HC Deb 29 January 1979 vol 961 cc1201-10

Motion made and Question proposed, That this House do now adjourn.—[Mr. John Evans.]

11.30 p.m.

Mr. Robert J. Bradford (Belfast, South)

Four great concerns combine to threaten the imminent success and the perpetuation of the health and personal services for the elderly in South Belfast. First, I assure the Minister that I shall not pursue this subject in a negative or carping way, and that I shall not simply express dissatisfaction; I shall make some suggestions which I hope will be both constructive and attractive to the Minister.

I express gratitude to those in South Belfast who have particular responsibility for the elderly—for instance, members of the DHSS who have had many hundreds of calls not only from me but from other Northern Ireland Members. I have in mind the health visitors, district nurses, social workers, area wardens, home helps and night sitters. But, in spite of their sterling efforts, there is growing concern among them as well as among relatives and public representatives in the district.

There are four areas of concern. First, there is a great need for a psycho-geriatric unit in the area. The development plan for health and personal social services which was published in March 1975 stated that there should be 15 beds per thousand for those who were confused and geriatric. Since there are 16,000 elderly people in South Belfast, the need is for about 100 psycho-geriatric beds. According to my information, there are only 30 beds, and they are part of the residential accommodation. Granted they are for the confused, but we are talking about more serious cases. We are talking about psycho-geriatrics.

Every week, without fail, in my constituency a number of these elderly people are found on the streets, very often in their night attire. They are brought home either by policemen or by concerned citizens. In the immediate future we need a 100-bed unit. The view that I am expressing now is not just my own view or assessment but that of those who have to try to deal with the elderly who are in this category of psycho-geriatric. I should therefore like the Minister to give an assurance that this problem will be tackled in the very near future.

It might be said that there is no space for that size of unit, but there is the possibility of building it at Musgrave Park hospital—a hospital in South Belfast—which has a great deal of space around the main building. It could be said that Purdysburn still has some space available for building. My view is that we should separate this psycho-geriatric unit for the elderly from the normal psychiatric hospital at Purdysburn, and so it is possible that the Musgrave Park site will be attractive to the Minister and his Department.

Secondly, I want to deal with the question of sheltered dwellings. Again, on the basis of the 1975 regional plan, we ought to have 420 sheltered dwellings in the South Belfast district. That is on the basis of 25 per 1,000. We have 39 sheltered dwellings, but we ought to have 420, and I believe that is a most deplorable ratio, particularly as South Belfast has far more elderly people than any comparable area in the Province.

I have three suggestions to make as we view this problem of sheltered dwellings tonight. First, I suggest that in the Woodstock area, which the Minister knows very well, there are at least three places where sheltered dwellings could be erected, almost without further delay, and these would help to obviate the immense needs which exists.

We have a project, which is under the auspices of the Belfast Improved Homes Association, in Richardson Street. It wants to go ahead with 20 flats. This will mean the demolition of an old area in Richardson Street, Nos. 1 to 25, but I cannot see why the problems cannot be overcome to allow 20 more flats to be built for the elderly, and of course these flats would have wardens and would be sheltered dwellings in every sense of the word. What is the cause of the delay? Is it that demolition is involved? Or is there some difficulty in negotiations with the Department?

My second suggestion concerns the Belgravia hotel in South Belfast. It no longer functions as a commercial hotel and is, I understand, up for sale. I understand also that some people are keen to acquire the hotel for the purpose of sheltered dwellings. If that is so, and if there is a group interested in converting this hotel into a sheltered dwelling complex, what difficulties are envisaged in that being done? Are the difficulties administrative? Is the delay in giving approval for this scheme due to an administrative problem? Or does the Department envisage that there will be serious structural difficulties in converting this property?

There is no need to add that if we got the Richardson Street scheme and the Belgravia hotel scheme under way and got under way the third scheme at Derryvolgie under the auspices of the Cheshire Foundation, they would considerably improve the deplorable rate of 39 sheltered dwellings in an area which, according to the Government's own statistics and strategy, ought to have 420 dwellings.

When will the Minister get buildings under way in area 31 and area 32 for the elderly? When will the James Butcher housing scheme in Donegal Pass get under way for the elderly? All those added to the three schemes I have already mentioned would go more than half way to giving us the proper number of sheltered dwellings in this area.

The Housing Executive is really frustrated because it simply cannot deal with the applications, and so a vicious circle is created. The Housing Executive cannot deal with these elderly people, and they find themselves in accommodation which is literally deteriorating around their ears.

The next need is for residential accommodation. What is the situation in that regard? Again, according to the 1975 regional plan, we ought to have 463 beds in residential statutory homes. We have the grand total of 173 beds. Again, that is a deplorable figure. When the Housing Executive cannot take these older people, they are forced to live in their dreadful dwellings until they are too ill to continue in their own rundown homes, and when they look for residential accommodation in some of the statutory homes the answer is "No, I am afraid that we cannot help you." The number of people who are seeking homes in residential accommodation is far beyond the number of beds—173 beds to be precise—now available.

The vicious circle continues. There are not enough sheltered dwellings, or enough residential beds in statutory homes, or enough psycho-geriatric beds, so the brunt of all this extra work falls upon the administration and the field workers inside the Belfast district. The health visitors are dealing with about 20 people per day. Each of the district nurses has about 30 patients to look after. The ratio might be far higher than that for qualified State registered nurses because among the number of nurses who are looking after the elderly are auxiliary nurses, and they cannot undertake some of the more difficult and sophisticated treatment that old people require.

Each social worker has 40 people to look after. But the number might be very much higher than that in some cases and rather lower in others, because there are certain jobs which certain social workers can undertake and others cannot undertake.

However, one thing is clear: the number of people who are receiving help, 5,723, is stretching the resources of South Belfast to the absolute limit. We must bear in mind that those 5,723 people are just one-third of the total number of elderly people in South Belfast. It is clear that many of them need help and are not receiving it simply because of this vicious circle of not enough statutory residential accommodation, which in turn puts pressure on the field workers who, at the end of the day, cannot cope.

I want very quickly to deal with one particular case which illustrates the point markedly. I have been told again and again by the noble Lord who is in charge of the Department of Health and Social Services in Northern Ireland that supportive services in South Belfast can cope with the problem. That is not the case, and this illustration helps to make the point. It concerns an elderly lady. I was told that the home help called on her twice a day for seven days. In fact, the home help did not call for four days. The area warden was supposed to call twice a day, but twice a week would be a more accurate assessment.

It is not that these people are neglecting their duty wilfully. They simply cannot cope with the burden of work. The Department expects them to produce the kind of supervision which theoretically it feels can be given but which in practice cannot because of the quota of workers and the number of elderly people depending upon them.

I finish on the important subject of finance. I make no apology for stating that I am against increasing public expenditure. But in this situation I do not believe that a great deal of additional public expenditure is required. Instead, we require a reallocation of public expenditure. Since we are broadly discussing building and housing problems, may I suggest to the Minister that if the Department can find £5 million to demolish the Turf Lodge flats and presumably rebuild some sort of housing complex there, it is very difficult to see why money cannot be made available for the 420 sheltered dwellings and the 463 residential beds needed by South Belfast and all the sheltered complexes needed in the redevelopment areas.

Within the Health Service there is a deplorable waste of money. I have correspondence which I shall be forwarding to the noble Lord from an eminent surgeon in one of the Belfast hospitals. Coming up to the end of the financial year, £425,000 was spent just to keep the allocation of the Department up to scratch for the forthcoming year. Much of this money is spent on equipment which cannot be employed in certain hospitals because they do not have the manpower necessary to use it.

I hope, therefore, that the Minister recognises that I am not asking for a dramatic increase in public expenditure. I am asking for a more judicious application of the money that is already spent. I ask the Minister when we are to get the 100-bed geriatric unit, when we are to get the sheltered dwellings, including those in the redevelopment areas, and when we shall get the proper quota of beds in residential accommodation. When will the pressure on field workers in the South Belfast district be eased?

11.48

The Under-Secretary of State for Northern Ireland (Mr. Ray Carter)

One of the more interesting features of life in Northern Ireland is to observe over the months Northern Ireland Members going through the Lobbies voting against public expenditure and calling for cuts in public expenditure but by letter and by debate, such as we have had tonight, urging the Government to increase public expenditure. It is a rather quixotic performance.

I share the concern of the hon. Member for Belfast, South (Mr. Bradford) that the elderly people of his constituency should be provided with the best possible service. However, it is quite inaccurate and totally misleading to say that a breakdown in services in South Belafst is imminent.

They could be better, and we all wish that they were, but the Eastern health and social services board, which is responsible for the provision of services for the elderly in South Belfast, in the face of many difficulties, some national and some local, is caring for and supporting an increasing number of old people.

On a national basis, the proportion of elderly people in the population is increasing rapidly—in part a tribute to advances in medicine and health care generally. This trend is also evident in Northern Ireland, and by 1980 it is expected that 11.6 per cent. of the total population will be over 65. South Belfast has a particularly high concentration of old people, and by 1980 the proportion of elderly there is expected to be 15.9 per cent., representing a total of 16,500 people over the age of 65. Of these, about 6,000 will be over the age of 75.

There are problems, too, both regionally and nationally, in filling consultant posts in geriatric medicine, in finding sufficient nurses with skill and experience, and in building up the broad range of community services required to support elderly people in their own homes for as long as possible to avoid having to take them into care. There are problems, too, in that medical beds in general hospitals are increasingly occupied by elderly patients, and that larger numbers of psycho-geriatric patients are occupying beds in psychiatric hospitals. These trends are apparent in South Belfast and are aggravated by the relatively higher number of old people in the area and by the difficulty of securing sites there for new residential homes for the elderly.

The Eastern health and social services board is well aware of these trends and the problems they cause, as is the Department of Health and Social Services. The Department is undertaking a general review of services for the elderly in Northern Ireland, and urgent discussions are taking place between the Department and the board about the specific problems facing services for the elderly in Belfast.

Without wishing in any way to suggest that either the board or the Department is complacent about the present level of service, I hope I can reassure the hon. Member by referring briefly to the scale and range of services at present being provided by the board through the efforts of a dedicated medical, nursing and social work staff.

The first aim of our programme of care for the elderly is to enable old persons to remain independent at home in the community for as long as possible, to provide support through community health and nursing staff and, through social workers and various para-medical and supportive staff, to help them to do so. Neighbourhood wardens are employed to keep an eye on elderly people in small local areas and extensive use is made of the home help service.

In South Belfast, there are 15 full-time and 812 part-time home helps, providing an invaluable service to the elderly in their own homes. I might add that in Northern Ireland as a whole more than £8 million was spent on the home help service in the last financial year, and more than £½ million was spent in South Belfast. This represents a substantially higher rate of provision than anywhere else in the United Kingdom.

In addition, the district provides some 600 meals on wheels twice weekly and there are 345 places available in luncheon clubs and 969 in old people's clubs. Day centres provide a variety of activities for members and facilities for meals, bathing, hairdressing and chiropody, and there are 562 places in five day centres in the South Belfast district.

In addition to the 140 people covered by neighbourhood warden schemes, 43 elderly people live in sheltered housing. Sheltered housing is one of the most practical ways to accommodate elderly people in need of support and keeping them in the community. There is a need for more sheltered accommodation, and the Housing Executive shares this concern and has recently appointed a special needs officer with special responsibilities for sheltered housing. The voluntary housing movement also has a part to play. The Department of the Environment for Northern Ireland is giving every encouragement to housing associations to come forward with schemes and approval has been given for the provision of over 2,000 sheltered units by housing associations. However, in order that the future provision of sheltered housing may be co-ordinated, officials from Northern Ireland Departments, the Housing Executive and the Northern Ireland Federation of Housing Associations are meeting to establish the need for more units, locate sites and determine the most appropriate agency for implementation. The group's efforts will be concentrated on Belfast and I would hope to see a significant improvement in the amount of sheltered accommodation over the next two years.

For those who require more than support in their own homes, the Social Services Department provides 173 places in four residential homes and assists in the maintenance of a further 160 elderly residents in homes run by voluntary organisations. Residential homes offer skilful care in comfortable surroundings. The primary aim of this care is to create an atmosphere in which residents can live as normally as possible and in which their individuality, independence and personal dignity are respected. Many residents enter homes now at advanced ages and in the expectation of living there for the rest of their lives. For this reason, new homes are being designed to meet the needs of increasingly frail residents. One, specially designed for the care of 30 mentally confused elderly people, is at present being planned for South Belfast district and construction work is expected to start this summer.

Overall, the provision of statutory old people's homes in the district is low, and the main reason for this is the difficulty in obtaining suitable sites. However, the search for sites is continuing and, when a suitable one is obtained, high priority will be given to providing another home.

By next year, the target scale of provision for all geriatric hospital beds for assessment, rehabilitation and continuing care will have been reached in Northern Ireland. This scale is 15 beds per 1,000 of the elderly population. In South Belfast district there is a total of 409 geriatric beds in the City, Musgrave Park and Hay-park hospitals—an excess of 166 over the planning norm. On the whole, there is a high standard of geriatric accommodation in these hospitals. Nurse staffing ratios and medical cover in the units are reasonably good, all the beds have consultant cover, and those at the City hospital, which serves South Belfast district, are in the care of the professor of geriatric medicine at Queen's university, Belfast. Day hospitals can reduce the need for admission to hospital, particularly where they are linked with a well-developed programme of services in the community. This form of care relates best to densely populated urban areas such as South Belfast. At present up to 20 patients daily are being cared for on four days each week at the Wakehurst house in the City hospital and on two days each week 10 to 12 patients attend Musgrave Park hospital.

The scale of provision for psychiatric hospital beds also takes account of the needs of the ageing long-stay population in psychiatric hospitals, the elderly with functional mental illness and those suffering from senile dementia. South Belfast district forms part of the catchment area of Purdysburn hospital, which has 1,252 beds. In Purdysburn, the problem is the number of existing long-stay patients, and a new purpose-built 72-bed psycho-geriatric unit was brought into use at the hospital in 1976. This serves mainly to provide accommodation for the care of elderly patients who have grown old in hospital.

Mr. Bradford

rose—

Mr. Carter

Admission criteria remain stringent for elderly people in the community suffering from senile dementia—

Mr. Bradford

Will the Minister give way?

Mr. Carter

—but while awaiting admission these elderly people and their families are, where necessary, being supported by community health and personal social services. It is hoped that the residential home for mentally confused elderly people, now in planning, will help relieve this situation.

Mr. Bradford

On a point of order, Mr. Speaker. I put some very detailed questions to the Minister, none of which has been answered. I appreciate that he has given information about what is taking place. I asked questions about what is not taking place and the need relative to many of the dwellings and a psycho-geriatric unit. May I have answers in writing, if not tonight?

Mr. Speaker

The Minister has about 10 seconds to do it.

Mr. Carter

As is normal in an Adjournment debate, any questions not covered in the reply will be answered by letter.

In addition, a survey is at present being completed of the physical facilities of psychiatric hospitals and units in Northern Ireland, including catchment areas as well as the need for additional facilities. However, the continuing care in hospital of these patients is a major and steadily increasing problem, not only in South Belfast but throughout the Health Service.

The Question having been proposed after Ten o'clock, and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at Twelve o'clock.