Care of the Elderly

HC Deb 22 February 1984 vol 54 cc877-917

Mr. Speaker

I have selected the amendment in the name of the Prime Minister.

7.20 pm

Mr. Michael Meacher (Oldham, West)

I beg to move, That this House condemns the falling standards of provision for the elderly over recent years and deplores the severe cut-back in resources relative to need now being imposed by the Government on community care; and calls upon this Conservative Government to give priority to improving the quality of life of the elderly rather than adding to the advantages of the rich. It is rightly said that the key test of a civilised society is its treatment of its elderly people. By that standard, in terms of the manifest collapse of community care that we are witnessing, Thatcherite society has lamentably and tragically failed. The quality of life for elderly people is measured not simply, or even mainly, in terms of the pension level, but by the adequacy of a range of services that can make life in old age dignified and fulfilling.

The motion draws attention to the deficiency in those services. It is widely recognised in the House and outside that the number of elderly people, particularly of advanced age, has been increasing year by year; hence the need for increased services. However, it is less well recognised that some crucial services for the elderly have been cut even in absolute terms. An example of that is the provision of residential accommodation. In 1978 there were 118,000 elderly residents, but by 1982 that figure had been reduced to 116,800. The same pattern of absolute decline is reflected in the important meals on wheels service. In 1978, 41. 4 million meals were served, but that figure was reduced in 1982 to 40.3 million. That is not a large drop, but it is significant in absolute terms.

That picture gives a falsely optimistic impression, because the figures take no account of the rising number of elderly people, with their increasing need for such services. That criterion—I do not think there will be disagreement about it for assessing what is actually happening — was used by the Social Services Select Committee, which said in its definitive study in 1982: Between 1975–76 and 1980–81, home help hours of service to those over 75 failed by 8 per cent. to keep pace with the growing numbers of elderly, and meals served to those over 75 fell by 11.6 per cent. The Committee could have added that, on the same basis, residential care places failed to keep pace with the growing demand by 10.2 per cent. By any standards, those figures reveal a serious decline in key services for pensioners in recent years.

The Government's defence is that a real growth of 2 per cent. per year in personal social services is sufficient to meet rising demand and that that has been achieved, broadly speaking, since 1978. However, all the independent studies have concluded that that is a substantial underestimate of the minimum required to maintain existing standards.

The most thorough analysis is that undertaken by Professor Webb and Mr. Wiston, which I am sure the Minister has at his fingertips. According to them, in their conclusion to a memorandum to the Social Services Select Committee report, given other demands from social services departments, but especially rising unit costs, a 2 per cent. growth is insufficient to maintain absolute levels of provision. I stress the words "absolute provision". It is certainly not enough to provide a constant level of service output to take account of rising demand.

The minimum growth required to preserve existing standards, let alone produce any improvements, was estimated by the Association of Directors of Social Services in the 1982 report at from 4 to 6 per cent. real growth per year. The association is an important witness in our debate. The report says that the figure would only begin to reflect the type of service development required to prevent standards from dropping. In other words, that is the very minimum necessary. The report shows how far short the Government's provision is of the 2 per cent. growth estimate.

The Association of Directors of Social Services reported in December 1983: If the results of our five annual surveys are taken together the resources of personal social services have been reduced by 4 per cent. and, measured against increased demand, have probably fallen 10 per cent. below those some impartial observers believe minimally desirable". The Association's general conclusion was that the standards of provision being meted out to the elderly were well below what a rich civilised society should tolerate. It said that it was "truly amazing" that the Government allowed them to continue. That is indeed amazing, until we realise that preserving or improving social services for pensioners is hardly one of the Government's highest priorities.

Another disquieting aspect of this fundamental failure to keep up with the demand is that pensioners get the services they need depending upon the accident of geography, of where they live. I hope I have proved that 2 per cent. real growth is inadequate, but Professor Webb and Mr. Wiston found that almost one fifth of social services departments in England failed to achieve even that low rate of growth. In other words, the Government do not keep a check on minimum standards. I emphasise that provision has fallen back alarmingly in some areas. The Department of the Environment audit survey in March 1983 found an immense variation in local authority spending on social services, out of all proportion to what could be justified with a balanced distribution of national resources.

Spending on the elderly 'was found to vary by plus or minus 37 per cent. in the four local authority areas surveyed. There could scarcely be a clearer demonstration of the Government's failure to enforce and monitor minimum standards, which are at present abysmal. A recent survey showed that an increase of no less than 32 per cent. in the number of home helps, perhaps the most crucial service to the elderly, was needed in Birmingham.

The apparent reduction in services might matter a great deal less if the Government were prepared to admit their past failings and put them right. However, they are doing exactly the reverse, and are not aiming at a gross figure of 2 per cent., or even a zero standstill. Personal social services will fall in real terms by 2.5 per cent. next year according to figures published in the public expenditure White Paper. Translated into the reality of ordinary people's lives, that means a drastic cut, at a time of increasing need, in residential provision, day care places, home helps, district nurses and the meals on wheels service. When the Government are boasting about 3 per cent. economic growth, that is the brutal measure of how much they are deserting the elderly.

However, even that conclusion, which is confined to demographic pressures, does not take account of two other crucial developments, which are making dramatically worse the standard of services to the elderly. Neither is new. However, they are important points to make in the context of this debate. The first is hospital closures. There have been 155 since the Government came to power. About 30 hospitals have been built, so there has been a net loss of about 125. That means that a huge number of elderly people are being dumped in the community. "Dumped" is an ugly word to use, but it is an ugly situation. Those people are being dumped in the community, where all too often no one is able to look after them adequately.

There is a second arm to the pincer. Not only are there more elderly patients each year—that is a demographic fact, at least to 1985–86 — especially in the over-75 age group, not only are district health authorities being forced by Government cuts to decant elderly people out of closed hospitals and geriatric wards back in to the community—

The Minister for Health (Mr. Kenneth Clarke)

No.

Mr. Meacher

The Minister will have a chance to reply. That is the experience all over the country.

Mr. Clarke

Rubbish.

Mr. Meacher

Last Friday I was at Thornton View hospital in Bradford. Some 59 frail, elderly geriatric patients are in a hospital that the district health authority has already decided to close, against the wishes of the overwhelming majority of the people of Bradford. The Minister has to take a decision whether to ratify that. I hope that he will tell us whether such hospitals will continue to be closed. There are 59 frail, elderly people there, for whom there is no alternative hospital accommodation. There are not enough carers in the community to look after that number of people.

Mr. Clarke

The hon. Gentleman knows that Thornton View is an old poor law institution. I forget how long ago it was built, but I do not think that it was built in this century. The discussion in that district is about whether the patients should continue to be cared for there or whether better accommodation can be found in more modern hospitals elsewhere. Ministers are looking at the proposal that the district has made. I assure the hon. Gentleman that any decision taken about the elderly in that area will be on the basis of improved services, not bad services. Most of the hospitals that the hon. Gentleman has talked about are old hospitals that are being closed because they were never fit to cater for people in this day and age.

Mr. Meacher

I am wholly in favour of the closure of hospitals when there is an alternative of better hospitals and better provision, but the point is that that does not happen. It has not been the case in 155 hospitals that have been closed. I hope that the Minister will take this point on board. Perhaps my hon. Friend the Member for Bradford, West (Mr. Madden), who represents that area, will emphasise it when he winds up. The people in Bradford and the existing hospital provision cannot cope better for those 59 frail, elderly people anywhere else. Even bearing in mind the age of that hospital, it would be better if that provision were upgraded until better provision could be made available.

I ask the Minister to accept that not only are there more elderly patients, not only are many being pushed back into the community without adequate community care, but local authorities are being forced by cuts in the rate support grant and by grant penalties to chop community care for the elderly and other needy groups—at the very time when, for the other reasons that I gave, demand for community care is rising faster than it has for many decades.

The victims of that deliberate squeeze on resources—not by the Department of Health and Social Security but by the Treasury—are the elderly themselves, plus those who are involuntarily forced into the caring role to look after them. In the majority of cases, that means women. If they have not already been made redundant by the Government's economic policies, they are now being forced to give up their jobs by the Government's social policies because, in all too many cases, there is no one else to whom elderly dependants can turn for care.

If the Minister does not like my views, I shall quote those of Age Concern. Perhaps the Minister will take them on board. Age Concern states: Community care must not be seen as a cheap option. It will only be cheap if the state relies on the good will and love alone of those who are caring, without the backup services in the community. Community care can be as expensive as other forms of care. I entirely agree with this: It should be viewed as a desirable goal, not as a cost-cutting exercise. But that is exactly how it has been regarded by the Government.

The Government's White paper "Growing Old" is widely regarded as the most shallow social policy document of recent years. At least it admitted: Care in the community must increasingly mean care by the community. There we have it. Behind the cosy refuge of community care, there is the hard-nosed reality. The Government are doing less and less for some of the most frail people in our society, including families. Female carers in particular are being forced to pick up the responsibility now being abdicated by the Government.

I hope that the Minister accepts this. The physical, emotional and financial strain on carers is often truly horrendous, as many examples from the Association of Carers testify which have been sent to me and which I shall send to him. Given the Government's alleged support for the family and voluntary action, their lack of meaningful back-up for carers is almost breathtaking. They have failed to extend the invalid care allowance to married women, although the cost would be only £60 million, which is a tiny fraction of the cost if that care were provided by social service departments. Moreover, even where the Department of Health and Social Security is finally taking an initiative—I think that the name of the exercise is "supporting the informal carers" — it is clear that improvements in services for carers and their dependants are to be achieved without any significant increase in resources. The limit to the Government's commitment is all too apparent when they talk of the way forward as being by the extension of good practice and the more effective use of existing resources.

Of course, the Government will say that extra resources are not available. They have said that so many times. Making extra resources available has never been much of a problem for the Government when it is a matter of dealing with the rich. I shall give a few facts. No less than £2,600 million has been doled out in tax reductions to the rich by the Government since 1979. No less than £9,000 million is being paid out this year alone in tax reliefs, on pension contributions, on life assurance, on mortgage interest and on investment income surcharge exemption, and the main beneficiaries are the rich. In addition, billions of pounds are now being lost to the Exchequer because so-called fringe benefits that can run as high as £12,500 on top of a director's salary of £25,000 a year remain untaxed.

Providing improved care for the elderly is not a financial impossibility. It is a matter of priorities. Because we in the Opposition believe that it is wholly objectionable that huge tax handouts should continue to be showered on the rich at the expense of cutting back basic services for the elderly, because we believe that it is intolerable that elderly people are being dumped in the community when people cannot look after them, and because we believe that community care must not be a cheap option in which families, especially women, are victimised with overloaded and unfair responsibilities, I call on all those in the House who share our concern for a higher social and financial priority for decent and civilised standards of care for all our elderly to vote for the motion.

7.40 pm

The Minister for Health (Mr. Kenneth Clarke)

I beg to move, to leave out from "House" to the end of the Question and to add instead thereof: `welcomes the steps the Government have taken in a period of economic difficulty to provide elderly people with improved financial support and to continue the development of health and personal social services for them; and pays tribute to the professional staff and volunteers who play a central and crucial role in the care and support of elderly people and their families.'. I begin on a non-contentious note. All hon. Members will agree that we are facing the consequences of the rise in the number of elderly people in the population. That must be the background to all our deliberations about the elderly in the next 10 or 20 years. The number of people aged over 65 is increasing rapidly and will continue to do so. In England there are now just over 7 million people aged over 65. The latest projections show that by the year 2001 there will be 7.5 million. The proportion will have risen from 15.2 per cent. of the total population to 15.4 per cent. Not only will the number of those over retirement age rise over the next 20 years, but the numbers of those aged over 75 will grow considerably, and the number of those in the over-85 age group will rise faster still. At the moment the percentage of the total population aged over 75 is 5.9 per cent. By the year 2001, the proportion will be 7.3 per cent.

We are all agree that ours is a civilised society which aims to provide a decent level of care and support for everyone in need. Over the next 20 years we must therefore fulfil our duty to give care to all who need it among the growing number of the very elderly. That is the biggest substantial challenge facing the welfare state over the next 10 or 20 years.

Dr. Dick and the Health Advisory Service have produced a booklet about this challenge entitled "The Rising Tide". There is indeed a rising tide of the numbers of elderly in our society, which will pose fresh problems for the Health Service, the community services, the voluntary bodies and the welfare state. We must face that problem, but we must not be overwhelmed by it or misunderstand its nature and scale. The fact that more of us live longer is good news, not bad. It is a mark of the success of the welfare state in raising health and living standards. The picture of growing numbers of elderly people is not a cause for despair. For instance—to take one end of the political spectrum—it is not necessary to talk of the impossibility of financing the welfare state or of meeting the challenge.

The cost to the working population of the current pension provision, projected forward on present policies, would tend to fall by the turn of the century rather than increase. On the other hand, it is equally ludicrous to talk about having to face the problem against a background of massive underfunding. Let us consider the welfare state that we maintain today. Despite the description given by the hon. Member for Oldham, West (Mr. Meacher), the budget of the National Health Service is over £15 billion, and the total budget for social security is some £35 billion. The hon. Gentleman suggests that the answer to every problem is to spend more billions of pounds, although he does not quantify how many billions would be required. That would be an absurd way of facing the challenge of the rising numbers of the elderly. The bill would cripple the productive economy, beggar the working population and thereby damage the real interests of the elderly.

Despite the hon. Gentleman's constant endeavour to produce studies that disprove this fact, spending on health and social security by the DHSS represents, under the present Government, about 30 per cent. of total public spending. Over half that massive bill is, in one way or the other, for the care of pensioners and the elderly.

The hon. Gentleman tries to portray modern Britain — Thatcherite Britain, as he calls it — in Dickensian terms. He conjures up a picture of abject poverty and social injustice. He uses language and statistics in a manner that reminds me of the Fabian tracts of the 1890s. However, he is talking about a modern welfare state. It is 40 years since Beveridge, and the nature of the problem has changed. It is the problems of the next 10 or 20 years that we have to tackle, and tackle sensibly.

For some, age brings poverty, frailty and ill-health; but it does not bring them to all. Very many people in their sixties and seventies, and some in their eighties, now lead happy, active, vigorous and even quite prosperous lives. In a conversation earlier today, my hon. Friend the Member for Mid-Kent (Mr. Rowe) reminded me that if one looks at the wider scene, one finds that they also tend to run super-powers. There are some extremely active elderly men among those who govern the world today.

As a group and on average, the elderly people of today and tomorrow are the fittest generation of elderly people that there has ever been. Growing numbers of them are fortunate enough to have been able to acquire some savings, or occupational pension rights on top of their modern state retirement pensions. That makes them—as a group and on average—the most prosperous elderly generation that there has ever been. That will continue to be so.

However, the expectations of today's and tomorrow's elderly people are also rising. Many of today's elderly people were young before the first world war. Tomorrow's elderly people will expect a higher standard of life. If one sets aside some of the hon. Gentleman's lobbying claims, I think that, in reality, rising expectations are posing as many problems as rising need.

As a boy, I walked every day past a workhouse built in Napoleonic times. It housed the derelict and poverty-stricken elderly of that part of Nottingham. By the time I reach old age, if I live that long, all my contemporaries will expect a way of life vastly better than that. They will expect that a long, comfortable and enjoyable retirement will form an important part of their lives.

With the changed background to old age and the changing expectations of old age, we must not plan as though the whole aim of policy must be to produce a world of institutions, long-term hospital care, social workers, means-tested benefits and bus passes. That is the vision of the future that the hon. Gentleman tends to produce. What we have to do is to increase the proportion of elderly people who are fortunate enough to be independent and self-sufficient and who are able to enjoy fit and active lives. We must also care in a proper way—the way that they prefer — for those who, because of age or misfortune, are not able to care for themselves.

Mr. Eric S. Heifer (Liverpool, Walton)

Is the right hon. and learned Gentleman aware that people like my mother had one great fear—the fear of going to the workhouse? Is he further aware that, although in 1945 the Labour party lifted that fear from millions of ordinary working people, that fear is now returning among elderly working people because of the policies of the Government?

Mr. Clarke

The hon. Gentleman's first point is true. The policies of successive Governments and the development of the modern welfare state have taken those fears away. The hon. Gentleman's second assertion is ridiculous. It is the rhetoric of the Liverpool Labour party and bears no relation to the day-to-day life of elderly people.

Large numbers of elderly people are fitter and better off than ever, but some still suffer from poverty and ill health, and need proper care. We need policies that match the expectations of the elderly—policies suitable for 1984, not 1945, which are not still based on fighting the old battles. The aim of all our policies must be to enable as many people as possible—

Mr. Heifer

They are the same battles.

Mr. Clarke

The hon. Gentleman may not have moved on since 1945, but life has.

Mr. Heifer

They are the same battles, and we are fighting the present Government.

Mr. Clarke

By attributing to me the problems of 1945 the hon. Gentleman is failing to notice that quite a lot has changed since then. Our policies must be aimed at today's problems. We must enable as many people as possible to live independently as part of the general community for as long as possible.

Mr. Roland Boyes (Houghton and Washington)

rose—

Mr. Clarke

We need a balance of services to enable the growing elderly population to live their lives in the community and to provide the care needed when age and infirmity finally make that impossible. We must make living as part of the community easier and to help to prolong that for more people.

Mr. Boyes

Will the Minister give way?

Mr. Clarke

I will in a second. Perhaps the issues of 1945 can be conducted in a more orderly way by hon. Members being given way to at a suitable point.

We must keep necessary periods of hospital care for the elderly as few and as short as possible. We must keep the need for long-term residential care as low as possible and we must provide the best possible quality of life for those who need long-term care in hospital or in a residential or nursing home. What I have described is a package of objectives aimed at supporting more people in the community, and enabling them to be self-sufficient and to lead fit and active lives longer. The objectives are not based on preserving poor law institutions in Bradford or on trying to refight the battles of 1945 in one hon. Member's far away Socialist youth.

Mr. Boyes

I am grateful to the Minister for giving way. As a former assistant director of social services I agree with the Minister's aim of trying to keep people in the community and out of residential homes. I am not talking about 1945 but 1985. I cannot see how it is consistent for the Minister to carry out that programme while the Government are imposing rate capping. The Association of Directors of Social Services calculates that the result of the Government's policies will lead to 50,000 fewer meals on wheels, 50,000 fewer home help hours and 7,000 people having to be found extra resources to keep them out of residential accommodation. Although I understand the Minister's line, where will the cash to pay for it come from if the Government are to take the money away from local authorities?

Mr. Clarke

I am grateful for the hon. Gentleman's support for the general approach of keeping more people in the community. He is a younger Socialist who seems to have moved more with the times. The Association of Directors of Social Services has, to the best of my recollection, made forecasts every year during the Government's term of office and, understandably, it puts in hair-raising forecasts in response to the Government's demands for greater restraint and careful use of local authority finance. Its forecasts never prove correct as I hope to show shortly.

Mr. David Winnick (Walsall, North)

Will the Minister give way?

Mr. Clarke

If I can remain succinct hon. Members will have. a chance to make a speech and if I give way too often I shall prevent hon. Members from speaking.

I should now like to deal with income support. One of the first things that one considers is pension levels, although they have not been heavily laboured today. There is still far too sharp a drop in income for people who retire. That gap is being steadily closed for more people by the accumulation of savings and occupational pensions. The Government have complied fully with our election commitment to maintain the purchasing power of the retirement pension. Between November 1978 and November 1983 the pension increased by 74 per cent. During the same period the retail price index increased by 70 per cent. Therefore, the purchasng power of the state pension has been kept ahead of prices and its real purchasing power improved modestly.

For people on supplementary benefit who have to look beyond the state's pension to maintain their basic living standard we have enabled people with modest savings—they are often the people who miss out worst in today's welfare state conditions — to accumulate and retain rather more benefit from their savings. The amount of savings that they can have and still qualify for supplementary benefit was raised in 1982 from £2,000 to £2,500 and again in 1983 from £2,500 to £3,000. From 1983 they could also retain £1,500 of life assurance policies without jeopardising their entitlement to supplementary benefit. For the poorest pensioners we have considered heating costs. We have a much better record on that than the Government whom we succeeded. This year we are spending £350 million on special heating costs for the elderly. Only £124 million was spent in that way when we took over in 1979. We are spending £100 million more in real terms on helping elderly people with fuel bills. We are helping 1.5 million pensioner households.

Our record on state pensions and help for the poor is good. We intend to take a broader look at the needs of all pensioners and how the growing number of pensioners ought to provide for their retirement. In November 1983 my right hon. Friend the Secretary of State announced an inquiry into the provision for retirement. It has started work and will consider how to maintain adequate financial support for elderly people.

In addition to financial support, I agree that we must consider the type of community care and support that is given to elderly people in or near their homes by family, friends, local authority social services and voluntary bodies. For all our anxiety and for all the battles about institutions and hospitals, 95 per cent. of the over-65s live outside an institution and in the community. I agree with the hon. Member for Oldham, West that many of them look to their own families and friends for support. I entirely agree with his sentiments about the need to examine what we can do to help carers—that is a perfectly convenient jargon word—who find that they take on the strain of looking after elderly people. They need all sorts of support. They need respite care whereby the elderly person goes to suitable accommodation for a short time while the carer has a break. There therefore need to be home helps, day centres, luncheon clubs and the rest.

The project supporting the informal carers is being sponsored by the development group of our own social work service. The project resulted in a two-day seminar at Oxford in June 1983 to pool ideas about the needs of carers and the ways in which to meet them. There was a national day conference on the same theme in London on 2 November to stimulate debate. My hon. Friend the Under-Secretary of State addressed the conference. A resource document about the schemes and ideas which are currently in practice for helping informal carers has now been produced. I agree that we must now move on from pooling ideas and decide what we can do to turn policy into action.

Mr. Michael McGuire (Makerfield)

Does the Minister agree that some of the most successful schemes for keeping old people in the community often involve moving them into their own small houses? Many of them occupy huge council houses, which are now too big for them, and they need to be moved into modern bungalows or similar housing where there is a warden and the houses are linked by a simple communication system. Elderly people therefore retain their privacy and their families are assured that they are being looked after in the best sense of that word. Insufficient attention is paid to that. If the Minister announced help for local authorities to do that we should be much happier than we are hearing him bandying statistics about and referring to 1945 and what has happened since.

Mr. Clarke

We all agree that sheltered accommodation for elderly people is important. I agree that most councils are now pressing ahead with providing such accommodation with wardens, alarm systems and so on. Local authority housing programmes have changed substantially. The most important part of local authority housing provision in areas where there is no longer a demand for housing for families is concentrated less on council house estates and more on specialist care. I do not have the statistics and, bearing in mind the hon. Gentleman's warning, I shall not give them. I think, however, that he will find that provision of sheltered accommodation is increasing steadily. It is certainly happening in my constituency and I hope that the same is true for his.

Supporting services are in large part provided by local authorities. The hon. Member for Oldham, West got back to his usual theme. He analysed the spending of local authorities and social services and compared it with the most ambitious desire for increases in spending that he could find.

The fact remains that 1983–84 local authority budgets show an overall increase on social service spending of 12.5 per cent. in constant terms compared with 1978–79. I accept, however, that increases in expenditure are not always matched by increases in service provision. The hon. Gentleman mentioned, as a throwaway line, the increase in unit costs. That means that local authorities may be spending more money without looking after more people. That is sometimes necessary. Sometimes the reasons for it bear closer examination.

The hon. Gentleman then gave a somewhat selective list of figures and percentage changes in certain aspects of local authority care. I could be equally selective and say that the 1981 figures show that in our first two years of office there was a 6.3 per cent. increase in the number of home helps employed and a 14.7 per cent. increase in the number of people visited by community nurses compared with the position in 1979.

One may argue about the adequacy of what the hon. Gentleman described as the Government's 2 per cent. growth provision. There has certainly been such a growth in resources for social services. In our projections for local government spending we accept the increased demand for social services by giving a 2 per cent. lead for personal social services compared with other services.

I prefer to consider the matter, as the hon. Gentleman usually does not, not in terms of what is being paid for a service but in terms of the service produced with the money provided. It is pointless to judge a local authority's achievement merely in terms of the amount of money that it has succeeded in consuming on that service in a given year. There are bound to be difficulties as we live in the real economy and we cannot print money, so it is useless for the hon. Gentleman, his researchers or anyone else to assume that policy determines resources.

We must consider experimental alternative patterns of service such as the Kent community care scheme, which has shown that better patterns of care can be provided at little or no extra cost by developing new and imaginative ways of providing services.

Although all social services departments are striving to do their best despite difficulties, some are extremely badly organised. At present, very little is done to spread good practice from one authority to another. Through the projected inspectorate, or in other ways, we must try to ensure that the performance of local authorities and the value for money provided is brought up to the level of the best so as to keep up with demand.

Mr. Meacher

Before the Minister becomes too complacent about his record, will he explain how he expects to achieve a greater volume of provision while spending less money? Will he confirm my contention that there is to be a 2.5 per cent. reduction in personal social services expenditure this year? How do the Government justify that when they claim that there is a 3 per cent. growth in the economy?

Mr. Clarke

There must be a reduction in overall local government spending if the rate burdens are not to cripple industry and cause unacceptable levels of unemployment to continue in some parts of the country. That is a perfectly worthwhile and desirable social aim. How the economies are effected is a matter of judgment for local authorities. They must choose their own priorities and deliver their most important services in a cost-effective way.

We prefer to compare our projections for local authority expenditure each year with the targets that we set in the past. The best-run authorities have achieved those targets and thus do not face draconian reductions. Those in trouble with the Government, who are affected by the targets and rate capping, are spending money in a wasteful way on the whole range of services. When challenged on behalf of the public and the ratepayers, they try to persuade the public that desirable objectives such as social services or education are the only areas in which economies can be made. I do not believe that.

In addition to developing sensible, well managed social services provided by local authorities we must bring local authorities, health authorities and volunteers closer together so that they can collaborate in providing a range of services. We must do away with artificial barriers between the Health Service, local government and volunteers whereby people with different professional disciplines and loyalties sometimes come close to competing with one another to help the same people needing one range of services from them all. Our main weapon in improving collaboration is joint planning and joint finance. Each year we allocate funds to help authorities to launch personal social services schemes jointly agreed between health authorities and local authorities. Spending on that has greatly increased to more than £24 million this year—an increase of more that 50 per cent. compared with 1979. It also helps to develop joint planning by bringing the authorities together to spend the money in a desirable way.

We have also launched our new care in the community project which enables health authorities to allocate funds without limit of time to provide care in the community for people who would otherwise be long-term patients but who are better provided for in smaller units outside. We allocated £15 million for pilot schemes last year and 100 applications for pilot funding have already been received.

Going beyond the personal social services, elderly people are now living and finding care in private residential homes and nursing homes. There has been enormous growth in that area and it is an extremely important source of provision. We very much welcome the growth in investment and accommodation provided, as it happens, by the private sector, especially in terms of residential and nursing homes.

We must ensure, however, that the enormous increase in accommodation bought by the elderly for themselves is of an acceptable standard and thus constitutes a desirable increase in the total stock of places. Last year we legislated for residential care homes. We are giving local authorities greater powers to inspect all residential care homes not less than once a year. A code of practice is being drawn up by an outside group and we hope to produce regulations by May to allow local authorities to charge fees for the provision of a proper service.

We are now ready to take the next step of improving standards in residential nursing homes and ensuring that all meet the best standards. The Government have decided to issue fresh proposals to ensure good standards of care in private nursing homes. We intend to tighten the checks made by health authorities on such homes to ensure that all are kept close to the excellent standards that most already achieve. With the rapid growth in the number of elderly people, we need that rapid increase in private nursing homes and hospitals, which will have an ever more important role to play in providing comfortable accommodation and care for people in old age. It is all the more important, therefore, to ensure that the best standards are maintained and it is essential that health authorities should be able to use their powers of inspection and registration effectively. The powers were strengthened in the Health and Social Services and Social Security Adjudications Act 1983 — and tomorrow I shall issue guidelines for discussion as to how the new powers should operate.

The conduct of private nursing homes is governed by the Nursing Homes Act 1975, which requires that all private nursing homes, including private hospitals, be registered with the district health authority. The Act and associated regulations ensure the maintenance of adequate standards and facilities in all registered homes, subject to regular inspections by health authorities. With the 1983 Act we introduced several amendments to the 1975 legislation which, when implemented, will improve and strengthen it.

The guidelines to health authorities on which we are now consulting interested bodies propose a number of changes to registration and inspection procedures. They include, for example, making it an offence to describe, with intent to deceive, premises not registered with a health authority as a nursing home, maternity home or mental nursing home. Thus, if proprietors advertise a nursing home the public will usually be safe to assume in future that the home has been inspected and approved by the local health authority.

My right hon. Friend the Secretary of State for Social Services also intends to issue a direction requiring health authorities to enter and inspect any unregistered premises believed to be functioning as a nursing home. It is already a criminal offence to run a nursing home without being registered, and health authorities already have power to enter such premises if they believe that they are operating as nursing homes. We propose the unusual step of placing authorities under a positive obligation to enter such premises because we are concerned about the welfare of patients receiving nursing care which is not subject to the rigorous standards applied to registered nursing homes.

We are also creating for the first time a national list of cancelled registrations compiled from returns submitted by health authorities and local authorities giving the names of persons whose registration in respect of nursing homes, residential care homes and children's homes has been cancelled. This "black list" will help authorities to prevent people who have failed to maintain good standards in a home in one part of the country simply moving elsewhere to start again.

A small but significant part of the country's health care has always been provided by the private sector which, of course, includes the voluntary sector. The biggest contribution to health care by private and independent people and groups in this country is made by small nursing homes which in total look after well over 20,000 elderly people. We are anxious to ensure that further development should keep pace with growing demand and at the same time to protect the public by maintaining and improving standards.

I have covered the financial support, on which the Government have an excellent record, and personal social services, for which the case put by the hon. Member for Oldham, West can be demonstrated to be over-dramatised and based on insupportable claims that a service that is spending more money each year is somehow starved of funds. I have described what we are doing to encourage the growth of private residential homes and private nursing homes and to make sure that the right standards are maintained as that welcome growth takes place. I assure the House that our policies for the National Health Service place the greatest emphasis on developing care for the elderly, and that includes closing some of our older geriatric hospitals and providing more modern, suitable and upgraded care in better and more suitable wards.

Those are the ingredients of the decent caring policy for the elderly that is the aim of the Government. We have not been saving money in this sector, but have been changing policy and adapting it for today's generation of elderly. The rather old-fashioned diatribes from the Opposition Benches cannot dent our record and are not a constructive, realistic or helpful approach to the problems of the next generation of elderly in the next decade.

8.12 pm

Mrs. Renée Short (Wolverhampton, North-East)

I am glad that we have an opportunity to give a little time to this problem. We have given much time to the young unemployed and it is time to look to the other end of the population. We are faced with a considerable increase in the number of elderly people through the rest of the century, but we have faced this problem before, so it is not a new one.

In 1901, if I can take the minds of some hon. Members back that far—mine will not go back that far—the population of the United Kingdom was just over 38 million, with 500,000 people over the age of 75—13 in every 1,000. Now the population is about 55.5 million with 3 million over the age of 75—56 in every 1,000.

In 1900 there was virtually no care for the elderly, who relied entirely on their families. There was no National Health Service and it took the Labour Government of 1945 to introduce that. The rest of the population is now fairly well stabilised. Between 1971 and 1991, an increase of about 1 million is expected in the total population, but the number of elderly people is expected to rise by 500,000, which is about half the increase.

While the number of elderly people is rising, we have to remember that at the same time the birth rate is declining. In 1966, the birth rate was 950,000 but in 1978 it was 660,000. The working-age population, if we take that to be from 16 to 64, is about 60£5 per cent. At the start of the century, it was 61£3 per cent. By 1991, it will have risen slightly from its present level to 61 per cent., so the demographic trend will not be as threatening as everybody tries to make us believe, provided that those of working age are able to work. That is the key issue in our discussions on the problems of the elderly.

The Government must realise that the problem is not the number of elderly people, but unemployment among the working population. The working population consists of those who will provide the resources to care for the growing number of elderly people. Everybody accepts that the elderly are entitled to a share in the wealth of the country as they have made their contribution in the past. The Labour party's view is clearly stated in all its policy statements, including that on which it fought the last election—that the elderly should have a fair share of the increasing prosperity of the country. However, as I said earlier, we are not increasing prosperity at the moment.

To put it in a nutshell, we stand for a policy of providing sufficient money for an active and independent life after retirement and for freedom of choice as to how to spend it. However, we must face the fact that many old people cannot look after themselves and are without family or friends to help them, so they are forced to rely on what the community can or is willing to provide, with services such as home helps, meals brought to the home or residential or hospital care.

Such valuable support has declined under this Government, and the shortcomings and deficiencies of the system are clear for all to see. As my hon. Friend the Member for Oldham, West (Mr. Meacher) said, the Select Committee looked at this. However, the serious decline in the past five years has meant that many people are now saying that we cannot afford to do any more. I refute that. At the moment, only about 67 per cent. of the elderly population receive help during the year. Less than 4 per cent. — a minute proportion—regularly receive meals either in their own homes or in clubs or centres and only about 10 per cent. are visited by district nurses.

My hon. Friend referred to the guidelines laid down for the provision of services. The key services, where existing service provision falls short, are home helps, of which the provision is 12 per 1,000 elderly people. Some 200 meals per week per 1,000 elderly should be provided, and there should be one district nurse for every 2,500 to 4,000 of the total population. For day centres, there should be three to four places per 100 elderly people. Amazingly enough, there are no guidelines for chiropody, which is an important service for elderly people. If they have bad feet but cannot get them looked at, that is a major factor in making them stay at home.

The implementation of the Department's policy on domiciliary care rests with the local statutory authorities, which sometimes adopt different attitudes. They do not always do as either we or the Government want. They do not always wish to expand their services for elderly people. Many of them cannot do so because they cannot afford it and many of them have difficulty in recruiting the necessary staff to provide for elderly people either at home or in establishments such as day centres.

There are other difficulties, such as the closure of branch surgeries, which create considerable problems for elderly people, the closure of chemist shops and of sub-post offices, which the Select Committee examined during the last Government, and which creates many difficulties, especially in rural areas where the elderly rely on the sub-post offices for the collection of their pensions and for doing a great deal of their shopping.

We have much to do to provide better facilities. I am concerned about the provision of many services. There are old people in hospital wards, usually in the old hospitals over 100 years old. The Select Committee visited some on Merseyside—and I am not singling out Merseyside as the only place where this happens—when it was looking at the problem of medical education in the last Parliament.

We went to some hospitals where elderly people were kept in enormous barrack-like wards. Everything had to be tidy, every bedspread had to have not a single wrinkle, there were no pictures on the walls, no personal property and nothing to make the ward look bright or cheerful. What I might call the custodial attitude of many of the staff has been criticised in the past. The Department should take this problem on board to see what can be done to improve those 19th century establishments where we put so many of our old people.

In visiting that and other hospitals, the Select Committee discovered that the medical care of the elderly is almost always the responsibility of doctors from the Commonwealth, who have got into dead-end jobs, much to their concern, and who have no chance of getting out of the rut. Doctors and patients have extreme difficulty in communicating, which helps neither of them. It is high time that the Department did something about that. It has had the Select Committee report for some years, but not enough progress has been made.

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

In her balanced and evenhanded account of the position thus far, does the hon. Lady recognise — here I shall indulge in some statistics, because I know that the hon. Member for Oldham, West (Mr. Meacher) likes statistics—the considerable growth in medical manpower devoted to geriatric care since 1978? There has been an 11 per cent. increase in consultants, a 37 per cent. increase in senior registrars, and an 11 per cent. increase in nursing staff.

Mrs. Short

The Minister is trying to steal my thunder, because I was going to mention that point later. Of course, that has happened, but the conditions that I described still exist, and it is time that the Department did more to change the position altogether.

There is a similar problem in local authority homes for the elderly. Perhaps I should not refer to my area specifically, but when Members of Parliament or members of the public visit homes for the elderly, they will find that in the television room the chairs are ranged round the room, but that people are not sitting in groups chatting to each other. No one is reading or doing anything active or lively. The television may be on, but no one is looking at it. We must do something about that, because otherwise we shall be encouraging the progress of senility in mind and body. The Minister must give a lead in this and take the problem by the scruff of the neck, because it is a most dispiriting and discouraging experience.

During the next two or three decades we must not overlook the fact that many elderly people receive splendid support from their families. We should strengthen that support so that more elderly people can remain independent in their homes for as long as possible, but the Government must take on board the fact that some elderly people need four times as much health care and six times as much social service care as do the rest of the population. The growth for that increased care has not been allowed for. Unless it is, the position will deteriorate.

The message that we must get over is that health care for the elderly should start in middle age, before they become old. Poor diet and lack of exercise contribute to health problems in the elderly. Geriatric medicine in Britain is acknowledged as a model for many countries, and we have made enormous progress in this area. The United States is funding fellowships to enable some American physicians to train here in geriatrics, and many countries want British geriatricians to train their students and doctors and to help them to establish services. About 35 years ago Britain had no geriatricians. Now we have 400, training has developed and teaching departments are attracting some of our best graduates who, until recently, would have preferred to specialise in surgery. That is an encouraging trend.

However, the elderly, who represent about 14 per cent. of the population, occupy about half of the surgical, orthopaedic, genito-urinary and eye beds in our hospitals. That is a high percentage. Those aged over 75 often need more care and more social services. The good teaching departments cross the boundary between health and social services, which means that we must have more efficient use of resources. The Minister referred to the private sector, but it is interesting to note that private medicine contributes little or nothing to the care of the elderly.

We must urgently provide more short-term facilities in hospitals and residential homes to diagnose and treat patients and to provide relief for families. Special housing, full-time care and nursing, long-term hospital care and medical supervision are all areas where resources have not been adequate. If the Government would get Britain back to work, resources would be available and we could devote a greater share of what we earn to the care of the elderly. At present we spend a minute amount—only about 2 per cent. —on personal social services, which is far too low. Caring for others must be made a worthwhile job, regarded as something important and properly rewarded. We need more domiciliary services, more housing, more short-term care and a more imaginative and flexible system of long-term care for those who need it.

When the Select Committee examined the problems of the elderly, we were told that plans were well advanced for three experimental National Health Service nursing homes for the elderly, and that four hospitals have been designated as demonstration centres for the rehabilitation of the mentally ill, including the elderly. Perhaps the Under-Secretary of State will tell us what progress has been made with those experiments.

With the proper management of our economy, we could do much more for the elderly to allow them to live better lives.

8.27 pm

Mr. Andrew Rowe (Mid-Kent)

When the hon. Member for Oldham, West (Mr. Meacher) quotes figures about the number of residential places or the number of meals on wheels, and purports thereby to show that a decline is inevitably a decline in the standard of care, he is advocating a static position in the care being delivered. If it were true that community care was becoming a completely successful programme, the number of residential places might fall. Similarly, it is a source of considerable consolation to many hon. Members that the WRVS is about to carry out a survey on whether the admirable meals on wheels service, of which it provides about 46 per cent., is the sort of service that the elderly need. Our anxiety to discover whether we are giving people what they want means that we can look for changing patterns in health care.

Mr. John Patten

Does my hon. Friend recognise that some studies of the meals on wheels service, such as that recently conducted by Leeds university, show that many people use the service not for the meals provided, which are often not consumed, but for the social care that can be provided? It is up to the community, not necessarily local councils or the state, to ensure that people have the necessary company from their neighbourhood and the community.

Mr. Rowe

I am grateful to the Minister for pointing that out. I have reservations about the standard of company that can be offered by people running down the path, delivering a meal and racing back to the van to move on to the next person. It is right that the community should try to improve on that service, especially if the meal is not being eaten.

As you will know, Mr. Deputy Speaker, it was Cicero who said, Old age is honoured only on condition that it defends its rights, is subservient to no one and to the last breath rules over its domain. These words are the motto and the inspiration of my county council's approach to the care of its rapidly growing elderly population. That approach has three main characteristics: innovation, value for money and cooperation with the voluntary sector. The fact that the county council is taking care of the amount of public money that it disburses is one of the only hopes of my constituency, which has unemployment running at between 16 and 18 per cent., to attract new jobs into the area. If it followed the kind of disbursement policies of many of the councils supported by Opposition Members, its chances of obtaining any new jobs and, therefore, any wider financial base, would disappear.

Mr. Jeremy Corbyn (Islington, North)

Is this a serious contribution?

Mr. Rowe

On innovation, the community care scheme was one daring experiment which flew in the face of much received wisdom, not least that of the professional social workers who had an anxiety that a relationship based on payment rapidly becomes debased. Under the scheme, elderly people who are physically handicapped—and it is being used increasingly for mentally handicapped people — remain in their own homes, cared for by friends and neighbours who are able to perform these services because they receive a small sum of money in return.

It is a central tenet of Kent's philosophy that schemes are objectively monitored. It was reassuring when the social services research unit, itself a pioneering venture in Kent university, discovered that old people covered by the scheme were in better health, were livelier and were less lonely than those who were not so covered. Small wonder that the scheme has been widely copied outside Kent. The researchers also found that the average cost per client was one third of the cost of keeping an individual in residential care. That is what I call value for money, however much Opposition Members sneer.

Co-operation with the voluntary sector in Kent has been developed to a high degree. Age Concern Kent, for example, shares massively with the council in the care of the elderly. Eight hundred and sixty-three day care places, 12 pop-in centres, although I dislike the term, and 37 lunch clubs are part of the fruits of that co-operation—money from the council, caring from the volunteers.

In similar vein is the tremendous advance in cooperation between those who provide social services for the elderly and the local health authorities. These are rational, constructive, steps towards providing real care and independence for the elderly of Kent — a very different approach from that sought by Opposition Members. They look for increases in public authority, increases in publicly provided accommodation and increases in public benefits. They never learn that such programmes lead instantly to massive inflation, the effect of which is to make paupers of those who spent, their working lives laying up what they had hoped would be sufficient provision to keep them off the state. They find that spendthrift Governments have destroyed their savings. It is a form of peculiarly damaging hypocrisy to parade as the party that wants to do more for the old, while advocating policies that destroy their independence and turn them into unwilling dependants of a bloated state bureaucracy. Kent has shown the way towards sharing of responsibility for its older citizens which I am proud to bring to the attention of the House.

I should not like the Minister to imagine that there is no more to be done, not that there is much danger that he would do so. There is a range of opportunity opening up before us so huge that those with courage less noticeable than my Friend's might quail rather than seize the chances. Let me end by mentioning two of them. Led by the voluntary sector—and in this context one thinks of Help the Aged — new ways of enabling the elderly to capitalise upon their major, and in many cases often their only, asset are being pioneered. As the number of 80-yearolds in Britain increases in the next decade by some 400,000 people, the realisation that their children may well have no need to inherit their house will become ever more widespread. It is therefore right and proper that schemes should be on offer which, in return for eventual ownership of the property, offer shelter until death. It is a lamentable feature of human society that, where there is brass, muck will be attracted.

I urge upon the Minister that he establish urgently clear guidelines as to what constitutes acceptable schemes, otherwise a Rachman will reappear, this time battening on the ageing pensioner. Can the Minister assure the House that his Department is fully seized of the need to ensure protection for this most vulnerable section of the population, and that he will take steps to secure it, without destroying the expansion of this entirely sensible solution to some of the difficulties facing the old?

As a nation we are singularly ill-served by our housing market, in one respect especially. Although each year brings further understanding of what old people require of their habitation in terms of accessible electric points, effective insulation, doors wide enough to cope with wheelchairs and no dangerous steps, and although many of these facilities are equally helpful to younger people, our housing continues to be built with only the first-time buyer, fit, careless and childless, in mind. Is there nothing that the Minister and his colleagues can do to encourage the building of houses fit for more than one generaton? I leave it to the Minister to reassure us.

8.37 pm

Mr. Archy Kirkwood (Roxburgh and Berwickshire)

I am grateful to be able to take part in the debate. I listened with interest to the contributions by the Minister and the Member for Mid-Kent (Mr. Rowe).

Taken by itself, the Minister's speech was balanced and reasonable, but it does not match at any point the experience I have had in my constituency when the old, the frail and the elderly come to consult me. They are confused by society, they are overwhelmed by the system of benefit on which most of them have to depend for their existence, they live in derelict housing and they are beset on all sides. In the Minister's part of the world and in mid-Kent, the situation may be different. If that is so, the Government have a responsibility to sort out the division that they are creating in the nation between those who live in the north and those who live in the south. The Minister as the Government spokesman should pay attention to what is happening in other parts of the country outside the south-east and mid-Kent.

I listened carefully to the speeches from both Front Benches. Hon. Members on the alliance Benches give high priority to the problem. My hon. Friend the Member for Ross, Cromarty and Skye (Mr. Kennedy) moved a motion on 10 November, when half of our only Supply day was devoted to the problems of people covered by the personal social services.

The demographic framework has been well argued in the debate. We all know that changes will be thrust upon us between now and the year 2000 which will mean that people will be more bedridden, more people will be living on their own and more people will find it difficult to live, will be unable to go out, and will be housebound and bedridden. Towards the end of the century, 25,000 people will be over 75, and living by themselves.

The Minister and the hon. Member for Oldham, West (Mr. Meacher) had a detailed and heated argument about money. Although money is important — indeed, it is fundamental to the provision of services for the elderly —we must also consider the attitude of mind that we adopt towards that provision. I do not want to sound semantic, but the Minister referred to the matter as a problem. Indeed, one can construct an argument that the elderly pose a considerable problem, but they should also be seen as a challenging opportunity. I see the Minister pointing to the Opposition Front Bench. I am addressing my remarks to the whole House. I appreciate that that attitude came not only from the Government Benches, but from the hon. Member for Oldham, West.

The Government amendment refers to economic difficulties. I recognise the economic difficulties, but there are ways other than hard cash in which we can approach some of the important problems. I reinforce the remarks of the hon. Member for Oldham, West about the Government's spending priorities. They are cutting back by 2.5 per cent. the money devoted to personal social services. I understand also that there is an estimated growth rate in the economy of 3 per cent. The combination of those two factors is important. The Government must say where they stand on the priority they give to provision for the elderly. I think that there is a cut in real terms in the expenditure on such provision.

We are dealing mainly with the problems of the elderly who live as part of their families in their homes. Indeed, only about 5 per cent. of the elderly population are in institutions or similar places. We should concentrate on providing facilities for the elderly who stay with their families, and we can do so only by making more use of more labour-intensive services.

The provision of care in the community is not a cheap option. If it is to be carried out properly, it must involve those employed in the domiciliary and home help services. That would provide an opportunity for the Government to deal with two problems at the same time. It would help to deal with unemployment. The hon. Member for Mid-Kent argued that that would mean pouring money into the welfare services, which would create inflation. We are all concerned about inflation, but if the money was put into the relatively unskilled work in such services as home helps, meals on wheels and so on, that would not cause inflation. The Government should consider expanding employment opportunities that would have the double benefit of cutting the employment queues and helping the elderly.

There is an overriding need for greater co-ordination between the Government Departments involved in providing services for the elderly at home. As the hon. Member for Wolverhampton, North-East (Mrs. Short) said, problems are faced by the elderly in rural areas, such as the provision of sub-post offices and similar services. Central Government could set the right framework by ensuring that housing, transport, and education Departments, as well as personal social services, are more aware of the problems. Whitehall could do a great deal more in co-ordinating the services provided for the elderly to make them more sensitive and effective.

The joint funding arrangements have been a good start, but they do not go far enough. However, I accept that it is not a matter only for central Government if we are to be successful in community care—it must be delivered by local people at local level through local authorities.

But the Government are positively hindering local authorities in their work. For example, there is no doubt that the housing benefit cuts took no account of the effect on the level of insulation grants available to the elderly, which have now been reduced from 90 per cent. to 60 per cent. I will give the Government the benefit of the doubt that that was inadvertent, but it has had a severe effect on the elderly whose houses are not insulated. That mistake was perpetrated by central Government.

There is a hot issue in my local authority in the Borders. It has decided to withdraw grants for providing wardens for sheltered homes because the new housing benefit regulations include an element for that for those living in a home with a warden on stream 24 hours a day. The local authority believes that if housing benefit includes that element—although it is only a maximum of 60 per cent. —it should not pay the salary of a warden or give a grant to the Hanover Association, or whichever association provides the facilities. That is a retrograde step. It is another example of how the Government, perhaps inadvertently, have caused problems for the elderly in my area. That is causing great hardship and anxiety. The policy of rate cutting means that local authorities are less able to provide the domiciliary services, home helps and so on.

I referred earlier to the possibility of using the problems faced by the elderly to create employment. Voluntary agencies and the MSC are currently giving help for house improvements, repairs and insulation in the private and public sectors. But more could be done. The Select Committee on Energy in 1982 said that all those in receipt of fuel allowances should have their homes insulated free as a matter of priority. That would be a tangible way to help old people, create jobs and save energy. Many benefits could accrue from such a policy.

Simple repairs to homes create problems for pensioners. They cannot carry out those repairs themselves. The 1981 house condition survey highlighted the need for assistance for the elderly living in less than standard accommodation. The problem goes beyond the DHSS. There is a discrepancy between need and services.

I endorse the comments of the hon. Member for Oldham, West about the sentiments expressed by the Select Committee on Social Services in 1982. I was interested in his reference to the Association of Directors of Social Services, who had said that resources had been reduced by 4 per cent. but that, measured against the increased demand, it had probably fallen 10 per cent. below what was minimally desirable. There are not sufficient home helps, meals on wheels, day centres, ambulances to day centres and so on.

Mr. John Patten

The hon. Gentleman has been endorsing, as is his right, a number of the remarks of the hon. Member for Oldham, West (Mr. Meacher), who condemned everything that the Government had done. He condemned everything completely and utterly; everything in our record was totally bad. I was wondering whether the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) endorsed those sentiments.

Mr. Kirkwood

I have had occasion in the past to lecture the hon. Member for Oldham, West — this sounds presumptuous coming from me, as I do not have his experience—on the extravagance of his language. I am happy to assure the Minister that I do not follow his hyperbole or agree with everything he says, but there was force in some of his arguments.

The hon. Member for Oldham, West made a fair point when he spoke, for example, about the invalid care allowance. It is unfair that single women and married men can get the allowance, whereas married women cannot. The hon. Member for Oldham, West said that it would cost £60 million to put that right. I appreciate that that is a significant sum and that pension rights are involved. However, various principles, such as the principle of sex equality, are also involved, and if I were in the Government's position I should be looking hard at ways of redressing that anomaly. It is unjust, and resolving it would have the double function of putting the discrimination aspect right at the same time as providing much-needed assistance to elderly people who are in the care of people in their own homes. That is an important issue on which I hope the Government will give an assurance, as I hope they will give assurances on some of the other matters that I have raised.

8.52 pm

Mrs. Edwina Currie (Derbyshire, South)

I begin with a confession. My interest in the elderly, which now extends over several years, is entirely self-interest. Most women live to be elderly. The higher proportion of the elderly population are women. It follows, therefore, that I am far more likely to end up old, grey, wizened and crabby than any of the present occupants of the Government Front Bench.

I am rather cross over the wording of the Opposition motion in suggesting, for example, that the elderly are separate from the rich. That is wrong and could be considered patronising. It is a misconception to think that all the elderly are poor, sick, indigent and helpless. Indeed, if Opposition Members came to my constituency and made such remarks to my good Tory ladies, not all of whom are well off, they would get a fine Derbyshire wallop.

Elderly people are, first and foremost, citizens. They benefit far more than most: from reductions in the rate of inflation and they are affected more than most by such problems as high crime rates, which are at last beginning to come down. They would be delighted to be regarded as part of society, not apart from it, and therefore they welcome, for example, the recent introduction of the clause that will give them the right to buy their own homes. Most of them are determinedly independent; 94 per cent. of them live at home; a large percentage—about 30 per cent. — live alone, frequently cut of choice; they are increasingly articulate and knowledgeable; and they are not available to be used by the hon. Member for Oldham, West (Mr. Meacher), who has shown his great interest in this debate by not being present for most of it.

The House will not be surprised to hear that, in my view, the Government amendment is first class, particularly in its reference to the health and personal social services. The increase in National Health Service expenditure between 1979 and 1983 has amounted to 17 per cent. in real terms, which by any calculation is more than enough to cope with the demographic problems. The public expenditure White Paper shows a further increase of £600 million, which again must be more than enough to beat both inflation and demographic change. Joint funding—which I have been able to use extensively for such services as night watchers, weekend meals on wheels and weekend home helps to assist with the discharge of people from hospital on Fridays—now stands at nearly £100 million.

I have often felt that the approach of Opposition Members to the NHS possibly contains some lessons for people such as Lord Whitelaw. If one says something often enough, people begin to believe it. If that works with something that is not true—such as the notion that we have been cutting the Health Service—perhaps, if we adopt it, it will work with the truth.

Those of us who have worked with the elderly and have, therefore, acquired what amounts to a shopping list of the things that we would like to see must nevertheless bear in mind two pieces of simple arithmetic. The first is common to this and most western countries. It is that about one fifth of the population are young dependants and that about two fifths are adult dependants — roughly half elderly and half others. That leaves about two fifths of the population who are working and, therefore, generating all the funds for all those services.

Those proportions have tended recently to change adversely, so that the ratio between the providers and the dependants is going against us in the western nations, and that is happening for a variety of reasons. It follows, therefore, that economic growth and improvements in productivity are needed just to maintain the constraints produced by that interface. Those who want to spend more money on the elderly must recognise that.

There is also the arithmetic of demography. I listened with interest to the comments of the hon. Member for Wolverhampton, North-East (Mrs. Short), and I am honoured now to be a member of the Select Committee of which she has been the distinguished Chairman for some years. The demographic problems are acute. If one compares the growing number of elderly with the next generation, who are the carers—in other words, the 45s to 65s—the problem becomes considerable. At the turn of the century, the ratio was about 10 carers to one elderly. It is now two or three to one and it is heading towards being one to one, and I can illustrate that by using my own family.

My grandmother had 10 children soon after the turn of the century and up to the period of the first war. As they grew up, they were perfectly capable of caring for their elderly parents, because there were only two of them. Of those 10 children, seven have now survived into old age, one of whom is my mother. They range in age between 60 and over 80 and they have managed, those seven people, between them to produce only eight children. The ratio, therefore, becomes acute. In other words, there will not be enough people in the next generation to look after the people who will need caring for.

It should be stressed that this generation of elderly people suffer from the fact that we lost 2 million men during world war 1, and therefore we have a high proportion of elderly single ladies who never had the opportunity to have a family; and in any case, even when they did, they never planned to be that old. They did not have the opportunity to provide for it and, even when they did, their savings tended to disappear through inflation.

Like most hon. Members, I have my own shopping list, but I will mention only two of the items. The first is sheltered housing. Recent literature has been critical of sheltered housing, although I believe that most of the criticisms have been misplaced. The arithmetic of the number of carers to the number of people needing to be cared for is such that shared care will have to be the way in which we manage in future, and most of the sheltered housing with which I have been associated has been a great success.

It does not all have to be provided by the local authority; it can be provided, and is increasingly being provided, by the private sector. An article in the Financial Times of 26 January 1984 suggested that the growth of the private sector in sheltered housing was such that we could be talking about £0£5 billion a year in that sector by the end of this decade. I warmly welcome that and hope that it will happen.

Provision does not have to be made by finding a piece of ground and building from scratch. That is the most expensive form of provision. It is quite easy to take a group of dwellings already occupied by the elderly, build a warden's house and, perhaps, a small common room and, at comparatively modest expenditure, wire the properties to a central alarm system. That approach will provide all the facilities of shared housing.

It was my privilege last year to create those facilities in tower blocks, perhaps the most unpromising of environments. It was found that many people liked living in their tower block flats and that they required only security, company and the knowledge that they would be able to live undisturbed. At one stage I was proud to become the largest buyer of carpets in the country, which were used to improve the lobbies, halls and lounge areas of the tower blocks.

My real beef is directed to invalid care allowance and attendance allowance. Most people want to be cared for at home, especially if they have a long-term illness. I hope that the figures that I am about to quote are right, but, on the other hand, I shall be delighted to be told by my right hon. and learned Friend the Minister for Health that I have them wrong. The attendance allowance is payable tax free at the rate of £18.15 or £27.20. If the disabled person is cared for by a younger relative who is not working, a total of £20.45, taxable, is paid as an invalid care allowance. If the younger relative is receiving unemployment benefit, no ICA is payable. If the relative is in work, no ICA is payable. That is the result if he or she is earning more than £12.27, which is 60 per cent. of the ICA. If the relative who is doing the caring is of pensionable age, no ICA is payable. Those provisions rule out the bulk of those whom we have been discussing because in most instances the elderly person who is being cared for is receiving care from another person of pensionable age — perhaps typically another woman who is 60 years of age or older.

The position becomes worse, because if the person concerned is a married woman, no ICA is available, even if she is not married to the person for whom she is caring. That applies to anyone who would otherwise qualify. For example, if my husband falls under a bus on his way home tonight and becomes disabled and I give up my job to look after him, I cannot claim ICA. If my right hon. and learned Friend offered his wife to look after my husband, she would not be able to claim ICA. However, if my very pretty secretary were willing to give up her job to look after my husband, she would be able to claim ICA. I am not a feminist and the House will not hear me advancing feminist arguments, but I think that the result is iniquitous. It is wrong, unfair and purely discriminatory. I accept that most married women would look after their husbands in any event, but it is wrong that ICA would not be payable to them.

If no attendance allowance is payable, there is no ICA, even though we all know of instances where the attendance allowance would be appropriate. If the allowance is claimed, the person concerned must have been disabled for six months. That means that the terminally ill cannot claim the allowance because they will be dead within the six months.

It should be possible for the DHSS to accept a certificate from an approved doctor stating that the applicant is terminally ill and entitled to attendance allowance and ICA. It should be remembered that if the applicant were to receive care in hospital he would be given free drugs as well. It can be an expensive business caring for the terminally ill at home, and we must examine our apparent lack of policy in this area. I have written in my notes that the present position is "disgraceful".

Anyone who takes the line that I am advocating must accept that £60 million must be found. However, a careful examination reveals that the money is being paid out in any event. For example, many local authorities pay for carers. Before I came to this place I was responsible for ensuring that that happened. Frequently, the alternative is to keep someone in a home or in hospital. When put together, the ICA and the attendance allowance produced £47.45. That would keep one disabled person in a teaching hospital of the sort for which I used to be responsible for half a day. That is the sum that is allocated to keep at home someone who is very disabled, and possibly extremely ill, for an entire week. If we are prepared to hand out—

Mr. Boyes

The Under-Secretary of State is leaving the Chamber. The hon. Lady's supporters are walking out on her.

Mrs. Currie

My right hon. and hon. Friends know what I have to say.

If we are prepared to hand over £200 or more to a private home to keep a disabled person for a week, I fail to understand why we jib so much at paying ICA at the rate of £20.45. I obtained the figures which I have quoted from the National Council for Carers and their Dependants, and my right hon. and learned Friend admitted to me over tea that he used to be its parliamentary adviser. Therefore, he knows all about the council and its work.

Most of the elderly want to retain their independence. They are indignant at the notion that they owe us anything; they properly feel that the reverse is true. They feel, for example, that they have paid for their occupational pensions and that my right hon. Friend the Chancellor of the Exchequer should keep his sticky fingers off them. I tend to agree with them. I venture to suggest that most elderly husbands and wives would like to care for each other, would like in their old age to be cared for by those whom they love, and hope to die in dignity, free from care and worry. Our children will learn from us how we look after old people and they will treat us accordingly in our turn.

Several Hon. Members

rose—

Mr. Speaker

Order. Three more hon. Members wish to take part in the debate. It might be helpful if I let them know that the Front Benches have said that they would like to begin the reply at 9.30 pm. If that could be borne in mind, I might be able to call each of the three hon. Members.

9.5 pm

Mr. Jeremy Corbyn (Islington, North)

I shall attempt to be brief. It is a shame that so few hon. Members can participate in the debate. My hon. Friend the Member for Oldham, West (Mr. Meacher) pointed out that there was a link between Health Service cuts, the effects on local social services and the effects on the elderly within each community. The council in the area that I represent has just been told by the Government that its social services budget is being overspent by well over 30 per cent. and that it is spending too much money on providing for the needs of the elderly. Yet the services for the elderly provided by Islington council, excellent as they are in many ways, are insufficient and do not meet the demands and wishes of councillors, the director of social services and others.

The council provides 900 meals on wheels. 1,700 elderly people's holidays, 2,674 households with home helps and 285 places for elderly people in day centres. Obviously, the cost of those services is considerable. It is incredible that, considering the borough's needs and the increasing dependence of elderly people on the council to provide services, the Government should be telling the council to make cuts.

On a first look at the demographic pattern of arty inner city area Ministers and many civil servants would say that there is a continual outflow of population from the boroughs. In many cases, that is true. An increasingly elderly and single population is dependent on local authorities to look after it. A document produced in 1982 by Islington council's social services programme plan working party states: The elderly now form a higher proportion of our population than they did 10 years ago, since emigration from the borough has been mainly by adults and children, leaving the elderly with less support from their families and neighbours. The number of single-pensioner households has decreased from 10,563 in 1971 to 10,170 in 1981. More importantly, the proportion of such households has increased. In 1971, single-pensioner households formed 13.7 per cent. of all households in the borough, while in 1981 they formed 16 per cent. In 1971, people over retirement age formed 15 per cent. of the total population; in 1981, they formed 17.3 per cent. It is important to emphasise that the great majority of the elderly do not require, or do not use local authority services; but when other support to the elderly becomes less available from family and neighbours then increasingly the Social Services Department is asked to fill the gaps, particularly when Health Service bed norms fail to reflect the significance of high proportions of single pensioner households. Local authorities are facing an increasing demand upon their services and a demand for better services and more imaginative use of homes for the elderly. Like my hon. Friend the Member for Wolverhampton, North-East (Mrs. Short), I have often been in old people's homes. I have been profoundly depressed not just by the conditions within them — I am talking of homes throughout the country—but the attitude that leads us to force people to live in old people's homes with a colour television blazing away in the corner as a piece of moving wallpaper and with people not participating in arty activity in the homes. That promotes and provokes senility.

We need a more imaginative approach towards care for the elderly and a recognition of the growing needs of the ethnic minority elderly communities in many parts of London and the major cities. I am pleased that my area has formed an elderly persons' luncheon club for retired West Indian people. The same is happening in many other places. It is incredible, and it makes me angry, that many old people in my constituency who rely entirely on the local authority to provide services for them do not have any relatives living nearby. They are not in a position to buy luncheon club facilities, to have meals on wheels delivered to them or to pay for maids or other people to come in to help. We do not have a huge, generous, middle class able to provide daily volunteers to do the work for the elderly. Unlike the case referred to by the hon. Member for Mid-Kent (Mr. Rowe), who spoke on behalf of Kent county council, the local authority and political system in my area is determined to provide for all our old people.

We resent the Government's attitude when they say that Islington is spending £9 million too much on its social services when there is clearly a demand for them. That figure has not just been thrown at Islington council; nearly every London social service department has been told that it is spending well over the Government's grant-related expenditure assessment formula. This is a scandal. If Conservative Members are serious about caring and supporting the elderly in a decent and humane way, they would not be imposing spending cuts on local authorities or attempting to control their spending.

Conservative Members have been quick to tell us that there have been no Health Service cuts. I challenge and refute that. A further £163 million is required for the National Health Service to provide for the elderly. As the motion points out, we are looking for a comprehensive policy on care for the elderly. That means an end to the attacks on local authorities that are trying to provide services, an end to the cuts and closures in the Health Service and a different attitude towards transport, mobility allowances and bus passes.

Mr. Winnick

Does my hon. Friend agree that one of the most unfortunate aspects of the Minister's speech, and his sneering remarks about 1945, was his refusal to recognise that many advances have been made in the care of elderly people since 1945? With a Labour Government, with a large majority, 1945 was a watershed in the provision of services by the state and local authorities. Without such provisions the elderly would be far worse off than they are at present.

Mr. Corbyn

I thank my hon. Friend for that intervention. The Government's policies of controlling local authority spending, cutting National Health spending and promoting private medicine and care for the elderly are a return to the workhouse. The only difference is that it is a capitalist workhouse rather than a discreet workhouse stuck away in the hills outside the town.

Last week saw the culmination of a massive campaign by pensioners throughout London, who are determined not to lose their concessionary bus and train passes, and who are determined not to see the gains won for them by a Labour-controlled GLC in 1973 swept away by the London regional transport authority.

We must recognise the other matters that are affected by the Government's change in policy. If cuts are made in public spending on the elderly or people in the Health Service, many relatives will be forced to look after elderly people. That care is often inadequate because the relatives cannot do the work. Women are forced to give up work to nurse elderly relatives. The problem caused by women having to give up jobs to look after elderly relatives is growing. One hears of unpaid carers giving up their work to look after elderly relatives without support or recognition from the state, despite lectures about bounteous volunteers.

I have heard of people in their sixties and seventies being full-time carers for elderly patients in their nineties. That will become worse unless the Government change their attitude towards the elderly and recognise the work done in homes for the elderly, by meals on wheels workers and home helps. I am sponsored by the National Union of Public Employees. The Government have said that those workers are not worth £100 a week for the jobs they do and the dedication they show. They are subjected to moral blackmail, in the way that Health Service workers were two years ago.

In addition to forcing local authorities to cut their spending, we have the Government's privatisation policy. There is a growing number of residential and nursing homes for the elderly. Conservative Members have asked what is wrong with them. I believe that there are two things wrong. First, I am not satisfied that the DHSS has the resources or the capability, or is prepared to provide them to enable local authorities to undertake the necessary tight supervision and inspection of those homes to ensure that they adopt progressive caring policies. Secondly, there is motive. If there is a local authority home with a caring policy for the elderly, the motive is clear. The people who work in that home, who manage and administer it, are doing so because they care for the elderly and wish to see them looked after.

The motive in operating a private home—not from the point of view of the staff but from that of the owners —is simply to make money out of care for the elderly. I reject the idea that one can privatise care for the elderly, which is what Conservative Members in their arrogant way continually tell us.

Mr. Boyes

Does my hon. Friend agree with the Association of Directors of Social Services, which says that the system is unfair and that the Government are prepared to allow private money to be poured into these homes whereas local authority homes are continually monitored by expensively paid auditors? On the one hand, private owners can provide even poorer services and get away with it, while, on the other, local authority homes are continuously under pressure.

Mr. Corbyn

My hon. Friend has hit the nail squarely on the head. The Government are restricting money for publicly run, publicly owned and publicly administered homes for the elderly yet at the same time are encouraging the development of private homes for the elderly without imposing the same conditions on them.

My own authority has been told that it is 33 per cent. over budget on social services. When the Minister kindly finds the time to visit my borough, or any other poor inner city areas, he might care to tell the people which home for the elderly should be shut, how many home helps ought to be dismissed from post and where exactly the cuts should be made.

Mr. Kenneth Clarke

The hon. Gentleman's whole speech is based on the ridiculous claim that his borough is in trouble for overspending solely because of its caring policies for the elderly. It is in trouble because of the totality of its spending. Islington is notorious for the money that it pours into crackpot political groups and the curious hiring of fringe officials to perform unnecessary duties on behalf of the borough. Does not the hon. Gentleman accept that something must be done to tackle Islington's wasteful expenditure so that it can maintain the services and reduce the rate burden for some of its elderly population?

Mr. Corbyn

The Minister, who is a member of a Government who are promoting the Rates Bill, which seeks to control local authority spending, shows a worrying misunderstanding of the way in which the GREA formula works. That formula is specified department by department. My borough, along with others, has been told that it is overspending on social services. I am not talking about the totality of its spending. Indeed, virtually every other London borough has been told exactly the same thing by the Minister and his Government colleagues. He ought to understand the way in which the Government's policies operate on social services spending.

Mr. Clarke

With respect, targets are not based on GREAs, as the hon. Gentleman, as an experienced councillor, knows perfectly well. He makes a quite misleading use of GREAs by suggesting that that is the measure of overspending that the Government are taking into account. They are taking account of the inexorable year-on-year increase in Islington's budget, because that borough spends its money in profligate, wasteful and sometimes downright foolish ways. That has got the borough into trouble and is threatening its services.

Mr. Corbyn

I do not know how long we shall be able to continue this discussion. The Minister ought to get a new brief on what the rate capping legislation means. The GREA formula is specific on each department, and it is specific that social services departments in London are overspending.

Care for the elderly is an important issue. It cannot be left to volunteers, charities or to people going out with collecting boxes to see that old people are looked after properly. The issue is central to our demands for a caring society. That means an end to the cuts and an end to the policy of attacking those authorities that try to care for the elderly. Instead, there should be support for and recognition of those demands.

Elderly people deserve a little more than pats on the head from Conservative Members. They deserve more than the platitudinous nonsense talked about handing the meals on wheels service over to the WRVS or any other volunteer who cares to run it. Instead, there should be a recognition that those who have worked all their lives to create and provide the wealth that the rest of us enjoy deserve some dignity in retirement. They do not deserve poverty, or to be ignored in their retirement, having to live worrying whether to put on the gas fire, or boil the kettle for a cup of tea, or whether they can afford a television licence or a trip out. They should not have to wonder whether the home help who has looked after them so long will be able to continue. The issue is crucial. The motion says clearly that care for the elderly comes before the promotion of policies that merely increase the wealth of those who are already the wealthiest in our society.

9.23 pm

Rev. Martin Smyth (Belfast, South)

I appreciate being called to speak. Lest the Minister asks why the Opposition have not said "Thank you" for anything that the Government have done, I welcome the announcement about the inspectorate. I am not yet sure whether I welcome that announcement more than the fact that the Minister left aside three pages of his brief.

I speak for a party that is concerned about the elderly. It is interesting that more than 50 per cent. of right hon. and hon. Members belonging to the Official Unionist party have been in the Chamber for part of the debate. That shows our concern.

In the time at my disposal, I shall encourage the Minister and his colleagues to do better in their work. I recognise the problems, and know something of the pressures of finance, but, even in the fulsome praise with which the amendment pays tribute to professional staff and volunteers in their central and crucial role of supporting elderly people and their families, we must take heed of the cries for more finance and help in specific areas. We should at least listen to the workers and volunteers who have been dealing with the problem at the coal face, so to speak, if as a party we are not always ready to listen to political opponents who criticise what we are trying to do. Those workers and volunteers say that more needs to be done for the elderly.

I should like to put it on record, in a debate where the need for greater care in the community has often been mentioned, that the British Medical Association stated recently that 94 per cent. of die elderly are cared for in he community, leaving 6 per cent. cared for in old people's homes and other establishments. That might be a distorted figure, as I understand it, but I use it as a warning, because there is a tendency simply to believe that if people were taken out of hospital to make geriatric beds available and were returned to the community, that would go a long way to solve our problems. I contend that that approach may add to our problems rather than solve them, if that is the strategy on which the Government's plans are based.

Tonight we have been told about two elderly people who have contributed to world leadership. I pay tribute to the elderly. A good friend of mine ceased driving at the age of 94. The car needed some attention. I believe that many of our senior citizens could be redeployed usefully in the community if there were strategic planning. However, when we begin to pay people off and tell them that they can do nothing useful after a certain age because of the problems of youth unemployment, and other concerns, we should re-examine the strategy behind our care procedures.

Figures have been bandied about in the debate. Some were useful and others were just argumentative. I plead with the House and above all with the Government not to lead us down the road to the time when a successor to the hon. Member for Derbyshire, South (Mrs. Currie) comes to the House as a robot, saying that every human is an elderly person, and that they must carry the can for them. If we do not provide the framework now, it will not be long before we are back to the deplorable practice of dumping our elderly and not caring for them.

We welcome the work that has been done, and the improvements, but not only financial considerations are involved. Because we sometimes do not realise that we are dealing with human beings, we fall down on the job. I suspect that at times Ministers and even civil servants are not fully aware of the problems facing people. I think that the Under-Secretary of State will admit that to a large extent the social services and hospitals in Northern Ireland compare favourably with other parts of the kingdom. Therefore, if I use illustrations, it is not with a sense of hypercriticism but with the suspicion that if that is the position in a place where I have respect for the level of care, it could be worse in other places.

In the previous debate, it was said how wonderful the youth training scheme is. However, the headlines of yesterday evening's edition of the Belfast Telegraph stated that there were 1,000 fewer places in youth training. When one talks about social services in the rest of the kingdom and the amount of money that is being spent, it is important to realise that senior citizens in Northern Ireland are in double jeopardy. That little strip of water is used as an excuse for exorbitant charges in virtually everything. Mention has been made of the extra sums paid for heating charges. Many people in Northern Ireland and other parts of the United Kingdom are in difficulties because they are pensioners. Their supplementary benefits, even with augmented heating grants, have not met their needs in a winter like this.

On Monday night I visited a senior citizens' group. Those people were fascinating in their approach to life. They meet regularly on Monday nights and are up to all sorts of antics. There is plenty of life in them. One was concerned about the dumping at the entrance of Belfast lough. One of the things that they were interested in, with regard to pensions, was television fees. One was concerned that the previous day's paper forecast an increase. The people in the group recognised that some pensioners who have the benefit of sheltered or warden accommodation can view television free of charge, but others cannot. We have been lobbied by a fine group of people who said that they were building their own dwellings, thus saving the state money, and who would like free television licences. I would welcome that.

I plead for a large percentage of pensioners on low pensions who would love to be in warden or sheltered accommodation or who would even like to join a self-help group, but who, because of their finances, cannot do so. Thus they continue to pay high television costs while others benefit from the rebate. I gather that that may not be just Government policy. It has been suggested that it is the BBC's policy—that the BBC does not wish to receive Government subsidies, because that would make it look less independent. The Government should think less about the independence of the BBC and more about the needs of pensioners.

Finally, it is a long time since the death grant was fixed at £30. We should be trying to meet the needs of decent people who fear the possibility of a pauper's grave because the state allows them only £30 in an age when the minimum requirement for a decent funeral is £400.

9.31 pm

Mr. Max Madden (Bradford, West)

On 1 March, pensioners from all over Britain will come to this House again from the National Pensioners' Convention to urge the Government to accept a declaration of intent which lists a number of demands. The declaration states: every pensioner has the right to choice, dignity, independence and security as an integral and valued member of society. These rights require an adequate State retirement pension. There must be an immediate commitment to a pension level of not less than one half of average gross earnings for a married couple and not less than one third of average gross earnings for a single person, uprated at six monthly intervals. Nine demands are listed. I shall quote the first two. First, there should be a right to live in accommodation which is appropriate to personal need and circumstance with a reasonable degree of choice including sheltered housing". Secondly, there should be a right to be able to call on the full range of community and personal social services to give full support as need arises, including, for example, home helps, meals on wheels, chiropody, television and telephone". Today in Britain there are 9.5 million pensioners—almost one in five of the adult population. Their pensions are the lowest, as a proportion of earnings, of any country in the Common Market. Pensions, compared with average earnings, have grown only modestly in recent years. The most important target for pensioners is to restore the link between pension, prices and earnings. That link was broken as soon as the present Government came to power. It must be restored at the earliest possible moment.

Pensions are now linked to the retail price index. There is considerable evidence to show that for pensioner households the retail price index is wholly unrealistic. The rate of inflation experienced by pensioners is greater than that reflected in the retail price index. The alternative price index prepared by pensioner organisations shows that for the average pensioner household the cost of living has increased by 0.6 per cent. more than the RPI in recent years.

Pensioners spend more of their incomes on food and energy. The prices of both have increased sharply in the past 10 years. Pensioner households spend more of their incomes on bread, margarine, sugar and vegetables. They spend more of their incomes on heating, and they often have the form of heating which is cheapest to install but most expensive to run. Some spend most of their days walking around inner city supermarkets in order to keep warm. Some spend 15 or 16 hours a day in bed to keep warm, covering the bed with an overcoat. The cost of living can be higher for pensioners because they have less access to large low-cost shops and they do not have the ability to buy in bulk.

My hon. Friend the Member for Wolverhampton, North-East (Mrs. Short) has a distinguished record in these matters. She pointed out how pensioners have been hit by the policies of this Government, which have brought about the closure of village shops, sub-post offices and chemists. The ending of doorstep deliveries of milk, if it came about on a general basis, would also hit many pensioners. Fewer than 40 per cent. of pensioners have access to a car. That is why many pensioners depend on public transport, and why many pensioners in London are determined to defend their free transport facilities and to oppose the loss of concessionary fares which may follow the abolition of the metropolitan councils by this Government.

A hospital which is close to my heart—Thornton View hospital in Bradford—has been mentioned. It was occupied in the early part of August last year by the staff to defend it against closure. Since then the staff, assisted by relatives and the local community, have been defending it not because they have a great relish for standing out in the cold in snow 2ft deep or in pouring rain or in the extremely bad weather that we have experienced recently, but because they know that that hospital offers first-class care for very elderly people and that if it is not allowed to remain open such care will not be available.

Through a series of clumsy efforts to threaten, coerce and victimise the staff— most recently by bringing a petty complaint for disciplinary action against a leading member of the occupation — the health authority has tried to do everything to secure the hospital's closure. I urge the Ministers who are facing me to respond sensibly to the community's demands. I urge them to announce that the hospital can be kept open — there is no better provision. The Minister talked of the need for better provision when old hospitals are closed. We all agree with that, but the bare fact in Bradford is that there is no better provision. The only alternative long-stay provision which is proposed is at the Leeds road hospital. It would cost at least £80,000 to bring it into use. Moreover, it does not offer better standards of patient care and it certainly does not offer patients or relatives greater access or greater convenience.

We know that about 19 per cent. of the over-85s live in residential establishments. Their need for residential hospital care is significantly higher than that of younger retired people. That also makes nonsense of any attempt to close hospitals such as Thornton View. It is those hospitals which provide the residential care which is often not available elsewhere.

We also know that many pensioners live in the most unsatisfactory conditions. One third live alone and have no direct family support. More than 400,000 pensioner households do not have exclusive use of a bath or an indoor WC. With hospitals closing, more pensioners are being compelled to look to community support. With local authorities reeling from cuts in their rate support grant, there are cuts in home helps, meals on wheels and other services which help pensioners to live independently. Moreover, as councils' part III accommodation is shrinking, an increasing number of pensioners are buying shelter in the private sector.

It is estimated that about 48,000 elderly people live in 3,400 private homes which attract an annual revenue of £250 million a year, about half of which comes from the DHSS's supplementary benefit budget. The assets of the private sector are valued at £6 billion. The private sector is booming. We have heard about that tonight. Indeed, it is ironic that when the Government are robbing pensioners through cuts in housing benefit to the tune of £185 million, they are propping up the private sector which is one of the biggest growth industries in Britain today.

Malcolm Johnson of the Policy Studies Institute, writing in the Health and Social Service Journal of July last year, said: over the past year or two it has become the practice for local social security offices to allow the payment of attendance and other allowances previously available only to those in their own homes, to receive these in residential care settings. Moreover, a discretionary topping-up payment is now widely made in accordance with the level of local costs. Thus, across the country there are supplementary benefit supported residents in Homes where the weekly costs range from £70 to £125. There is no indication that the DHSS is moving towards a curbing or withdrawal of his considerable source of revenue for proprietors who are increasingly aware of its benefits. One new owner, wishing to fill his beds, recently advertised a free weekend trial stay for elderly people. When the rested carers came to collect their equally satisfied elderly parents, lamenting that it would be nice to continue the arrangment except for the money, the proprietor had a solution. Ready to hand he had a supply of supplementary benefit forms—and rapidly filled his beds. This facility is undoubtedly costing tens of millions of pounds a year, and some social services directors share my view that it may already have reached £100 million in the payment of allowances and top-up awards. In opening the debate for the Government, the Minister gave an extensive, apparently written explanation of the measures announced today. Will the Minister in replying to the debate tell us what the registration fee will be? If it is as inadequate as those previously proposed, local authorities will have great difficulty in policing the proposed system. Secondly, is there to be a ceiling on the benefit paid to elderly residents in the private sector?

What kind of money is being made out of this? I recently obtained a prospectus being circulated to potential investors in a nursing home proposal. It states: Financial experts now take the view that nursing homes for elderly people are likely to become a growth industry. And that, because of the special circumstances described above, this growth will continue through bad years as well as good. Through the Business Expansion Scheme, where investment is subsidised by the Government, Mrs. Thatcher can effectively influence the switch of emphasis to private care in this area. We believe that, with this impetus behind it and the tax advantages of a BES investment, 'An Investment in Nursing Homes' will prove a lucrative long-term opportunity for large-scale capital growth. Indeed, it is. The brochure gives the equivalent gross annual return as more than 20 per cent. for a £1,000 investment by an investor with a marginal tax rate of 30 per cent. With a marginal tax rate of 75 per cent., the return is 57 per cent. and the return on a £10,000 investment over a period of five years is equivalent to an annual growth rate of 115 per cent. That is not bad at all. That is the type of carrot being dangled increasingly before the noses of all kinds of people with money to invest.

Sir Raymond Gower (Vale of Glamorgan)

Will the hon. Gentleman give way?

Mr. Madden

I am reluctant to give way as it is a short debate. If the hon. Gentleman had been here earlier, he might have caught your eye, Mr. Speaker.

We in no way oppose the private sector in the way that Ministers have suggested, but we are concerned that the people involved should have the right caring qualities and managerial and business experience. We are extremely concerned about the standards of care available in the private sector. We readily admit that some of the best residential homes are in the private sector, but so are some of the worst. We are also worried about the thoroughly inadequate training available to people serving in those homes.

In this debate on the needs of the elderly all hon. Members who have spoken have expressed deep concern about the plight of many elderly people in this country today. There is no excuse for selling pensioners short and not giving them the best possible opportunity to live with dignity and with a standard of living that allows them a full life and a life of quality. That is what the debate is about.

I urge those who agree that the Government's policies appear to be a determined attempt to reduce the standard of living of pensioners to join me in supporting the Opposition motion and doing all that we can to oppose Government policies that are hitting British pensioners extremely hard. Britain is one of the richest countries in the world. The time has come for that wealth to be mde more available to pensioners so that they may enjoy an increasing share of it and escape the never-ending prospect of drab, depressing lives which at present so many of them have to endure.

9.44 pm

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

In answering the debate, I do not intend to refer to what the hon. Member for Bradford, West (Mr. Madden) had to say about hospitals in his constituency, a subject more suitable for an Adjournment debate than for a debate such as this, which arises on an Opposition motion. The Government do riot regard the elderly as a dependent group in the way that, all too clearly, the Labour party does. We reject the patronising attitude that anyone over the age of 65 is helpless and a member of a client group, in need of care or suffering from illness. That is not our view of the role of the elderly in society. Retirement is not an illness, and that is why in our 1983 manifesto we pledged that, together with a number of other priority groups such as the mentally ill and the mentally handicapped, we would give special attention to the needs of those over 65 who needed special care. My right hon. and learned Friend the Minister for Health pointed this out clearly in his introductory remarks.

Nothing in the motion on the Order Paper pays any attention to the important work that can be done in looking after the elderly by voluntary societies and community work. That is why the Government's amendment correctly points out the critically important role of the voluntary societies and organisations in helping with the mixed care of the elderly provided through funds from the state, in increasing amounts through the resources of the elderly themselves and through voluntary organisations.

Mr. Boyes

rose—

Mr. Patten

I cannot give way as I have only a quarter of an hour in which to reply to the debate.

I need only give a few examples of the way in which the Government have encouraged the development of voluntary care in looking after the elderly to substantiate the case that my right hon. and learned Friend made in his introductory remarks. The Government are giving increasing attention to involving voluntary organisations more deeply in joint planning, in which we hope that voluntary organisations will soon have a statutory part to play. That will be of great importance in the care of the elderly.

More and more, we shall make finance available to help joint planning between health and local authorities and to stimulate work in community care. Already there have been considerable increases in this over the past five years. In 1983–84 the total stands at £96 million, and I hope that our record in recognising the role that community care can play in joint planning is recognised by members of the alliance.

Mr. George Foulkes (Carrick, Cumnock and Doon Valley)

I hope that the hon. Gentleman is not looking at me.

Mr. Patten

I am not looking at the hon. Gentleman —I try to restrict myself to looking at those things at which I enjoy looking.

The alliance has to think carefully before it decides to go into the Lobby supporting the Opposition.

Mr. Foulkes

rose—

Mr. Patten

I apologise unreservedly. I enjoy looking at the hon. Gentleman.

Mr. Foulkes

rose—

Mr. Speaker

Order. I think that the Minister is not going to give way.

Mr. Foulkes

The Minister was referring to me.

Mr. Patten

I apologise. I do not wish to upset the hon. Gentleman.

I hope that the alliance will think carefully before going into the Lobby in support of the Opposition. The motion's blanket condemnation of all the developments since 1979 is unfair and unjustified. The hon. Member for Oldham, West (Mr. Meacher), with his love of statistics, should recognise the improvements that have been made. I do not intend to go through a Dalek-like repetition of statistics in the next 12 minutes, but in an intervention in the speech of the hon. Member for Wolverhampton, North-East (Mrs. Short) I gave her three statistics, with which she was good enough to agree, concerning the provision of geriatric care in hospitals. I quoted the 11 per cent. increase in consultants, the 37 per cent. increase in senior registrars and the 11 per cent. increase in nursing staff looking after geriatric patients. All those developments since 1979 have enabled the average length of stay in geriatric units—this is another statistic for the hon. Member for Oldham, West—to be reduced by 20 per cent. down to about 60 days, which then enables the elderly to return to the community. That is exactly what they wish to do.

When talking about returning to the community, it is nice to see the hon. Member for Oldham, West returning to the Chamber. He did not stay in the Chamber for any of the speeches, except one, in this most interesting debate. It would have shown greater interest in the debate on his part had he spent some time listening to what other people said.

Let me tell the hon. Gentleman about some of the speeches that he missed. He missed an admirable speech by my hon. Friend the Member for Mid-Kent (Mr. Rowe), who gave the House a rational exposé of the prudent approach of his local authority and who went through all the advantages of the social services set-up in Kent. That social services department involves the voluntary services in the care of the elderly. My hon. Friend also referred to the fears of the elderly, especially the fears of those who are giving up their accommodation to enter local authority accommodation. He raised several important points, and I undertake to consider them.

Had the hon. Member for Oldham, West been in the Chamber, he would have heard an interesting speech by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood), who paid many compliments to the hon. Member for Oldham, West. He endorsed several of the comments of the hon. Member for Oldham, West, but he did not endorse the language in which so much of the hon. Gentlman's speech was expressed—the language of total condemnation, which does him less than justice.

The hon. Member for Roxburgh and Berwickshire talked about the importance not just of spending money but of developing and changing attitudes towards the elderly and of developing care for the elderly. He said that there are other ways of approaching issues than spending cash. I am pleased that the hon. Gentleman shares the view that is common among Conservative Members: that we must consider the efficiency and effectiveness of social services provision for the elderly, not just the amount of money spent on them. Considerable improvements can be made in social services departments to improve the effectiveness and efficiency of the delivery of social services care.

My hon. Friend the Member for Derbyshire, South (Mrs. Currie) treated the House to an extraordinary picture of herself growing old, grey and stooped and unable to deal with life. I find that picture hard to substantiate. She raised one specific point about the need to extend the provision of invalid care allowances to married women. When the invalid care allowance was introduced in 1976 the Labour Government believed it necessary to confine the allowance to those who were thought to need it most. I am afraid that those considerations still apply, together with the considerations of cost. As my hon. Friend said, the cost would be about £60 million. My hon. Friend has often spoken about the need to restrain public expenditure. She understands the hard decisions that have to be made. While the Government are sympathetic to this as a long-term aim, I am afraid that at present we will not be able to oblige the hon. Lady.

The House then heard the voice of sanity from Ulster in the shape of the hon. Member for Belfast, South (Rev. Martin Smyth). I point out to my right hon. and hon. Friends that when the hon. Member for Belfast, South was speaking at 9.22 pm, there were eight members of the Ulster Unionist party in the Chamber, and five members of the Labour party, to listen to speeches on their own Opposition Supply day. I congratulate the Ulster Unionist party on showing its characteristic interest in these affairs, which has not been shown by members of the Labour party, or, most important, by the Opposition's Front Bench spokesman.

Mr. Boyes

rose—

Mr. Speaker

Order. I hope that it is a point of order.

Mr. Boyes

On a point of order, Mr. Speaker. If the Minister is going to quote the number of hon. Members in the Chamber across political parties he ought to quote the number of Members of all political parties present.

Mr. Speaker

As I suspected, that is not a point of order.

Mr. Patten

I shared your suspicion, Mr. Speaker, and, like you, I have not been surprised to hear the result.

It is critically important to remember that the major attack on the Government has been launched by the hon. Member for Oldham, West. The hon. Gentleman is an important man in his party. He is a seminal thinker and he has written a book that I have read called "Socialism with a Human Face". I bet that is an experience that not many of my right hon. and hon. Friends have shared. Indeed, I do not know how many of his hon. Friends would be able to hold up their hands to say that they had read it. What is so interesting about the book, which was published in 1982, is that, despite being called "Socialism with a Human Face", there is not one mention of the National Health Service, and not one mention of social services. However, it is a document of great interest, because it is very honest. One has to read only as far as the sixth line of the first page to come across the need for a drive to transform the party under the campaigning leadership of Tony Benn". I am afraid that the hon. Gentleman has a record. The hon. Gentleman served as a junior Minister in the DHSS. The hon. Gentleman suffers from amnesia, because he can never quite recall that he was a member of the DHSS when the Christmas bonus was "daylight-robbed" from pensioners in 1975–76. He somehow cannot manage to recall, curiously enough, that he was part of the ministerial team that decided to mount a daylight robbery exercise on pensioners when they moved from the historic to the forecast method of calculating pensions. That is the trouble with the hon. Gentleman: this amnesia creeps in.

The other point that is characteristic of the hon. Gentleman's argument is the automaton-like repetition of statistics, which many of my hon. and right hon. Friends were not privileged to hear at an earlier stage this afternoon, in his frantic attempt to identify a new client group for the Labour party to get hold of—in this case the elderly. The Labour party has tried it time alter time since the second world war. It has tried to make the council tenants its own client group, and it has failed. It has tried to make industrial manual workers its own client group, and it has failed. It has tried to make new Commonwealth immigrants its own client group, and it is failing in that. I have to say that it is failing completely in trying to make the elderly its own client group, as all opinion polls showed after the result of the last general election, when 50 per cent. of those over 65 correctly voted Conservative. They voted Conservative because they recognised the record of the Conservative Government before the last election, and they recognised the realistic way in which we have not made promises that we cannot keep, but have moved to improve the lot of the elderly within their own means.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 185, Noes 285.

Division No. 173]	[10 pm
AYES
Alton, David	Dalyell, Tam
Anderson, Donald	Davies, Rt Hon Denzil (L'lli)
Archer, Rt Hon Peter	Davis, Terry (B'ham, H'ge H'l)
Ashdown, Paddy	Deakins, Eric
Ashley, Rt Hon Jack	Dewar, Donald
Ashton, Joe	Dormand, Jack
Atkinson, N. (Tottenham)	Dubs, Alfred
Bagier, Gordon A. T.	Duffy, A. E. P.
Banks, Tony (Newham NW)	Dunwoody, Hon Mrs G.
Barnett, Guy	Eadie, Alex
Beggs, Roy	Eastham, Ken
Beith, A. J.	Edwards, Bob (W'h'mpt'n SE)
Bell, Stuart	Fatchett, Derek
Bennett, A. (Dent'n & Red'sh)	Faulds, Andrew
Bermingham, Gerald	Field, Frank (Birkenhead)
Bidwell, Sydney	Fields, T. (L 'pool Broad Gn)
Blair, Anthony	Foot, Rt Hon Michael
Boothroyd, Miss Betty	Forrester, John
Boyes, Roland	Forsythe, Clifford (S Antrim)
Bray, Dr Jeremy	Foster, Derek
Brown, Gordon (D'f'mline E)	Foulkes, George
Brown, N. (N'c'tle-u-Tyne E)	Fraser, J. (Norwood)
Brown, R. (N'c'tle-u-Tyne N)	Freeson, Rt Hon Reginald
Brown, Ron (E'burgh, Leith)	Freud, Clement
Bruce, Malcolm	Garrett, W. E.
Buchan, Norman	George, Bruce
Callaghan, Jim (Heyw'd & M)	Gilbert, Rt Hon Dr John
Campbell, Ian	Godman, Dr Norman
Campbell-Savours, Dale	Golding, John
Canavan, Dennis	Gould, Bryan
Carter-Jones, Lewis	Gourlay, Harry
Clark, Dr David (S Shields)	Hamilton, James (M'well N)
Clarke, Thomas	Hamilton, W. W. (Central Fife)
Clay, Robert	Hardy, Peter
Cocks, Rt Hon M. (Bristol S.)	Harman, Ms Harriet
Cohen, Harry	Harrison, Rt Hon Walter
Coleman, Donald	Heffer, Eric S.
Concannon, Rt Hon J. D.	Hogg, N. (C'nauld & Kilsyth)
Conlan, Bernard	Home Robertson, John
Cook, Frank (Stockton North)	Howells, Geraint
Cook, Robin F. (Livingston)	Hoyle, Douglas
Corbyn, Jeremy	Hughes, Dr. Mark (Durham)
Cowans, Harry	Hughes, Robert (Aberdeen N)
Cox, Thomas (Tooting)	Hughes, Roy (Newport East)
Craigen, J. M.	Janner, Hon Greville
Crowther, Stan	John, Brynmor

Jones, Barry (Alyn & Deeside)	Radice, Giles
Kennedy, Charles	Randall, Stuart
Kilroy-Silk, Robert	Rees, Rt Hon M. (Leeds S)
Kirkwood, Archibald	Richardson, Ms Jo
Lambie, David	Roberts, Ernest (Hackney N)
Lamond, James	Robertson, George
Leadbitter, Ted	Rooker, J. W.
Lewis, Ron (Carlisle)	Ross, Ernest (Dundee W)
Lofthouse, Geoffrey	Ross, Wm. (Londonderry)
Loyden, Edward	Rowlands, Ted
McCartney, Hugh	Sedgemore, Brian
McDonald, Dr Oonagh	Sheerman, Barry
McGuire, Michael	Sheldon, Rt Hon R.
McKay, Allen (Penistone)	Shore, Rt Hon Peter
McKelvey, William	Short, Ms Clare (Ladywood)
Mackenzie, Rt Hon Gregor	Short, Mrs R.(W'hampt'n NE)
McNamara, Kevin	Silkin, Rt Hon J.
McTaggart, Robert	Skinner, Dennis
McWilliam, John	Smith, Rt Hon J. (M'kl'ds E)
Madden, Max	Smyth, Rev W. M. (Belfast S)
Maginnis, Ken	Soley, Clive
Marek, Dr John	Spearing, Nigel
Martin, Michael	Steel, Rt Hon David
Mason, Rt Hon Roy	Stewart, Rt Hon D. (W Isles)
Maxton, John	Stott, Roger
Maynard, Miss Joan	Strang, Gavin
Meacher, Michael	Thomas, Dr R. (Carmarthen)
Mikardo, Ian	Thompson, J. (Wansbeck)
Millan, Rt Hon Bruce	Thorne, Stan (Preston)
Miller, Dr M. S. (E Kilbride)	Tinn, James
Mitchell, Austin (G't Grimsby)	Torney, Tom
Molyneaux, Rt Hon James	Walker, Cecil (Belfast N)
Morris, Rt Hon A. (W'shawe)	Wallace, James
Morris, Rt Hon J. (Aberavon)	Wardell, Gareth (Gower)
Nellist, David	Wareing, Robert
Nicholson, J.	Weetch, Ken
Oakes, Rt Hon Gordon	White, James
O'Brien, William	Wigley, Dafydd
O'Neill, Martin	Williams, Rt Hon A.
Orme, Rt Hon Stanley	Wilson, Gordon
Owen, Rt Hon Dr David	Winnick, David
Park, George	Woodall, Alec
Parry, Robert	Wrigglesworth, Ian
Patchett, Terry	Young, David (Bolton SE)
Pavitt, Laurie
Pendry, Tom	Tellers for the Ayes:
Powell, Rt Hon J. E. (S Down)	Mr. Frank Haynes and
Powell, Raymond (Ogmore)	Mr. Don Dixon.
Prescott, John

NOES
Alexander, Richard	Chapman, Sydney
Ancram, Michael	Churchill, W. S.
Arnold, Tom	Clark, Sir W. (Croydon S)
Ashby, David	Clarke, Rt Hon K. (Rushcliffe)
Atkins, Robert (South Ribble)	Clegg, Sir Walter
Banks, Robert (Harrogate)	Cockeram, Eric
Batiste, Spencer	Colvin, Michael
Beaumont-Dark, Anthony	Conway, Derek
Bellingham, Henry	Coombs, Simon
Bendall, Vivian	Cope, John
Best, Keith	Corrie, John
Biffen, Rt Hon John	Cranborne, Viscount
Body, Richard	Critchley, Julian
Boscawen, Hon Robert	Currie, Mrs Edwina
Bottomley, Peter	Dorrell, Stephen
Bowden, A. (Brighton K'to'n)	Douglas-Hamilton, Lord J.
Boyson, Dr Rhodes	Durant, Tony
Brandon-Bravo, Martin	Dykes, Hugh
Brown, M. (Brigg & Cl'thpes)	Edwards, Rt Hon N. (P'broke)
Browne, John	Emery, Sir Peter
Bruinvels, Peter	Fairbairn, Nicholas
Buck, Sir Antony	Farr, John
Budgen, Nick	Favell, Anthony
Bulmer, Esmond	Fenner, Mrs Peggy
Burt, Alistair	Finsberg, Sir Geoffrey
Butcher, John	Fletcher, Alexander
Butterfill, John	Fookes, Miss Janet
Carlisle, John (N Luton)	Forman, Nigel
Carttiss, Michael	Forsyth, Michael (Stirling)

Fox, Marcus	McCrindle, Robert
Franks, Cecil	McCurley, Mrs Anna
Fraser, Peter (Angus East)	MacGregor, John
Freeman, Roger	MacKay, Andrew (Berkshire)
Fry, Peter	MacKay, John (Argyll & Bute)
Gale, Roger	Maclean, David John.
Galley, Roy	McNair-Wilson, P. (New F'st)
Gardiner, George (Reigate)	McQuarrie, Albert
Gardner, Sir Edward (Fylde)	Madel, David
Glyn, Dr Alan	Major, John
Goodhart, Sir Philip	Malins, Humfrey
Goodlad, Alastair	Malone, Gerald
Gow, Ian	Maples, John
Gower, Sir Raymond	Marland, Paul
Grant, Sir Anthony	Marshall, Michael (Arundel)
Greenway, Harry	Mates, Michael
Gregory, Conal	Mather, Carol
Griffiths, E. (B'y St Edm'ds)	Maude, Hon Francis
Griffiths, Peter (Portsm'th N)	Mawhinney, Dr Brian
Grist, Ian	Maxwell-Hyslop, Robin
Gummer, John Selwyn	Mayhew, Sir Patrick
Hamilton, Hon A. (Epsom)	Mellor, David
Hamilton, Neil (Tatton)	Merchant, Piers
Hampson, Dr Keith	Meyer, Sir Anthony
Hanley, Jeremy	Mills, Iain (Meriden)
Hannam, John	Mills, Sir Peter (West Devon)
Hargreaves, Kenneth	Miscampbell, Norman
Harvey, Robert	Mitchell, David (NW Hants)
Haselhurst, Alan	Moate, Roger
Havers, Rt Hon Sir Michael	Monro, Sir Hector
Hawkins, C. (High Peak)	Montgomery, Fergus
Hawkins, Sir Paul (SW N'folk)	Moore, John
Hawksley, Warren	Morris, M. (N'hampton, S)
Hayhoe, Barney	Moynihan, Hon C.
Hayward, Robert	Mudd, David
Heath, Rt Hon Edward	Murphy, Christopher
Heathcoat-Amory, David	Neale, Gerrard
Heddle, John	Needham, Richard
Henderson, Barry	Nelson, Anthony
Hickmet, Richard	Neubert, Michael
Hicks, Robert	Newton, Tony
Higgins, Rt Hon Terence L.	Nicholls, Patrick
Hill, James	Norris, Steven
Hind, Kenneth	Onslow, Cranley
Hirst, Michael	Oppenheim, Philip
Hogg, Hon Douglas (Gr'th'm)	Oppenheim, Rt Hon Mrs S.
Holland, Sir Philip (Gedling)	Osborn, Sir John
Holt, Richard	Ottaway, Richard
Hooson, Tom	Page, John (Harrow W)
Hordern, Peter	Page, Richard (Herts SW)
Howarth, Alan (Stratf'd-on-A)	Parris, Matthew
Howe, Rt Hon Sir Geoffrey	Patten, John (Oxford)
Howell, Rt Hon D. (G'ldford)	Pawsey, James
Hubbard-Miles, Peter	Peacock, Mrs Elizabeth
Hunt, John (Ravensbourne)	Percival, Rt Hon Sir Ian
Hunter, Andrew	Pink, R. Bonner
Hurd, Rt Hon Douglas	Pollock, Alexander
Jenkin, Rt Hon Patrick	Porter, Barry
Jessel, Toby	Powell, William (Corby)
Jones, Gwilym (Cardiff N)	Powley, John
Jones, Robert (W Herts)	Proctor, K. Harvey
Joseph, Rt Hon Sir Keith	Raffan, Keith
Kershaw, Sir Anthony	Raison, Rt Hon Timothy
Key, Robert	Rees, Rt Hon Peter (Dover)
King, Roger (B'ham N'field)	Renton, Tim
King, Rt Hon Tom	Rhodes James, Robert
Knight, Gregory (Derby N)	Ridley, Rt Hon Nicholas
Knight, Mrs Jill (Edgbaston)	Rippon, Rt Hon Geoffrey
Knox, David	Roberts, Wyn (Conwy)
Lamont, Norman	Robinson, Mark (N'port W)
Lang, Ian	Roe, Mrs Marion
Lawler, Geoffrey	Rost, Peter
Lawrence, Ivan	Rowe, Andrew
Lee, John (Pendle)	Rumbold, Mrs Angela
Leigh, Edward (Gainsbor'gh)	Ryder, Richard
Lewis, Sir Kenneth (Stamf'd)	Sackville, Hon Thomas
Lilley, Peter	Sainsbury, Hon Timothy
Lloyd, Ian (Havant)	St. John-Stevas, Rt Hon N.
Lloyd, Peter, (Fareham)	Sayeed, Jonathan
Lord, Michael	Shaw, Giles (Pudsey)

Shaw, Sir Michael (Scarb')	Townend, John (Bridlington)
Shelton, William (Streatham)	Tracey, Richard
Shepherd, Richard (Aldridge)	Trippier, David
Shersby, Michael	Trotter, Neville
Silvester, Fred	Twinn, Dr Ian
Sims, Roger	van Straubenzee, Sir W.
Skeet, T. H. H.	Vaughan, Sir Gerard
Smith, Sir Dudley (Warwick)	Viggers, Peter
Smith, Tim (Beaconsfield)	Waddington, David
Soames, Hon Nicholas	Waldegrave, Hon William
Speed, Keith	Walden, George
Spence, John	Walker, Bill (T'side N)
Spencer, D.	Wall, Sir Patrick
Spicer, Jim (W Dorset)	Waller, Gary
Spicer, Michael (S Worcs)	Ward, John
Squire, Robin	Wardle, C. (Bexhill)
Stanbrook, Ivor	Warren, Kenneth
Steen, Anthony	Watson, John
Stern, Michael	Watts, John
Stevens, Lewis (Nuneaton)	Wells, Bowen (Hertford)
Stevens, Martin (Fulham)	Wells, John (Maidstone)
Stewart, Allan (Eastwood)	Wheeler, John
Stewart, Andrew (Sherwood)	Whitfield, John
Stewart, Ian (N Hertf'dshire)	Wiggin, Jerry
Stokes, John	Wilkinson, John
Stradling Thomas, J.	Winterton, Mrs Ann
Sumberg, David	Winterton, Nicholas
Taylor, John (Solihull)	Wolfson, Mark
Taylor, Teddy (S'end E)	Woodcock, Michael
Temple-Morris, Peter	Yeo, Tim
Terlezki, Stefan	Younger, Rt Hon George
Thomas, Rt Hon Peter
Thompson, Donald (Calder V)	Tellers for the Noes:
Thompson, Patrick (N'ich N)	Mr. David Hunt and
Thorne, Neil (Ilford S)	Mr. Tristan Garel-Jones.
Thornton, Malcolm

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 33 (Questions on amendments), and agreed to.

MR. SPEAKER forthwith declared the main Question, as amended, to he agreed to.

Resolved, That this House welcomes the steps the Government have taken in a period of economic difficulty to provide elderly people with improved financial support and to continue the development of health and personal social services for them; and pays tribute to the professional staff and volunteers who play a central and crucial role in the care and support of elderly people and their families.