§ 11.28 p.m.
§ Mr. Ted Leadbitter (The Hartlepools)
On 23rd May I had three Questions before the House concerning the conditions in private nursing and old people's homes. On 25th May I wrote to the Secretary of State for Social Services pointing out my disappointment at his replies. The Under-Secretary of State, who is to reply to this debate, was kind enough to write to me on 16th June in response to my letter, adding that he hoped tonight to clear up any misunderstanding. I appreciate this. I hope, however, that he will not concentrate too much on clearing up misunderstandings.
I concede that there are problems at Question Time or in written replies. I accept that the Minister might not have been fully aware of the magnitude of the problem I wanted to develop had I been able to extend the subject by means of supplementary questions. This, therefore, is the purpose of tonight's debate, and I hope that the Under-Secretary will consider what I have to say rather than refer too much to the proceedings of 23rd May.
I take for granted that on a subject which is now causing considerable alarm and concern there is no need to criticise the Minister. There is no time in this debate to embark upon that. On the contrary, I am looking for his co-operation on a subject in which we both have a positive interest. I genuinely seek that co-operation.
I also take for granted that there are many well-managed homes providing an excellent service and giving the highest standards of comfort, care and kindness to their residents. I also take for granted that all those responsible for what is best in private nursing and old people's homes would be the first to support any steps that were taken to stamp out the corruption, the indifference, the cruelty, the meanness and, in some cases, the wanton neglect which are the hallmarks of the basically greedy profit-seeker in this business. No less do I condemn homes, however, where there is dirt and the pervading persistent smell of people who are not washed and cared for in 199 a proper manner. This is the state generally of unqualified management, underpaid staff or even a lack of staffing.
It is not unknown, nevertheless, for poorly-paid staffs to be over-worked and yet set the highest standards in personal sacrifice and dedication. No blame is to be attached to them. Many people have appeared in the Honours Lists for contributions to society which are microscopic compared with their daily toil.
Finally, I take for granted that the 1936 nursing homes legislation, as amended by the Nursing Homes Act, 1963, the Public Health Act, 1936, and the National Assistance Act, 1948, together with the regulations flowing from these as well as the supporting administrative local health committee byelaws, are a formidable set of provisions. Enforcement, however, falls desperately short of intention, and here lies the loop-hole for the slick and the slap-happy homes operator.
According to the News of the World in its published investigation during May this year, 200,000 people over the age of 65 are in homes of one kind or another. There are 5,600 old people's homes. Councils run about 2,614 of these, the remaining 2,986 being privately owned. Surely these figures by themselves point plainly to the need to enforce the law and the regulations flowing from it.
During the last few years there has been an increase in the number of homes, and with this increase growing evidence of profit-seeking and of growing numbers of complaints. That is the more important reason for vigilance and a fresh look at the whole question of care for the old. The News of the World has done a great service in focusing public attention on this area of the matter as well
I have received some considerable correspondence from the Registered Nursing Homes Association, and from discussions that I have had with its officers I am satisfied that the work in establishing a code of standards in this field demonstrates the need to consider its views in the controversial area of private old people's homes where such a code and association influence do not exist.
200 Since this debate became publicly known I have received a number of letters from a wide range of qualified people. All this information has been documented by myself in a file of 85 pages. I have the file here ready for the Minister, and when I give it to him to night, apart from any other points that I have to make on the subject of enforcement, I expect every home mentioned in this file to be examined and reported upon. I expect every local authority or local health authority in which these homes are registered to be informed by the Minister that action is needed, will be entered upon, and a full report made to him. That is my immediate request to the Minister, and in the light of evidence it is not an unreasonable request.
I want to assure the Minister that residents, nurses, officials and owners have been questioned on the conditions in private old people's homes in the United Kingdom. On public reaction, in the early days of the News of the World investigation about 417 letters were received. Of these 103 praised the homes experienced, but 314 were critical, and many were highly critical.
Let me mention some types of case work. One owner is reported as claiming that a 50 per cent. profit from every resident could be made every week.All we needhe saysto get into the 25 to 30-guinea class are velvet curtains and new carpets. There are fantastic profits to be made if we go about it correctly. I have maids who do 40 hours for £9 plus dinner. I could double charge residents without paying out a single penny more in wages.added this lover of aged.
Part of another letter reads:My mother was locked up with two mental patients. She wasn't even allowed to the lavatory.One published account states:My mother never got any attention. After her death all my mother's jewellery was missing.A cook at an old people's home says:I used to cry at the way the residents were treated.A daughter writes:My mother was paralysed on one side but the staff at the home would leave her lying in her urine for hours.201 There have been reports of striking patients, the use of vile language, and residents being treated with contempt and scorn.
One startling, spine-chilling case describes a room next to a sick bay, a place to put someone who died in the night. Some bodies were taken there, the report says, before being certified dead. One very old man was left in this morgue for days, but he was breathing for hours afterwards. An auxiliary nurse, inexperienced in these matters, had the man taken there because his face was cold. That is a perfect example of having unqualified people dealing with these serious problems of the aged in private homes. Another case has been brought to my attention in which a deceased person was put on the steps of a home wrapped in towels ready to be taken away.
Before I proceed any further with this case work, let me make it clear that the reason why I have not mentioned the names of these homes is that I do not want to be accused of making accusations without examining the totality of the evidence. That is my exercise with the Minister. But the case work is in this file for him to see. This justifies my saying that he must look at these matters with exceptional care, and consider the broad problem of privately-owned old people's homes so that this kind of thing can be eliminated with whatever action he thinks best. The Registered Nursing Homes Association has given a great deal of information. I cannot do justice to it in the time available, but I invite the Minister to study these observations in the file.
One thing is clear: nursing, and especially acute nursing, care should be taken out of these private homes altogether. Upon this subject in particular I should like some discussion with the Minister. Where this care is allowed in these private homes, I assert that it is a breach of the law. It is only lawful if the private establishment is registered under the Nursing Homes Act, 1936.
The time has now come to give the protection and care for old people in a manner that the country expects. Let us not pretend that we are not aware of the nature of the problem. It will not be sufficient to say that the responsibility lies with the local authorities, or that if 202 they close a place they have nowhere else to put the residents. It is sufficient to say that where this rot exists it must be surgically cut out.
Our task now is to draw up a charter for the treatment of old people, to establish an association with its own council and agreed standards, and to give the supreme authority to the State, through the regional hospital boards, to ascertain that the needs of the old are satisfactorily met. We need better trained people and more of them, an inspectorate providing the right standards of inspection, at regular intervals, by qualified inspectors. Every old person should be registered, either in the courts or with some established authority, so that their persons and their property shall be protected from violation from whatever quarter.
I think that the Minister will agree that I have used this Adjournment debate as I have done before on a hospital matter involving public concern. I have no intention of addressing myself to him critically or of criticising the Government. My intention is to crystallise public concern about the growing evidence, particularly from the communications media and from people with experience of either working or living in these homes. Therefore, through natural democratic processes, the House has become aware of this matter. As it has been described to the Under-Secretary in that spirit, I hope he will look upon it as evidence certainly not of a fresh subject but of the kind of thing that can happen in a society such as ours, where our machinery is often bypassed by those who are unscrupulous and unworthy of taking part in any aspect of our social services.
I repeat that in the vast majority of cases there are high standards. But the growing number of unworthy cases is such that I call upon the Under-Secretary to respond to it.
§ 11.45 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
The House rarely has an opportunity to consider this particular part of the services available for elderly people, and it will be glad that the hon. Member for The Hartlepools (Mr. Leadbitter) has found the timely chance to raise this subject tonight.
203 In their later years some elderly people, fortunately a relatively small proportion, find it necessary to give up their ordinary independent domestic life and seek help and security in other ways of living. Some are so infirm or ill that they need continuous nursing care and look for it in hospitals or in voluntary or private nursing homes. Others needing less help turn to the local authority residential homes, to the voluntary homes, their equivalent, and to private homes. Others, those who do not go to live with relatives, find accommodation in hotels or boarding houses on ordinary commercial terms. To some extent the decision to act in this way is forced: there is no other way open to the elderly person concerned. But for many the choice will have been made freely. The new way of living is seen as better because it is safer, it removes the burdens, cares and worries of daily living and it offers the society of contemporaries. Most of those who resort to hotels and many who enter voluntary and private homes go there because they have chosen to do so. But the ability to choose inevitably declines with the years and elderly people can become very vulnerable. I am sure we all agree that there is a public responsibility to secure so far as is practicable that this vulnerability is not taken advantage of and exploited. That, I take it, is the nub of the hon. Member's arguments tonight.
The title of the debate refers to private homes, by which I take it is meant the home provided not by a voluntary body but by an owner who makes his living in this way. In fact, at least one of the homes mentioned in the News of the World articles was a voluntary home, and, as I hope to show, the same law applies to both and they need to be considered together. Both face the same difficulties in ensuring adequate management, supervision, and staffing. While all charge fees for their services, the wealthier charities, in the voluntary homes, are able to put in money to keep charges down.
I should like to consider first the purely residential type of provision to which most reference has been made, both by the hon. Gentleman and by the newspaper articles, and to look at nursing homes separately, for while there are 204 points in common there are also considerable differences.
Before doing so, I should like to stress one point on which I feel sure the hon. Member will agree; he has said so in terms. The News of the World itself says—I think the hon. Gentleman agreed it—that a few bad cases do not make a public scandal. There is really no evidence at all to make people generally uneasy about their elderly relatives in homes or to make elderly people themselves feel that the system exists simply to exploit them. There is, on the other hand, overall, I feel sure, an honest desire to serve which needs to be supported if there is to be the proper range of choice open to the public. It is important that this debate should not deliver the wrong message, an unnecessarily gloomy and worrying message, to the public.
First of all, what is known about the non-public sector and what is being done to find out more? I have already given the hon. Member, in a Parliamentary Answer, some figures about private homes. It may help the House to have just a few more to set the scene and to correct perhaps some impressions.
English local authorities—I included Wales in the answer—had about 87,000 elderly residents in their own homes at the end of 1970. There were about 23,000 in voluntary homes of whom a half were supported by the local authorities, which are responsible for about 100,000 elderly people. In registered private homes there are about 18,000. Authorities can take powers to use private homes too, but have not yet done so to any significant extent. Thus the non-public sector accounts for about one-third of the whole and private homes for a little less than half of this. But, whereas the public sector homes are reasonably well-distributed about the country, the non-public sector is heavily concentrated in the south and west. Of the total of about 2,800 voluntary and private homes no fewer than 1,150 are in the areas of only 14 local authorities. This is important when considering what can be done, because the burden on some is particularly heavy.
There is little organised knowledge about the characteristics of homes. The annual statistics of my Department show 205 that the net number is growing, particularly private homes, but there is a disturbing fall-out, approaching 10 per cent, each year, the reasons for which are not known. Financial stability may be one factor. Private homes typically are small—much smaller than either public or voluntary homes. The average number of residents is only 10 or 11 and substantial numbers must have only five or six. While a good number of homes cater for the wealthy and are really to be seen as expensive specialised hotels, the general picture is clearly pretty different. Many must be not much more than extended family groups. Little is known about fees, but a small study by the National Corporation for the Care of Old People a few years ago suggested that they were not exorbitant. The worry may be not that they are too high but that they are too low for decent standards to be afforded.
It is to the credit of the last Administration that they took the first steps to fill the gap in knowledge with a census of local authority and voluntary homes, covering the characteristics of residents, staff and buildings. This is now being written up. They were unable to complete a proposed sample survey of private homes, and we undertook this last year. We have the figures, and we intend to have an up-dating sample survey covering the whole field in 1973. This is the first time work of this kind has been attempted and the results may leave something to be desired, but we hope we have established the precedent of a series of surveys which will successively improve on the first. This should provide the essential basis of knowledge on which any general action should be based, including, if it seems necessary, the amendment of legislation and regulations.
What can be done meantime depends in part on that legislation which has remained unaltered since 1948 and in part on the practicalities. The legislation it self makes a clear division of central and local functions with one small bridge between the two. On the one hand, the Secretary of State is given no executive powers but only powers to make regulations for enforcement by the local authorities.
Regulations were, in fact, made by the last Conservative Administration in 1962, 206 and I have sent the hon. Member a copy. These deal with the conduct of homes and refer comprehensively to accommodation, furniture and equipment, staffing and catering. They cannot in the nature of things go into great detail of standards, because of the wide range of circumstances to which they apply, and this is unavoidably left to the good sense of the authorities administering the regulations. They do not deal directly with questions of staff pay and conditions, or of fees—and these are obviously related.
On the other hand, the powers of the local authorities relate to registration and the administration of the regulatory powers. The owner of any home holding itself out—an important phrase—to provide accommodation solely or mainly for elderly people is required to be registered with the local authority, and generally the social services department will be concerned about this. The authority may refuse to register and it may later cancel the registration if it is not satisfied as to the bona fides of the owner or the fitness of the home or its staff or the conduct of the home, and it may prosecute if there is an offence against the regulations.
§ Mr. Leadbitter
I accept that, but while registration is done inspection is not, and enforcement is not.
§ Mr. Alison
I am coming to enforcement. The power of inspection exists, but refusal to register or cancellation are subject to appeal to a court of summary jurisdiction. The same would be true if an authority sought to require, say, a guest house with a number of elderly boarders to register. The important point is that the authority cannot imply step in and enforce its will. It must prove its case for enforcement in the courts. It needs always a standard of proof that will stand up in a court of law, and that is not always easy to get. These may be thought to be weaknesses, protecting the owners and managers more than the residents. Before any change is proposed, however, the facts are needed to justify it.
Authorities do, however, have the power of entry to premises that are used, or thought reasonably to be used, as homes. They can use these powers both 207 in the process of enforcement and constructively to give the help and professional advice that owners and managers very often badly need. Many do so, so far as they can, though I have no information about the frequency of visits. The bridging power that I referred to lies in the concurrent power of inspection by authorised officers of my Secretary of State. Since executive action is in practice limited to a report to the registering authority, the local authority, our powers are rarely used in cases of special difficulty, but they can be used to support the authorities when needed.
The problem of practicalities is both general and particular. In general, the social services departments set up under the last Administration's legislation are at a crucial phase. They inherited a wide range of services, and took on the task of setting up a new and complex organisation. They have since been asked to absorb new tasks of considerable magnitude—the development of community homes for children, services for the elderly and the physically and mentally handicapped, and so on. I should be loth—and I hope that hon. Members in their zeal of action on this front will also be loth—to press on the new Seebohm departments new wide-ranging enterprises that their own local priorities do not justify. We must leave it to the good sense of the local authorities in these matters, in which Parliament has given them considerable freedom.
The particular problem arises from the heavy concentration in the south and 208 west. I see no reason at all why authorities with small numbers of homes in their area cannot get down to regular visiting—rather than formal inspection—to help put right anything that is wrong and to give constructive advice. In those which are lucky or unlucky enough to be over-well-endowed it is a different matter. In these areas the right course for the time being is to try to secure that any difficulty is brought to the notice of the social services department so that it can judge where action is feasible. Here I readily undertake to scrutinise carefully the file the hon. Gentleman is giving me, and to pass to the responsible authorities details of the questions which apply to their own area. Indeed, the course I have described is the right course elsewhere, since only the authority can act. My Department's social work service will in all this help as constructively as it can, but the first point of contract is the authority itself.
I turn to the nursing home scene. At the end of 1970 there were 1,004 registered nursing homes with a total of 23,346 beds. I do not have figures showing which of these are run by voluntary bodies and which privately by companies or individuals.The basic legislation in this field has remained unaltered since 1936—
§ The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. Deputy Speaker adjourned the House without Question put pursuant to the Standing Order.
§ Adjourned at two minutes to Twelve o'clock