§ 2.51 a.m.
§ Mr. Christopher Woodhouse (Oxford)
Although it has taken a long time for the cows to come home, I hope that the House will bear with me for a little longer while I raise on the motion for the Adjournment an important topic of which the Minister has had notice.
I think the Minister will agree that one of the most difficult problems that faces the social services is that of identifying need and establishing who is in need of what and where they are. That is difficult for a number of reasons, of which probably the two most important are that many people simply do not know what they are entitled to under the social services and, therefore, do not ask, and, second, that many people are too proud to claim the benefits to which they are entitled, which they mistakenly regard as charity.
The Minister, as a private Member, made an important contribution to overcoming these problems in part in one sector through the Chronically Sick and Disabled Persons Act 1970, under which local authorities are now obliged to compile a register of those who are entitled to benefit under the Act. That is clearly the right approach and it is one which should be extended to other sectors of the social services.
There is one narrow but vulnerable sector to which I draw attention—namely, elderly people living entirely alone. Naturally, they do not qualify under the terms of the 1970 Act unless they are 1449 sick and disabled, yet they may be just as vulnerable as those who are so categorised. I must confess that I do not know—and I think probably very few hon. Members could claim to know—how many old people live entirely alone in my constituency, but the number must run into hundreds, and perhaps many hundreds. What I do know is that some of them live in constant anxiety about what might happen if they have an accident or if another emergency occurs whilst they are living alone at home.
In parenthesis I would add that it is an extraordinary feature of our times that the sense of community, at any rate in large cities, has so broken down that it is possible today for old people living alone not to be missed for days, weeks or months on end, even by their relatives. Thus we occasionally read in the newspapers tragic stories of old people being found dead in their homes, without anyone having sensed in time that anything was wrong. The question is, how can we safeguard people against such tragedies?
One of my constituents who is elderly and lives alone recently suggested to me the provision of telephones as a lifeline for people in her state, the cost of installation, but not the cost of calls, being paid by the local authority. I was interested to learn this morning from the National Federation of Old Age Pensions Associations that at its annual general meeting in Blackpool last month a resolution was passed, which I believe has been communicated to the Minister's Department, urging that there should be a reduction of charges for telephones supplied to old people living alone; and, more strikingly, that in new housing projects designed for elderly people telephones should be included as an essential service, just as water and gas or electricity are included.
If my constituent were disabled as well as elderly she would qualify for this provision under the 1970 Act. Fortunately she is not disabled, but there comes a time when it is not easy to distinguish between disability and mere age. I tabled a Question on this point which the Minister answered on 4th April. At the same time I wrote to the Director of Social Services in the new county of Oxfordshire to seek his views. I received helpful replies in each case.
1450 My only reason for pursuing the matter is a slight but crucial inconsistency between the Minister's reply and the director's letter. In his reply the Minister said:Local authorities already have such powers under Section 45 of the Health Services and Public Health Act 1968. I am sending the hon. Gentleman a copy of a circular on this matter issued by my Department in 1971."—[OFFICIAL REPORT, 4th April 1974; Vol. 871, c. 422.]I would add that this circular is an excellent document, to which I shall return.
The director of social services for the county also wrote helpfully, setting out the various considerations. He ended with these words:At the same time there is no doubt that the provision of a telephone or other means of alarm can increase a sense of confidence in those who are anxious about themselves in a house with no one else readily available, but until such time as legislation alters and greater resources are made available I doubt whether we should be able to meet demand made on this ground alone.Helpful as these replies were intended to be, they seem to disagree about the existing powers. The Minister says that the necessary powers exist under the 1968 Act, but the director of social services uses the phraseuntil such time as legislation alters …".I know that it would be difficult to ask the Minister to introduce new legislation in this debate. Fortunately it would also be quite unnecessary, because if such legislation were needed he would be the first to sponsor it.
I ask, instead, for three things: first, for clarification of the existing powers under present legislation; secondly, for the Minister's view about the desirability of making some such provision for old people living alone by means of either a telephone or some alternative means of giving the alarm in case of accident or emergency; thirdly, for a brief general progress report on the success of Circular 19/71, of which the Minister sent me a copy. As a document it could hardly be improved, but admirable documents are not always turned into instant realities.
The circular says that the Secretary of State at that date—that is in 1971—had no intention of using his power under 1451 Section 45 to direct local authorities to make arrangementsuntil considerably more experience has been gained of the best ways of promoting the welfare of old people.Does that intention still hold good?
The circular also says that the Secretary of State had decided togive general approval to all authorities to make arrangements under Section 5 for purposes set out belowand there followed a list of eight items, one of which would no doubt cover the provision of telephones for the elderly living alone, namely, item (f)to provide all practical assistance in the home, including assistance in the carrying out of works of adaptation or the provision of additional facilities designed to secure greater safety, comfort or convenience.How far have those provisions, especially item (f), been carried out in practice?
I have heard it said that at least one county council decided some time ago to provide telephones for old people, virtually on demand if they lived alone, because it was the cheapest as well as the most effective way of providing them with security and ending their anxiety, and as that was the Lancashire County Council perhaps the Minister can comment from his personal knowledge.
I should also like to mention another case which came to my knowledge today which I think may need careful consideration, and this again occurred in Lancashire. An elderly couple had installed a telephone at their own expense. When the husband died, the widow was living alone and was in much less well off circumstances. The local authority refused to help to meet the cost of the telephone because it had originally been installed privately, although, being a disabled person, she would have been entitled to a telephone under the 1970 Act if she had not had one already. That seems a somewhat harsh interpretation of the law by the local authority concerned, but I shall not pursue the matter further because that local authority has gone out of existence and been merged in the Lancashire County Council which appears to have a more liberal attitude.
Another point in the circular was the suggestion of a survey of need, followed by the creation of a "working team" 1452 of representatives of each of the relevant services such as home help, meals on wheels, the housing department, social workers, health visitors and so on. How far has that proposal been effective?
The circular also rightly says that "wide and continuing publicity" is needed about the services that exist, and I should like to know whether that is being satisfactorily dealt with.
The circular then says, and it is a little surprising at first sight, thatExperience suggests that attempts to compile a comprehensive register of the elderly are misconceived".On reflection I can see sense in that, but it would surely not apply to the more restricted category of elderly people living alone.
I have spread the net of questions wide, but I assure the Minister that I have not done so in order to trap him. I hope that he will be able to give me some reassuring answers, especially on the central question of providing elderly and lonely people with a lifeline in the form of a telephone or some means of safeguard in case of emergency.
§ 3.5 a.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Alfred Morris)
This is a very late hour, but I am grateful to the hon. Member for Oxford (Mr. Woodhouse) for giving the House an opportunity to debate this deeply important subject tonight. It is always a pleasure to debate with the hon. Gentleman, because he is at once well informed and fair.
The hon. Gentleman did me the courtesy of indicating in advance of the debate the points he would be seeking to raise. This has been extremely helpful to me in enabling me to attempt to prepare a constructive reply.
The fact that the hon. Gentleman has chosen this subject for debate is evidence of the deep personal concern for neglected elderly and disabled people who, sadly, comprise a substantial section of our society, and especially in our cities.
My day-to-day knowledge of the city of Oxford dates back to my time at the university there over 20 years ago, but I can well appreciate the scale of the local problem which informs the hon. Gentleman's concern.
1453 I will deal first with what I am sure the hon. Gentleman will agree is the most important point in his speech, namely, the power of local authorities to make the sort of provision that he is seeking. I can give an assurance that, in our view, social services authorities have powers to provide telephones to the non-handicapped elderly, whether living alone or not. We regard these powers as conferred by the approved arrangements under Section 45 of the 1968 Act as set out in Circular 19/71 of which, as the hon. Gentleman kindly recalled, I sent him a copy when answering his Parliamentary Question. The particular approval is in paragraph 4(f) of the circular which, although it does not specifically refer to telephones, covers them as much as any other "facilities".
It is true that the arrangements referred to in Circular 19/71 were discretionary and did not in terms refer to telephones. I should like to reiterate that these arrangements cover telephones, but local authorities must, of course, be left, so far as is possible, to set their own priorities in the light of local circumstances and limited resources. We do not believe that a more interventionist line would be justified, given this background and also the need to preserve the independence of local government.
The hon. Gentleman asked about action taken by authorities in pursuance of the circular, which rightly emphasises the importance of local authorities obtaining better information about the needs of elderly people in their areas. I understand that all local authorities have made solid progress in this respect, with some having undertaken surveys organised either by their own research sections or by outside bodies such as universities.
I do not have precise information on how many local authorities have implemented the circular or on the actual provision of the wide range of services allowed for in Section 45. Such information as I do have suggests that, bearing in mind the inevitable constraints, authorities are doing a very great deal to meet the needs of their elderly people. There has been a steady growth in the provision of such services as home helps and meals in the home and elsewhere, of which the elderly are the main recipients.
I have noted carefully the hon. Gentleman's reference to the resolution approved 1454 by the National Association of Old Age Pensions Associations. The proposition that public authorities should include provision for telephones at the design stage of all new housing projects for the elderly is both stimulating and important. As I know the hon. Gentleman will appreciate, I cannot make any definitive statement about this tonight. My Department will, however, be giving detailed consideration to the submission made to us, in consultation with other Departments, and there will be a reply as soon as possible.
It is true that certain authorities, for instance Glamorgan and Manchester, have provided proportionately more telephones than have others. It is also true that there are variations among authorities in all types of provision. An authority that is comparatively generous in some respects may be obliged to be less generous in others because of financial constraints. The reason why authorities tend to concentrate on certain types of provision lies not in the findings of research but in subjective judgments.
In the case of the 1968 Act, we have no means of knowing whether authorities which have concentrated on telephones have done so at the expense of other pressing needs. Accordingly, the Department of Health and Social Security is not in a position to issue authoritative recommendations.
The hon. Gentleman mentioned Lancashire. Inquiries made of the Lancashire Social Services Department suggest that it follows the criteria recommended by the local authority associations. It does not have a policy of providing telephones for old people virtually on demand if they live alone. In the year 1973–74 the old Lancashire County Council provided 1,472 telephones and paid for 699 rentals. That is an impressive record on which the council is to be congratulated, but it is comparable with that of some other authorities and does not bear out any impression of a notably generous policy.
I pay tribute to the officers and members of the Post Office Engineering Union who, through their scheme for the free installation of telephones provided under the Chronically Sick and Disabled Persons Act, have enabled local authorities to provide far more telephones for the elderly than would otherwise have been 1455 possible. Members of the union voluntarily install such telephones free of charge in their own time. As a result, the Post Office is able to reduce its connection charges by 50 per cent. Since 1971, when the scheme started, POEU members have installed 4,035 telephones in their spare time without pay. Their humane gesture is warmly appreciated by disabled people and public authorities alike.
To turn to the central question of telephones for the elderly, I appreciate that the cost of a telephone is an important deterrent for old people, but two important questions arise. The first is whether, in the light of the limited resources available to us, we could justifiably argue that the provision of telephones for all elderly people is a top priority for the social services. The second is whether the installation of telephones would in all cases have the beneficial effect expected of such a policy.
Statistics suggest that there might be 600,000 people in England aged 75 or over, and that there are 200,000 households where the sole occupants are a married couple both aged over 75. Even if only one-third of those who are potentially eligible accepted a telephone, the cost implications are serious. The real cost of installing a telephone is more than £150, and is normally heavily subsidised by profits on calls. The Post Office would, therefore, have to meet an initial cost of between £40 million and £50 million, which would be unlikely to be recouped as the elderly would not in general make many calls.
We must assume that these high costs would be passed on to local authorities. The current estimated expenditure on all local authority social services in England and Wales is £450 million a year, so a potential £40 million or £50 million initial cost for telephones is extremely significant.
The local authorities are trying first to meet the most urgent need for telephones, and that is the only possible approach at this stage. The merits of a more general provision of telephones are not perhaps as self-evident as they seem at first sight. Not all elderly people would be willing to use a telephone. There is also a danger of it being assumed once a telephone has been installed that the disabled person is all right in the absence 1456 of a call. This may neglect the possibility that the elderly person may be unable to reach or use the telephone at the moment of greatest need. In a situation of emergency, the telephone may very well turn into a lifeline that cannot be used unless it connects the user with immediately available expert assistance.
The suggestion has been made that the provision of telephones for the isolated elderly would be justified not so much because the individual would be able to telephone out for any necessary assistance, but rather on the grounds that the social worker could telephone in. The idea is that, in this way, social workers could keep in daily touch with relatively large numbers of people whom they could never hope to visit so frequently. Alternatively, it is argued that the visiting which is done by social workers could be carried out with great economy of manpower. It has been similarly argued that such a lifeline might well defer institutional care for a significant time with further resultant saving in money and manpower.
No one can deny the advantage of telephones for selected individuals, but telephone calls must not be regarded as a substitute for social work visits, since case work cannot itself be adequately conducted over the telephone. While a telephone can help, it can never replace face-to-face contact. Moreover, if an old person is in need of care to the extent that he or she needs to be checked on daily, it is doubtful if telephone communication by itself would be adequate. Certainly, a daily telephone call would not represent any sort of emergency alarm system, as the interval between calls would be far too long.
I should like now to refer briefly to the first question that I posed, and to which the hon. Gentleman referred, namely, the priority that telephones for the elderly should command. Local authorities are already faced by a great many competing demands on their limited resources and have adopted fairly stringent criteria with regard to the provision of telephones in order to be able to meet the requirements of the Health Services and Public Health Act and of the Chronically Sick and Disabled Persons Act. An unselective provision of telephones would, frankly, not represent either their or the Department's top priority.
1457 If, as we surmise, the cost of installation might be £45 million, plus possibly £5 million for additional facilities such as amplifying handsets, and continuing annual capital of perhaps £13 million, to which perhaps £17 million annually would be required to meet annual rental costs, the question arises whether sums of this magnitude would not better be used on extra staff provision—for example, social workers or home helps. Annual expenditure by all welfare services for elderly and disabled people under Section 45 and Section 2 of the Chronically Sick and Disabled Persons Act would be likely to be less than the expenditure on telephones, and the latter would seem out of proportion.
We must clearly think in terms of a long time-scale for the expansion and development of services of all kinds. The provision of telephones is, of course, only one of many services. I am anxious that plans for such expansion should be backed by reliable research information. My Department has a great deal of information about experiments with communication devices and schemes of all kinds, and I am considering ways in which we can 1458 participate in still others. Whatever we do, it is unlikely that we can ever tackle the problem of isolation among the elderly and disabled without directly involving the community generally. It is here that we must concentrate our efforts.
Local authorities are developing warden schemes and good neighbour schemes of various kinds. They are marshalling voluntary organisations and volunteers, but we cannot really expect statutory bodies alone to solve this vast human problem. It will only be substantially alleviated through the efforts of neighbours, friends and families. What is needed is active, sympathetic interest by people everywhere, based on the understanding that what those who are lonely want is that others should take a human interest in them. No amount of telephones or alarm devices can substitute for that interest. I believe this debate will itself help to, improve public attitudes towards helping the elderly who have to live alone.
§ Question put and agreed to.
§ Adjourned accordingly at nineteen minutes past Three o'clock a.m.