HC Deb 01 August 1984 vol 65 cc395-401

2.3 pm

Mr. Derek Fatchett (Leeds, Central)

I was happy to allow that time from the Adjournment debate because it raised an important issue and one that was relevant to my constituents as it was about the Leeds-Edinburgh train.

The debate raises an issue of importance to many people in Leeds. It is about the care of the elderly, particularly in the southern part of the city. The problem first came to my attention just over a year ago when I was first elected as a Member of the House. The Minister may have heard many similar stories, but if I can put my case I believe that it illustrates the general problem graphically.

The problem involved a constituent of mine whose daughter came to see me and said that she was prepared to continue looking after her mother, but that her mother was causing increasing difficulties and could not be left at home in the daytime while the daughter went to work. The mother was becoming increasingly verbally aggressive and her behaviour frightened other elderly people. The daughter was looking for hospital day care for her mother. The daughter wanted to come home from work in the evening and, in a caring way, look after her mother for the rest of the day. The problem that we have in Leeds—the Minister may well recognise this—is that there is no immediate adequate provision for that mother and daughter.

The daughter made every effort to persuade the local social services department and the district health authority to provide the necessary resources to enable her to do that. The problem is that those resources are allocated in the northern part of the city. They may be insufficient but they are also wrongly allocated geographically for my constituent.

There was no hospital day care provision available. If the lady were to be cared for in hospital, she would have to go to Wakefield, but there was no day care available. She would be on the waiting list for nearly two years to go into Wakefield hospital. In those circumstances, the daughter was faced with the unpleasant choice of giving up her work or taking the risk of leaving her elderly mother whilst she was at work. It was a difficult choice. It is one that none of us should have to face, but I suspect that it is fairly common for my constituents and those of my right hon. Friend the Member for Morley and Leeds, South (Mr. Rees).

That case illustrated the general problem. It has come to my notice in my surgery many times during the past 12 months. I accept that it is a common problem, and I am sure that the Minister will make that point when he replies. It arises because there is an increasingly elderly population. I do not underestimate the importance of that response, nor am I trying to make a party political point out of a central problem for our society of how we care for the elderly. I am trying to open the Adjournment debate in a way which shows the Minister that I am not making a simple party political point but one that may help us to understand and characterise the type of services that we have in our society.

In Leeds there is, as the Minister will no doubt say, a problem of a growing, elderly population. I shall quote one or two of the figures. There are 66,800 pensioner households in the city, and 41,300 of those people live alone. That represents a massive demand upon social services, housing and the district health authority. We are living longer. That may well be to our satisfaction and something to which we can look forward, but it creates extra demand upon the available resources within the community.

In 1979 it was estimated that there were 12,100 people between the ages of 80 and 84 in the city of Leeds. By 1991 that figure will have increased by nearly 16 per cent. to 14,700. The population over the age of 85—the very elderly—in 1979 was 8,000. It will be 10,700 by 1991.

Many of the problems in south Leeds would not be as difficult if we had adequate resources that fitted the criteria established by the DHSS. Unfortunately, the provision of old people's homes, part III accommodation, does not match DHSS requirements. The Minister will be aware that the DHSS issues a guideline of 25 part III accommodation places for each 1,000 elderly people. We provide only 19 in Leeds, and I am in no position to suppose that that figure will increase dramatically over the next few years. I am sure that the Minister will be the first to recognise the pressures on local authority capital expenditure. To reach DHSS standards we would need an additional 609 places in pan III accommodation.

I understand that the DHSS guidelines are now 10 years out of date. It may well be that different guidelines should be established, given the increasing age of the population and the increasing frailty of many of the elderly.

We have the problem of a growing, elderly community, and against that backcloth I should like to mention the sort of health services provided in Leeds—and particularly in south Leeds—for the elderly. It is obvious that the elderly are dependent upon the general provisions of the National Health Service. They make use of the available resources. Indeed, they probably use them to a much greater extent than younger people do.

It is worth noting that 45 per cent. of the total bed-days taken up by general medicine in the Leeds general infirmary in 1982 were attributable to patients over 75. The elderly make use of the excellent resources at the Leeds general infirmary and St James's hospital, but there is a particular problem with geriatric beds.

The Government have established their own guidelines for the number of geriatric beds. The position is a little complicated, because the area that the Western district health authority calls central Leeds is what my right hon. Friend the Member for Morley and Leeds, South and I call south Leeds. In central Leeds, the number of geriatric beds allocated is below the DHSS guidelines. I am sure that the Minister will have seen the report of the working party set up by Leeds western district health authority. The working party reported in December last and concluded that there was a general shortage of resources in the southern Leeds area. On page 12 the report says: The root of the difficulty here is a severe shortage of resources, in both quantity and kind, needed to operate an effective service in the area of heaviest demand. The Minister will no doubt recognise that the problems in south Leeds are exacerbated by the fact that it is an area of low average incomes and high unemployment. Those factors add to the difficulties of provision and the demand upon provision. That was recognised in the report of the Western district health authority.

There is a specific problem of geriatric provision but there is a greater problem in regard to psychogeriatric care in south Leeds. Increasingly, elderly people have to be referred to psychiatric care. If elderly people need psychiatric care in south Leeds, such care is not available there. It is not provided by either the eastern or western districts in south Leeds.

An elderly person has to be referred to Stanley royal hospital in Wakefield. It puts great demands on the family of an elderly person. There are travel problems and it is difficult for a family in those circumstances to keep in touch with an elderly relative. An additional problem is that there is a waiting list of nearly two years for beds in Stanley royal hospital. I make no criticism of the facilities at Stanley royal hospital or of the staff there, but it is scandalous that in south Leeds a substantial elderly population has to rely upon Wakefield district health authority for psychiatric care and provision.

I shall conclude my remarks shortly so that my right hon. Friend the Member for Morley and Leeds, South may have an opportunity to make some comments. I suspect that the Minister is in no position to write the two of us a blank cheque for the provision of the necessary resources. It may well be that we are not in a position to say in detail what those resources should be. At this stage we need a recognition by the DHSS that an inquiry into the nature of the resources needed and their allocation would be beneficial for the people of south Leeds. There is the difficulty that four health authorities—the regional health authority, the two Leeds district health authorities and the Wakefield health authority—are concerned with the problem.

I suggest that the only way to resolve the deep-seated problem—I hope that the Minister recognises that it is a deep-seated problem—would be to set up an inquiry through the DHSS bringing together the four relevant health authorities. They could then help to answer questions as to the services and resources that are needed. I am sure that there would be a positive response to such an inquiry, and that the authorities would all agree that they need more resources for the community and more day care facilities.

I hope that the Minister will recognise the problems facing us in south Leeds and give us the opportunity of establishing our case through the procedures of the DHSS. Then, perhaps, we shall not have to come back on a future occasion and increase the demands, because we shall know that we are talking to a sympathetic Minister and a sympathetic Department.

2.16 pm
Mr. Merlyn Rees (Morley and Leeds, South)

I am very grateful to my hon. Friend the Member for Leeds, Central (Mr. Fatchett) for giving me three or four minutes in which to speak about the problems in south Leeds.

My hon. Friend noted that he now represents part of south Leeds. After 21 years in the area, it is apparent to me that south Leeds does not matter. Whichever Government are in power, and whatever the reorganisation in a variety of areas, south Leeds does not matter.

South Leeds was the area of the industrial revolution. Clearance has taken 25 years and some remarkable things have been done. The Boundary Commission split south Leeds. I speak as a former Home Secretary, but not in any political way. South Leeds did not matter because it was not the sort of place from which people wrote letters to the press.

Ghastly flats were built and had to be knocked down. The architects who designed them lived not in south Leeds but elsewhere. Prince Charles knew what he was talking about when he criticised architects. If it had happened in the Soviet Union, the architects would have been sent to Siberia. I do not advocate that, but the architects were to blame for all those flats.

Where are the only two motorways in Leeds? They run right through south Leeds.

With regard to the Health Service, we need resources, but first the needs of south Leeds have to be properly considered. The Yorkshire regional health authority has told me that what I am advocating would involve a transference of resources.

I should like to make just three points of a large number that have built up over the years. Services for the mentally ill in south Leeds are provided by Wakefield. There has been serious under-provision for some time. Services for the elderly who are also mentally ill—psychogeriatric services—are non-existent. That is a matter for serious concern. Some people say, "Block the waiting list." Thirdly, the increasing number of elderly people presents an escalating problem in terms of special housing needs and of care. There are no psychogeriatric services in south Leeds. I am telling the Minister, because he must have some responsibility in this area. Lack of psychogeriatric services puts a strain on the primary care teams and the relatives. Unless something is done there, we shall be wasting our time. If it was north Leeds or almost any other part of the country that was concerned, more notice might be taken of the problem. The general feeling in my area is that something should be done.

Excellent geriatric services are provided by the eastern Leeds health authority, but, in their wisdom, the Government split us in two. The position in the western Leeds health authority is unsatisfactory. So far as this is his responsibility, we want the Minister to press for the provision of a psychogeriatric service, and not at someone else's expense. The service should be based at Leeds hospitals. South Leeds needs day hospital facilities, and the geriatric services provided by Leeds western district health authority should be made responsive to the needs of the people living there.

If the House were full, hon. Members from other areas would still not comprehend what I am saying. Most of the people concerned are old ladies. If they have to go to hospital, they must go to Wakefield. They must travel to the middle of Leeds by bus and then all the way round to Wakefield, where they have to get further transport. Most hon. Members would not notice the sum of money involved, but it is a sizeable proportion of the income of these people.

I do not say that Wakefield is not a desirable place. From the new constituency, I often pass through it. I can reach Wakefield easily in my car, but those people cannot, and they deserve to be treated in Leeds. There is something seriously wrong in south Leeds. I am not making a political point. South Leeds needs help and pressure, and that is what we are asking the Minister to provide.

2.22 pm
The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)

Thanks to the generosity of the hon. Member for Leeds, Central (Mr. Fatchett)—both to those hon. Members who are concerned about the tragic railway accident and to his right hon. Friend the Member for Morley and Leeds, South (Mr. Rees)—I do not have a great deal of time for my reply. If I go at the best approximation that I can manage to an Olympic sprinter's pace, I hope that the hon. Gentleman will forgive me.

I appreciate the spirit in which the hon. Gentleman talked about this issue and which was reflected in the way in which the right hon. Gentleman described the problems of south Leeds. It is good to see such issues discussed here in such a way.

One of the accidents of my diary is that, at 3 pm today, I am to meet the chairman of the Yorkshire regional health authority. I shall draw this debate to his attention and make sure that he reads what has been said by the hon. Gentleman and his right hon. Friend.

I could not accuse the hon. Member for Leeds, Central of having double standards—of being reasonable here, but highly critical of the Government in his own constituency. That excellent paper, the Yorkshire Evening Post, quoted the hon. Gentleman last Friday as saying that the problems of south Leeds had built up over the years. The hon. Gentleman did not especially blame the present Government. That is a very fair and even-handed way of examining the problems of the area.

I will not rehearse the figures and statistics relating to the increasing problems that we all face in providing for a growing aged population, in the community, in geriatric homes or in terms of psychogeriatric provision. In many parts of the country, such provision is well distributed but, according to the hon. Gentleman, it is greatly underrepresented in his own constituency and that of his right hon. Friend.

The hon. Gentleman referred to the lack of facilities in south Leeds and the dependence on the facilities in the neighbouring district of Wakefield. He made that point very forcibly. He referred to the lack of certain specific facilities within the district health authority area. I concede that in an ideal world every health authority would reflect, within its own geographical area, provision of every sort. However, we do not live in an ideal world. The boundaries between health authorities resemble in some ways the boundaries created by the boundary commissioners which split up old constituencies and break up old loyalties. They are not solid structures which are difficult to cross, like brick walls. They are administrative boundaries, often conterminus with local authority boundaries, and often designed to facilitate joint planning between health authorities and local authorities.

The question is not just a matter of resources, although it would be foolish to deny the importance of resources. It is not just a matter of bed norms or norms for the number of places in part III accommodation. Norms may be easy to plan and easy enough to reach, but when one has reached them one may find oneself saying, "So what?". Care in the community has been one of the great developments of the past 10 years. We have tried to keep in the community, where most of them wish to be people who, 10 or 15 years ago, would have been regarded as geriatric. The hon. Gentleman should not be too deterministic about the boundaries of his local authority. He should not think that any movement from one district health authority to another is bad and that geriatric provision should be provided solely within a hospital, an institution or part III accommodation.

In the five minutes that remain to me, I should like to examine the problem in a local context and then within the regional context. These are the very issues that I shall draw to the attention of Bryan Askew, who does a good job as chairman of the regional health authority, when I meet him later this afternoon. In the local context, one of the most important things is good joint planning between district health authorities and local authorities. The joint consultative committee is the best forum for improving co-operation between them. The establishment of a working group is an important step in the care in the community approach that we are trying to foster. The south Leeds working group consists of representatives of the eastern Leeds health authority, the western Leeds health authority and Leeds city council.

It is interesting to note that the group's final report refers to the need for officers servicing the Joint Consultative Committee … to apply their high level of managerial skills towards ensuring better co-ordination in the planning and delivering of joint services so that individuals needing different kinds of help from more than one authority receive a more flexible responsive and truly joint service. That is an excellent aim. It also makes four crucial recommendations: first, to develop both short term and long term plans for increasing the level of service offered to elderly people with psychiatric problems; secondly, to assess the most appropriate future use of St. George's hospital, Rothwell; thirdly, to establish ways of improving the geriatric services provided by the western health authority for people living in south Leeds; and, fourthly, to establish the needs of homeless people in relation to the present and future use of Shaftesbury house—a local authority facility. All four recommendations are important and thought-provoking. Both Leeds health authorities have seen the working group's report and are preparing their responses for the next meeting of the joint consultative committee in September. We must await that committee's full consideration of the report before making any decisions on where to go next.

In the wider context of Leeds, Wakefield and the county, we have asked all regional health authorities to prepare regional strategic plans for the next 10 years by early next year. I understand that, on 3 July, the chairman of Yorkshire regional health authority launched the outline strategy for the development of services in Yorkshire and emphasised the Government's and the regional health authority's desire that urgent emphasis be given to the development of services for elderly people, community-based services and especially services for the mentally ill who cannot look after themselves or be maintained in the community.

In that outline strategy, Yorkshire regional health authority has instructed its district health authorities not to plan for district self-sufficiency, although it recognises that each district is responsible for securing, as far as possible, a comprehensive range of services for people in the area. The objective of the planning process is to ensure that the available resources of finance, manpower and capital are deployed as effectively as possible to maximise the services that are needed for patients. Everyone in the area can now make an input into the discussion of the 10-year plan.

The western and eastern health authorities can do a great deal to help themselves by carrying through a substantial and sustained cost improvement programme which will make services more efficient and release resources for improvements in new developments, such as those which the hon. Gentleman and his right hon. Friend would wish to see in south Leeds. It is within the framework of careful planning at local level by joint consultative committees involving the district and regional health authorities—within the framework of driving for greater efficiency and cost improvement—that the problems of south Leeds can, and will, be solved.