufficient to do justice to a subject of such wide interest and such far-reaching implications for social provision. It is agreed on all sides that our country would be much poorer without those who are sometimes rather unfeelingly called single women. Some of the women we are discussing have already given a lifetime of devoted service, frequently in trying circumstances, such as those my hon. Friends describe. There is little doubt that individual families and society in general expect a great deal from the single woman.
With the restricted scope of the debate, it is only justice that it has to be confined to the single woman, although one has to recognise that there are others in a broadly similar position, for example, the husband or wife with a severely disabled partner, the widowed mother with a handicapped child, the man who, perhaps because he has no sister or other female relative, assumes the rôle of nurse to aged parents.
It is not as easy as it was once, I admit, to find single women to assume the responsibilties of an unpaid attendant on behalf of the family and the community—and I recognise the community implications of the rôle they play. But there always will be such women whose financial and social position has 1122 been radically altered by the age or disability of relatives and the demands which are placed upon them, and it does not do to take their sacrifices for granted. This is another reason why I am grateful to my hon. Friends for focussing attention on this issue.
Last week's "National Dependants' Week", sponsored by the National Council for the Single Woman and Her Dependants, has provided us with a healthy reminder of what is involved. Looking over the studies produced by the National Council and listening to this short debate, I find myself thinking more of what the community can do to help than of what the State can do to help, but I assure my hon. Friends that this is not an excuse for seeking to dodge or avoid necessary public expenditure.
But the State cannot make good, for example, a number of the liabilities and hindrances which my hon. Friends mentioned, for example, the loss of social life, the loss of career or marriage prospects, a sense of loneliness, the fear that being needed all too much at present will in time give way to being needed not at all by anybody. There is a real sense in which these losses and these privations cannot be costed or quantified in money terms.
§ Mr. Kilfedder
Would not my hon. Friend agree that there is a substantial saving as a result of the dedicated work that these single women do—and I am referring only to those who have to give up their employment—and could not that be recognised as I have suggested?
§ Mr. Alison
I take the point. I will not dodge the issue of financial liability, but it is worth pointing out that there are aspects which cannot be quantified or costed in money terms. Friends and neighbours can do something. I am impressed by the fact that the National Council is clearly meeting the need simply for somebody to talk to who understands the problems. It creates the impression of a body of people who are concerned, involved and interested which is a substantial contribution in itself. I sometimes wonder whether we are not just as ready to let people be cut off from our neighbourhood and community life as we are reluctant to welcome people from institutions back into community life. Perhaps the problem is that sometimes 1123 there is no real community life into which people can be fitted or in which they can feel they have a place. This is why the easy way out often is to take refuge in the rather impersonal State provision.
Hon. Members will be aware that the National Insurance (Old Persons' and Widows' Pensions and Attendance Allowance) Act received the Royal Assent yesterday. The attendance allowance which it introduces is to be paid to the person requiring attendance rather than to the person giving it. There are two reasons for this. Firstly, the range of people giving such attendance is very wide. There may be various members of the family of both sexes or there may in some cases be a paid attendant waiting upon such people. Secondly, we think it is important that the extreme physical dependence of these severely disabled people should be counter-balanced to some small extent by a measure of financial independence. But the allowance will, when it becomes payable, be a very real improvement for families containing the most disabled members of the community, and, not least, for families consisting of an elderly and very disabled mother or father who is being looked after by a daughter. Similarly, the pension "as-of-right" for the very old, which the Act also provides, will almost certainly help some among the families with whom we are concerned this afternoon.
Hon. Members are also well aware that, when a single woman is required at home to care for elderly or ailing relatives who cannot afford to pay for her services she is entitled to supplementary benefit in the ordinary way and on the ordinary scales, including provision for rent and the 10s. long-term addition after two years. Additional payments can be made to meet special requirements not otherwise covered, and up to £2 a week of part-time earnings can be disregarded. And, of course, the elderly relative may in turn be entitled to supplementary benefit on the basis of his or her own resources and requirements. There may be instances in which two identifiable and distinct people in the sort of household which we are discussing will be entitled in their own right to supplementary benefit, with all the additions which I have mentioned. However, I 1124 recognise that there is beyond the demand, to which my hon. Friend the Member for Down, North referred, a demand for a special benefit for those who look after elderly dependent relatives which is non-means-tested. If I were to pursue this point, I should be out of order because it raises a number of other issues relating, particularly, to taxation.
My right hon. Friend the Secretary of State said in reply to my hon. Friend the Member for Tynemouth (Dame Irene Ward) as recently as Monday this week that we shall certainly want to consider carefully, in conjunction with our colleagues, the general position of single women attendants and their elderly relatives. More than this I cannot say at the moment, but this is a definite undertaking.
There is, however, one other aspect of this matter to which I should like to turn for a moment. There was common agreement between the parties that the Ministry of Social Security and the Ministry of Health should be brought together. The unified department emphasises the close link between cash and care. Cash benefits have much to recommend them as offering the beneficiary some measures of choice within the limits of the benefit level; but purchasing power perhaps more readily produces goods than it produces services. I am glad to acknowledge the progress made under the previous administration in this direction, and equally happy to give hon. Members the assurance that we are very well aware of the importance of home helps, home nursing, and the many other personal domiciliary services, and that we shall give their development every encouragement.
Coming fresh to this Department, I find one of the most encouraging and interesting developments of recent years has been the concept of sharing in caring, in which both voluntary bodies and local authorities have played a part. The contrast between care in an institution and care in a family need not be total. Both the person in need of the care and the family in which that person is can benefit from provisions which enable the responsibility to be shared.
It has long been thought natural, for example, that the responsibility for children should be shared between the 1125 parents and the community, and that children—not least disabled children—should spend part of their day in the family and part in a community—namely, a school—with their peers. This concept, is slowly being extended to the elderly and disabled through the provision of day centres and day hospitals and voluntary clubs. In addition, help is being stretched into the home by the provision of laundry facilities to relieve the family of part of the most unpleasant aspect of caring for the infirm—an aspect to which my hon. Friend the Member for Lancaster referred in her intervention. In this way, the family, whether it consists of two or more people, can provide a stable base offering continuity and a sense of being wanted, without proving claustrophobic, either for those giving the care or for those receiving it. Clearly there is much room for experiment in this field—
§ Mr. Ernie Money (Ipswich)
One aspect which causes grave concern to certain people in this position is that when holidays are provided for the old and the infirm the answer that has on occasions come from the Department has been that the single daughter looking after those parents loses her supplementary benefit for the period that the old parents are being sent on holiday because she can find a job for that period of perhaps two or three weeks. I hope that my hon. Friend will accept that it is quite impossible for somebody in that position to find a job during that time.
§ Mr. Alison
I am glad that my hon. Friend made that brief intervention. What he has said will be on the record. Therefore, I should like to look at it on the record to consider what can be done about it. I will certainly get in touch with my hon. Friend on that point.
1126 I was saying that there is clearly much room for experimentation in this field. I know that in some areas there is already provision whereby a severely disabled person in need of nursing care can alternate periods in residential accommodation with periods at home. I believe that this is moving in the direction to which my hon. Friend the Member for Down, North was referring, namely, the need to focus on the real contribution which the home can make to save the heavy cost involved in hospitalisation.
The National Council for the Single Woman and Her Dependants has done much sterling work in the seven years of its existence and very many more people are now aware of, and concerned about, the problems which the Council's publicity and unremitting efforts have highlighted. There is no easy solution, but progress is being made. And for this progress the Council and other voluntary bodies can take a good deal of credit. Looking at the list of distinguished members of both parties, including members of another place, who are or have been formally connected with the National Council, including my right hon. Friend the Secretary of State, I am sure it is safe to say that the particular needs of the single women who dedicate their lives to the care of the disabled or elderly at home will not be overlooked.
I am quite certain that my hon. Friends will keep us up to the mark in this respect.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Four o'clock till Tuesday, 27th October, pursuant to the Resolution of the House yesterday.