§ 10.20 p.m.
§ Mr. Greville Janner (Leicester, North-West)
I am happy to have the opportunity to raise the subject of the meals on wheels service. I do so in the knowledge that we have a very brief span in which to deal with a most important topic. At the start I pay tribute to the angels of good cheer who operate the service. Nothing that I say hereafter must be taken in any way as a criticism of those folk. They provide far more than food for the people who are fortunate enough to have the service.
In many cases they provide the only communication that those people have with the outside world, the only communication which is possible for them. They provide life itself and the only means whereby these people are able to remain in their own homes. We have here an arrangement which enables food to be brought by individuals, by those who care, to people who otherwise would be totally isolated. We are accustomed to think of this service as being largely for the elderly but many of its recipients are housebound because they are disabled. For them it is of equal importance.
But for the service, many such people would be institutionalised, would have to go into a home, and that would be a disaster. Many others would die. Those who have need of the service are often people who have lost their spouses and have lost the urge to cook for themselves and who say "What is the difference? A jam sandwich will do for me." In providing food, the meals on wheels service often provides also a desire to live. It gives help, and the help itself provides the means for many of these people to resume a normal life, to resume cooking for themselves and often to give up the need for this service altogether.
So why, if the service is so fine, is it necessary to raise it in the House? Alas, it is limited in its means, in the number of people it reaches, in the days of the 500 week and the weeks of the year in which it operates, and it is limited by virtue of the isolation of the service which it provides.
Let me deal first with the days of the week. An old or disabled person does not cease to need food because it is a weekend. The service stops not only at weekends but often for much longer periods, for example over Christmas. I have seen elderly people in the Leicester area who are well served by the service during the week but who are desperately lonely at weekends and on Christmas Day. It is then that they need help more than ever. The efforts of Age Concern and other voluntary organisations cannot cope with their needs.
I raised this matter in the House a little while ago and the Minister said, in one of his less inspired moments:The number of people known to be receiving the service on a seven-days-a-week basis has increased from 1,361 in 1970 to no less than 2,343 in 1971—a rise of nearly 100 per cent."—[OFFICIAL REPORT, 6th November 1973 ; Vol. 863, c. 785.]If he had said that out of the thousands who receive the service there had been a rise of perhaps 50 per cent., I would have been impressed. But a rise from one to two is a rise of 100 per cent. and a rise from 1,000 to 2,000, while acceptable as a start, is pathetic.
I am sure that in his reply the Minister will recognise that this is only a beginning. This is a major defect in the scheme. The service does not operate on sufficient days in the week or enough weeks in the year. It should be operating seven days a week for 52 weeks.
We come to the enormous discrepancy of the service in the areas. For example, in the city of Leicester the service operates five days a week. It is operated in the main by the local authority and by people employed by the local authority who are totally devoted to their work. I pay warm tribute to them. My wife and I have been out with them and seen the way in which they are received and the warmth and affection which they give and receive when they bring food, companionship, good will, laughter and life to the people whom they serve. In the county of Leicester the service operates on two days a week only and is staffed almost entirely by volunteers. Again, 501 they are tremendous people doing a fine job, but for only two days a week.
We do not know what will happen under the reorganisation. I should like the Minister's assurance that the Government will take every step in their power to ensure that, under the reorganisation, there will not be a levelling-down process which will result in the city of Leicester's service becoming less when it is amalgamated with the pathetically small service operated by the county. It is important that the county service should be built up and that the city service should not be allowed to decline.
The first assurance I should like to have is that the Minister will take all steps within his power to encourage and enable local authorities to extend the service to further days in the week. Secondly, I ask for an assurance that when the Minister is considering the reorganised service he will take all necessary steps to ensure that those services, which are superb within their limits, will not be cut down when they become part of a larger unit. I appeal to the Minister not to use the old excuse that it is a matter for the local authorities to decide what they do. To an extent that is true, but the local authorities have their hands tied by the resources which are available to them and which are in decline.
Thirdly, it is vital not merely to provide meals on wheels for people in their homes so that they can remain there as long as possible, living contentedly in their own surroundings, but also to remove them from those surroundings for their meals wherever possible and to get them into day care centres where they can eat their meals in company and not in isolation. It is often possible to get people out if there is somewhere for them to go, and to get rid of the "hermit" complex that affects elderly people living on their own who never see anyone else. I should like an assurance from the Minister that the Government are aware of this problem and are doing something about it.
I have been told—I hope that the the Minister will be able to deny it—that, as a result of the latest cut-back in expenditure, the first day care centre in the Leicester area is not to be proceeded 502 with but is to be postponed, and that the plans of the local authorities to open a day centre shortly have had to be shelved, so that the hermit complex is to remain a feature of our society for longer than is necesary. Surely there should be no cut-back in the provision of day care centres.
The plan is to have a centre in which meals are served through a hatch to elderly people who are able to get to the centre, and to provide transport to the centre for those who can benefit from the companionship. Those elderly people would thereby be enabled to lead much more normal lives. From the centre would go out meals on wheels to those who could not get there. The idea is to knit together the system in one fabric.
One needs more than a fleet of vehicles delivering meals. Those who deliver them take far more care and time than the law would require of them in doing their job. They know when their clients are unwell, when to call in a doctor and when help is needed. Alas, they also know when a client dies. All too often those not receiving the service may die without anyone knowing of their death, sometimes for weeks. Parliamentary Questions which I have asked have shown that no one knows how many old people die in their homes without anyone knowing of their departure.
We must get a closely knit system. In Leicester we now have a marvellous new scheme being developed whereby an elderly person who needs help puts a cardboard fish in his window so that a street warden may know that help is required. This operates in part of the city. We also have a system of warning lights which, despite all our efforts, the Government have refused to make compulsory. Such warning lights operate in many old people's dwellings. All this is part of a detailed system of concern of which the meals on wheels service is a very important section. But it should not be allowed to operate on its own. We have a start with the system. It must be expanded.
I hope that the Minister will give an indication of the number of people who are now receiving meals and of the number who it is intended will receive them. We should also welcome the hon. Gentleman's assurance that the importance of the scheme is appreciated by the Government.
503 I hope that the hon. Gentleman will join me in expressing appreciation to those who operate this scheme—not only those who send out meals but those who cook them, not only those who deal with patients but also those very patient people working at the Hill Crest Hospital in Leicester and in the school meals service who put in a great deal of extra time to see that the meals on wheels services are provided. I hope the hon. Gentleman will indicate that the scheme will be extended and will form part of other schemes.
I hope, too, that the Minister will assure us that in the reorganised service areas such as the city of Leicester will not be levelled down to meet the needs of other areas not so well served and that in the cut-backs ordered by the Government the day care centres will not be allowed to disappear into a sad limbo.
This is a problem involving hundreds of thousands of people who receive the service, others on waiting lists and others still for whom the service is inadequate. I trust that the Government will put their full weight into extending the service as such, both on its own and in conjunction with the other services so badly needed by the elderly and the disabled.
§ 10.33 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
I am glad that the hon. and learned Member for Leicester, Northwest (Mr. Greville Janner) has given us an opportunity to discuss meals on wheels. As he said, it is a service of great importance to many elderly and handicapped people both in the cities and outside them. I welcome especially the opportunity to pay tribute to the many thousands of volunteers, notably members of the WRVS, who give their time so generously. I cannot overemphasise the debt that we owe to the thousands of volunteers on whom meals on wheels services in most areas of the country continue to rely. Volunteers were entirely responsible for or made a significant contribution towards the provision of nearly 11 million of the 18 million meals on wheels served last 504 year. In most cases they contribute their services free or merely claim out-of-pocket expenses. Without them the cost of meals on wheels would be considerably increased.
The hon. and learned Gentleman has spoken of the need for continuing expansion and improvement of the meals on wheels service. I do not dispute this. For the sake of perspective, however, I make no apology for setting out some brief facts and figures to show what remarkable progress the service has made over the past 20 years.
Surprisingly, interest in a really large-scale expansion of the service is of comparatively recent origin. Until 1961 local authorities had no powers of their own to provide meals to old people, though they were empowered by Section 31 of the National Assistance Act 1948 to contribute to the costs of voluntary organisations which provided such meals. As an indication of the scale of the service, before Section 31 was amended to give local authorities a direct power to provide meals services a survey by Miss Amelia Harris showed that in 1958 some 20,000 people throughout Great Britain were receiving about 1½ million meals on wheels a year. Contrast that with the 18 million to which I referred earlier.
It is interesting to note some of the more detailed findings of the Harris survey. In 1958, for example, more than four out of five recipients received only one or two meals a week and only 4 per cent. received five or more meals. Only 21 individual people—or one in 1,000 recipients—received a meal on all seven days of the week.
While two-thirds of the schemes surveyed by Amelia Harris provided a service throughout the year, one-quarter of schemes closed down entirely for at least five weeks in the year, and sometimes much more. Even at this level of provision, almost two-thirds of the recipients of meals on wheels said that they had at least one good meal every day of the week, and a much higher proportion managed to get satisfactory meals at weekends, particularly Sunday.
Among a random sample of non-recipients the 1958 survey showed that 95 per cent. got at least one good meal a day, with no significant difference 505 between the proportions of men and women or between the different age groups concerned.
The conclusion drawn from the survey at the time was that the overall need was to expand the service to provide 40,000 recipients with some 6 million meals a year.
Not long after that survey report was published, local authorities were first empowered by the terms of the National Assistance Act 1948 (Amendment) Act 1962 to provide meals to old people either directly for the first time themselves or through voluntary agencies as heretofore. Since then the meals on wheels service has grown steadily, and in the past year or so literally spectacularly, so that in England alone in the year ended March 1973 about 135,000 recipients received over 18 million meals in their own homes. I think that was the figure for which the hon. and learned Gentleman was asking.
In addition, a substantial number of people enjoyed a total of about 10 million meals served in clubs or centres. Despite all the difficulties caused by inflation, staff shortages, vehicle shortages and other shortfalls in resources, local authorities, with magnificent support in most cases from voluntary organisations, achieved a remarkable expansion of the service between 1971 and 1972. Not only did the number of recipients of meals on wheels increase by 13 per cent.—no small increase on a figure of over 100,000 recipients—but the average number of meals served per week increased still more. Over the same period there was a 19.4 per cent. increase in the number of meals provided in clubs and centres. The hon. and learned Gentleman, with his special emphasis on the value of these centres, will know the even higher rate of increase of meals provided there.
I recognise, however, that there is no room for complacency. Though the proportion of recipients receiving fewer than three meals on wheels a week has dropped from 67 per cent. in 1968 to 59 per cent. in 1972, there is still a long way to go before we achieve a five-day service in all areas.
In 1972, 18 per cent. of recipients—24,000 people—received five or more meals on wheels a week and 23 per cent. received three or four meals a week. What is not reliably known from available 506 national statistics is the number requiring but not receiving meals on wheels, and the number of meals on wheels recipients who received reliable help with meals from other sources—for example, the home help service, attendance at a day centre or lunch club, family, neighbours, or on their own initiative—on days of the week when meals on wheels are not provided.
A survey of meals on wheels recipients in 1972 in Nottingham, a city not far from Leicester, showed, however, that nearly half the people interviewed did not wish to have any more meals each week even though most received meals only two days a week. A special analysis of those requiring more meals a week suggests that perhaps one-third of existing recipients of a two-days-a-week service in Nottingham might wish to have three or more additional meals a week, though a much smaller proportion—2½ per cent. of all recipients in the city-would have welcomed a six- or seven-day service.
The Department's figures for the country as a whole for a sample week in November 1972 show that just under 4,000 people received six or seven meals on wheels in that week, of whom almost 2,500 lived in Greater London and 1,300 in Liverpool and Manchester. In addition, over 11,000 meals were provided in the sample week in clubs or centres open on six or seven days of the week, including nearly 4,500 in Greater London, 1,500 in Hull, 1,000 in Liverpool and 1,700 in Cheshire. It may be true that reasonably large-scale daily meals services are found only in a few areas of the country at present, but so far the main emphasis has been to seek first to build, as resources allow, towards a regular five-day service for all who need it.
Even this goal is not without its difficulties. It is not easy in all areas to find staff or volunteer helpers who are able or willing to prepare or deliver meals on a shift rota basis which includes regular weekend working. Nor is it always easy to find conveniently sited premises where suitable meals can be prepared every day of the week without a break. In some areas the service can be run only as a paid service, though in other places there are tangible advantages in organising a service of this kind in a 507 way which mobilises all available resources of the local community. No two areas are exactly alike. No single solution is right for all areas, and it is unlikely that a uniform need exists for all areas to expand services at the same uniform rate.
It would also be unrealistic of me if I did not add that for many authorities the resource costs of early implementation of a five-, six- or seven-day meals service wherever it was thought necessary could be met only at the expense of cutting back other services of equal or possibly greater priority. Given the shortfall of resources to meet total demand for local authority services—the hon. and learned Gentleman will know only too vividly from his experience in Leicester how many calls there on the personal social and health services provided by local authorities—there will always be scope for differences between authorities in the assessment of relative priority needs for their area.
Some authorities have clearly wished to give particular priority to ensuring a seven-day meals service, possibly for a limited number of recipients, and perhaps at the expense of other services for which there is a pressing need. Others have preferred to use additional resources for meals services to increase the number of recipients, or provide more club or centre meals, before turning their minds to the possibility of increasing the number of days of service. Yet others have been unable to expand their service more than marginally because of physical limitations of personnel, premises or equipment. In other words, there is a whole range of variations and permutations of the possible ways in which resources can be applied to this need.
I know it is not popular to discuss considerations of hard cash, but we must face the fact that the meals on wheels service costs money—over £3 million in England in 1972–73—and every increase in expenditure on the service must be weighed against the alternatives forgone.
My right hon. Friend the Secretary of State is deeply concerned that this vital domiciliary and community service should grow. With that in view, first he has to ensure that the continuing need to expand meals services in most areas is not overlooked when the total of relevant 508 expenditure used in calculating rate support grant is being considered.
Before last month's announcement by my right hon. Friend the Chancellor of the Exchequer of a 10 per cent. reduction of expenditure on goods and services within public expenditure, provisional planning for meals services had been on the basis that local authority expenditure on meals was currently rising at a rate of about 15 per cent. a year. The consequences for local authority social services of the recent announcement on public expenditure are still to be worked out, and, of course, within the agreed total expenditure local authorities will determine their own priorities for local development of particular services. This is an unavoidable and, I believe, proper concomitant of local government reorganisation.
The hon. and learned Gentleman must not overstress the Government's power to direct local authorities, particularly the new and larger authorities, to do exactly as the Government would wish. But there is little doubt that the local authorities will be less willing to effect reductions in expenditure on personal social services than on many others of their services, so that we can reasonably expect them to continue to operate the meals on wheels service at least at the present level.
Second, we have provided local authorities with a tentative guideline figure for long-term indicative planning of the meals on wheels services. This is a power to influence which we have and use. It envisages 200 meals per week per thousand of the population over the age of 65. That is more than twice the existing national average provision but less than existing provision in some parts of London and in one or two other places.
The guideline is based on the evidence of a number of large-scale surveys of need among elderly people but takes no account of the possible development of alternative ways of supplying hot main meals to people who need them or of variations in need between different types of area. For planning purposes no distinction is drawn in the guidelines between home meals and club or centre meals since we would hope that, where-ever it was practicable, local authorities would seek to provide required meals either regularly or occasionally in the social setting of a club or centre.
509 Third, we are trying to assist local authorities by developing a programme of research studies to provide answers to the short-term and longer-term practical problems of providing adequate meals wherever and whenever they may be needed. Thus, a firm of management consultants recently undertook a study of 33 existing meals on wheels services in order to see how existing resources used within the service might be applied more effectively so as to enable bottlenecks to be overcome and expansion sustained whether or not additional resources can be made available. The report of this study was circulated to all social service authorities and relevant voluntary organisations last October and provides a most informative comparative analysis between different kinds of service and some very useful guidance on how time and manpower constraints on the service could be tackled. We are also involved in research 510 into the nutritional needs and situation of elderly people as reflected in the recent report on the last Nutrition Survey of the Elderly.
I hope that what I have said has demonstrated the Government's deep concern to develop organised meals services for elderly and handicapped people within the context of expanding the key domiciliary care services which are so vital to the continuing independence and well-being of these groups. Much has been achieved in a relatively short while. Much remains to be done. But we confidently expect the encouraging trends of the recent past to continue, and indeed improve, as the economic situation improves.
§ Question put and agreed to.
§ Adjourned accordingly at eleven minutes to Eleven o'clock.