HC Deb 23 May 1980 vol 985 cc983-95 1.26 pm
Mr. William Hamilton (Fife, Central)

The basis of this debate is the report "Changing Patterns of Care ", which deals with the services provided for the elderly in Scotland. It has been produced by the programme planning group of the Advisory Council on Social Work and the Scottish Health Service Planning Council.

I think that, at the outset, I should put on record the gratitude of the whole House to Mrs. Elizabeth MacDonald the chairman of the group, and to all the members of the group and its subgroups. As Mrs. MacDonald says in the preface, it is the most comprehensive report on the elderly to have been published in Scotland.

Having read the report, I think that it merits that description. It is a valuable reference document, though I must say that, priced at £4, it will hardly be a best seller among old people. The price of the report shows inflation in full spate, and I hope that the Secretary of State and the Scottish Office are not using the price in order to prevent wide distribution of the report. I also hope that the Scottish Office will make sure that the report is distributed in the proper quarters throughout Scotland and that it is widely debated.

Obviously, with an extremely wide remit, the group was not able to cover all aspects of the challenge. I regard the increasing numbers of old people as a challenge rather than as a problem. The group indicate the breadth of the problem in the nature of its recommendations.

Perhaps it would be worth while if I quoted some of the facts. There is an increasing number of people over 65 today and the number of people living beyond 85 is also growing. The figures produced in appendix 2 of the report are startling. About one person in seven in Scotland is over 65—which means a total of 705,100 people. In the 10 years 1976–86 the 75 to 84 age group will increase from 200.500 to 243,000—an increase of about 21 per cent. The number of people aged 85 and over will increase from 41,200 to 54,000 in the same decade. By 1991 there will be another steep rise, to over 74,000 people aged 85 and over. By 1991–11 years from now—over 310,000 of Scotland's population will be over 65 years of age.

These people have to be kept by the rest of the community. Their demands are for housing, hospital services and community-based local services, such as day centres, home helps, chiropody, lunch clubs, meals-on-wheels, laundry and transport facilities. The report states: Growing old is part of normal human development … Every effort should be made to allow this process to take place in the home and family environment with whatever support might be needed from both statutory and voluntary services. It is trite to say that the rest of the community must be prepared to foot the bills to meet the challenge by taxation, rates, voluntary effort and increasing the total national wealth. The Government's reply will stress the importance of increasing national wealth. I accept that that is important, but the Government must ensure that national wealth is more fairly distributed not only in incomes but in the form of the services to which the report refers.

More money in the pocket, and better housing, health services and transport are essential if the fear, boredom and immobility of ageing are to be reduced to tolerable levels. The problems cannot be solved by the laws of the market. The free play of market forces cannot meet the challenges posed by our old people.

Few old folk are able to buy their own houses. The Government make great play of selling council houses. That incites little response from old people. Few old people can buy private health services. The Government propose to introduce a Bill to extend private medicine. That will be irrelevant to most old folk. Government policy is that people should receive in accordance with their wealth.

For financial and physical reasons, few old people can use their own transport. The majority of our old people are in low-income groups and depend increasingly on the public services, which are paid for by the rest of us out of rates and taxes.

The most important recommendation in the report relates to housing. The report says that about 90,000 extra places in amenity and sheltered accommodation are needed in the next decade. The report makes a tentative estimate of the cost—about £1,000 million. The report reckons that about 1,000 additional hospital beds and places will cost another £30 million up to 1986. The provision of day hospitals will cost between £6 million and £10 million. They are tentative figures, but they are guidelines that indicate, very broadly, the challenges in financial terms.

In a foreword to the report the Secretary of State for Scotland recognises the need for improvement in the services for the elderly. He indicates that the Government will publish a White Paper later this year, but there is a warning that the report will be pigeonholed to gather dust on the shelves of the Scottish Office.

I could write out the gist of the Minister's reply, because, in the foreword the Secretary of State said that all proposals would be considered in the light of the Government's plans for public expenditure, and in the light of the prospects for the economy. We hear that sort of reply all the time. The Minister's reply will be no exception. He could speak without a note, because he knows the answer by heart. Without a note, he will ostentatiously reel off the answer. I have heard it all so many times.

Put bluntly, the Secretary of State's foreword means that there will be at least three years—it may be a decade—of hard slog. That is official Government policy. The Prime Minister is always saying that. She blames everybody but herself. We shall have a decade of increasing misery and hardship for the elderly and the poor, with ever-increasing pressures on local authorities to reduce expenditure on the services to which I have referred. There will be a greater reduction in the quality of health services, in national insurance provisions and in housing. The sign of things to come was provided only this week in the debate on the Social Security Bills.

I wish to put on the record what will happen in housing in Scotland. The Housing Bill relates principally to England and Wales. According to the White Paper on public expenditure, the Government are planning to cut expenditure on Scottish housing by 42 per cent, in the next four years. The current level of spending is £702 million. Next year that will be reduced to £603 million, and in 1983–84 to £410 million. Of all the expenditure in Scotland within the responsibility of the Secretary of State for Scotland, that on housing is to be cut more savagely than any other, yet we all know that parts of Scotland are the most deprived in the whole of Western Europe. There are still acute housing shortages in many parts of Scotland. The Minister knows that.

Paragraph 2.6 of the report states: The provision of a greatly increased supply of sheltered housing is one of the central recommendations of our Report. The scale of increase required will mean that a higher proportion of the financial allocation of local authorities will need to be devoted to this purpose … local authorities should be enabled to enlist the aid of the Scottish Special Housing Association. They can also expect aid from other housing associations. But this SSHA cash is being drastically cut. Its capital allocation for 1980–81 is to be 20 per cent, less than the provisional allocation. The housing associations are also to be clobbered, so there is no hope of implementing or going any way towards implementing the recommendations of this group along those lines.

I am asserting now that there is absolutely no hope whatever of achieving within the next decade the housing targets set out in this report. That I regard as a great tragedy and, moreover, an unnecessary tragedy—a tragedy that need not happen. It is avoidable.

Some of the most exciting and humane projects in Fife, in my own area, are to be found in sheltered housing schemes—the Minister should visit them, if he has not done so already—in Glenrothes new town, in Lochore, in Keltie and in Cowdenbeath—all Labour-controlled authorities. That must be emphasised. It is principally in Labour-controlled areas that that kind of provision is to be found. I remember the miners' rows in those communities. Not one miners' row now exists in any of those communities. That is a great tribute to what Labour control can do locally and nationally.

These services are vital to the old. They are provided with companionship. They are provided with a degree of privacy. Not least, they are within a community of younger people. They are also provided with communal heating, which is very important. One of the most important facilities for old people is warmth, and they get this in the community housing schemes.

The report also asserts, in paragraph 1.4 on page 10, the need to ensure that our old folk should be able to count as of right on a pension at a level which means that they do not have to claim supplementary payments for such necessities as heating, rent and clothing. The question must immediately be put: how far have the Government gone towards satisfying those requirements? The answer is: not very far. The Government have made a change in the provision of pension increases. The previous Labour Government tied the pension to increased prices or increased earnings, whichever were the greater. One of the first things that the Tory Government did was to remove that obligation and tie the pension only to increased prices. Indeed, they have gone further than that, because the increase due to the old-age pensioners in early November this year is being deliberately delayed by the Government for a fortnight.

The junior Minister at the DHSS has said that this was deliberately done to rob the old people. She did not use the word "rob", but she said that it was to save £125 million of public expenditure. What was that but robbing the old people of two weeks' increase in their pension? The £10 Christmas bonus will be far less in sum than the £125 million that the Government are taking off the pensioners by retarding the increase in their pensions.

Incidentally, the Social Security (No. 2) Bill is the first Bill in this House for 50 years to be described officially by a Government as a Bill to abolish certain national insurance payments and to reduce others. That Bill provides for the freezing of the earnings rule for retirement pensioners at £52 a week, in order to save £16½ million. It phases out the earnings-related supplement, which has been paid for by national insurance contributions. That is the breaking of a contract between the Government and the contributor. That is being done to save £360 million. It provides for cuts in unemployment benefit and for occupational pensioners with pensions of over £35 a week. That is being done to save £25 million.

All that is in aid of what? Why cannot the plans in the report be fulfilled? The Government say that they cannot afford to do that. They say that we must all make sacrifices and that no Government Department can be excluded from the cuts. They argue that we must have cuts in education, health, housing, roads and help for the unemployed, and that we must all do our bit.

That is not true. If a person earns over £20,000 a year——

Mr. Ronald W. Brown (Hackney, South and Shoreditch)

He is all right.

Mr. Hamilton

Yes, that person is all right. Those earning over £20,000 a year have been laughing all the way to the bank, following the past wo Budgets. Those who are suffering are the sick, the unemployed and the aged. If someone is unemployed, sick or old, he has done badly out of the lady in No. 10. It will all get very much worse over the next few years. It will all be blamed on greedy trade unionists at home, on greedy Arabs abroad, and on the Russian menace. The scapegoats are ready for the mess into which the Government are rapidly plunging the country.

We hear the nonsense about all Government Departments having to cut their expenditure. Again, that is untrue. Two execptions are defence and the police. The Army generals, the Navy admirals and the police are happy with their lot.

Mr. John Home Robertson (Berwick and East Lothian)

And Royalty.

Mr. Hamilton

I am glad that my hon. Friend reminded me. They are part of the same bunch. They are all happy with their lot. However, nurses, teachers, steel workers, the old folk, one-parent families, the sick and the disabled are suffering.

As I said, £125 million is to be taken from the old folk in November. They are to be robbed of that sum. That £125 million will almost pay for an extra nuclear submarine, which is priced currently at £140 million. I am sure that old folk in Scotland and in the rest of the United Kingdom will be very happy in the knowledge that they will sacrifice £125 million in November to buy a brand-new nuclear submarine for the lady in No. 10. The £1,000 million that could be spent on the sheltered housing for the old folk in Scotland that is mentioned in the report will, instead, be spent on guided missile destroyers at £85 million apiece, or will help to pay for a torpedo.

My hon. Friend the Member for Hackney, South and Shoreditch (Mr. Brown) will be glad to know that we are building a torpedo for the Navy. It is an underwater-borne torpedo that is designed to blow up somebody else's boat and the men in it. That is costing us £920 million. That is about the sum that would provide housing for the old folk in Scotland for the next decade.

The Government's priorities seem to be fewer houses and health services and more guns and bombs. So long as these priorities prevail there is little hope for the elderly on whose needs the report concentrates. The policies now being pursued by the Government and the priorities that they have determined are bitterly divisive as between the rich and the poor, and the privileged few and the hard-pressed millions of ordinary decent folk. Despite all that the Minister may say in the minutes that are left to him, we are still an extremely wealthy nation.

Yesterday, a question was asked about our revenue from North Sea oil. I should like to put the figures on the record. In 1976–77 the Government received £81 million in revenue from North Sea oil. By 1977–78 that revenue had increased to £238 million. By 1978–79 the Government were receiving £521 million in revenue, and by 1979–80, they were receiving £2,229 million. Independent estimates have been made to the effect that by 1984 the Government will be receiving £10,000 million per annum from North Sea oil. There is no reason why the report's recommendations should not be implemented with the aid of some of that revenue. We lack the will to distribute that wealth—with a sense of social justice and equity—either in the form of incomes or of services. The report shows what needs to be done for the elderly in respect of housing health and local authority services. There is no reason why this process should not be repeated, not only in Scotland but in the rest of the United Kingdom. However, the Government lack the will to do that.

1.53 pm
The Under-Secretary of State for Scotland (Mr. Malcolm Rifkind)

I listened carefully to the speech of the hon. Member for Fife, Central (Mr. Hamilton). At one stage he indicated that the Government's response would be predictable. Those who have listened to the hon. Gentleman's speech will not have thought that his contribution was particularly original.

He spoke for a long time, but very little of his speech had anything to do with the report. Most of it was a replay of the general election campaign. The hon. Gentleman appears to have forgotten that his party lost that election.

I shall deal specifically with the points included in the report. I agreed with the hon. Gentleman when he commended the chairman and members of the party that produced the report. Due to the report's excellence and its many desirable recommendations, the Government have decided to publish it. In his foreword the Secretary of State points out that the Government recognised the need for many of the changes included in the report's recommendations. The hon. Gentleman correctly said that the report suggested that there would be an increase in the size of the elderly population. It is significant that although the total population over the age of 65 is unlikely to change dramatically over the next 10 years, the proportion of those who are 85 or over will probably increase substantially. Such people are more likely to be frail than those who are younger. Attention must therefore be given to the ways in which those in that age group can be dealt with properly.

I commend hon. Members to a point that is made on page 17 of the report. It states: It is important to remember too, that the great majority of this sector of the population over 65 (95 per cent.) have their needs met within their own homes and often by their families. The report rightly seeks independence for the elderly. Fortunately, that independence is available to a substantial proportion of old folk. We must concentrate our resources on the minority of old folk who do not have that independence, but who could respond to the desirable context that independence provides if the facilities were available. The Government share the hon. Gentleman's view that, whenever possible, the elderly should be enabled to continue to live in their homes, or in homes that are adapted to their needs and requirements. That would be a more sensible use of resources and would accord more closely with what elderly people consider desirable.

The recommendations in the report to which the hon. Member referred go far wider than he implied. He suggested that virtually all the recommendations involved the use of substantial sums of money. However, I am sure that he has read the report in detail and he must agree that a large proportion of the recommendations have nothing to do with resources, or affect resources in only a marginal way.

A significant number of the proposals are already being carried out. Some of the recommendations, such as the establishment of joint liaison committees, which exist in almost all regional health board areas in Scotland, have already been achieved. The training of nurses already pays special attention to the treatment of elderly patients, as recommended in the report. On mobility, a longer duration of pedestrian crossings is being considered, and research is being carried out into better travel information. The Government's Transport Bill will give greater scope and encouragement to voluntary transport. These are all matters which are the subject of recommendations in the report and which have already been achieved or are in the process of being achieved.

Equally, a significant number of recommendations have relatively little resource implications. These include the involvement of the elderly in taking decisions that affect them, the paying of greater attention to improving the design of facilities in accommodation for the elderly, the better use of existing resources, such as community centres, schools, day centres, and better planning and integration of services. A lot can be done with existing resources in a better and improved way. The report highlights a number of ways in which that can be achieved. I know that this will be warmly welcomed not only by local authorities but by a large number of the voluntary organisations that are involved with care for the elderly.

The position of the voluntary organisations is highlighted in the report, and it is worth quoting from page 21: Much more could be done in finding methods of collaboration with voluntary organisations and individual volunteers than has hitherto been the case. The Government feel very strongly that that is a sensible recommendation that will be warmly welcomed.

The hon. Member indicated that some of the recommendations had substantial resource implications, not just for this Government. It would be equally so whichever Government were in power and whatever economic policy was being pursued. The hon. Member correctly pointed out that the recommendations for sheltered and amenity housing would amount to £1,000 million, which is not only far greater than the present Government's housing budget, but far vaster than the housing budget of any Government over the last few years. When he was castigating the Government for reducing the housing budget, he might have mentioned in passing that the reduction in the housing budget in Scotland and elsewhere in the United Kingdom has been going on for six years—not just for 12 months.

In 1974, 13,000 council houses were built in Scotland. In 1979, at the end of the Labour Government, 5,000 were built. Those are dramatic reductions in public sector house finance. It has been a matter of agreement between both parties that housing needs in Scotland are not the same as they were a few years ago, and it has been agreed that there should be an increasing concentration on such things as sheltered housing because that can more adequately respond to the needs of housing in Scotland.

The hon. Member mentioned the Scottish Special Housing Association. The allocation to the association is on a par with its actual expenditure last year. Also, we take account of specific proposals of the SSHA for sheltered accommodation in determining the local level of resources that can be made available. The hon. Gentleman wrongly suggested that we were reducing the money available to housing associations. He may have been looking at figures for other parts of the United Kingdom, but if he cared to contact the Federation of Housing Associations in Scotland before he made that claim he would have discovered that it was quite unfounded and that the level of resources to housing associations has been maintained at the level of previous years. The hon. Member could have checked that easily.

The hon. Gentleman could also have pointed out that the National Health Service, on which so many elderly people depend, is not subject to reductions as a result of Government policy. Indeed, a 2 per cent, growth in real terms has been provided for in the public expenditure White Paper over the years to come. If the hon. Member reads the White Paper he will find that reference.

The hon. Gentleman will also find that in Scotland for the current year there is a real increase in the resources available for personal social services, and that will mean that some modest improvements can be made. I was interested to note that he made no reference to the recommendation for home helps in Scotland. Clearly, home helps are of great importance to elderly people. I suspect that the main reason why he did not mention them was that the greatest reduction in the number of home helps came after 1976, when a Labour Government made savage reductions in public spending. Of course, they now prefer to forget that that ever occurred.

Therefore, we are in a situation in which it is not a matter of dispute between the political parties—whatever the hon. Gentleman says—that resources should be concentrated on those, such as the elderly, who have special needs and who need special provision. But it is equally the case that all Governments—not only the present Government—must point out that it is only by the creation of increased national wealth that these facilities will ultimately be provided. The hon. Gentleman said that that remark was predictable from me. He knows that it would have been predictable whichever Minister from whichever party was standing at this Dispatch Box, because it is one of the facts of life. If the hon. Gentleman does not recognise that, he is doing a disservice to those who sent him to this place.

I simply say, in conclusion, that the Government welcome the vast majority of the recommendations in the report. There is likely to be a White Paper later this year on the Government's overall strategy for the elderly, and of course proposals in this document will form a valuable part of that strategy when it is declared.

Many of the recommendations in the report have been implemented—some can be implemented quite easily, even in the present economic climate—and as for those that require substantial resources, over a period, we, like the hon. Gentleman's Govenment, will seek to implement them, consistent with the national economic interest. That is the Government's position.

Mr. John Home Robertson

Catch 22.

Mr. Rifkind

If it is Catch 22, it is a Catch 22 that has been shared by all Administrations over the years. It is only those who would seek to fly into the face of reality who would wish to deny that.

I thank the hon. Member for Fife, Central for raising the subject of this report. It was published only two weeks ago. It is right that it should have been discussed in the House, and it is right also that the Government's view and that of the hon. Gentlemen should be made known now.