HC Deb 27 November 1970 vol 807 cc837-58

2.52 p.m.

Dr. Tom Stuttaford (Norwich, South)

I beg to move, That this House having regard to the fact that a greater proportion of the population is reaching old age, welcomes the promise of increased expenditure for this section of the community, but calls on Her Majesty's Government to continue to improve the medical and nursing care available for them in hospitals, and to provide more facilities for home care so that they may continue to live a reasonable life in their own surroundings for as long as possible. I feel very conscious how lucky I was in the Ballot. All of us will grow old, and this is an important Motion, I feel, not only from a constituency point of view but nationally—and I do not think that its importance is in any way affected by the fact that the House at the moment is as crowded as a church at the time of a pauper's funeral.

Old age is inevitable, but senility is not, and it must be our ambition to see that when we grow old we retain our vigour, and our policies should be directed to this end. The proportion who are ageing in society, those over 65, has increased enormously in the last 70 years. Society has not measured up to this challenge.

We have to realise that we are not dealing now with the old normal three-generation span, but four generations: people are marrying younger and living older. This will present a greater strain on the community's services and on the individuals caring for the sick and the old. The figures are interesting. The proportion of the old has gone up from 5 per cent. of the total population in 1900 to 12 per cent. today. Their number, of course, is even greater; it has gone up by several million, a fourfold increase.

All these must be cared for. It is the duty of the community to come to terms with this problem of accepting the elderly, and of accepting them as partners, as citizens, together in the community. They have a rôle to play. It must be seen that they have to play this rôle for as long as possible. Their rôle is not that of the Victorian grandma who could sit with her cap on her head by the fire. If we fail to integrate this section of the community with the rest of the community we shall not only be indifferent and cruel, but we shall be laying up for ourselves a problem which will be an extremely expensive one, because indifference to the aged begets disease, and disease cost money.

People are living to a greater span of time because of improved treatment, because of improved housing, and because of improved working conditions. Partly too the proportion of the elderly has gone up in the last 10 years because the birth rate has been falling. This means that the numbers of old people have not increased as much as they will in future. In the next 10 years we shall see the effects of the modern drugs, which have been applied now for some 10 to 15 years, and which will keep more and more people alive for a greater time. Up to now the life expectancy of the 70 year old man has only gone up by two years. More people have reached ages between 70 and 80, but we have not increased man's life span by more than about two years up to now. Now, however, we are going to; now more people will reach the age of 80 and above than in the past. It is the last years which are expensive.

That is why I welcome the Government's announcement on 11th November that they are to spend some £300 million on the old and incapacitated over the next four years, of which £40 million will come out of funds available for the mentally afflicted. That sum is not enough, as we all know, but we hope that it is a sign that we shall get even more later. At any rate, it is a start and shows that the Government recognise the problem. We shall be doing rather better than did the other side: it is a 6 per cent. increase in cost as against the 4.7 per cent. increase promised by the previous Government for this year and the 4.3 per cent. they showed for last year.

When discussing the old we must consider why the problem they represent is beginning to become so prominent. It is not only that there are more of them and that the proportion is getting greater but that families are becoming smaller. As that happens there are far fewer unmarried daughters to live at home and care for elderly parents; fewer married women who can be spared from the rest of society, their friends, their work, and their husbands and children.

In addition, this is essentially a rootless generation. As one time it was always possible in any area to find members of a family who could spare the time to come in and care for the aged. That state of things is disappearing, too, and must be taken into account when we discuss community care. One can no longer rely entirely on the family. It is certainly unfair and unreasonable to expect it. They have the additional generation to look after, and they have their own lives to live, emotionally as well as physically.

It is a considerable problem. Doctors know that one can never tell what will happen after an old person who was gay and bright and cheerful has developed some disease. One never knows what one will be left with. One hopes that one will be left with the same gay and cheerful person, but too often one is left with someone whom disease has left a senile mental wreck. A little later I want to consider in greater detail the problem of senile dementia. We know that 50 per cent. of the places in mental hospitals are filled by people of over 65 years of age.

Let us now consider those receiving physical treatment in geriatric hospitals. The situation is far from satisfactory, and those hospitals will need every bit of a half share of that £300 million. Geriatric medicine becomes more scientific and detailed and, from the clinical point of view, more effective, but it does not always ease the load on the community services.

Geriatric medicine has now become a science and is losing its custodial rôle. Patients are admitted in what is called the "revolving door" principle—one person out and the next person in. There is now no question of putting up extra beds to cope with a flu epidemic: if there is not a bed available, the patient stays at home. In the past, our geriatric hospitals could provide a nursing service for the old and elderly when they became ill, and it was a great consolation to the family doctor to know that if patients were too ill any longer to be nursed at home the local geriatric hospital would take them in.

We must put forward a defence for what has occurred. The cause is not some bloody mindedness on the part of the geriatrician, but the difficulties he has in providing nurses and junior medical staff. He knows that if a lot of his beds are filled with long-stay cases he will not get nurses to come forward, nor will scientifically trained and mentally active junior staff come to a hospital where much of the work only means looking after those awaiting death. That being so, the geriatrician does not admit the cases, and they lie at home. Normally, in summer it does not matter, but in the winter, if there is an epidemic, it can be very difficult and serious for the individual.

It must therefore be our job to see what we can do to find some cheaper method of caring for these people. I have here figures relating to the care of people in the various types of geriatric ward in Norwich. It costs £32 a week in the acute geriatric ward, which is very much less expensive than the ordinary hospital bed. It costs £27 a week in a long-stay ward, and £22 a week in a chronic sick ward. This is opposed to £13 a week in an old persons' home. It can therefore be seen that we should try to keep cases which need medical care away from those hospitals where the cost is very high.

I think that the answer is the cottage hospital. I am not a great advocate of the cottage hospital for the treatment of acute diseases, but there are some things which are admirably treated in it. I think that the care of the elderly when they are suffering from the acute illnesses which they develop in the winter months is one of the services that it can provide so well.

The cottage hospital has another great advantage, and that is that it keeps the patient with the family. With a district general hospital it is all too easy for a patient to be whisked 30 or 40 miles away from his relatives, who then develop the habit of seeing him at very irregular intervals. The younger members of the family lose the habit of visiting, and the elderly person loses his family and friends.

A survey carried out about 10 years ago showed that the majority of those who admitted to being lonely the whole time had, at some stage or another been in hospital. Loneliness can be precipitated by a short stay in hospital, and therefore the preservation of the cottage hospital as a nursing and minor medical care unit within the community can be very valuable.

It must be our object to keep these people from ever getting into hospital, and to keep them mentally active and alert, and here we have to go right back to the war years. Unlike the debate last night, we do not have to start at 1825. During the war years old people, unlike every other group in the community, lived longer. They did not live for as long as old people do today with the help of modern drugs, but for a short while during the war the age at which death occurred was postponed. Why was this? It was not only a matter of improved nutrition due to rationing. It was thought to be due also to the fact that they worked longer and had a rôle to play in the community and in the family. Younger people being taken away for the war meant that elderly people felt themselves to be useful, and they lived longer.

One in three of our elderly today is lonely sometimes. One in four live alone, and one in 15 are lonely nearly all the time. This is because we run only crisis welfare services. We do not think in terms of preventive medicine, because we do not have the money for that. We think of the bill for the hospitals, and we think of the bill for the welfare services, but we do not link the two together. If we could get our welfare services running so that they stopped crises from occurring, it may be that patients would never have to go into hospitals at all. So long as we have a crisis service we are not carrying out any form of prophylactic medicine.

We must see to it that the old people get their fair share of housing. This has happened in the last year or two. The proportion of housing for the elderly has gone up rapidly. We in the Conservative Party like to feel that this is due to the increase in the number of Conservative-controlled councils. No doubt the Labour Party has a different explanation. It is a fact, however, that only in the last year or two have the elderly had anything like their share of the proportion of houses, that is 12 per cent. to 15 per cent.

We do not want just the sheltered housing in which we can put somebody who is decaying. We must stop this decay from occurring. We want sufficient groups of housing for the over 65's to be there for everybody of that age to move into should they need it. If they move in when they are young enough, they will not only help to care for their less fortunate neighbours but, by belonging to a community, they will live longer and happier lives.

The concept of the old persons' homes which exist in some areas today, I hope, will be as out of date in 10 years as the concept that Dickens had of the average boarding school. On the subject of the cost of feeding these people in old people's homes, I will give the figure for Norwich—and Norwich is good in its care of the elderly. They are fed on £1 6s. 7d. a week. That is less than the ration allowance which the Army had when I was in it 15 or 16 years ago. We now feed our old people on less than the figure on which the Army fed its soldiers 15 or 16 years ago, despite inflation, despite the cost of food and the cost of labour in preparing that food. Nobody in the Army would ever have considered that the rations they were given were sufficient. There was not another rank who did not go to the N.A.A.F.I. or the N.C.O.s' club to supplement his diet and there was not an officer whose officers' mess did not pay extra for food.

Yet in old people's homes they spend on food just under the cost of two meals in the dining room of the House of Commons, and that is not exactly luxurious fare. Out of this money the matrons have to set aside the money needed for the additional fare at Christmas and for other festivities. This is a very good measure of how in the past we have tended to regard our elderly.

When we design these communities for the elderly we must be very careful. Up to now we have tended to produce the usual set of almshouses tucked away in some quiet secluded spot in the country, or we have tended to buy a large Victorian mansion where urban dwellers can live in solitude, peace and unhappiness, or in the lower storeys or the ground floor of a multi-storey block of flats, or at the top of a block of flats if there is a lift.

Put them in a tall building, and they sit there in their chairs staring out at the sky. Put them on the ground floor of a block of flats, and they sit there staring out of their windows fearful that the neighbours' children will kick a football through the window and that they will be called upon to pay. Put them in almshouses, and they are isolated from the community. Isolation is the start of the break-up of any person.

What we need is to have special housing units within sight and just within sound of the rest of the community so that one can maintain the community which has grown up and maintain the traditions that we have always had up to now in British cities of having a village within the city where everybody will know everybody else. We must also see that our old people's homes are within the centre of a city.

When the new Welfare State started in 1947 we rather tended to copy the private hotel of Kensington or Chelsea and translate it to the needs of the ordinary working person, and so we bought the isolated mansion and put the people in it. Once they get there, there is nothing for them to do except to sit around the room and stare into space, and they literally twiddle their thumbs. There are always too many people within the home for any of them ever to get any really effective form of occupational therapy. This compares very unfavourably with the more modern homes where people can look out upon the community and still take part in community activities, and where the people become much more interesting people not only to themselves but to the other inmates and to visiting relatives. And here I will say a word to my own Front Bench. This process of change from the old to the new concept can be speeded up by making it easier to obtain loan sanction for new buildings.

I mentioned earlier the geriatric bed situation and said that I would return to it. I want to deal particularly with the mentally handicapped, those handicapped not by health but by age who are known as senile dements—a rather unpleasant Victorian term that has persisted until this day. All modern countries will have an increasing population living a cabbage-like existence as a result of the brain dying before the body. Once people have reached this stage, they are as happy in an institution as they are at home, and this is the tragedy. We must make certain that no one reaches this stage if it can possibly be avoided.

The establishment of day centres is all important. A day centre is comparatively cheap to run, and if people can be persuaded to go into a day centre before they lose their reason they may never lose it. The day centre in Norwich has an almost 100 per cent. success rate with people attending the centre for a time. The failures occur among those who are awaiting admittance. This residential unit has accommodation for 206 people and a waiting list of 106. As these old people die at the rate of 50 a year, the average person on the waiting list has a 1 in 2 chance of getting in. This is very worrying. One constantly comes across families which are being destroyed by the presence of a senile dement.

The unit is very progressive although it is badly housed. There is no nursing prolem, it has always been over-subscribed for nurses. Yet the geriatric service, because of the lack of nurses, has had to close down 70 beds and although the population has increased, the number of geriatric beds has not. In the last 20 years we have gained four beds whereas the number of people needing them has increased enormously.

To summarise, we shall achieve nothing if we see this problem entirely from the point of view of the care of the aged once they have become sick. We know that slightly less than £50 million per annum is additionally to be made available for people in local authority care. This is where the money can best be spent. By the provision of day centres, luncheon clubs and home help services we may achieve prophylactic medicine. There has been a lot of pious hope and not much cash. The Health Service and Public Health Act, 1968, gave everyone fresh hope, but since no money has been forthcoming that hope has not been fulfilled. The Chronically Sick and Disabled Persons Act was passed in the middle of the local authority financial year. If no additional funds are made available, it will be an entirely meaningless Act.

We need more funds, so that more people can be looked after in their own homes. It may be possible to house people in specially designed units, not for the decrepit but for those over 65, with a nearby cottage hospital keeping people well and fit even in their last illnesses so that they remain part of the community. We may find that we start by spending large sums of capital but end saving large amounts of income.

All the 12 per cent. of old people are individuals, and it can never be civilised to carry out an appreciation of an individual without thinking of his emotions and sensibilities. The prolonging or shortening of a life by a certain course of action is only one factor. The other factor is whether that life will be more or less happy.

Let me illustrate that by referring to a medical case which I came across in my constituency last week. An old lady of 88 had been admitted to the local geriatric ward for the second time this year. On the first occasion, she had had a benign but very large tumour removed. When she was taken back on the second occasion, it was for a medical condition from which she made a complete recovery. Regrettably, however, she developed gangrene in her left foot while she was in hospital. This is not only death-dealing but incapacitating. She refused treatment because she felt that she could not undergo the trauma of a second major operation in such a short time. The hospital said, quite rightly from a medical point of view, that since no more could be done for her she must be sent home. The welfare services take the line that although she has one foot that is dead and starting to rot at the toes, she can still stand on it. As a result, she has not received top priority for a welfare bed. She has been left. She says, "I am imprisoned in my chair." She just stares out of the window at the world outside. She can move only with discomfort. It is painful for her to go to bed. There she sits.

That is the level of the need for more money. I am grateful for the promise of more that we have had from my hon. Friend. I ask that it should be still more.

3.23 p.m.

Mr. Laurie Pavitt (Willesden, West)

I must congratulate the hon. Member for Norwich, South (Dr. Stuttaford) not only on his good fortune in the Ballot but on the way in which he has put his case. He spoke with cogency and with obvious compassion. He will find, as most of us do, that although we have profound differences, there is a great deal of agreement between the two sides of the House on most matters on the subject of health.

In some of his illustrations, the hon. Gentleman brought home to us not only his understanding of the problem but also its background. Time and time again he brought out the intense need of all old people to retain their dignity and independence. One of his throw-away lines revealed not only his understanding of old persons in the community and the geriatric ward, but he went on to refer to the problems of the family which highlighted the plight of an unmarried daughter, who looks after an aged parent. If he had had more time, I feel that we might have learned more about these very human problems.

One of the more fortunate facts of Parliamentary life is that both parties have recognised for many years the problems within the Health Service associated with the lack of money. When the Labour Government first came to office in 1964, hospitals were being asked to contain expenditure, but the two areas exempted from cuts were mental health and geriatrics. Of course we welcome the fact that whichever Government are in power recognise the importance of these two things.

The point of the Motion which I like very much and about which I want to talk most concerns not inside the geriatric wards but outside. The hon. Gentleman uses the phrase: … in and out of hospitals … In tackling this problem, the whole community must get away from its hospital fixation. At the moment, we are spending 68 per cent. of the money available for the National Health Service on running hospitals apart from the fact that next year we are to have an additional £120 million for hospital building. Yet in terms of old people the solution lies more outside hospital than ever it does inside. We have all had experience of the old lady or gentleman in the community who, when all the services break down that would keep them within the community, go into a geriatric ward, turn their faces to the wall and die within a week because all the incentive to live which they have had outside has gone.

Like the hon. Gentleman, I hope that we shall have more resources but I hope also that we shall get better orientation, and one of the basic things I look forward to from the Government is the speedy publication of the Green Paper No. 3, because if there is one area where we need integration between the three sectors—the hospital service, the local health authority and the general practitioner service—it is in the care of the aged.

But because we have a comprehensive health service, I am afraid that we are always having to ask ourselves what priorities we should have. If we are going to spend, for example, £10,000 on a heart transplant operation, is that more important than providing the money for 30,000 incontinence pads for the old people mentioned by the hon. Gentleman and who still need to be cared for within the community? A comprehensive health service does demand that for the aged we have a comprehensive community responsibility. This means that we must not just talk in platitudinous terms about the care of the aged. We have to be able to accept our responsibilities, and that means not only more public expenditure for care within the community, but more participation by all of us in the community in that care.

The kind of thing one hopes for is that some of the present breakthroughs on disabling diseases will be able to save some of the suffering which takes place in old age. One of the exciting facets of the last Medical Research Council Report was its reference to rheumatism and rheumatoid arthritis. There is a breakthrough here and the report talks of a new chapter being reached but we know that it will not be early enough to save the present generation of the aged from their suffering from rheumatism. I hope, however, that within five or six years the next group coming along will enjoy some considerable amelioration of the pain of rheumatism.

But in a number of these things we are only looking at the basic care and attention for the elderly person—the senior citizen—within the community, when we should also be looking at the question of other things which they also need. The provision of hearing aids, for example. I was shocked to learn that over 1,300,000 people over the age of 65 have hearing disabilities for which no action has been taken. There has been no attempt to get them any aural examination or give them some facilities to cope with their deafness despite the fact that the Government will provide them with a Medresco aid entirely free of charge, including free batteries for as long as they live.

The question of geriatric provision is also contingent upon how far we get on with gerontics. It is perhaps very probable that my grandchildren will live to be 100. What is just as likely is that, in some cases, they can become fathers at the age of 80 or 85 because they will remain younger very much longer. I do not know whether that is any great consolation to the female part of our population. We are not only putting back the age of death but are pushing back the age of ageing as well.

The hon. Gentleman is concerned, as we all are, that the cost of looking after the aged both inside and outside hospital is now £1,650,000 a year. The cost of the National Health Service as a whole is £1,800 million a year. In asking whether we can look after the elderly in the community and can afford to do so, we must not forget that we spend £5,600 million a year on wine, women and song. One can leave out the women but must include beer, cigarettes and gambling. What the hon. Gentleman has done by his Motion today is to bring our consciences to bear on all the money that is spent in our society on things which are not necessary when we could be putting more energy and resources into looking after the old.

If we are to decrease the number of old people in geriatric wards, there must be a larger, a greater expenditure, not on bricks and mortar, but on the services to support them. The number of cases—mainly the elderly—visited last year by home nurses was fewer than 1 million: 933,719. Since there are 600,000 elderly people living alone in the community, this means that there were only three visits per year per old person. The number of visits by home helps was 427,849, which means one-and-a-half visits by a home help per year for each elderly person living alone.

I am sure that hon. Gentlemen opposite as well as I myself have gone around with the Meals-on-Wheels visiting elderly lonely people. I have more than 4,000 such people in my constituency. They sit in one room surrounded by their possessions and if they are to be kept out of hospital they need to be fully supported. This means more home helps and more nurses to visit them; it needs more incontinence pads and more neighbourliness to prevent the most dreaded disease—that of loneliness.

The last matter I wish to raise is the welcome announcement yesterday from the Supplementary Benefits Commission in regard to the elderly. One of the problems in poor areas is that of coping with heating once winter sets in, and the Commission in raising the rates which they will now pay to all old people for heating will do a great deal to help these people. Some of these old people have been taken to Part 3 houses with central heating, but have had to turn the heating off because they could not afford to pay the electricity bills. They have then gone back to old oil heaters, with great risk to their health, and with the consequent fire hazard.

We must get away from the concept of the institution, and reach back into the community. There was an article in today's Guardian by that most excellent writer on health matters, Ann Shearer, which has a great bearing on this matter. She said in that article: The institution is nothing if not tidy to administer. Bringing services to people is notoriously hard work, when their individual quirks have not been crushed by the demands of institutional living. There is not much to show for the effort when people are cared for at home, either; the sum of their untidy small lives hardly amounts to a signpost to posterity". We keep on talking about increases in capital expenditure. We should be talking about spending much more on the day-to-day revenue account.

Mr. James Hill (Southampton, Test)

I appreciated the humour brought to this subject by my hon. Friend the Member for Norwich, South (Dr. Stuttaford) in a matter that can be said often to be humourless. In my own area the number of beds in the geriatric service has slipped from 389 in 1955 to only 368 in 1970. The cost of these beds is £37 a week; in regard to long-stay beds the figure drops to £23 a week. The local authorities in my area estimate at this moment that they need an additional 120 beds. In my area we are very fortunate in having a new medical school at the university and a professor of geriatrics who has been appointed to deal with the problem.

I attack this problem in the light of the last line of the Motion so that they may continue to live a reasonable life in their own surroundings for as long as possible. I have always maintained that one of the finest things a local authority can do is to put more money into warden-controlled flatlets for old-age pensioners. These are the answer; such accommodation gives the old people privacy and also an emergency service if they fall ill, because they can ring for the warden. It gives them a community of their own, which can be integrated into the normal council estates or even as infilling in the private sectors. Most elderly people would prefer homes of their own rather than being looked after in welfare homes. Non-warden types of old people's flats are very useful. They give old people the privacy they want and the ability to look after themselves, while maintaining in them a feeling for life. The general policy in my area is of infilling the low density estates with purpose-built O.A.P. warden-controlled flats.

Local authorities must take a certain proportion over and above that which they have taken in the past, and aim particularly at this type of building. But housing for the elderly must commence in their middle years. It is no good a person's being chronically sick at 65 because he has been poorly housed in his middle years. I realise that we must have more day centres, and not merely temporary ones. Another useful occupation for the elderly would be luncheon clubs. These are very desirable, and can be organised by voluntary bodies, but I should like to see local authorities taking them increasingly under their wing.

3.36 p.m.

Dr. Shirley Summerskill (Halifax)

The hon. Member for Norwich, South (Dr. Stuttaford) is to be congratulated on choosing this subject for his Motion. I think that I am right in saying that the last time the House debated the subject of the elderly was in March of last year. We all realise that a much greater proportion of the population reaches old age now. Due to medical advances and improved social conditions these old people are fitter and more active, have a longer expectation of life, and expect a higher standard of living than their predecessors.

Hon. Members have referred to the retirement age as being 65, but, in fact, it is 60 for women and 65 for men, although the expectation of life for women is longer than that for men. I need not go into the reasons for that, but some thought must be given at least to equalising the retirement ages for men and women. One person in eight in Britain is now over 65. We must compare that with the situation in a developing country such as Peru, where the expectation of life is only 52 years.

Before long about 20 per cent. of our population will be retired. We cannot allow that 20 per cent. to become a depressed minority with a low status and low purchasing power—a kind of second-class citizenry. They must be given identity and importance, for they have no trade union and can take no strike action. They look to the Government, local authorities and ordinary individuals to give them this identity.

Old age is difficult to analyse. When do we become old? Some people, like Picasso and Dame Sybil Thorndike, never seem to become old. The old are getting younger every day. Modern drugs and preventive medicine have created a revolution in geriatric care. Instead of people going to hospital to die, they go to a geriatric ward to get well and come out again and take their place in the community.

There is a misconception about the old. One hears Members of Parliament who may be not even 65 saying, "I am going to retire and make way for a younger man"—they never say, "a younger woman". They somehow feel that because they are reaching some magic age of 65, even though they might be perfectly fit, in full command of their faculties and making a good contribution to the House, they must retire and make way. Executives make the same remarks.

Preparation for retirement will be an exceedingly important aspect of life in the future—physical preparation and psychological preparation. There will be more leisure for everybody. It is important that when people retire they are useful and able to use their hands and their minds or both. Any doctor knows that the will to live is extremely important when it comes to caring for the elderly But elderly people have great problems in many cases. Mental illness, as has been pointed out, is fairly common. It is often brought about by bereavement due to the death of a partner, but often by tediousness, apathy, a feeling of dependence, and a feeling that they are of no use.

Poverty must be abolished in old age. People must have enough to live on, and prices must not overtake their income. Malnutrition must be tackled so that old people know the type of food to eat and do not just live on the cheapest food. Chronic physical illness has been mentioned by my hon. Friend the Member for Willesden, West (Mr. Pavitt). More research must be done into arthritis, rheumatism, bronchitis, and debilitating diseases which old people suffer.

I take issue with the mover of the Motion in that there is good evidence that the bonds of the family are not being eroded by the freer supply of the social services. Only 3.6 per cent. of elderly people in Britain live in hospitals or other institutions. The rest are living in their own homes.

Dr. Stuttaford

I was not trying to suggest that the bonds of family life are being eroded by social services. I would be the first to agree that the greater the social services the easier it is to maintain family bonds. But family bonds are being eroded by the demands of modern industry and conditions. The younger members of the family are having to travel all over the country, and it is difficult to maintain a family bond if the daughter is in Edinburgh and the parents are in Southampton.

Dr. Summerskill

I agree with the hon. Gentleman. In this connection I would pay tribute, as other hon. Members have done, to the thousands of single women who look after an elderly parent, or both parents. Deprived of much social life and often combining this with a job outside the home, they are a dwindling band of women. But the social services are essentially for childless elderly people and those without relatives to care for them.

The continuation of the improvement of medical and nursing care in hospitals is essential. I emphasise that the Government should pay particular attention to the staff of geriatric wards. For young girls, this work is mentally and physically hard and completely unglamorous. It is essential that their pay and conditions of work should be improved if we are to staff the wards. I should like the impetus begun by the Labour Government to be continued with regard to the part-time employment of married women. Between September, 1964, and March, 1969, the number of qualified nurses and midwives employed on a part-time basis rose by nearly 60 per cent.

The main factor is that the total expenditure on health is too small. Although only 12 per cent. of the population of Britain, the elderly absorb nearly 30 per cent. of the expenditure of the National Health Service, and Britain spends less on medical care as a percentage of its national income than do industrial countries such as Sweden, Canada, America and France.

As for facilities for home care, the revolution in geriatric care has obviously meant more old people at home. There are town differences and regional differences, but those are not based particularly on political differences in those regions, but depend rather on the keenness and enthusiasm of the people of the areas.

I applaud the efforts of voluntary organisations like Contact which arranges for visits to be made and helps the aged. It is important for a register to be set up and to know where the old people are, who they are, how many they are, and whether they are living alone or with other people—similarly for the disabled—because unless the elderly can be identified, it is difficult to help them. I want the impetus maintained in the building of health centres which will help the elderly. A total of 250 will be in existence by next year.

We rely particularly on women to carry out jobs such as home helps, health visitors, meals-on-wheels and so on. But I do not want these women, who are in short supply, to be economically exploited. Here, again, a good wage and not what is often called a woman's wage will make sure of an adequate supply of these vitally important people.

We should maintain the impetus of day clubs and centres. Between 1969 and 1976, 430 more clubs and centres are planned. Between 1964 and 1968, the number of elderly people attending geriatric day hospitals was doubled, but still the demand for facilities far exceeds the supply, and yet only £20 million a year is spent, for example, on the home help services.

I welcome the Motion. The whole House will realise that in 1970 Britain it is often a hard struggle for the old to live, and to be both sick and old can often lead to real helplessness and despair. The House should give its fullest support to the Motion.

3.48 p.m.

The Under-Secretary of State for Health and Social Security(Mr. Michael Alison)

I should like to join the hon. Lady the Member for Halifax (Dr. Summerskill) in congratulating my hon. Friend the Member for Norwich, South (Dr. Stuttaford) on taking the time of the House this afternoon to move this important Motion. If I may say so without being patronising, I welcome the attendance and contributions of what for a Friday afternoon is substantial number of hon. Members who are showing great interest in this important topic.

The Motion calls attention to the need to increase the allocation of resources to the elderly in and out of hospital. My hon. Friend has already welcomed the fact that this is recognised as being one of the key vulnerable sectors in which my right hon. Friend the Secretary of State for Social Services in his statement to the House on 11th November announced that an extra expenditure of £110 million was planned for the health and personal social services over the next few years.

The House will recall that about £40 million of this increase is to be spent on improving hospital and local authority services for old people and the mentally ill, bringing the total increase in expenditure on the improvement of these services over the next four years to nearly £300 million. I take the point of the hon. Member for Willesden, West (Mr. Pavitt) that much of this should be going to local authorities and that overall revenue should have its fair share. I am glad to be able to assure him that so far as I can calculate it the greater proportion of the extra £300 million will be revenue expenditure and not capital expenditure.

I must congratulate my hon. Friend on the subtlety with which he has drafted his Motion, because he has managed to embody the vital continuum, if I may put it like that, of the elderly person as an identifiable whole in or out of hospital. This I welcome, because it is essential not to think of a great abyss between the community and the hospital but to have a view of the patient as one who may go into hospital as an old person with a view to coming out as early as possible.

Dr. Stuttaford

On 11th November my right hon. Friend the Secretary of State for Social Services said: Another area for expansion is the improvement of hospital and local authority services for old people and for the mentally ill. Nearly £300 million additional to present running expenditure will be spent over the next four years."—[OFFICIAL REPORT, 11th November, 1970; Vol. 806, c. 391.] Am I right in assuming that that is the case and that it is not just £110 million, but £300 million in addition?

Mr. Alison

No. The £300 million extra embodies what one might call the normal increase, supplemented by the extra portion of the £110 million which is applicable to the mentally ill, as distinct from the mentally handicapped, and the elderly.

I hope, however, that my hon. Friend will not think it improper if I make a division—not in nature, but simply in analysis—between the hospital side of the treatment of the elderly person and what might be described as the community or social services side. The bulk of the speeches during this short debate have tended to focus on the social services side, the lot and prospects of the old person in the community rather than in the hospital. In the short time that remains to me, I hope that the House will think it proper that I should, therefore, concentrate on the social services rather than the hospital aspect, although I came prepared to deal with both.

While not spending too much time on the hospital side, I should like to take up a point made tellingly by the hon. Lady the Member for Halifax about the crying need for better and more numerous nursing provision, particularly for the elderly and the geriatric and mentally ill hospitals. This is a crying need. The hon. Lady will, however, recognise that it is not simply a matter of hard cash—at least, not hard cash applied directly to the nurses as such. There are other factors. There is the desire to be away at weekends and in the evening, a phenomenon of the age with increased leisure and opportunities for leisure.

There are, perhaps, as the hon. Lady says, inadequate facilities for encouraging the older married nurse with children to return to work in the hospital. We are certainly looking hard at the possibility of increasing, for example, creche provision in hospitals so that mature nurses with children can come back and continue nursing while leaving their children in the hospital.

There is also the whole question of some of the terribly outdated and antiquated facilities at some of the mentally ill and geriatric hospitals, in which even the toilet facilities are not wide enough to take modern wheelchairs. The working conditions, therefore, likewise have a disincentive effect. It is not simply a question of the pay of nurses. It is a whole complex of factors. I agree, however, that the essential thing is to increase the attractiveness of the conditions and the actual numbers of nurses who are available to look after our old folk who have to go into hospital.

The hon. Member for Willesden, West used a telling phrase when he said that we must get away from the hospital fixation. It is this aspect on which I want to dwell for the few minutes that remain. I suppose that the striking fact about the present situation, as the hon. Lady mentioned, is that the man of 65 is probably fitter today than he has been at any time in the past. Undoubtedly, different problems confront the elderly, and these problems tend to become more difficult and more accentuated as time goes on. It is necessary to help the elderly to face their problems, which may be due to a drop in income, to contemporaries dying off and an increasing sense of isolation, or to a whole range of possibilities. It is the essence of the task of the social services to help the elderly person with his problems in his own home, in his own domestic or community environment.

The starting point of the whole of our work really involves seeing that the elderly are an integral and natural part of society as a whole. This is where we can learn from primitive societies, perhaps Latin societies, where the whole family, from the child to the grandfather or grandmother, are helped to be part of an organic communal whole. This is what we need, and need to maintain in our society, despite the tendency of the family to be atomised through such development referred to by my hon. Friend, as Southampton—Newcastleupon-Tyne inter-city trains, which help to contribute towards this atomisation.

It is worth saying, I think, that the approach through centres for the elderly, holidays for the elderly, and other services for the elderly is a distinctive and necessary approach for many, but it will often give place, as it is important that it should, to the approach of helping the elderly to take full advantage of services available to society at large. This is the course which we must pursue. I would not say anything against the specific services provided for the elderly, but one has to recognise that they have a tendency to treat the elderly as a class and sector of the community apart, and I am sure that what we want to do is to make it as far as possible easy for them to enjoy all the common services available to society at large.

This is likely to be more clearly seen when Section 45 of the Public Service and Public Health Act—I congratulate the party opposite on its initiative and work in bringing that Measure forward—is implemented next year.

As the essentially experimental work of welfare services for the elderly develops and the existing forms of service will continue one needs also to look at novel forms of help to those in special need in this category; we need novel forms to be developed under the impetus of Section 45 of that Act. The Secretary of State for Social Services deferred the operative date of Section 45 from 1st September, 1970, the previously announced date, only so that he could further consider its implications for the policies of the incoming Government. Discussions with local authorities are now going on. The necessary order will be timed with the inauguration of the Local Authorities (Social Services) Act and directors of social services will be set up under that Act to ensure that the social service requirements can be looked at together.

In the minute only which remains to me I want also to stress that in the development of the services which will come from the impetus of the 1968 Act, particularly Section 45, we want at all costs to maintain the emphasis which my own Department places upon the absolutely essential work of voluntary bodies and innovations which voluntary bodies of all sorts can make. I take the point which was made by my hon. Friends and hon. Members opposite that an unmarried daughter, or son, possibly, who stays at home, or does only a part-time job, and sacrifices her or his normal participation in the life of the community as a whole, is a keen volunteer in the whole complex of voluntary services, and as much so as anyone else with a more glamorous title or name.

We have had time for only a short introduction to debate on this important subject, and I hope there will be opportunities for discussion of these problems on future occasions.

3.59 p.m.

Sir David Renton (Huntingdonshire)

I beg to move—

Mr. Deputy Speaker (Sir Robert Grant-Ferris)

Order. First I have to put the Question on the present Motion, unless the hon. Member who moved it wishes to withdraw it.

Question put and agreed to.

Resolved, That this House having regard to the fact that a greater proportion of the population is reaching old age, welcomes the promise of increased expenditure for this section of the community, but calls on Her Majesty's Government to continue to improve the medical and nursing care available for them in hospitals, and to provide more facilities for home care so that they may continue to live a reasonable life in their own surroundings for as long as possible.