Amendment made: No. 25, in page 5, line 25, after 'hospital)', insert:
'and every Regional Hospital Board constituted under section 11 of the National Health Service (Scotland) Act 1947'.—[Mr. Alfred Morris.]
§ Mr. Deputy Speaker
Order. It may be for the convenience of the House to consider with it Amendment No. 27, in page 5, line 28, after 'disability', insert:'other than one admitted on geriatric grounds including precocious senility'.and amendment No. 28, in page 5, line 43, leave out'under the age of 50'.
§ Mr. Latham
As with the previous set of Amendments, I am moving the Amendment in place of my hon. Friend the Member for Manchester, Exchange (Mr. Will Griffiths), who is unable to be here. I shall move it briefly because the most important thing is not to impede the passage of the Bill.
The Bill as drafted makes a tremendous advance. In the past it has been possible for a person of any age to find himself, simply because he is chronically sick or disabled in some way, placed in a ward for geriatric patients which may well contain a majority of patients—if not all—who are not merely over 65 but well into their 70s and 80s. That that practice has occurred is nothing short of criminal, and we welcome the fact that the Bill seeks to remedy that to a large extent. But there is still the problem that, while it will not be possible for someone of 49 who is chronically sick to be housed in a geriatric ward, for a similar person who is just over 50 this practice could continue. I believe it to be just as criminal to put a young chronically sick or disabled person in his early 50s into a geriatric ward as those in the other categories which the Bill would preclude.
Amendment No. 26 would delete the words:under the age of 50900 and Amendment No. 28, which is consequent upon it, would delete a similar reference in line 43. It is acknowledged that there may be cases where it would be appropriate for a person ageing prematurely to go into a geriatric ward, even though he has not attained the age of 65, not as a direct consequence of his sickness or disability but as an indirect consequence, in that he has prematurely aged as a result of his incapacity or for some other reason.
I am in some difficulty because Amendment No. 27 includes a misprint or a mistake in drafting. I find the concept ofprecious senilityas described in the Amendment rather interesting. One could perhaps make some amusing attempts to define exactly the condition of someone who is senile and at the same time precocious. I am sure that the word intended is "premature", and it is to that word that I have addressed my remarks. I believe that the rules of the House prevent me substituting "premature" for "precocious". Therefore, it is difficult for me to press the Amendment in the form of words on the Notice Paper. Perhaps my hon. Friend the Minister could give an assurance that the word might be amended in another place.
I understand that one of the objections to deleting the age limit is that it is thought that sometimes, purely for reasons of administrative convenience, advantage might be taken of this to describe a person as prematurely senile with the result that someone under the age of 50 could still find himself in a geriatric ward. However, I think that we must have some confidence in the way in which the medical profession will act after the passage of the Bill, and I cannot see any justification for making this very arbitrary distinction between someone just under 50 who may be chronically sick but very young in heart and someone in the same frame of mind who is just over 50. I ask my hon. Friend to try to offer some justification for that. It escapes me. I also ask him to consider very sympathetically the difficulty in which I find myself as a result of the use of the wrong word in Amendment No. 27.
§ Mr. Golding
The Clause is a very big advance in our social legislation. It has been brought about in great part 901 by the activities of Mr. Marsh Dickson and his national campaign for the young chronic sick. Everyone is indebted to him for the enthusiasm with which he has pursued the matter.
We are all very conscious of the distance the Government have gone in accepting the Clause, and we are indebted to them for accepting an increase in the age limit from 45 to 50. Any criticism we make must be put in the context of that general acceptance and their willingness to increase the age.
I hope, however, that this will be regarded as a starting point, because the important characteristic is not the degree of physical incapacity or the age of the individual. The important characteristic is the state of mind of the disabled person, and it will be equally undesirable for those aged 50 and over, if they are of an active disposition, to be in wards with geriatric patients.
This is something which the Government must consider seriously, either during the next week or so, or perhaps even in the months ahead. The important thing to do today is to emphasise that, although this is a great milestone in the treatment of the young chronically sick, and in the history of social legislation it is only a starting point.
§ Mr. Hugh Jenkins (Putney)
I hope that the Minister will accept the Amendment. I was not a member of the Committee which considered the Bill, but on Second Reading I said that perhaps the origin of public concern about this matter was due, at least in part, to an article written in the Guardian in December, 1966, by a constituent of mine, herself a chronically disabled person, Miss Pamela La Fane, who was in a geriatric ward from the age of 16. She is a close associate of Mr. Marsh Dickson.
Miss La Fane drew attention to the problems and difficulties of people in her condition when they found themselves in wards with people with whom they had very little in common in terms of age and condition. Owing to the efforts of Mr. Marsh Dickson and his colleagues, and to her own bright intellect, Miss La Fane was able to leave the geriatric ward, and she is now living in Putney, though, of course, not alone. Incidentally she is a member of the Putney Labour Party.
902 Unless the Amendment is accepted, someone who was almost brought up in a geriatric ward but is no longer there faces the possibility, as she grows older and passes the age of 50, of being returned to that ward. I can see no reason why being a disabled person or being chronically sick should make it desirable for a person to enter a geriatric ward at an earlier age than any other person. It does not seem to me that the condition of being disabled makes it more appropriate that someone should be regarded as being old before his time.
I hope that my hon. Friend will accept the Amendment. If, for reasons of wording, or anything of that sort, he feels that it is undesirable that the Amendment should be accepted, I hope that he will accept the Amendment in principle and assure us that it is not the Government's intention to leave in the Bill a provision which will make a person of 51, 52, 53, 54 or 55 feel that there is a possibility of his being returned to a geriatric ward. I hope that my hon. Friend will be able to remove that shadow from those concerned.
Although it may be slightly out of order, I should like to take this opportunity, not having been on the Committee, of saying that I have watched closely the progress of the Bill through the House, and that I am filled with admiration for the way in which it has been conducted through its various stages.
§ Mr. Alfred Morris
We are discussing one of the most sensitive issues dealt with in the Bill and I have a disturbing case to mention to the House.
In Standing Committee I said that Mrs. Harriet Keeling, of 34 Warham Road, South Croydon, herself a sufferer from multiple sclerosis, had written to me about a younger person suffering from the same disease who had been admitted to a geriatric ward. She said:She is an attractive, alert young woman, suffering from multiple sclerosis. She is very unhappy in her surroundings. She says that it is fatal to become fond of any of the old ladies in the ward, because they die so very soon. At the moment there is no one interesting to talk to in the ward.I contacted Mrs. Keeling to see whether it was possible to help this 903 lady in advance of the enactment of the Bill. Since then there has been a whole series of inquiries to see whether we could find less unsuitable accommodation, and I have now heard from Mrs. Keeling to this effect:I am told that she"—Beryl—is becoming vague and forgetful, in fact prematurely senile, at the age of 44.This case has upset me deeply, because it seems to show that if fairly young people are wrongly placed in a geriatric ward they can soon degenerate mentally to the point where geriatric accommodation is the correct provision.
I have said before that if a chronically sick young person is admitted to a geriatric ward this can add not only anguish but mental distress to physical disability. As my hon. Friend the Member for Putney (Mr. Hugh Jenkins) said, many young people who have been stricken by such complaints as rheumatoid arthritis, multiple sclerosis, and other grievously disabling diseases, are people of lively intellect. Their lively intellects are imprisoned in crippled bodies. If these people are in their 20's or 30's, and even if they are in their 40's or 50's, they desperately require accommodation suited to their age group.
There has been a reference to Mr. Marsh Dickson. Hon. Members who served on the Standing Committee will recall that I quoted a letter from his wife, who suffers from advanced multiple sclerosis, in which she said:The idea of having to spend even three months in a geriatric ward … horrifies me.She went on:I therefore beseech you … to ensure that this Clause is strengthened …".Mr. Marsh Dickson has done a remarkable service on behalf of the younger chronically sick. The National Campaign for the Young Chronic Sick has played a leading rôle in drawing the attention of the general public to the great importance of this issue. However, Mrs. Marsh Dickson is herself 49 years of age.
It was said in Committee that my right hon. Friend the Member for Easington (Mr. Shinwell), for whom I have some affection, is at the age of 85 any- 904 thing but geriatric. Were my right hon. Friend to be admitted to a geriatric ward, that might well do him mental injury.
I know that my hon. Friend the Under-Secretary, who is fully seized of the importance and sensitivity of this matter, recognises the difficulty. No one has been keener than he to find a solution which would be generally acceptable to those who have contributed to the debate. It may be that by excluding those who are "precociously" senile, we may find that some younger people in geriatric wards being classified as precociously senile so that the description of their condition will suit the accommodation. I fully recognise that there are tremendous difficulties.
I recognise two other factors. We have taken a great step forward in having Clause 16 as it now stands. We shall be putting this country ahead of many others simply because of that Clause. On his own initiative, my hon. Friend the Under-Secretary introduced Clause 17 which seeks to separate younger people from the very elderly in Part III accommodation provided by local authorities. I thank my hon. Friend and his officials for the great help which they have given me and the other sponsors of the Bill in that matter.
During the last five years, expenditure on hospital building has been doubled. This shows that the Government recognise the importance of modernising existing hospitals and building more hospitals. We need special units for the younger chronic sick. It may seem hard to press a Government who have doubled hospital building expenditure in the last five years, but we want even more.
I recognise the problems, but I ask my hon. Friend to look at this matter again. I know that he meets the problem with the maximum possible sympathy, but I would be grateful if he would agree to consider the matter again to see whether we can reach a position in which someone who is not geriatric shall not be placed in a geriatric ward, which is all we are arguing.
I pay tribute to the geriatricians, who do a remarkable job in helping very elderly people, but if a person is not geriatric, he should not be in a geriatric ward. I make this appeal to my hon. 905 Friend knowing how deeply he feels personally about what is certainly an extremely sensitive, if not the most sensitive, issue in the Bill.
§ 2.45 p.m.
§ Dr. John Dunwoody
I should like to endorse the view of my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) that this is one of the most sensitive and one of the most difficult issues in the Bill. I have listened with great care to the views of hon. Members in support of these Amendments. I fully understand their reasons for suggesting them and I appreciate the helpful way in which they have argued their case.
I have already acknowledged that it is unsatisfactory that action of the kind proposed in the Clause should depend, or may seem to depend, on the attainment of a certain age, but I must warn that if we abandon the age criterion now laid down in the Clause we must be certain that its replacement is superior. I am a little unhappy that the Amendments as worded may fail to achieve what I know to be the intention of the sponsors of the Bill, as it is my intention, that they may create problems not now apparent to the sponsors of the Bill.
The intention is to extend to the 50–64 age group the requirement in subsection (1) to use "best endeavours" and to make a report under subsection (2). It has frequently been said that many seriously disabled people in the 50–64 age group are far from senile and that it would be monstrous to imply that they could be best housed in geriatric wards. The difficulty is that the Amendments are not concerned only with geriatric wards, and their wording is therefore, open to certain objection. I share my hon. Friend's view that the state of mind is far more important than age. Chronological age is probably the least important factor in determining the most appropriate and correct form of care for a given individual.
May I outline how the Amendments would fail to achieve the intention? We are dealing here with a small band of people whose misfortune it is sometimes to spend long periods in hospital and who suffer from a progressive condition. Any Amendment must, therefore, take account of changes in the patient's condi- 906 tion since admission to hospital—and, tragically, this may sometimes be a long period—changes which will influence the clinical judgment as to the most appropriate place for the patient to be cared for. The Amendment does not take that into consideration.
There is a more significant objection. One of the problems is that the Amendments would imply that a patient admitted to hospital for long-stay care above the age of 65 would be wrongly placed in a ward with others of his own age if his admission were not on geriatric grounds. It is far from being the case that all long-stay patients over 65 are geriatric, which is a rather imprecise word, or senile. In this context, hon. Members frequently quote colleagues on both sides of the House who are well over the age of 65, but very far from being geriatric or senile.
I have in mind when talking of admission to long-stay units for people with mental illness or handicaps or chronic disabilities needing prolonged orthopædic treatment. There is obviously no logic or sense in having legislation suggesting that it is most appropriate that these patients should be in geriatric wards. If this were laid down by Parliament it would be difficult for people in the hospital service to take it seriously because they would not be patients of the type that I have been talking about. If they do not take it seriously we would not see their "best endeavours", to use the phase in the Clause, being exercised in a realistic way.
I recognise that the use of an age criterion is an arbitrary and unsatisfactory division. I can see how easily there could sometimes be tragic result when certain cases fall on one side or the other of the age barrier. We do not want to be diverted too greatly by this theoretical view from what happens in practice now and what I hope will happen more in the future.
The truth is that doctors already use their judgment about the most suitable place for their patients. They are no more likely, for example, to say that a geriatric ward is a suitable place for a lively-minded patient of 51 when the Bill becomes law, and if it remains as drafted, than they are now, even though the Bill specifically mentions the age of 907 50. My right hon. Friend is prepared to issue advice which includes this thought and refers to this assurance.
§ Dame Irene Ward
The hon. Gentleman says that the doctor, quite rightly, will exercise his judgment as to where a patient should go, but would he not agree that the doctor is restricted in that he cannot always get his patient into the hospital that he would like? Is not this one of the main features in our discussions on this part of the Bill?
§ Dr. Dunwoody
There is, of course, a real difficulty here. My hon. Friend the Member for Wythenshawe instanced the remarkable improvement in the hospital building programme in the last four or five years. This does not mean that we are complacent and do not believe that we still have a long way to go. There is the division of special units for the younger chronic sick. This is a valid point, but we have to concern ourselves with the Bill. There is the difficulty over accommodation, but I was underlining the point that we must have some confidence in the medical practitioner in these circumstances, and I have this confidence.
One of my hon. Friends referred to the use of the phrase "precocious senility" and asked whether this was not the wrong wording. Probably this phrase has been put in because it has a medical meaning. It is a medical phrase with a rather narrow technical meaning, and I am not sure that it is necessarily appropriate. I am not certain that it would cover all of the types of case which the sponsors of the Bill want it to cover. There are certain sorts of case, perhaps pre-senile dementia, which would not be covered by the use of this phrase.
These are some of the difficulties. I have given these matters careful consideration because I want to help the House. I feel strongly about this part of the Bill, and at all costs I do not want to write something into it that could make what is inevitably a somewhat difficult situation even more difficult.
I know that hon. Members would like me to give an undertaking that if the Amendment is withdrawn I will recon- 908 sider the matter with a view, possibly, to introducing a suitable Amendment in another place. I give that undertaking, and I hope that it will be possible to devise a suitable Amendment which will ensure that the obligations in the Clause shall apply to all patients under the age of 65 except where, on clinical considerations, it would be inappropriate. It is a difficult task but we are united in wanting to be able to do this.
I hope that, as I have given this assurnace, my hon. Friend will feel able to withdraw the Amendment.
§ Mr. Latham
I am very grateful for that undertaking, and in view of it I beg to ask leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.