§ 4.9 p.m.
§ Mr. Greville Janner (Leicester, North-West)
I am delighted, if somewhat surprised, to have the opportunity to raise on the Adjournment the matter of warning devices in and upon the dwellings of elderly and disabled persons. Of course, I am not permitted to discuss any form of legislation which might be desired or be desirable. I wish merely to deal with the situation as it exists. At present there is plenty of legislation enabling local authorities and private developers and builders, if they wish, to ensure that those who go into the homes which they build or adapt are not cut off totally from the world.
Before turning to the subject I wish to express my appreciation to the Under-Secretary who has agreed to answer this debate at very short notice and who I know to be extremely concerned with this problem. However much we may disagree on matters of legislation, I know that there is no difference between us about the desirability and need for elderly and disabled people to be kept in touch with the world. Nor is there any difference betwen us about the need for local authorities and others who create homes to do their best to keep the people into whose care elderly and disabled people go, whether directly or indirectly, in touch so that in emergencies they are not cut off totally.
It is also right to pay tribute to those hundreds of people who have shown their concern to me personally both by suggesting that some steps should be taken in this House in connection with the need for warning devices and by writing to me from all over the country. I also 942 pay tribute especially to the boys and girls from schools in my constituency who have shown their personal feeling and concern for the needs of elderly and disabled people. It is a source of great satisfaction to me when young people take an interest in the disasters, needs and difficulties of the aged and infirm.
Thousands of elderly and disabled people die alone in their homes simply because they are not able to summon aid when they need it. If a person lives on his own, falls ill during the night and cannot get out of bed, in most cases there is no way in which he can call help. It is only if he has a kindly neighbour who comes by during the day or if there is some sort of form of warning device by the side of his bed with which he can attract the attention of passers by that it is possible for him to summon a doctor.
We do not know how many die alone, lonely and without the help that they need. We have no idea how many dead people are found simply because the milk or newspapers have not been taken in from their doors. I have asked Questions concerning the numbers who die on their own. No one knows. Making a rough guess, it is probably as many as 5 per cent. of the entire population. Of them the majority are women, because they live longer and live on their own far more often. In many cases there is no need for this kind of terminal suffering. If the means is available to people who are cut off and on their own whereby they can draw attention to their suffering and their need for help, the help will be readily available.
The question is what help they should have and what devices are available. There are many. There are simple ones such as those that have been installed in houses in Leicester. Generally they are just ordinary flashing lights by a window activated by the pulling of a cord by the pensioner's bed or beside his living room chair.
They have many disadvantages, one being that the pensioner cannot always get to the cord and another being that if he falls down the stairs the cord is not available. But it is infinitely better than nothing and those pensioners to whom I have spoken who have had the device 943 installed, and they have been many, are immensely grateful for it. It is not only that it may be used in an emergency, but the knowledge that if there is an emergency the device is there for use, is a tremendous comfort.
There are more sophisticated devices, some attached to warnings which sound in someone else's home, in the home of a neighbour or a warden. Some operate by remote control so that the elderly person carries a little box, or perhaps a tiny microphone, about with him so that there is no question of a pull cord.
All the devices have their advantages and disadvantages. Some are very expensive and some very cheap. Some are almost foolproof in their simplicity but, because, they are so simple, are not always available. Others are complicated. When they work, they work beautifully, but they are more likely to go wrong. There are alarm clocks that go off automatically if a button is not pressed, but an elderly person may forget to press a button. There are remote control devices that some elderly people may not like to carry, because they are too independent to do so; or because they feel ashamed that they may need to call for help, or they may forget it; or they may put it in a drawer. Nothing is perfect, but while waiting for perfection, one can reach towards some form of satisfactory solution.
In many areas this is already being done. Devices are being installed—alarms, bells, buzzers, lights—to attract attention. They are working not perfectly, but reasonably. In many areas voluntary organisations are providing devices. I have heard, for example, of Round Table organisations being concerned, as are many women's organisations. In many areas boy scouts are helping to fit out old people's dwellings, not old people's homes where they live with others, but dwellings where they may be on their own and cut off.
It is only if the availability of these devices is known and only if the need for the devices is realised, only if public outrage is brought to bear on those who can provide the devices but do not, that results are likely to be obtained for the hundreds of thousands of elderly and disabled people who need them. This, unfortunately, is a misfortune that one 944 day may strike us all. Any of us may find himself in the sad position of being elderly or infirm and lonely and alone. It is one of the inevitabilities of longer life. Today we may be fit and well and able to talk about this as someone else's problem, but tomorrow it may be ourselves, and the time for the problem to be dealt with is now.
It can be dealt with. There is no requirement at present that there should be warning devices, but plenty of power is available to anyone in the public or private sector to provide these minimal comforts and guards for elderly and disabled folk. If the enabling powers were fully exercised, there would be no need for any legislation.
I hope that the end of this week of debate will be an appropriate time for us to call upon all local authorities to take heed of the needs of their hundreds of thousands of elderly and disabled citizens living on their own and to recognise that one of their needs is simply to be able to get in touch when they need with those who can help them. They must inform doctors and social workers in touch with elderly people that these devices are available and that some of them are cheap.
Even if an expensive remote controlled device is a dream for so many, at least those who want a light in their windows should have one. No one should be forced to have it. People may prefer not to because they fear burglars. Everyone is entitled to his view. But the vast bulk of elderly and disabled people bitterly resent the fact that they are cut off, and eagerly await that time when they will have some form of warning device at their home.
I therefore call upon all local authorities and private developers voluntarily to place a warning device within the reach of their elderly and disabled citizens. I hope that all good neighbours will keep an eye on elderly and disabled folk who live near to them, and who are not in the happy position of having homes equipped with a device, so that a great deal of totally unnecessary loneliness, fear and suffering may be avoided.
§ 4.21 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
I am happy to collaborate with 945 the hon. and learned Member for Leicester, North-West (Mr. Greville Janner) in giving the House an opportunity to consider, albeit at rather short notice, this very important subject.
I am glad that the hon. and learned Gentleman stressed the common interest in promoting and improvement in the facilities available for these people, because I confirm that it is a common interest. In my Department we have a deep concern for the hazards of isolation in frail old age. As a result of the well-known Amelia Harris report, we are only too acutely concerned about the extent to which elderly, often disabled, people—mostly elderly women—live alone in their own households and flatlets.
I appreciate, too, the opportunity to speak on this subject in the context of the enlightened and imaginative initiative taken by youngsters at school in the hon. and learned Gentleman's constituency. I am sure that we both pay tribute to them for the concern that they have shown for those members of the community right at the other end of the age scale to themselves whose capacity to look after their future is so much more contracted than that of the youngsters themselves.
Everything is not quite as gloomy as some might think, and it is worth reminding the House that where there are what we call warden-assisted flatlets there is a departmental circular requiring—that is to say making mandatory—the provision of an emergency call system linking the warden's quarters with each flatlet. The same circular indicates that the cost of installing an emergency alarm system in self-contained dwellings for elderly people can be met—it is permissive, rather than mandatory—whether it links each dwelling with a nominated person or provides a signal clearly noticeable to a passer-by outside the House or in the immediate neighbourhood.
I think the hon. and learned Gentleman knows that a similar provision exists—that is to say it is permissive, rather than mandatory—in respect of the provision of such alarm signals in relation to self-contained housing for disabled persons by whomsoever it may be provided, and particularly local authorities.
I stress the difference between what is provided for warden-assisted flatlets and for self-contained homes for the frail 946 elderly, because whilst there is no problem of satisfactory communication where there is an internal link between warden-assisted flatlets and a warden whose whole raison d'etre is to be on duty to look after the people who live in the flatlets, there are some difficulties in connection with self-contained homes for elderly people where there is no necessary communicating link direct to somebody who is on duty to look after them.
It is for this reason, in respect of the self-contained homes, that we deliberately make the provision permissive rather than mandatory. We want local authorities to be forward-looking and imaginative, in the way in which the hon. and learned Gentleman has encouraged them to be, but we want them to hasten slowly because of some of the difficulties and deficiencies in alarm systems as we at present understand them.
I bring to the notice of the House two research studies set in train by the National Corporation for the Care of Old People with which my Department is in close touch. The first of these studies involves a full evaluation of the various mechanical warning devices now available or at various stages of development. It is being undertaken at the Loughborough Institute of Consumer Ergonomics. I apologise for that appallingly long title.
I believe that the hon. and learned Gentleman knows something about this and has met the Institute's assistant director, Mr. Feeney. The Institute's study team is looking at 36 different devices and has already found some fairly basic design faults or deficiencies in some, including I am sorry to say, some which have been purchased in bulk by various local authorities.
It is hoped that by the spring the Institute will be in a position to produce an interim report showing those devices which do not merit further study and which could not be recommended for bulk purchase by local authorities or other customers. This will not be the green light for approval of the remaining devices. It will be an indication that they justify further rigorous testing and evaluation. Until the first study is completed no one can be sure that any one of the devices now available can be accepted as a totally 947 reliable means for all kinds of elderly or handicapped people to summon help in the more likely kinds of emergency situation, such as sudden falls or the unexpected onset of illness.
The question which then arises is: even if the means of summoning help is reliable, will help be forthcoming unless suitable preparations are made to ensure that whoever is on hand at the time knows what is required of them?
A flashing light, for example, may not attract anyone if it is operating in the early morning when there is no one about. In broad daylight it may not be sufficiently visible to neighbours who perhaps, should be expected to respond. A buzzer that simply buzzes within the household of the person in difficulties will probably add to his suffering and frustration and may not be heard above the din of the outside traffic. Equally it may not enable help to be directed quickly to the right house.
We might decide to install a loud bell similar to the burglar alarm bell on the outside of premises. The hon. and learned Gentleman will probably share what is a common experience of walking down a crowded pavement in daylight when such an alarm bell is ringing on a shop. One thinks, "How funny, the alarm bell is ringing. It must have gone off by accident." Many people pass by such bells because they think it must be an accident, it is an oddity, it does not concern them. Once again we come up against the inherent problem of communicating effectively with the agent or person who is responsible for seeing what is happening. These are all issues which will be resolved if we find answers to the technical problems thrown up by warning devices.
The second study is intended to provide an in-depth look at one alarm device which appears to offer real possibilities for further development. The device is put in a number of elderly households over a period and the consequences monitored. The device used at the start of the project is based on a radio transmitter device used for opening garage doors. It consists of a small battery-operated transmitter the size, roughly, of a pocket radio, on which is a recessed button. The 948 transmitter can be carired around in a pocket or on a cord hung round the neck rather like a light microphone loudspeaker. In an emergency the button is pressed, which sends out a coded radio signal to a receiver situated in the home which converts into a simple alarm call.
At a later stage it is hoped to look at more sophisticated forms of alarm call which might be built into such a system, but the immediate intention is to ensure that the transmitter end is acceptable to elderly users who might need to have it on them more or less permanently.
I must enter a special proviso that it must not be forgotten that the existence of an alarm system in an individual's home, particularly an elderly person's home, may itself cause him anxiety lest he should set it off by accident and cause a response to a false alarm. It must, therefore, be one that is not too easily triggered and yet at the same time is not attended by too much difficulty in setting it off.
Unfortunately, the device used initially in this in-depth research was found to suffer from a number of serious drawbacks, in particular that the alarm was being set off by radio signals from other outside sources. It was also found to be too bulky for elderly women to carry with them on their persons and there was a tendency for them to leave it in a drawer where is became overlooked.
For these reasons, efforts are now being made to develop new prototypes which overcome these problems and which offer substantially increased reliability. Naturally it will be some time before these are ready and they will need to be assessed over a period in elderly households.
The House will recognise that these two projects offer hope for the future but that at present it is open to conjecture whether any of the available devices would offer a 100 per cent. degree of reliability, which is obviously of itself essential in respect of emergency situations.
§ Mr. Greville Janner
Does not the Minister agree that, although obviously 100 per cent. reliability is desirable, it is better to have 89 per cent. reliability than nothing, which is what people have at present?
§ Mr. Alison
The snag about the 98 per cent. reliability is that the 2 per cent. failure rate may precisely coincide with the critical emergency. Anything which is devised for a critical emergency, such as a parachute or an escape hatch, must be 100 per cent. reliable. Anything else is useless. We must be able to count upon 100 per cent. reliability, otherwise the whole efficacy of the operation is lost.
It may interest the House to know that we have been asked by a major voluntary body concerned with the needs of elderly people to request local authorities to weigh carefully whether large quantities of particular warning aids should be installed and purchased, on the grounds that no existing device could be taken as satisfactory for all the situations which might arise, and that it is advisable to work progressively on the basis of proven use in particular types of cases than on indiscriminate issue.
I hope that from what I have said the House will appreciate the seriousness with which we view the problem of the isolated frail elderly and that, although it is thoroughly in accord and in line with public policy that local authorities should themselves consider urgently what provision they should be seeking to make, they should nevertheless hasten slowly 950 and keep an eye on the very specialised research and development projects which are proceeding at Loughborough. They should bear in mind, in particular, not only the need to have a foolproof appliance in home conditions but the essential prerequisite of having a satisfactory terminal—somebody to receive the signal who will understand it at all hours of day and night so that even if the machine itself is 100 per cent. effective, as it is bound to be before it is acceptable, it also makes the necessary connection with the person who alone can bring help.
These are simply some of the complexities and difficulties we face. I believe that we shall find a solution. I believe that it will involve the local authorities, perhaps rather more than many of them may think, in attending to the question of having the equivalent of wardens so that there is somebody who can look after the elderly and disabled in isolated homes. Meanwhile, I am certain that we must all await with eager anticipation the outcome of the Loughborough experiment, which we hope will be terminated in the not too distant future and will have a satisfactory outcome.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-five minutes to Five o'clock.