§ Mr. David Alton (Liverpool, Edge Hill)
First, I wish to say something about the debate that has just ended. It is always an experience to listen to the hon. Member for West Lothian (Mr. Dalyell) and to observe the resolute way in which he pursues his arguments about the Franks report and the Falkland Islands. In that respect he is an example to all Back Benchers of the need for determination in pursuing the things that we believe are right. It was equally fascinating to hear the remarks of the Leader of the House. I can only hope that the Minister who is to reply to this debate, which is my first experience of breakfast-time Parliament, will reply as courteously and helpfully as his right hon. Friend replied to the last one.
I wish to deal with the care of the elderly, especially in Liverpool, where in years to come this will be perhaps the biggest challenge after tackling that of unemployment. It is estimated that by the year 2001 the number of people aged over 75 will have risen to about 493,000. The number aged over 85 will increase by 288,000, or 52 per cent. The number aged over 75 who will be housebound or bedfast will rise by about 74,000, and those over 75 who are unable to bathe without help will rise by 200,000. A further 60,000 elderly people will be unable to go out by themselves, and 250,000 more people over 75 will be living alone, including 143,000 over 85 who will be very vulnerable indeed.
The Liverpool director of social services states in a report that the situation in Liverpool will be much the same. He says that the number of men and women aged 65 or over in Great Britain has risen by one third in the past 20 years and now represents about 15 per cent. of the population. There are just over eight million over-65s, or one in seven of the population, and more than three million over-75s. In the city of Liverpool, almost one in four of the population is now over retirement age.
It is easy to become punch drunk with statistics after an all-night sitting, but it is precisely because of the scale of the problem that this is such an important challenge. I wish to raise a variety of matters connected with that challenge.
The number of home helps in Liverpool has doubled since 1973 and there is no charge to the client. That is to the credit of the local authority and I pay tribute to Liverpool city council for the way in which it has responded in that respect. In a letter which arrived yesterday, however, the director of social services makes it clear to me that extra provision will be required. In 1981–82 some 6,500 people, about 6,000 of them over 65, received that service, but there is a waiting list of several hundred. He says thatwith the massive problems of the elderly in Liverpool we would certainly like to see extensions, particularly with community based services such as home help provision, which we would intend to extend to cover a 7-day period".He goes on to say that application is to be made by the local authority within the inner city partnership funding arrangements to try to increase that provision. I hope that the Minister can give us some idea of how that might be received by the Treasury Bench.
There are 1,000 home helps in Liverpool—excluding those involved in the home care service—to deal with the one in four of our population over the age of 65, many of whom are reliant on home help. It is far better that people should stay in their homes than be incarcerated in some 847 institution for the elderly. It is often the best and most sensitive way to deal with them. Now, it is somewhat ironic that in Liverpool there are 57,000 unemployed on the dole. It costs taxpayers £5,500 per person to keep them unemployed. Would not it be more sensible to use some of that money to put those people into work to deal with the problems of our elderly, especially through increasing the number of home helps?
The home care service was introduced in 1974 and provides an intensive service of help, domiciliary meals and social work support. There were 144 home helps assisting 1,900 clients last year. But the DHSS guidelines, with which the Minister will be familiar, show a need for 967 home care helpers. The present provision proposals, which total 717, reveal a gap of 250, which would be required if the service were to be maintained at the level at which most professionals at work in the field believe is necessary.
Another area of concern is the provision of day care and geriatric care, which was referred to recently as "the silent epidemic." I took the opportunity last week to visit the Royal teaching hospital in Liverpool to talk to its senior geriatricians. I met Mr. Raymond Tallis, the senior lecturer in geriatric medicine, and Dr. Jeremy Playfer. While there, we spoke of the inadequate help available for the elderly in the southern and central sector of Liverpool health authority. I wrote to the Secretary of State on Wednesday setting out the problems at the hospital. I sent a copy of the letter to the chairman of the area health authority. I understand that a meeting later today will discuss the problems of geriatric care.
I want to bring to the Minister's attention the scale of the problem at that hospital and throughout the city of Liverpool. In 1976, Barbara Castle, in her report, recommended that there should be 10 beds for every 1,000 retired persons, and that 50 per cent. of those beds should be in general hospitals such as the Royal. Yet less than 30 per cent. of its beds are available for that purpose. In a city where 25 per cent. of its citizens are over retirement age, that is clearly an unsatisfactory position. There should be 140 acute beds, but there are only 41. In all, there should be 280 beds—140 in the general hospital alone. The position is so bad that the consultants claim that many elderly people are left neglected in their homes because space cannot be made available. They gave me the example of an 82-year-old lady with acute jaundice who cannot be admitted to the hospital because no bed is available. When the elderly are taken into hospital they are often left in general wards and not given the specialist care which the geriatricians believe they should receive.
All that has an inevitable knock-on effect for the remainder of the Health Service. If people are not treated early enough, geriatricians cannot use preventive medicine. So those who could have been short-stay patients become long-stay patients, thereby merely compounding the problem of overcrowding. Had they been short-stay patients, they could have been sent home to live relatively normal lives.
The consultants at the Royal hospital point out that it was built at enormous expense and is probably the most costly hospital built in Britain, yet it laughs at the population surrounding it. It is almost as though the hospital envisages the typical and desirable patient as a young man with appendicitis or a common ailment. It is as though the hospital feels that its training staff are best suited to deal with that group, yet the needs of the 848 community that surround the hospital are those of a community that has more than its fair share of elderly people and provision for them is actually being reduced.
The consultants said that the Princes Park hospital, which is attached to the Royal hospital, is being considered for closure. If provision is not improved they say we will return to the 1930s. They say that instead of being placed in a pleasant homely environment, many elderly people will end up in a battered old bed in a ward that might overlook a cemetery. What sort of a way is that for us to treat our elderly people? There must be an increase in provision of that service.
The geriatricians told me that many skilled and highly dedicated people came to Liverpool to work for the elderly. When they were interviewed, they were told that they would be given increased resources, especially at the Mossley Hill hospital, where a new ward with day care facilities was to be opened. They were told that the facilities would be pioneered by the Area Health Authority.
Yet, in the past two weeks, the regional health authority has told the area health authority to cut back on that provision. That inevitably means that people who came to the city can now feel only disgust. They have lost morale as they feel despondency creeping into their own lives. Many dedicated staff now feel that the best thing for them to do is to up their roots and go elsewhere. That would be a tragic loss to Liverpool. Professor Williamson, who held the first chair in geriatrics at Liverpool university, which is attached to the hospital, left in disgust in 1976. He said that the service did not measure up to what was required. When I met geriatricians last week they said that nothing had changed. I hope that the Minister will reply to that point.
I next pay tribute to the Liverpool Echo, which last week highlighted the problems of the elderly. As a compassionate and caring journal it recognises the scale of the problem in the city. I commend that article to the Minister.
I have previously raised the issue of providing? incontinence pads to voluntary hostels that are attached to the local authority. The problem is not confined to Liverpool, where I am president of the Liverpool old peoples hostel association. At the hostel that my association runs, at St. Augustine's hostel, and at Stapley Home, they face the problem of having to buy incontinence pads for their elderly patients. I have made representations to the Department and to the local social services committee. This need could be financed legitimately by the DHSS. It is a major overhead for many of the voluntary concerns. The cost often works out at several hundred pounds a month, which must be met out of voluntary funds. It would be much better if that money were released by the DHSS, thus making funds available for the better care of the elderly.
If the voluntary homes close down, statutory provision for old people will have to be made and that will cost the Government a great deal more. On this point, I am grateful to the Minister for his sympathetic replies to the Parliamentary questions that I tabled and the letter that I wrote, but I hope that he will give us more than sympathy today.
The old-age pension was introduced at the turn of the century by a great Liberal Prime Minister, David Lloyd-George. In 1944, the Liberal Member, Sir William Beveridge, made his maiden speech in the House. He said: 849I suggest that our aim should be that every British citizen, who works while he can and contributes while he is working and earning, should be assured of an old age without want, without dependence on the young, and without the need for charity or assistance."—[Official Report, 3 November 1944; Vol. 404, c. 1127.]Today perhaps more than ever the elderly are suffering far more from the effects of inflation than any other group in our society. Since 1974 they have suffered by about 12 per cent. more from inflation than any other group. That is because the basic things that they require, such as heating and food, which are affected more by inflation than any other commodities, form a greater proportion of their household expenditure than in families with more resources at their disposal.
A single person's pension is now worth only 20 per cent. of average male earnings. I should like the link between pensions and earnings to be restored. I hope that the Minister will also give us an assurance that next year the Christmas bonus, which is pitifully below the level at which it should be if it is to keep pace with either inflation or earnings, will be increased to meet people's needs.
In the city of Liverpool one crime is committed every four minutes and one home is burgled about every 17 minutes. Many of the people whose homes are broken into are elderly. If the Minister has had the chance to read my speech when I introduced my Victims of Violent Crimes Bill, he will be aware of the demands that I made for statutory telephone provision and the provision of alarms for elderly people. People who are unemployed could be used to provide those things. If both telephones and alarms could be provided, that would enhance security.
We need increased help through victim support units. I saw the Minister of State, Home Office recently and discussed the problem, together with the hon. Member for Liverpool, Garston (Mr. Thornton). We both pressed the matter on the Minister. I feel strongly that there should be greater statutory provision of victim support units, complementing those of the voluntary organisations. I pay tribute to the work of people such as Joan Jonker on Merseyside, who has done a great deal of work with elderly people who have suffered from violent crime.
One of the other things that we could do to help elderly people who are vulnerable is provide more sheltered accommodation, granny flats and bungalows for the elderly. Often accommodation for the elderly is bigger than it needs to be. How sensible it would be if we built more sheltered accommodation, bungalows and granny flats. This could make available the houses in which they live for families on the waiting lists. If they wished, the elderly would be rehoused in the same area in sheltered blocks where there is both security and independence. In the properties in which they live there is frequently poor wiring because the properties are old and there is inadequate insulation, leaving many people to suffer from hypothermia. It is estimated that 60 per cent. of the lofts of elderly persons' homes have no insulation. That is more work which the unemployed could do.
Many elderly people have become prisoners in their homes. Age Concern says that 750,000 people are at risk from hypothermia. Long hours are spent in cold and uncomfortable surroundings because old people are afraid to turn up the heating because of the cost. Therefore, there should be, first, increased insulation; secondly, increased 850 fuel allowances, and, thirdly, the savings of the elderly should not be regarded as a disqualification for help, particularly towards heating.
In 1971 the Age Concern manifesto defined the overall needs and aspirations of the elderly as follows:The elderly need to have sufficient income to meet their needs for social physical and emotional well-being; accommodation which ensures their right to privacy and the retention of their own material possessions; and the freedom to exercise those preferences and prejudices which express their individuality and sense of the past. They need easy access to transport to enable them to supply many of their own wants and to pursue their personal inclinations. They need the security of knowing that, in the event of an emergency, they will not be put at risk through the failure of essential domestic supplies or shortage of basic food stuffs whether living in residential institutions or their own homes, they need the kind of help, care and domiciliary support which will help them to obtain the maximum degree of independent living in spite of increasing infirmities or disabilities.That was over 10 years ago, and those great challenges remain. We shall be judged by our response to the needs of the elderly. They have served the country well, some in two world wars. Many feel lonely, dejected or isolated. Others are frightened or insecure. If we measure up to the challenge of tackling their problems, we shall have earned the right to call ourselves civilised. I am grateful for the opportunity to raise these important issues this morning and I hope that the Minister will be able to reply to some of those points.
§ The Under-Secretary of State for Health and Social Security (Mr. Tony Newton)
I am not sure that I should be believed if I were to say that I was grateful to the hon. Member for Liverpool, Edge Hill (Mr. Alton) for having kept me here all night in order to deal with this matter this morning. However, even in my slightly bleary state I am prepared to acknowledge that it is important. I certainly recognise the hon. Gentleman's anxiety about the subject.
It is unlikely, in the limited time now available, that I shall be able to cover comprehensively all the points that the hon. Gentleman has raised, but my colleagues at the Department and I will take note of his remarks, together with the letter that he has written to the Secretary of State, which unfortunately I have not yet seen, and the many parliamentary questions that he has asked about this matter over the past few months.
It would be sensible if I were to begin, not by reiterating the Department's official version of the statistics which illustrate the size of the problem that we face, because the hon. Gentleman began his speech by emphasising the numbers of people potentially and actually involved, but by dealing with one or two points which seemed clearly of particular interest to him—the provision of geriatric services in Liverpool against the background of his recent discussions with people in hospital.
The hon. Gentleman will realise that I am constrained by a number of factors, not least of which is the fact that the decisions about the future provision of the strategy on these matters is, if not now, shortly to be discussed by the Liverpool health authority. Indeed, the notes with which I have been kindly provided by my Department have the word "tomorrow" written on them. That is now today.
The hon. Gentleman will know, as I do, that the Liverpool health authority has been considering options for its long-term strategy for some months and is due to consider the detailed strategy at the meeting which is to 851 take place today. That draft strategy, as the hon. Gentleman said in his speech, has a considerable effect on geriatric provision.
At present there are 707 designated geriatric beds in Liverpool including 93 reserved for patients from south Sefton health authority. In practice, other general medical beds, particularly at Newsham hospital are used for geriatric patients. Mersey region estimates that Liverpool should have about 600 geriatric beds by the end of the decade. The existing beds are located at no fewer than eight sites, including two where contractual beds are used. The hon. Gentleman will surely recognise that there is some scope for rationalisation. In addition, a number of hospital beds are in a poor state of repair.
The health authority is being asked to consider a strategy which will result by the end of the decade in the closure of two hospitals—Princes park and Newsham general. Geriatric patients from Princes park will go to Sefton general hospital and from Newsham beds will be transferred to Mossley Hill, Rathbone and Broadgreen hospitals. The beds used by south Sefton patients will be reprovided at south Sefton itself. There will be other adjustments to geriatric beds at other hospitals.
I want to emphasise that the strategy is not solely interested in bed reductions, because it contains a number of intended positive improvements. For example, a new 95-bed geriatric unit and a 50-place geriatric day hospital are proposed at Broadgreen as part of the plan. Wards at Park hospital will be upgraded and a 50-place day unit will be opened there. Wards at Mossley Hill and Rathbone hospitals will be upgraded also and a geriatric day hospital will be provided on the Royal Liverpool site.
The overall strategy has several objectives, as I understand it, in respect of geriatric services. First—this ties in with some other remarks made by the hon. Gentleman—the general level of community services in the city will be improved. Secondly, an increase is planned in day facilities for the elderly and the elderly severely mentally ill. Thirdly, the strategy proposes an integrated admissions policy for general medicine and geriatric services. Fourthly, the plan is to locate beds in relation to the population served, especially in respect of services for the elderly.
Although, inevitably, I have outlined the broad thrust of the intended strategy under discussion, the hon. Gentleman will understand that I cannot now comment on it, either personally or on behalf of the Department. The strategy has not yet been adopted today, it will then be subject to widespread consultation. If, during that consultation, a health council opposes the closure of Princes park and Newsham general hospital, the ultimate decision on closure will rest with my hon. and learned Friend the Minister for Health, who is present now to show his interest in this matter as well as in another matter that will be discussed in a few moments. It would be wrong, especially in my hon. and learned Friend's hearing, to express my view on the merits of the strategy before consultations have taken place and local opinion has been assessed. However, I assure the hon. Gentleman that my hon. Friends and I will take his remarks into account in considering the strategy.
§ Mr. Alton
One issue that was raised with me by geriatricians is that rumours have been flying about and statements have been made by the area health authority almost every week to the effect that different hospitals and 852 wards seem to be at risk. They have not been consulted, and although I am grateful for the presence of the Minister for Health, would it be possible for the Under-Secretary of State or his hon. and learned Friend to meet those geriatricians to discuss their misgivings?
§ Mr. Newton
My hon. and learned Friend will have noted that request, as I have. It would be inappropriate to go beyond acknowledging it and saying that we shall consider what the hon. Gentleman said, until Liverpool health authority has had its meeting today and we see precisely what is being proposed. Perhaps the appropriate course would be for discussions and consultations to take place between the health authority and those immediately concerned in Liverpool. The hon. Gentleman will understand, for the reasons that I have just outlined, that my hon. and learned Friend would find it a little difficult, at the outset of a process of formal consultation between the health authority and those affected in the area, to become directly involved.
I cannot comment in detail on all the hon. Gentleman"s remarks, but he will appreciate that several of his points—about home helps, the home care service and the provision of sheltered accommodation—are ultimately matters where central Government can exhort, in some cases encourage, or even try to persuade the health authority. However, decisions about the allocation of resources fall ultimately to the local authorities, and especially local social services.
Central Government can ensure—we can fairly claim to have done so already—that the needs of the elderly and the problem of social services in general, against the background of the increased number of elderly people, are given the attention that they deserve. The hon. Gentleman will know that Ministers have emphasised repeatedly the importance that they attach to that aspect of social services provision for both the elderly and the elderly mentally ill, who have tended for many years to be a somewhat neglected group.
There are various ways in which Ministers can show their concern, short of trying to control what happens in detail on the ground. We have shown and will continue to show and develop that concern. Although it is inescapable in the world in which we live, there is never enough money to spend on those matters that we would wish. I hope that the hon. Gentleman recognises that spending on personal social services is about £2 billion, which is about 9 per cent. more in real terms that it was in 1978–79.
That does not accord with some of the gloomier remarks that have been made about what has happened in social services.
What is more important is that the longer-term figures in the Government's recent White Paper continue to give personal social services what has been described as a 2 per cent. lead over average cash increases for local authority services generally. Again, that reflects our recognition of the problems in this area. It is reflected in the forthcoming year by the fact that more than 25 per cent. of the £232 million which has been added to the service figures for 1983–84 has gone to the personal social services despite the fact that personal social services account for only 10 per cent. of local authority current spending.
The number of initiatives that the Government have taken either to provide examples which local authorities may be able to follow in improving their provision or to provide resources for health authorities and local 853 authorities to develop good new projects and practices to carry forward is now becoming impressive, and perhaps not yet sufficiently recognised.
The hon. Gentleman may remember that, in the middle of last year, my right hon. Friend the Secretary of State announced our intention to go forward with three experimental schemes run by health authorities for nursing homes with a special style of care for elderly people in need of nursing care but based on the provision of homes of about 20 to 30 beds rather than keeping people in large hospitals. We are hoping that one of those experimental homes will be under way by the middle of this year and others early next year. Only a few weeks ago my hon. Friend announced £6 million over the next three years for demonstration development districts, with at least one for each regional health authority. We would provide the funds for comprehensive and integrated service for the elderly mentally ill. Again, it is an example and encouragement to improvement of provision throughout the country.
Within the next week or two, we shall be publishing the new circular entitled "Care in the Community" on improving joint finance arrangements. Again, we are making extra money available to support schemes for getting people out of hospital. Sometimes, that will be the mentally handicapped but it should also include some of the elderly and especially the mentally ill elderly to remove them from hospital and get them back into the community.
In the Bill currently passing through the House of Lords, there are provisions to improve the registration of residential homes, to provide for dual registration of residential homes and nursing homes and to improve the flexibility and quality of the care and the alternatives that are available.
In the context of his remarks about unemployment, the hon. Gentleman may wish to recognise the important steps that we have taken to fund and encourage opportunities for unemployed people to volunteer to help in personal social services. It may not go as far as many people would like, and it is not specifically what the hon. Gentleman suggested, but Age Concern and other large voluntary organisations which have been operating this scheme on our behalf have welcomed it and have pressed us to expand it. Only last week my right hon. Friend was able to respond by announcing the doubling, from £2,500,000 to £5 million, next year of the amount of money we are making available directly through voluntary organisations to fund such schemes. That picks up another of the hon. Gentleman's thoughts.
Although I accept entirely that there is a long way to go and that it will be many years before a Minister can stand here and say that he is satisfied, we are beginning to make some real progress in dealing with the type of problems that the hon. Gentleman has rightly described.
§ Mr. Anthony Berry (Comptroller of her Majesty's Household)
I beg to ask leave to withdraw the motion.
§ Motion, by leave, withdrawn.