Health Care and Services for the Elderly

HC Deb 25 February 1987 vol 111 cc329-70 7.13 pm

Mr. Frank Dobson (Holborn and St. Pancras)

I beg to move, That this House deplores the failure of the Government to provide sufficient resources to enable the National Health Service and local councils to provide Britain's elderly people with the services they need, deserve and have paid for.

Mr. Speaker

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

Mr. Dobson

We all know that a growing number of people in our country are living longer. Everyone should welcome that. In terms of history and geography, life expectation has been a measure of the prosperity of a society and can be safely used to compare our society with earlier times or with other contemporary societies, simply on the basis of how long people live. The judgment is usually—the longer, the better. Certainly that is most people's judgment for themselves, their relatives and friends, and so it should be for our country.

Nothing irritates me more than people who go on about the problems of people living longer and the problem of there being more old people. When it was mainly the well-off who lived for a long time, nobody said that it was a problem, even though some of them sponged on society for all of their lives. Therefore, I should like to know why it is described as a burden when it is ordinary people who are living longer.

What is needed for all the people who are living longer is a decent standard of life that can be enjoyed by all throughout their extended lives. That includes a reasonable and secure income, somewhere warm and decent to live, a sense of security, and the stimulus of company, together with the practical services that will help them to keep healthy and mobile.

Under this Government, the living standards of elderly people have not kept up with those of the rest of us—[Interruption.] Apparently, some Conservative Members were not listening to the earlier debate or they would have—

Mr. Tony Marlow (Northampton, North)

As somebody who was present during the two Front-Bench speeches in the previous debate, from which, I believe, the hon. Gentleman was absent, I remind the hon. Gentleman of two points that were made. First, his hon. Friend the Member for Oldham, West (Mr. Meacher) was holding forth with out-of-date statistics. Secondly, the real living standards of pensioners have actually gone up more during the last few years than the real living standards of the population as a whole; and they have gone up considerably anyhow.

Mr. Dobson

What the hon. Gentleman asserts is palpably false. The standard of living of most elderly people in this country has not gone up in line with the standards of living of most of the rest of us.

Keeping warm and having somewhere to live has become more expensive and more difficult for many old people—

Mr. Patrick Nicholls (Teignbridge)

Will the hon. Gentleman give way?

Mr. Dobson

No, I shall not give way.

Crime and the fear of crime keeps many of our old people in what amounts to self-imprisonment, denying them much of the company that they need and would enjoy. During the last two years of the Labour Government, in the years 1977–78 and 1978–79, crime fell by 4 per cent. If witless Conservative Members cannot remember that, perhaps they can remember that crime has increased by 50 per cent. under this Government, leading to damage to the health, welfare and practical living standards of many old people, because if one decides or chooses— if that is the right word— not to go out because of all those pressures, one's standard of living is considerably reduced.

The practical services to help elderly people to keep healthy and mobile have not expanded in line with their numbers and needs. Nor has there been any recognition of the need to extend those services so that the quality of life of the increasing number of elderly people may be improved.

To put things into perspective, we must remember that 95 per cent. of people over 65 live in their own homes and look after themselves, or are looked after by professional or voluntary carers. Some need help to do tasks that are simple for the able-bodied but difficult for them, such as getting in and out of bed or round and about their houses or flats. They may need such assistance when they want to get in or out. Those are simple tasks, but some of the tasks carried out by the professional carers are considerably more complicated and demanding.

Those services could be expanded but they are not being expanded in line with need, nor are there any significant plans nationally to improve the situation. There has been no increase in the number of community or district nurses devoted to looking after the elderly. There are no plans to do as the health visitors wish and to build up their role in providing continuing care and advice to elderly people in their areas.

One of the objectives, it is said, of the policies of all Governments is to try to make sure that as many elderly people as possible can stay in their own homes for as long as possible. But, because of the curiosities of the benefit system, there is now a financial incentive to be institutionalised in a private institution. Plainly, that runs contrary to the intentions of the Government and their predecessors in trying to keep people well looked after at home.

The Government have been keen to expand the provision of private residential care for the elderly, and some of the outfits that provide it are dubious. I shall not talk at length about such an expanding sector, save to point out that many of the private homes, good or bad—quite a few of them are bad—do not last long. It is estimated that about one in three proprietors of small private residential homes go broke or leave their businesses with heavy losses. When they do so, they often leave the residents in a bit of a state because there is no continuity of care.

Mr. Nicholls

The hon. Gentleman will nevertheless concede that many people live in private homes. That is where they expect to spend their twilight years. How does the hon. Gentleman think it helps their security when they read about the plans that the Opposition announced last week? They will be driven out of private homes because of the alterations that the hon. Gentleman's party will make to the social security payment. Does the hon. Gentleman think that that will contribute to the well-being of elderly people?

Mr. Dobson

The hon. Gentleman has obviously read The Sun's version of what we said last week, which is not likely to reach even to his low intellectual standards. We have given guarantees for any transitional arrangements that cover people in such circumstances. I remind the hon. Gentleman that, under the present system that he apparently strongly supports, roughly one third of smaller homes go out of business and leave old people bereft of any care or cover. If he is to attack what we suggest is an improvement, he should remember that he has a lot to defend on his own side.

A further problem is that, even now, in our medical schools, after the recognition by many people outside medical education of the vast increase in the number of elderly people, education in the treament and care of elderly people is not a major requirement, and it should be. The Department of Education and Science and the DHSS should do something about it. Many doctors who were trained years ago are certainly not well versed in dealing with the problems of the elderly. Many general practitioners, social workers and other people who are supposedly helping elderly people are not well aware of the provision available to help them. Last year, the Health Education Council produced a leaflet entitled "Who cares", but it did not reach many carers because its circulation was so low.

If we examine the basic services for the elderly that are provided by local councils, we see that the councils with the best records seem to be those most often vilified by the chairman of the Tory party, the right hon. Member for Chingford (Mr. Tebbit). Of course, they are vilified and mocked also by his friends in the gutter press. Newcastle, St. Helens, Greenwich and Lewisham have three or four times as many home helps per 1,000 elderly people as Tory Surrey or Sussex east or west, Tory Barnet, which is represented by the Prime Minister, or, worst of all, the Liberal-controlled Isle of Wight. If we consider the number of meals supplied per resident over 65, the picture is much the same, with Islington, Haringey and Greenwich supplying three or four times as many as Tory Redbridge or Tory Barnet supply. Overall, between 1979 and 1984, the number of home helps has not kept pace with the number of people over 75, while the number of meals on wheels and luncheon club meals has fallen a long way behind.

Informal carers—family, neighbours and friends—need a lot more help if they are to keep on caring. All of us recognise the immense burdens that relatives and friends take on in trying to care for elderly people. We must recognise that, if they are to continue to carry out that difficult task, they need respite from it. We need respite care to give the carers a holiday. That requirement has been cut as the number of hospital and local authority beds available for elderly people is reduced.

When we consider the hospital service, we need to remember that many of the services that are used by the elderly are the same as those used by the rest of us. Care for the elderly cannot stop at the door of the geriatric ward. Indeed, 34 per cent. of patients over 65 are in acute beds—that is, just 1 per cent. fewer than the number of elderly patients getting specific geriatric treatment. Long hospital waiting lists and long waiting times for all sorts of treatment have as adverse an effect on elderly people as they do on the rest of us.

Some of the changes portrayed as improvements in efficiency do not seem to be so to an elderly patient. What a newly appointed general manager logs as improved throughput can seem to an elderly patient like being shifted out of hospital too soon. I understand that some elderly people are referred to by health economists as bed blockers. To the persons concerned, it is simply a way of getting the attention that they need and, over the years, have paid for and have a right to expect.

The recent increasing problems that hospitals encounter in coping with emergencies hit old people in two ways. Frequently, they are the people who need emergency treatment and for whom it is hard to find a bed. They are also among those who cannot get into hospital because their planned admissions are not possible as beds are full of emergency cases. They are caught out both ways. In case anyone denies that this is happening, I shall quote circumstances that have arisen at the Royal Free hospital in Hampstead. It was recently reported: Two 80-year-old patients, who had both suffered strokes, had to wait 25 hours and 14 hours respectively … before beds could be found for them at the Royal Free hospital … the one waiting longest lying on a trolley in a corridor. … a 79-year-old woman with peritonitis … had to wait four hours in casualty before a bed could be found for her in the Coronary Care Unit, and an 84-year-old woman … had to be placed in an obstetrics ward. That is a bit late for an 84-year-old. It was further reported: Admissions from the waiting list for surgery had come 'virtually to a standstill' and patients were being discharged"— as the consultant described it— before they were fit, to make room for others. Specialties like dermatology and rheumatology"— both of which heavily affect old people— could not admit patients from the waiting list at all".

This very day, I received a letter telling me what had happened about closures of the Brook general hospital and the Greenwich district hospital to all cold admissions because they were overwhelmed with emergencies. On nine occasions between 19 and 23 January 1985 and in February 1986 that has occurred at Brook general hospital. It has happened twice at the Greenwich district hospital within the same period. That meant that predominantly old people, particularly emergency cases, were filling beds and that other people had to be turned away. When there is difficulty in finding beds, there is usually a long delay before treatment can be given.

That picture is repeated all over the country, from Barnet to Birmingham. Certain specialties that are available to us all but that are of particular interest to old people frequently command little public attention, or they are not very fashionable in the medical profession. Consequently, they are not well provided for. Rheumatology is a good example. Twenty million people suffer from rheumatism. Some of them are young. many are middle aged, but even more are elderly. Yet about 30 health authorities or health boards in England, Scotland and Wales do not have a single, solitary consultant rheumatologist. Health authorities such as Warrington, Huddersfield, Dewsbury, Bolton, Bury, Milton Keynes and North Tyneside do not have a rheumatologist. Twice as many health authorities were described by the Arthritis and Rheumatism Council as being grossly deficient in their provision of specialist rheumatology services.

Recently the National Association of Health Authorities warned that the National Health Service faces a serious and growing shortage of occupational therapists and chiropodists who play a big part in helping, for example, stroke victims to recover and in helping to keep elderly people mobile. The NAHA report said that the demand for those services already outstrips supply and that we need 70 per cent. more occupational therapists and 30 per cent. more chiropodists to get us into the 1990s. The latter estimate is lower than the DHSS study, which said that 35 per cent. more chiropodists are needed.

There are other perturbing developments in the philosophy of the National Health Service under this Government. The measures of quality of life that have been canvassed in some quarters seem to carry with them the assumption that life after 65 does not have quite the importance of life before that age. That may be because health economists would like us to come into existence, fit and well, at 21 and to die suddenly on our 65th birthday without requiring medical treatment in between. That is the beau ideal human being for the health economist. Fortunately—I think that it is "fortunately"—humanity is not built like that. We are an awkward lot, and a lot of people get a bit more awkward as they grow older. People want to live for a long time and to receive proper health care both at home and in hospital. We want top quality health care from the cradle to the grave and we want that period to last a long time.

We owe that quality of service to the older generation. It is worth saying that the older generation to which I am referring is a rather special older generation. It is the generation that defeated Hitler. There are old men who once ran up the Normandy beaches, or fought in north Africa, or worked on the Burma railway. There are many, many more old women, some of whom lost their husbands at that time.

More than once I have been asked by the leader of our party to represent us at the Cenotaph ceremony for war widows. It struck me, as I stood there among women in their sixties and seventies, that the men they were remembering were not 60 or 70. They were strapping 20-year-olds or 25-year-olds—young men in the prime of their lives who sacrificed their lives for this country. Women, including those who were not widowed, made many sacrifices. They survived the blitz and they brought up the generation that, generally speaking, fills this Chamber and this country today. They are a special generation.

Those people are even more special, because when this country emerged from the darkest period in its history, absolutely flat broke, the self-same men and women had a vision. Their vision was that we should create a National Health Service that would provide the best health care available for everybody—rich or poor, man or woman, wherever they lived. The country was flat broke. Now that those self-same people are older, they are faced by a Government and, to some extent, by a news media who say that, although we are now one of the richest societies the world has ever known and producing more oil every day than Saudi Arabia, we must tighten our belts and must not expand the provision for these people who have done so much for our country. It would be a national disgrace if we failed to do our duty by not expanding the services that they need, deserve and have paid for.

The Opposition believe that very deeply. That is why we have put down this motion and why we are determined, both in this House and outside it, to struggle to ensure that the elderly in our society are looked after in the way that they expected to be looked after when they fought, struggled and secured the establishment of the National Health Service and in the way that we look forward to being looked after when it is our turn. That is only fair and decent, that is what we are in favour of, and that is why we have put down this motion.

7.37 pm

The Minister for Health (Mr. Tony Newton)

I beg to move, to leave out from "House" to the end of the Question and to add instead thereof: 'congratulates the Government on the steps it has taken to facilitate and prolong the health and independence of elderly people; welcomes its provision for the increasing proportion of elderly and very elderly people in the population; notes the substantial increase in health care of elderly people in hospitals and in the community; and applauds the Government's success in helping elderly people to improve their quality of life.'.

The one matter upon which, from what I have heard so far in this debate, we shall agree is that this is an important debate about one of the major challenges that is facing the National Health Service. It is three years since the House last had the opportunity to debate specifically health care and services for the elderly. That is surprising, perhaps, as we estimate that more than 40 per cent. of the present expenditure on the hospital and community health services relates to people who are aged over 65.

To echo something that the hon. Member for Holborn and St. Pancras (Mr. Dobson) said, or to give additional figures, between 1985 and 2025 the number of people over pensionable age in England and Wales is expected to grow by nearly 3 million. Within that total, the number of those aged 75 and over, who are obviously the most likely to be in need of services, will grow by about 1.6 million. There can be no doubt, therefore, about the importance of the subject that we were discussing, the importance of the services that the National Health Service provides for the elderly, and the growing demand that there will be for those services.

Beyond that, I have very little in common with the hon. Gentleman's rhetoric, with his facts and figures, or with his suggestions about the way in which the health services have been moving and developing. I want to spend a moment or two on the figures relating to the Health Service and to pick up not only what underlay what the hon. Member for Holborn and St. Pancras said, but also what the hon. Member for Oldham, West (Mr. Meacher) said more specifically in his speech earlier today—which I regret I was unable to be present to hear—and also in his statement that was reported in some of today's newspapers—which, almost equally, to my regret, I have been able to read. I will pick out only the most glaring errors.

First, so far as I can judge, the figures which he says relate to expenditure on the National Health Service do nothing of the kind. They are plainly wrong. They exclude entirely the hospital building programme, which is now running at nearly £1 billion a year, and the family practitioner services, which are running at nearly £5 billion a year and which are of particular importance to many elderly people. Both those elements, which the hon. Gentleman appears to have ignored in his statement, have increased by about 36 per cent. in real terms since 1978–79.

Secondly, in the table at the back of the statement which he issued yesterday he appears to have assumed that demographic trends, principally the self-same rise in the number of elderly people, have required an annual expenditure increase of 1 per cent. each year throughout the period just to stand still. That, too, is completely wrong. As the detailed figures provided to the Select Committee on Social Services last year showed, the demographic effect for most of the period in question was substantially less than 1 per cent. Those two errors alone mean that the hon. Gentleman's figures are not worth the paper on which they are written, so far as I can judge.

What is almost as bad as these basic errors is the thoroughly misleading way in which even these figures were presented. Again I shall take only the most significant points. First, they seem to take no account whatever of the improvements in efficiency which have taken place, often as a result of the Griffiths management reforms. Over the past three years that factor alone has meant some £400 million extra for patient care. In the current year about £150 million is expected to be released in that way. I emphasise that that is money being made available for patient care that would previously have gone in another direction.

Secondly, when the hon. Member for Oldham, West talks about the number of beds, he takes no account whatever of the changes in the pattern of care not only of the more efficient use that is being made of beds, but of the shift towards care in the community for many thousands of mentally handicapped and mentally ill people whom everyone agrees ought not to have been in hospital at all. I have made the point to him before that I find it little short of deplorable that, on my assessment, he includes in his figures for cuts in the provision of hospital beds the beds that have been removed because mentally handicapped children are not in long-stay hospitals for the mentally handicapped on the scale that they were before, which all of us have been seeking to bring to an end.

Perhaps the most glaring omission from what the hon. Gentleman has been saying is the absence of any reference to what went before. When he talked of the reduction in beds, why did he not tell us that the annual reduction was greater under Labour between 1974 and 1979 than it has been since this Government came to office? When he talked about waiting lists, why did he not tell us that the lists are 80,000 lower than those left behind by the Labour Government?

Dr. John Marek (Wrexham)

That is misleading and a misrepresentation.

Mr. Newton

The hon. Member for Wrexham (Dr. Marek) can make his speech later. It is a fact that the waiting lists are nearly 80,000 lower than when this Government came to office. Those lists were left behind by the hon. Gentleman's Administration.

When the hon. Member for Oldham, West purported to deplore that Britain spends what he claims is an inadequate 5.5 per cent. of GNP on health, why did he not tell us that when Labour left office that figure was only 4.8 per cent.? In other words, the proportion of GNP that is being spent on health has risen substantially under the present Administration.

The fact is that the way in which the hon. Gentleman is using health statistics is in danger of going beyond a joke to being a disgrace.

Mr. Michael Meacher (Oldham, West)

As the hon. Gentleman has chosen to use this debate to make a slanging attack on something that has obviously nettled him greatly, may I answer his points? First, the figures are all based on Government figures. They are hospital and community health services figures. If one were to take gross NHS revenue expenditure, I suspect that the difference would be minimal.

Secondly, the figures do riot include efficiency savings, as the Government call them, although I suspect that is a euphemism for cuts. Anyway, £150 million out of the £18 billion NHS budget means that that again is a footling qualification.

Thirdly, of course, we support the movement of mentally ill and mentally handicapped patients back into the community, but in the acute sector there has still been a cut of 10 or 11 per cent. That accounts for most of the 36,000 beds that have been cut since 1979. So none of what the hon. Gentleman has said alters the basic truth of the points that I was making on their record on the Health Service since 1983 in particular.

Mr. Newton

All I can say is that last night I read the hon. Gentleman's statement carefully. The table at the back, on which much of the rest of it is founded, with some wrong assumptions about demographic patterns which I shall not go into again, is clearly headed: Percentage change each year in total NHS expenditure. The hon. Gentleman has just said that it is not that; it is hospital and community health services expenditure. The difference between the two is billions, not just peanuts. Expenditure on the primary care services, which are of particular importance to many elderly people, has more than doubled in money terms in that period. It has risen by about one third in real terms and that has led to a sizeable expansion in the services themselves, on which I shall comment. I do not mind in a sense what the hon. Gentleman does with statistics so long as he uses them clearly, knows what he is talking about and presents a fair picture. I object to statistics which purport to be something which they are not, and which are calculated to mislead the public and to distort real debate about health issues.

There are two plain and simple facts about the totality of NHS expenditure. One is that total expenditure has risen by 26 per cent. in real terms between 1978–79 and 1986–87, and will rise again next year. The other is that within that total we are carrying through the biggest sustained drive to modernise the country's hospitals that has ever been seen, and that is now well on the way to undoing some of the damage done by the drastic cuts—real cuts, not statistical illusions—that were imposed by the Labour Government in 1977 and 1978. In one year alone the hospital building programme was cut by 22 per cent. when the Labour party was in office.

Mr. Dobson

Is it part of the drive to improve the efficiency of the National Health Service that the cardiothoracic theatres and wards at the Brook hospital in Greenwich closed at the beginning of this week because the health authority cannot afford to run them until the start of the new financial year?

Mr. Newton

The position in Greenwich, as in many other health authorities, is that the health authority is actively seeking ways of making sure that it uses its resources to the best effect. The hon. Gentleman implied in his speech that the regional health authority was attempting to get the district to close Brook hospital.

Mr. Dobson

I never said that.

Mr. Newton

It certainly came across to me as the implication of what the hon. Gentleman was saying. I want to make it clear that the district health authority is conducting a review of the acute services and that the outcome of that is far from clear.

The most important point about the Health Service is that, in the end, it is to be measured not by the amount of money it has or by the number of beds in its buildings, any more than by the number of doors or windows in its buildings, but by the people it treats, the care it provides and, as my right hon. Friend emphasised in his widely welcomed statement today, increasingly by what it does to prevent avoidable illness occurring in the first place. By that measure of patients treated and care provided, the NHS is by any standards not a service which is being cut, let alone a service in decline, but one of sustained expansion.

Between 1978 and 1985 in-patient cases rose by very nearly 1 million, or about 18 per cent. Day cases rose by 400,000, which represents an increase of over 70 per cent. Out-patient attendances were up by 3.5 million, or 10 per cent. The growth in 1985 alone was 176,000, or nearly 3 per cent., in in-patient cases, 60,000, or nearly 7 per cent. in day cases, and 398,000, or 1 per cent., in out-patient attendances. Those increases have been more than enough to match the growing number of elderly people and they represent a real improvement in services.

The hon. Member for Holborn and St. Pancras referred to staffing in hospitals and within the increasingly important community services. In both those areas there have been substantial increases. The number of district nurses in community health services has risen by 18 per cent. The number of hospital nurses caring for geriatric patients has risen by 22 per cent. The hon. Gentleman also mentioned chiropodists—and that staff has increased by nearly a quarter. The number of consultant geriatricians has increased by over a third. There is no pattern of decline.

I wish to give some figures for primary care services, which the hon. Gentleman appears to have entirely ignored, despite the fact that for most people their interface with the Health Service is the general practitioner rather than the local hospital. Compared with 1979 there are 3,500 more GPs, an increase of 15 per cent., 13,000 more support staff in general practice, an increase of nearly 40 per cent., and about 2,500 more dentists, an increase of 20 per cent. There are 1,500 more nurses, whole-time equivalents, specialising in mental illness, and that represents an increase of well over 100 per cent. I could go on.

This is a story not of decline but of expanding services in the areas of most importance to many elderly people. The next line of argument advanced by the Opposition may be to claim that those increases do not match the number of elderly or very elderly. Let me make it clear that between 1978 and 1984 the number of hospital treatments provided for people over 75 per 10,000 of that population has increased from 1,736 to 2,057. Thus, an increased amount of treatment is being provided for those in the very elderly age group. It is a question not of increased treatment being outmatched by the growing numbers of the elderly, but of a real improvement in services.

The fact that the hon. Gentleman persistently wished to disguise or run away from is that more elderly people than ever before are receiving hospital treatment. More elderly people are able to take advantage of the opportunities provided by modern medical technologies and skills to improve the quality of their lives. Whether or not we discuss quality adjusted life years—QUALYS—many of the things that we are discussing improve the quality of life for elderly people. That is why we want to see those services increased and have devoted our attention to achieving that objective.

Let me take two obvious examples that particularly benefit elderly people. The number of cataract operations rose from 38,000 in 1978 to 55,000 in 1984. We have set a target of 70,000 a year for 1990. Hip replacements rose from 28,000 a year in 1978 to 38,000 in 1984. We have set a target of 48,000 a year in 1990. [Interruption.] I do not know what the hon. Member for Wrexham is complaining about. Does he or does he not want an increase in those important operations for elderly people, to whom they make a great deal of difference?

Dr. Marek

I am grateful to the Minister for giving way. The hip replacement is a comparatively new operation, and of course such operations will increase. I do not mind giving credit for the fact that at least the Tory Government have not refused to allow such operations, but the waiting lists for those operations are getting longer. However, I object to the Government claiming credit for the advance in medical science and the maintenance of standards of service because of that advance.

Mr. Newton

No one is claiming credit for the advance in medical science. We claim credit for the fact that, far more than the Labour party, we have made it possible for elderly people to benefit from those advances. We have every intention of ensuring that elderly people continue to benefit.

So far I have concentrated on health services, especially hospital services, for elderly people. However, 95 per cent. of elderly people live at home and, like most of us, can expect to spend only short periods in hospital or, indeed, in any kind of institutional care. Most of them want—and we wish to help them in this respect—to be able to stay and be cared for in their homes. That involves a wide range of agencies, statutory, private, voluntary and informal. Undoubtedly, the key to success to ensure that that community care takes place is proper co-ordination between the agencies and the individuals involved. We have devoted considerable extra sums of mony to that in the form of joint finance and improved machinery in the form of joint planning. The changes in joint planning and the involvement of voluntary organisations in that planning have helped to create better co-ordination. There have been some significant and important effects.

Personal social services manifestly have an important role. Since the Government came to office, spending on personal social services has increased by over 20 per cent. in real terms. The key indicators of service provision have also increased. For instance, there are 14 per cent. more home help staff, and the number of places in day centres has increased by over 15 per cent.

I was puzzled by the reference to home helps made by the hon. Member for Holborn and St. Pancras, because today I answered a question tabled by the hon. Member for Oldham, West on the number of home helps expressed as whole-time equivalents per thousand population aged 65 years and over in the three years from 1982 to 1985. I use those three years because they were the ones that the hon. Gentleman asked about.

I thought I heard the hon. Member for Holborn and St. Pancras refer to Greenwich. In the period 1982 to 1985 the number of home helps per thousand population aged 65 years and over in Greenwich has risen from about 11.5 per cent. to more than 13 per cent. If one considers England as a whole during those three years—the figure not only represents the total number of home helps, but that figure expressed per thousand of the population aged 65 years and over—there has been an average increase from 6.7 per cent. to 7.2 per cent. Where are the cuts? Where is the great story about the dimunition in the provision of important services? Wherever one looks one finds that the picture painted by the hon. Member for Holborn and St. Pancras does not stand up to reality in virtually every part of the country.

Mr. Dobson

Does the Minister recognise that if it was not for the very councils that he, his party and especially the chairman of the party constantly denounce for wasting money and providing services there would not be a jot of increase in services? If, in London, we had to rely on services provided by Sutton, Bexley, Redbridge, Barnet or Bromley, there would be no increase in services.

Mr. Newton

Perhaps I may say gently to the hon. Gentleman that I am not sure that I have been denouncing the London borough of Camden, to which he is so dedicated, for wasting money. I rather thought it was denounced by an independent report that the council had commissioned.

Mr. Dobson

Following the courageous decision of the Camden council to set up an independent inquiry and to publish it immediately it was received—unlike virtually any document that the Government receive—will the Minister confirm that the independent report said: The Department (DHSS) has statutory inspectorial duties and the periods between inspections seem to be of an unacceptable duration. The report continued: Some of the issues raised in this report would have been identified and possibly dealt with earlier had the Department exercised its statutory duty.

Mr. Newton

If it is the hon. Gentleman's view that the London borough of Camden can only be expected to run its services in a remotely acceptable way with the social services inspectorate permanently breathing down its neck, he may be right, but I would regard that as a proud claim on behalf of Camden.

This is an important, short debate, in which a number of hon. Members wish to take part. We have been discussing one of the great challenges that face not just the NHS but the whole community. It undoubtedly presents problems. Of course, there is a need for continued development of policies to overcome those problems and to meet needs still more effectively. In a variety of ways that is precisely what we are seeking to do. They include, not least, the review that my right hon. Friend the Secretary of State has asked Sir Roy Griffiths to undertake on the ways in which public funds are used to support community care.

No one who studies the facts of the expansion of services for the elderly that the Government have brought about can vote for the motion tonight. No one who studies the Opposition's mixture of bogus statistics and half-baked promises would vote for them at any other time either.

7.59 pm

Mr. Simon Hughes (Southwark and Bermondsey)

Quite rightly, I must address myself to the statement just made by the Minister. I must consider what I should recommend my colleagues to vote for. I looked carefully at the motion and the amendment when they were made available.

The fallacy of the Government's amendment is that although, for example, more money has been spent in the Health Service on the elderly, although there has been new provision, although new initiatives have been taken, and although there has been greater throughput, to use the clinical word, these have not taken into account the relatively enormous and growing proportion of the demand on our Health Service and on our other services which is caused by the increasing number of elderly people in our community.

I remind the Minister of what her right hon. Friend the Member for Braintree (Mr. Newton) said in 1983 when he was wearing his other departmental hat: central Government concluded last year that a minimum expenditure growth of 2 per cent. was needed to maintain existing standards of service in the face of growing numbers of the very elderly and other increasing pressures."—[Official Report, 15 February 983; Vol. 37, c. 135.]

When I look at the issue in the round, I allege that the failure of which the Government have been guilty since 1983 is in having committed themselves only to the minimum real growth in expenditure that is their responsibility in managing the public purse and that is needed to maintain the standard of health care provision for the elderly. It is the Government's greatest failure that the figure that they set and defined for themselves as being necessary has not been fulfilled in reality.

There has been a bit of double talk since then because the Government have since argued that a 2 per cent. growth in services is necessary, not a 2 per cent. real growth in expenditure. The Minister will know that that 2 per cent. growth in services requires slightly less real growth in expenditure because one can make efficiency cuts, and so on. I think that we are on common ground in that.

The argument should not be—I would never make it—that simply putting money into a service necessarily improves it. That is always fallacious. None the less, the substantial deficit in funding, which is the burden of the Labour party's motion, has prevented the sufficient development of the care services, which I hope everybody in the House will admit we need. I should like to develop some of the relevant points.

I shall start with one or two statements of principle that people do not always bear in mind, in relation to the elderly. We are talking in general about health care services for people over 60. It is easy to conclude, and for the public perception to be, that old age in itself is a disease, brings problems and requires expenditure, but it is not true that just because somebody is old he or she need be ill. That does not necessarily follow. Indeed, Lord Shinwell was perfectly well until within a few days of his death, to take a topical example from this building. Old age is a triumph, not a problem. The objective of the state's services should be to enable people in their old age to make as much of their opportunities as they can. Often, people have not had many opportunities for several years before by virtue of their working life, family responsibilities and so on. It is an insult to presume that old people are ill people, because many old people are not ill. Clearly, they become more frail as they grow older, but they do not necessarily become ill.

It must be admitted that as people get older the relative cost to the Exchequer of their illnesses grows. The most recent figures that I have are for 1983–84. National Health Service expenditure in England per head for the 16 to 64 age group, which is not covered by the debate, was £150, whereas expenditure for people over 75 was over £1,000. Rightly, we shall have to face the fact that the demand for expenditure on the elderly will increase enormously.

Over the 20-year period beginning at the end of the last year, the population aged over 75 will increase by 10 per cent. from 3.7 million to 4.1 million. The population over 85 will increase by a staggering 54 per cent., from 700,000 to 1.1 million. We must make sure that we plan the commitment to meet the inevitable bills that will accrue to the Health Service and the inevitable demands that will be made on our personal social services, given the size of this growing part of our population.

I should like to consider another general presumption. In this debate we need not go into every corner of the issue. It is often a failure of our health and social services that elderly people are incorrectly diagnosed as being mentally ill. The Minister may have seen the example in New Society on 12 December last year of an elderly man being diagnosed as having dementia when he had a severe heart problem, which was confirmed when he was admitted to hospital.

The Parliamentary Under-Secretary for Health and Social Security (Mrs. Edwina Currie)

indicated assent.

Mr. Hughes

I see the hon. Lady accepting that.

Often there is a presumption that old people have certain types of condition. The presumption is based on something of which we lay people may be guilty, but of which the medical profession never should. It is an ageist approach, based on the presumption that elderly people are more likely to suffer from such conditions. As everybody in the House will know, the vast majority of elderly people do not suffer from dementia in any way. Under 5 per cent. of people over 65 have a severe impairment of memory, intellect, orientation or personality. About another 3 to 5 per cent. have milder forms of dementia. Although dementia in its general definition is a problem of advancing age, 80 per cent. of those over 80 have no form of it.

Often old people suffer from an incorrect perception of their need. Of course, 20 per cent. of elderly people suffer from some form of mental disability or dementia, which is a tragic condition. Alzheimer's disease is the most common. I challenge the frequent automatic assumption that the elderly in our community are a general problem for the Health Service, or a specific type of problem, that they are incapable of managing themselves as human beings.

Mr. Laurie Pavitt (Brent, South)

Will the hon. Gentleman make this plain when he talks about senile dementia? Unfortunately, most of the public think that the clinical term "dementia" has something to do with people being demented. It means nothing of the sort. It means merely a loss of memory in various degrees.

Mr. Hughes

I am grateful to the hon. Gentleman. He is absolutely right. That is another example of a conclusion drawn from a false analysis. Clinicians will define that condition, but it might not be as grave or problematical as the common assumption would have it. I entirely accept the hon. Gentleman's point.

Another issue is as much to do with social services as with the Health Service. As people get older, they suffer physical disability. For example, one third of those over 85 cannot get upstairs. About one fifth are bedridden or housebound. Social and welfare provision must respond to those facts in the way in which the community cares.

The Secretary of State made an announcement today, which I welcomed, on cancer and on AIDS, all of which are, to a substantial degree, preventable illnesses and diseases. Many of the illnesses from which old people suffer are preventable. Tragically, many old people die from diseases that we could do something about.

The preventative arm of the Health Service is as applicable to the elderly as it is to much younger people. We must work to avoid the problems of heart disease, cancer, strokes, bronchitis, diabetes and incontinence. Those illnesses can, in different ways, be treated early and cured. A topical example, which occurred this winter, is hypothermia. If we manage our communities properly there is no need to have nearly so many deaths from hypothermia, as I am sure the Minister will accept. Our European neighbours in colder countries do not have as many deaths from hypothermia. The problem of hypothermia cannot be solved at a stroke; it is not just a matter of health and social service provision but of homes insulation, educating people to look after themselves, and giving them the proper provision. A proper approach to preventive medicine, health care, and health education will reduce the burden on the Health Service.

Another area of common agreement is that we must all try to make a reality of the commitment of Government and Opposition parties to community care wherever possible. I shall take a topical example, which applies to the acute services as well as to properly defined community care services. The local small cottage hospital in my constituency, St. Olave's hospital, was recently closed, as the Minister knows. The closure meant not just a loss of beds from a local hospital, but the loss of the feeling that people were being treated in their community, even though they were in a hospital bed. They went to a large regional hospital where they felt more isolated. There must of course be acute services for the acutely ill, and we do not want to keep people unnecessarily in beds in hospitals for the acutely ill. The strategy must be to plan for, and meet the demand with, care in the community services.

One criticism which applies equally to my health authority of Lewisham and north Southwark, and to Camberwell—for which I am in part responsible—is that the strategy is not yet being matched by the provision of service. Everybody has agreed that we should have care in the community, for example, by removing the mentally ill from residential care in horrendous Victorian long-stay institutions, but we do not yet have the facilities to cope with them at home. Without the commitment to that, which needs to be planned, care in the community is, to many people, still a mirage and not a reality.

One of the beliefs that I stand for, and to which I commit myself and my colleagues—it is not a cheap option—is properly funded care in the community. It has three elements in terms of professional support for the elderly. First, we must have the doctor in the community. There is still a weakness in proper GP provision, particularly in the inner cities, where the elderly are often concentrated. I hope the Government will seriously consider—they have taken up many of the recommendations made by Age Concern and others over the years—building up training and the appropriate level of service capability for GPs and staff in health clinics and centres so that they will be able to deal in the community with many of the problems and needs of the elderly.

The second matter, on which we have had a lobby today, relates to the nursing profession. The Cumberlege report and the general pattern of recommendations from the Royal College of Nursing and others is that we should train people for a new nursing profession—not the old bedside Florence Nightingale nursing, but a much more adaptable community nursing provision. That gives enormous potential and enormous possibilities for people to be looked after and visited at home. I wrote to the Minister about nurses being able to prescribe at a day centre in my constituency. She replied that a pilot scheme was being looked at. I hope that we can progress quickly down that road—although we must have safeguards—so that health care practitioners, at the appropriate level, can administer that health care in the community. There is every opportunity to secure that as each health authority develops its strategy.

One of the encouraging signs is that we have been able to agree to develop in Lewisham and north Southwark a combination of facilities. One is for respite care on the health authority site at St. Olave's hospital where elderly people who are cared for by relatives day after day can go so as to give their relatives a week or two off. The other facility is a small domus-type institution where small numbers of people can form their own communities. These are much more personal than the old geriatric or psycho-geriatric wards in big and impersonal hospitals. There is a problem in delivering enough of those services quickly. Those sorts of things show where the will is and whether the service can be delivered.

The third group is the people who are not trained at all, or who are not trained professionally as doctors or nurses. I sincerely ask the Government urgently to think about requiring a payment of, and validation for, carers who are not doctors or nurses. We need the home helps, the visitors, the people to provide laundry services for the elderly. We need them all, and many are willing to work in the caring service. Relatives, neighbours, friends, part-time and full-time, a small number of hours a week or many, youngsters and older people, all are willing to be the complimentary, substantial band of practising supporters of the elderly. In that way we can keep our elderly in the community, and they can feel reassured. I hope that the Government will develop that area.

I hope that the Government will respond positively to the requirements on general practitioners. I hope that they will respond positively to developing community nursing services and to the RCN paper at the end of the consultation period. I hope that carers can see that the Government will be committed to them and to funding them, so that we will be able to maximise that third group of people in support of and to help the elderly.

Mr. Newton

I hope that the hon. Gentleman will recognise that almost every one of the thoughts that he has uttered in the last five minutes are thoughts that have been actively raised by the Government in the course of the primary care consultation, our own Green Paper and the Cumberlege report, and by the positive response in the direction of consultation that we have already shown to Project 2000 and by work which I am sure he knows is going on in the Department about support assistance for nurses. I can tell him, as he already knows, that we have been acting positively in the ways that he mentioned.

Mr. Hughes

I want to end on something that has a slightly harder edge than that. The most acute problem is that, as yet, there is not proper co-ordination of the services that try to fulfil. Health Service requirements. For example, in my local health authority there are still massive waiting lists. The figures have gone up 260 per cent. since 1983. On 31 March 1986 more than 8,000 people were waiting. That applies not just to old people, but to all people. The other day an elderly man presented himself at a hospital for a bed, was told that there was not one and he went away. He returned, was accepted, and anaesthetised and then was told that he could not be dealt with. He had to be sent home and to return. The lack of co-ordination that allows priority care cases to be accepted, but fails to make sure that when people need to be admitted they are, and the then failure to co-ordinate with the social services so that when people are discharged they are discharged into a community that can care for them seems to be the greatest gap.

I hope that a real effort will be made to co-ordinate social service provision and Health Service provision through joint consultative committees and the like, so that there can be a strong combined effort that does not allow many old people to fall through the gap of our national welfare care. Old people often do not shout the loudest. The test of a caring welfare state is that we heed and serve most those who are the most vulnerable.

Several Hon. Members

rose—

Mr. Deputy Speaker (Sir Paul Dean)

Order. This is a very short debate, and many hon. Members wish to speak. I appeal for short speeches.

8.20 pm

Mr. Lewis Stevens (Nuneaton)

I was interested in many of the points made by the hon. Member for Southwark and Bermondsey (Mr. Hughes) and I congratulate him on making them in such a reasonable way. I am sure that many of us would agree with what he said. It seemed that he was saying that the Government were moving in the right direction but should try harder and do better. Many of us feel that that is the way in which we have to approach the matter. Demographic changes have brought about a growing problem. We have coped to some extent with the recent changes, but we shall have to continue further along the path, in view of the large number of elderly people and the problems that will be created, particularly at the turn of the century.

My hon. Friend the Minister quoted an important figure which shows how much the Government have paid attention to the National Health Service. The NHS's share of gross national product has risen from 4.8 per cent. to 5.5 per cent. That is a 12 per cent. increase in NHS provision.

Dr. Marek

Has that got anything to do with gross domestic product being a lot smaller than it need be because of the Government's economic policies?

Mr. Stevens

There is a net growth in the economy and a growing share is going to the NHS.

With the new buildings in the Health Service and a change in facilities, there has been a definite improvement. I am sorry that the hon. Member for Holborn and St. Pancras (Mr. Dobson) was so emotive, talking about what people have a right to expect and what the elderly have done for the country. We accept what they have done, but many of the elderly would also accept that the developments in the Health Service, not just through Government but through discoveries, are a considerable improvement on what they might have expected 30 years ago.

I am extremely surprised that the Opposition should dismiss, as they so often do, the need for efficiency improvements. The hon. Member for Southwark and Bermondsey rightly said that there is scope for such improvements. In an organisation with as many as 800,000 employees, and with £20 billion expenditure, efficiency must be an important factor. That leads not to the detriment of service, but to a great improvement. The West Midlands regional health authority has made cost improvements. The three main areas of the four into which it intends to put those savings are care for the mentally ill, for the mentally handicapped and for the elderly.

The problems of the elderly do not all occur in hospitals. They are not all ill or in difficulties. In the private and the public sectors, there is a wide range of residential accommodation, ranging from that with virtually no medical attention to that with much medical attention. While I do not doubt that some establishments are of a low standard, I am sure that there are many, some of them newly opened, of a high standard.

In my constituency, a nursing home has been set up to care mainly for the elderly but also for others with medical problems. I am proud to see its standard, the care and attention that it gives, and the availability of medical attention 24 hours a day, with a qualified nurse on duty and easy access to doctors. However, other nursing homes and homes for the elderly start off merely with better accommodation such as sheltered accommodation. All of this is helping elderly people into more acceptable and usable establishments and homes in which they can enjoy the company of others. We shall see more of these developments. We should be encouraging them rather than condemning them, as Opposition Members do. They can make an important contribution to the welfare of the elderly.

The hospital building programme has led to the removal of many old hospitals and old facilities which were never a joy for old people to go into, irrespective of whether they had permanent bad health or were ill for a short time. Some old hospitals were not of the sort in which we would want to see our elderly relatives.

Now, new hospitals are being built and old hospitals are being extended or rebuilt, as in my area with the George Eliot hospital. That improvement was long overdue, but it is at last happening, and we are seeing the benefit. While there are not the number of beds for geriatrics and the mentally infirm that we would like, there is accommodation of a better standard. They are getting better attention. As my hon. Friend the Minister said, the number of operations that relate to elderly people, such as cataracts and replacement hips, is being extended considerably. That is important for not only the physical well-being but the mental outlook of old people. They can expect these operations and improvements in a more reasonable time, which is extremely encouraging.

The hon. Member for Southwark and Bermondsey spoke about community care for people coming out of mental institutions. A great deal of attention must be paid to training and co-ordination. Without that, we shall not get benefits for the people involved. Co-ordination is a vital factor, and within the NHS one of the major reasons for new management thinking was to get this right. Coordination is still the problem within some parts of our Health Service, and if general managers have any part to play, it is better co-ordination.

We have not had community care for long. We have had district nurses and other services coming in, but there has not been a co-ordinated effort, on a professional basis, with many different parts of the medical and social services professions. I hope that that will prove a major part of our development. As my hon. Friend the Minister said, the Government have provided extensions in both district nurse and special nurse care for geriatrics and in many other sectors. The Department has been going along gently, perhaps not fast enough, but it is going in the right direction and facilities and resources are being provided.

The Government's record stands comparison with any predictions that might have been made a few years ago that such things could not happen. We are taking steps to make sure that resources are provided to help the elderly. How fast is that being done? People always ask for it to be done faster, and it would be amazing if the Opposition did not say that it should be done twice as fast. Had they been in government, I doubt whether they would have been prepared to advance the Health Service as fast and as effectively as this Government have done.

8.30 pm

Mrs. Renee Short (Wolverhampton, North-East)

There is a rather poor showing of hon. Members in the House. I should have thought that many elderly hon. Members would have been happy to be here to get a few tips. However, they are absent and the youthful hon. Members are here.

After the Green Paper was published the Select Committee on Social Services looked at primary care. Its report dealt with many of the problems relevant to the care of the elderly. In our report we drew attention to the greater use of primary care by the increasing numbers of elderly people in the community and to the growth in private residential homes financed virtually from the social security budget.

The health needs of the elderly are clearly linked to the social services—for example, to housing, social security, home helps and community nursing. All these things are important, and we put more and more burdens on community care not only by changes in population and the fact that people are living longer, but by reducing hospital care. People are moved out of hospital more quickly and look to the social services to help them at home. That inevitably means that we need more general practitioners and a significant sharing of care by nurses and others and much more education about prevention and about self-care by patients.

Health education is crucial for the whole population but especially for older people, and perhaps the Minister will tell us what is going on at present in the Health Education Council which seems to be lying dormant because of all sorts of problems, The consultation paper contains proposals for making more suitable premises available in inner cities, for new financial initiatives to encourage doctors and nurses and perhaps some salaried general practitioners to work in inner cities, and perhaps different rates of pay to encourage other health workers to work in inner cities. All those ideas which were endorsed by the Select Committee were put forward five years ago in 1981 in the Acheson report. I wonder why Ministers are not giving a clear reply now and undertaking to take steps to improve the availability and quality of health care generally and in inner cities.

We need many more properly trained nurses and nurse practitioners working with general practitioners to improve the service for elderly patients, especially the housebound elderly. There is movement in the right direction. I recommend the Minister to study our report about the Birchfield medical centre in Birmingham. It offers comprehensive health screening to elderly patients registered with the practice, runs a patient liaison group which is good for getting patients together in the practice to discuss common health problems, and produces first rate leaflets on patient care for patients to collect when they go to the surgery.

Some hon. Members have spoken about the Government's policy on discharging patients from mental hospitals. Many of those patients are very elderly and many have spent the major part of their lives in an institution. if the Government policy is to work, many more professional workers, including social workers, will be needed to work in the community. Local authorities are being asked to do very much more about providing housing for patients who are discharged, providing community centres and workshops and providing all the other things which the Select Committee said in its report on community care for the mentally ill and handicapped we could not do on the cheap. We need the resources and the will to do those things and money has to be provided to help those who want to do them. Money must be found if that policy is to succeed, and there is great anxiety throughout Britain that the Government are not providing adequate resources to carry out their policy.

At every conference that I address, especially conferences on this crucial matter, I am told of great concern especially about long-stay patients. I hope that the Minister will respond to that. The problems faced by elderly people are important to them and to their families. I hope that the Minister will tell us exactly which of the proposals in the Government's Green Paper and the recommendations made on them by the Select Committee will be provided with the resources to enable them to be carried out. I hope we will be told that the Department has the will to do those things.

8.36 pm

Mr. David Evennett (Erith and Crayford)

In my constituency, as in the whole of Britain, there is an increasing number of elderly folk. Over the last few years I have been privileged to meet a great number of pensioners in my constituency. I have met them in their homes, in local authority homes and in hospitals. I have talked at great length with them, listened to their comments and wishes, heard their concerns and listened with interest to their expressions of gratitude for the many facilities provided today which were not provided in the past, especially the increasing provision of facilities.

It must not be forgotten—and I am sure that the Minister has not forgotten—that we are providing many more facilities than ever before for the elderly and that they are grateful. As president of the League of Friends of Homeleigh, an old people's home in Erith in my constituency to which I am a regular visitor, I am extremely impressed by the facilities provided by Bexley local authority and by the quality of the care provided. Too often in this House and outside we criticise and too rarely do we praise, yet the increased provision at that home and at others, like Meyer house and Wolsey house, which are also in my constituency, is a matter for congratulation. The local social services staff are to be complimented for the excellent job that they do in a changing world.

The care of the elderly concerns us all, and, as my hon. Friend the Minister said, it is a challenge for the nation and a challenge for tomorrow. I am always disappointed to hear the Opposition voice criticisms and display manufactured hysteria about the facilities for the elderly. I would rather discuss this matter in a constructive way and try to go forward rather than make party political points. I was impressed by the constructive speech of the hon. Member for Southwark and Bermondsey (Mr. Hughes) who spoke about south London, which I know very well.

As the years pass and medical science advances, this problem grows. Many hon. Members have spoken about that. Many pensioners in my constituency are fed up with being lectured or talked down to by politicians. That is because they value their independence, but, like other people, they are also realistic and appreciate the economic situation. They want to advance the services provided by the Health Service and local social services. We do them no credit or justice if we do not accept that they appreciate those things and realise that there are financial constraints. Within those constraints they want an efficient service. The Government have shown that they are determined not only to increase resources, but to increase efficiency in the provision of services. That is vital.

Pensioners are grateful to the Government for controlling inflation not only because of their own fixed income—as we heard in the previous debate, they are the section of the community that will be hardest hit by inflation—but because with. inflation they see the destruction of services. They saw that in the 1970s, as a result of inflation and economic mismanagement. Therefore, they are well aware of how important it is to maintain low inflation and get real value for money in the services provided.

I agree with my hon. Friend the Member for Nuneaton (Mr. Stevens) that when one looks at the record, we could always do better. We would like to see more money provided. The hon. Member for Southwark and Bermondsey mentioned community care provision. We would all like to see more community care provision. However, we are aware of the increases that have taken place under this Government. The total Health Service budget increased from £7.75 billion in 1978–79 to £18.9 billion in 1986–87. That is a real achievement. When one realises that over 40 per cent. of that is spent on caring for the elderly, it shows the Government's concern to ensure that the elderly are well provided for in the Health Service.

With a progressively aging population there is inevitably an increasing demand for services. There are 1 million more pensioners today than in 1978, so we face a daunting task. I listened with interest to my hon. Friend the Minister when he mentioned the percentage increase in Health Service personnel dealing with elderly people. He mentioned district nurses. There has been a 34 per cent. increase in consultant geriatricians since 1979. That is a real achievement and one of which we can be proud. Of course, it is not enough. We need more, and hopefully we shall see more.

The other issue regularly raised with me in my surgery and in my meetings with pensioners is the waiting list problem for particular operations. We all know that the length of waiting lists in the Health Service was not good in the past, but we have seen a considerable break-through in reducing the length of waiting lists. In the south-east region, in which my constituency is situated, the waiting lists have not been reduced enough. I look forward to the visit of my hon. Friend the Minister for Health to my constituency and to Bexley health authority next month when we will put our case to him for increasing resources for our area to reduce waiting lists. However, the number of operations taking place, especially for elderly people who are often in considerable discomfort and need hip replacements and so on, has been increasing. The number of hip replacement operations increased from 28,000 in 1978 to 38,000 in 1984, and the target we are projecting is 48,000 in 1990. Those are real achievements and we should be grateful. However, that is not enough. Of course, we would like more, and I am sure that when my hon. Friend the Under-Secretary of State replies she will take note of the points that have been made and will seek to improve the situation further.

Although we would like to see more money spent, Conservative Members must say to Ministers that it must be spent efficiently and effectively and it must be spread fairly across the country. We have had many debates in the House on funding for the Health Service in the south-east region and the London region because we often feel that London has been somewhat neglected under the RAWP reallocation. However, we were grateful for the Secretary of State's comments last week on additional funding for the Thames region. We must year in mind that in some areas of the country the number of elderly is increasing more rapidly than in others. I hope that the increasing number of elderly in certain regions will be taken into account when the allocation of resources is determined.

The Government's record is creditable to date and we are grateful for the advances that have been made in provisions for the elderly. However, there is much more to do, and all we can say is, "Keep going, but perhaps a little faster."

8.45 pm

Mr. Lewis Carter-Jones (Eccles)

I should declare an interest at the outset because I am an old-age pensioner and, therefore, one could say that is an example of enlightened self-interest. I am pleased to say that I am enjoying good health.

I would like to strike an optimistic note. I would like the Minister to answer the three issues I am going to raise. I want to talk about a continuing interest I have had over 20 years in the House—the whole concept of rehabilitation for disabled and elderly people. I want to spend time on the problem of incontinence because of the size of that problem and a couple of minutes on the possible treatment of Alzheimer's disease.

I am trying to keep as up to date as I can and I want to refer to the report of the Royal College of Physicians which it published in July 1986 entitled "Physical Disability in 1986 and Beyond". In many ways it summarised my feelings within that area. Frequently elderly or disabled people suffer despondency and despair because they feel they cannot cope with life. My own feeling is that the proper and wise application of rehabilitation techniques to those people can give them the independence that they so worthily need. That can be provided at a relatively low cost.

The three issues that I want to discuss today are related to my philosophy with regard to health care: that if it is technically possible—I say this over and over again—economically sound and morally right, it ought to be implemented. I suggest that in areas where it is possible to establish sound concepts of rehabilitation, it would be a worthwhile economic procedure for the Government to follow.

The Minister is an old friend of mine and he knows that I have ridden that hobby horse for a long time. I plead with him to apply greater resources to rehabilitation in general terms and specifically to the care of the frail elderly. At the end of the day, the experience we possess in rehabilitation medicine is such that we can provide a much better quality of life to our elderly folk. It means collaboration between physiotherapists, geriatric consultants, nursing staff trained in that area and a whole range of paramedical professions. They can provide a quality of life which we at one time thought had gone from certain people. I must pay tribute to the good work being done within my own constituency at Ladywell hospital and the Hope hospital. The Minister will realise that I shall come back to that subject on a personal basis at a later stage.

I shall now deal with a subject that is almost taboo in the House—the question of bowels and bladders. Some people seem to assume that human beings go around at certain times without bowels and bladders. However, we should get it quite clear: there are 2.5 million people in Britain who suffer from incontinence. Those are figures not from my imagination, but figures that the Minister gave me recently. What is worrying is the fact that we accept incontinence as a way of life. The Under-Secretary of State who will be replying to the debate knows full well that it is the female of the species who accepts incontinence without taking action about it. That is very sad. The assumption is that one has had a couple of kids and all one needs to do is to pad up because there is nothing one can do about it. That is the most tragic misunderstanding that takes place in medicine. I ask the Under-Secretary of State to look carefully at expanding the uro-dynamic clinics for the incontinent, because I have had some startling information from the Minister. According to our national records, for the 200 health districts in Great Britain and Northern Ireland there are only 134 nurses with responsibility for and interest in incontinence. Therefore, not all districts are covered. There are only two in Scotland, both of whom are based in Edinburgh, and in Northern Ireland there are no facilities for this sort of advice.

First, there should be an assessment of the needs of a patient suffering from incontinence. Often that leads to dramatic improvements. We should not write people off as being incontinent for the rest of their life. I have personal knowledge of the work done in the Maelor hospital, Wrexham. Incontinence can be reversed medically and surgically, and we should say that loud and clear to prevent the 2.5 million people and their families from having to suffer the indignity of this complaint.

If incontinence cannot he cured by medical or surgical means, the problem can often be managed successfully by exercise. That can overcome what is known as stress incontinence. I am trying to take an optimistic approach to this issue. We tend to start at the end by saying, "Oh, it's pads." Pads should be the last in a long line of careful analysis. Again, the Minister will find that this does not involve great cost. Indeed, bed occupancy would decrease if the symptom were treated properly.

Following the substantial number of parliamentary questions that I asked on this subject, I received a letter from a nurse in Blackpool who looks after incontinent people. Throughout the country we would like to have walk-in incontinent clinics so that men or women can walk in, state their problems with this often taboo subject, and have them analysed and assessed there and then. In that way their suffering can be discontinued. The nurse's letter reads: The incontinent client is, in many ways, a social outcast; alone in their suffering and one who incurs much needless expense. I feel it is time the problem was considered at Government level so that guidelines may be given to professionals and carers in the promotion of continence … It can be prevented, it is often curable and it can be managed. The work done by the Disabled Living Foundation is remarkable, and I pay tribute to the fact that the Department supports it. However, I am worried that faecal impaction is often treated by somebody who is untrained. Despite the optimistic reply I received from the Minister, I have reason to believe that it is treated more frequently by untrained people than the Department is aware of. This is an extremely sensitive issue. All too often people, particularly elderly people, are put into a psychiatric ward because of the misunderstanding and confusion that the condition creates in their mind. People like Dorothy Mandelstam, who works at DLF, would state that there was evidence of that.

I shall end shortly because other hon. Members wish to speak. I should like to refer to a matter which I must approach delicately— Alzheimer's disease, or senile dementia. All too often people assume that it is incurable and nothing further can be clone. Nobody ever wants to raise false hopes, and the Minister knows full well that I tend to receive information from all sorts of sources because all sorts of people trust me. This subject is particularly difficult to advance on the Floor of the House because it is not yet generally accepted that the condition can be contained.

Will the Minister look carefully at the experimental work being done with success on tetrahydroaminoacridine substances which help in this disease? Sometimes middle-aged but most frequently older people suffer from this dreadful disease. Some 500,000 people are involved, and their carers and families also suffer. I do not wish to raise false hopes, but in reply I hope that the Minister will say that she will look carefully at the work being done in this area by Nottingham and the Guy's Maudsley unit.

8.55 pm

Mr. Peter Bruinvels (Leicester, East)

As the youngest hon. Member taking part in the debate, I am particularly pleased to follow one of the best experts on the disabled and the elderly, the hon. Member for Eccles (Mr. Carter-Jones). I know that he has championed many causes and I have learnt something just listening to him.

I wish to talk about two important matters: residential care for the elderly, and a local problem in a hospital in Leicester. However, I must begin by congratulating the Government on the additional £25 million to help cut hospital waiting lists and by thanking the Minister for the £2³4 million given to Trent. That will help the elderly and reduce some of the long waiting lists, to which my hon. Friend the Member for Erith and Crayford (Mr. Evennett) alluded.

The Daily Telegraph, not The Sun, of Wednesday 18 February reported rather frighteningly that a Labour Government would axe help for the old in nursing homes. I appreciate that there is anxiety about the way in which some of these homes are run, but it is particularly important to allow our elderly to have the best possible facilities first at home and then, when it is too much of a strain for the rest of the family or for carers to look after them, in a residential care home or registered nursing home where they can be given independence and respect.

The hon. Member for Holborn and St. Pancras (Mr. Dobson) spoke about a numbers game and said that the number of registered nursing homes was reducing. I shall prove that their number has increased. On 31 December 1984 there were 1,491 registered homes. In 1983, there were 1,316. Obviously there has been quite an increase.

I have a lot of respect for residential care homes. The majority of the people who run them do an excellent job. But in 1984 there were 4,090 residential care homes with 55,168 residents; in 1985 there were 5,200 homes with 69,000 residents; and in 1986 there were 6,303 homes with 80,000 residents—a tremendous increase. Much of that increase is to be welcomed because obviously not all elderly people can be cared for in their own homes and many have to turn to residential care.

I should like the fees for residential care homes to be better controlled. My hon. Friend the Minister is aware of my feelings on this matter. Those people who are unable to cope on their own must either be looked after in a local authority home or the local authority sponsors them in private or voluntary homes. It appears that the Labour party plans to take away the finance for that. Labour Members must appreciate that there are many hard-up elderly people, although not a huge number, who need the best possible care. Homes are available for them and, whether they are local authority homes or private or voluntary homes, Labour Members must ensure that those facilities are allowed to continue.

Dr. Marek

Will the hon. Gentleman give way?

Mr. Bruinvels

I would rather not give way because time is short.

The availability of generous supplementary benefit board and lodging rates has ensured that many people who otherwise might not have been able to take advantage of private sector care can use those facilities. That system should continue. We must consider the wide choice of private residential care homes and the type of care available. I should like each residential care home to publish its charges, the number of staff on duty and whether staff are totally professional in the sense that they are fully qualified. There should never be a residential care home that is not registered. Some such homes are not registered at the moment because they have fewer than four beds. I believe that residential care homes with just one bed should register. I hope that my hon. Friend the Minister will consider that important point further.

Public money is offered to these homes and the Government are especially careful to target it in the right way to ensure that it is spent on the best, most suitable form of care for the people who need it. A working party, comprising Government officials and local authorities, is examining ways of using these funds rationally.

The hon. Member for Holborn and St. Pancras (Mr. Dobson) said that the elderly were living longer, and that is true. Obviously it is good news. It must be because of the atmosphere, their determination to survive and the general way of life. About 50 per cent. of the care needs of the elderly are catered for by the private sector at about 50 per cent. of the cost incurred by the public sector. That means that about 35 per cent. of people in private care pay their own way, although they have contributed to the state system throughout their working lives. Residential care homes offer a homely care facility and are nothing like the Victorian and Edwardian institutions at the turn of the century.

A confederation has been set up to represent the interests of the large number of privately owned registered residential homes. It is self-monitoring the bad residential homes. The hon. Member for Holborn and St. Pancras talked about a number of them being bad, but I do not agree. There are a few bad apples—obviously we must weed them out—but the rest have done extremely well. I should like minimum standards to be guaranteed in every residential care home. The Registered Homes Act 1984 must ensure that that happens. Facilities and services must be provided— for example, lifts, fire exits, proper directions and proper food, which in some homes has not been up to reasonable nutritional standards.

The regulations lay down the bed square footage which should be provided and standards are always being updated. The Registered Homes Act 1984 has given district health authorities the right to inspect premises regularly. The Registered Nursing Home Association is fearful because residential homes are inspected "at all times". Inspections should be encouraged, provided that they are carried out reasonably. Some people have alluded to raids on residential nursing homes. According to my information, that does not happen. We must give residents the best possible care and ensure that facilities are the same in all residential nursing homes.

Staff, including ancillary staff, must be adequtely, professionally and technically trained. There must be adequate arrangements for the patient in the home so that he or she receives proper medical and dental services as and when required.

Minimum and maximum charges must be considered. Obviously, charges must be realistic in view of the services offered. Many residential care proprietors give far better care than some of the relations of the elderly could. It is a sad fact of life that, in certain cases, love and care is given by a residential care home because it is too difficult to look after the elderly person at home. My hon. Friend the Minister of State announced new limits on the charges and the gross costs and the minimum standards. That announcement was welcome.

In the long term, we must obviously provide more suitably qualified staff in homes. There must be proper night staff and we must consider the precautions for fire risk. That is an area of difficulty as the elderly need to get out of residential homes fast. Certainly the requirements in regulation 10 give due regard to those obligations. We must ensure that homes are properly registered and check on them when they take residents in for residential care, and the residents should have a say in the way in which the home is run. It is especially important that there are proper and adequate facilities at all times. None of my constituents should be charged £16,000 for a room with just a bed, as one of my constituents is being charged outside Leicestershire.

The hon. Member for Holborn and St. Pancras referred to the elderly and the tremendous service that they have done for their country. All hon. Members will agree with that. I am sorry that the hon. Member for Holborn and St. Pancras is not in the Chamber at the moment, but it is important to put on record the fact that when there are war memorial services in Leicester the entire Conservative group attends. However, at the last service only three Labour councillors out of 39 went to the service. I do not need any lectures on how the elderly are to be supported and honoured at war memorial services.

Will my hon. Friend the Under-Secretary of State for Health and Social Security pay an official visit to Leicester Royal infirmary? I know that my hon. Friend has visited the infirmary in the past, but one part of the hospital is in a decrepit and Victorian state, especially around the entrance to the hospital. As my hon. Friend knows, the Leicester Royal infirmary is a renowned teaching hospital and the university relies on it as a training hospital. However, some old Victorian wards are in a decrepit state and the elderly are being treated long term in those wards. When I visited the Leicester Royal infirmary two Fridays ago, I was appalled at the poor state of repair of that facility area for the elderly. It is unusual for me to call for additional funds, but I urge my hon. Friend the Under-Secretary of State for Health and Social Security to supply additional funds to that hospital.

Mrs. Currie

For the sake of balance, does my hon. Friend recognise that a substantial sum of money was spent in Leicester not very long ago? Off the top of my head, I believe that that was about £25 million. It provided a brand new hospital just up the road.

Mr. Bruinvels

I acknowledge that additional funds have been given. The problem is that we have almost too many hospitals in Leicester—almost, not definitely.

The Leicester Royal infirmary is not in my constituency and the funds have gone to the constituency of the hon. and learned Member for Leicester, West (Mr. Janner). However, one part of the Leicester Royal infirmary is very drab indeed. It has no private facilities and the morale of the staff is not at its best. When I paid my semi-official visit to the hospital and spoke to the staff, it was clear that more funds were needed. I ask my hon. Friend the Under-Secretary of State to treat that as a matter of urgency as many of my constituents attend that hospital.

The closing of the Fielding Johnson hospital and the Roundhill maternity hospital will provide additional funds which, I hope, can be channelled to the Leicester Royal infirmary. However, obviously I do not want my hon. Friend to forget the Towers hospital and the Leicester General hospital in my constituency which are well looked after, and 1 thank my hon. Friend the Minister for that.

The elderly are living longer in Leicestershire and they need the best facilities that are available. Provided that those facilities are properly channelled and correct decisions are taken by the Trent regional health authority and the Leicestershire area health authority, and the RAWP requirement is sufficient— my hon. Friend knows that we receive 96 per cent. at present, but we would like a little more—I believe that the elderly will continue to be well cared for.

I pay tribute to both Ministers for what they have done to help those who are desperately in need in the city of Leicester and in the county. The health provision is second to none. The finances put into Leicestershire are pretty good, but a little extra would be welcome. The future is rosy for the elderly people there, provided that we can reduce the waiting lists, and the additional funds that my hon. Friend announced earlier this month will ensure that the elderly in Leicestershire receive the best possible care.

The Government amendment is by far the most realistic proposition. It acknowledges the work that has been done, the dedication of the staff and the certainty that the elderly will have more chance of getting better more quickly in the best-provided hospitals in the county of Leicestershire.

9.10 pm

Mr. Tom Pendry (Stalybridge and Hyde)

As the motion refers not only to the Health Service but to local councils and services, I am puzzled that we have two Health Ministers and two Opposition health spokesmen in this debate. I wish to discuss not Health Service provision, but some of the other services that are essential for the elderly.

It is right that the House has turned its attention this week to the problems of the elderly, through the two debates initiated by the official Opposition today and the debate initiated by the Government yesterday. I suppose that the latter was intended to be an occasion of self-congratulation about the EEC food surpluses, but it turned out to be yet another self-inflicted wound. It was right for my colleagues to point out yesterday that charities such as Age Concern, Help the Aged, the Salvation Army and the Women's Royal Voluntary Service are toiling to get those food surpluses to the needy, but, through no fault of theirs, to little effect. Indeed, the scheme is costing those charities a good deal of their precious money. Age Concern in my constituency received its first consignment of butter yesterday, and it has spent £700 through telephone costs organising meetings, issuing literature, and so on. It wanted to spend that precious money on 10 high-backed chairs for its new day centre. I hope that the House will press the EEC to ensure that that money is repaid to the charities which are trying to distribute food to the elderly.

The branch of Age Concern in my constituency, like most branches in other constituencies, does valuable work, but its work in Tameside will be restricted because the Government plan to lop off Tameside council from their urban aid programme. The Manpower Services Commission's programme is also severely restricting Age Concern, the welfare rights charities, Help the Aged and other organisations in my constituency. The MSC is being asked to give more of its thin cake to the inner cities. I do not decry the problems of the inner cities, but in some pockets of my constituency, and in many other constituencies in the north-west, there is similar deprivation and there are similar problems for the elderly. We should be talking not about slicing this thin cake, but expanding the cake to meet our ever-increasing problems, especially those which affect the elderly. No Government who allow organisations such as Age Concern to run down to their present level can be called a caring Government.

In my constituency, Age Concern is sponsored by the MSC. It does many of the jobs that have already been outlined, including the jobs that the elderly cannot do for themselves, such as repairing flexes, painting their homes, and so on. Unfortunately, they will be under threat if the Government's current policies are pursued. Those services will be run down by the Government if the urban aid programme is not restored to many local authorities like mine, and if the Manpower Services Commission programmes are cut.

The Government pay a great deal of lip service to caring about the elderly. During the winter months we heard about their aims, but they gave only empty promises to the elderly. Some 2,000 old people died from hypothermia or cold-related illnesses during the week following the recent cold spell. However, .the Government have steadfastly refused to tell us with what, if anything, they intend to replace the single payment allowance that has been invaluable in helping old people to insulate and draught-proof their homes. We want to know from the Minister tonight what will happen after April, because many people throughout the country want to know what will happen then.

I want the Minister to address herself to the drastic cuts that have been planned by the MSC. I know that that is not the responsibility of her Department, but the MSC is directly responsible for many energy-saving schemes that are currently being held up. In her capacity as a "caring"—if I may put it this way—Health Minister, she should be knocking at the doors of the Department of Energy and of the MSC and finding out exactly what is being done to ensure that those energy-saving priority projects—or so we are told—are realised and come on stream for those elderly people.

Two such schemes have been held up in my constituency. One is called "Keep Hattersley Warm"—nothing to do with the deputy leader of the Opposition, but with a Manchester overspill estate. According to an independent survey, 90 per cent. of those interviewed said that their homes were hard to heat, 88 per cent. had draught problems, 85 per cent. had difficulty paying their heating bills and 34 per cent. of the total number were pensioners. It is a cold and bleak estate in winter, as hon. Members who have visited it will know.

The second scheme is called "Keep Tameside Warm". That is another estate in my constituency with a high proportion of pensioners. They are waiting for a scheme that has been approved by the MSC but held back because it has cut 10,000 of 255,000 places that it promised for next year. That means that in my constituency there will be a great deal of resentment because expectations are already high in those estates. However, the residents will not benefit from the schemes because the community programmes are designed to try to meet the needs of all those people currently on the schemes. The MSC does not wish—I do not blame it—to lop off any of the schemes currently in place and working.

It is the new schemes that are being held up. The MSC should tune its criteria more finely and consider energy-saving projects, as distinct from other projects within its scope. It is disgraceful that the schemes, which are designed to save energy and lives, are not considered separately from other environmental schemes.

Time is short and other hon. Members wish to speak, so I have already shed most of my speech. I see my Whip nodding. The Government should look more closely at some of the other areas that are so desperately important to the pensioners of this country.

We should ensure that the Manpower Services Commission, the Department of Energy, the Department of the Environment and the Department of Health and Social Security work more closely together to ensure that elderly people have a much better deal than they presently have, especially in areas in which the elderly need to keep warm during our cold winters. If the Government wish to be caring in future—we all know that that is a false claim—they should address this matter in a much more positive way.

9.20 pm

Mr. Laurie Pavitt (Brent, South)

I hope that the House will bear with me as I relate a recent personal experience that I believe will provide an insight. I have had a crash course on dying. For three months, I experienced the way in which one nurses a dying person and the trauma, stress and strain that is involved. My elderly sister with terminal cancer came out of hospital three months ago. Because she lived alone, she had to be nursed by my wife and another sister until her death four weeks ago. That experience gave me an entirely new perspective on the matter of care at the end of one's life. Previously, the debate was dominated by two poles—on one hand, a geratric hospital ward and, on the other hand, community care. But the Cinderella is the care, compassion and medical help that one needs in the process of dying.

A recent new dimension that has caught a certain amount of public attention is the hospice movement. There is an inadequate number of hospices and inadequate support for them, yet they are perhaps one of the most civilised developments in the care of the elderly that have taken place in this decade.

What is being done about the domiciliary care of the dying that is provided by two excellent services? I defer to no one in my appreciation of district nurses, but two special organisations, the Marie Curie nurses and the MacMillan nurses, provide terminal care with special experience and expertise. I have experienced the trauma of what can happen when necessary home support is not available. What support are the Government prepared to give those excellent organisations that provide a service that nobody else provides so effectively? A district nurse is competent over the whole area of care, but her time is limited, especially as there is a shortage of district nurses. Therefore, those who suffer the constant day-to-day pressures at the time of a person's death need far more support than we, either governmentally or locally, are giving. I ask the Minister to rethink his strategy on geriatric wards and hospices.

I object to the fact that in my constituency two hospitals with 180 geriatric beds have been closed over the past four years. I want the Minister to think more clearly about institutional and community care. At the moment the matter is too rough and ready. I pay tribute to the primary care consultations that are going on and to some of the excellent ideas that are being shared between those who need to care.

Although we think in terms of illness and the elderly, as has been said, to be old is not a problem, but it can create and have problems within it. There are four main areas of concern for the person who does not need hospitalisation or even community physicians. They are, first, hearing disabilities; secondly, dental problems; thirdly, eye problems; and, fourthly, foot problems.

I recently had the privilege of having an article published in a magazine called "Saga", which goes to a few million elderly people. As a consequence, I am getting letters from all over the country. I am surprised when I continue to get the kind of letter that I received from an elderly lady of 85, who was conned out of—650 for two hearing aids by a door-to-door salesman, because she filled in a coupon. The NHS hearing aid service is as good as one could expect, and 1.5 billion hearing aids have already been issued, free of charge. Batteries are also free. Will the Minister provide the maximum amount of publicity to inform elderly people that they do not need to pay hundreds of pounds for hearing aids, because the NHS hearing aid is just as good? I am wearing two NHS hearing aids—the BE52s. By buying in bulk, the Government, according to a recent answer from the Minister, is paying £21 for each of these aids. The same aids are being sold for £300 each in the private sector. I know the makers. The elderly are being conned, and they need to be protected.

Will the Minister refer to the statement of the right hon. Member for Wanstead and Woodford (Mr. Jenkin), when he was the Opposition spokesman on health, who agreed that my Bill, to amend my own Hearing Aid Council Act 1968 to plug this doorstep loophole, would be accepted by the Tory Opposition? I have introduced that Bill for 10 years, with the support of the Royal National Institute for the Deaf, the British Association for the Hard of Hearing and of all other hearing impaired people. Each time the Government Whips have blocked the Bill. I have been to see the present Minister and pleaded that something should be done about it. Therefore, I ask the Minister to take steps to lift the ban so that, when it comes up for Second Reading in May, I shall be given a clear run.

Increased dental charges now mean that an elderly person has to pay £47 for dentures. I hope to goodness that the charge will not be increased again on 1 April. The House knows that as people grow old there is gum and ridge shrinkage. Consequently, new dentures are needed. Elderly people, who have much dignity, do not like to ask for charity, so most old people make do with what they have already got. Therefore, the Government should take action and listen to the pleas of the British Dental Association.

The only people who now have any help with glasses are those on supplementary benefit. At one time, all old people had that privilege. Testing remains obligatory, but I wish that the Government would make it mandatory that opticians should go further than just testing visual acuity.

One can obtain from an optician an early diagnosis of glaucoma, cataracts, hypertension and diabetes long before anybody, but in particular the elderly, goes to see the general practitioner. Surely it was Scrooge at his worst to take from old people the right to free spectacles that they had enjoyed for so long.

I refer the Minister to her report "More Trouble with Feet." That survey was conducted by Dr. Ann Cartwright. Old people need to be mobile so that they are not lonely. They need to be able to get about. However, despite the increase in provision that the Government boast about, there is a drastic shortage of chiropodists and also of training for chiropodists in the year ahead. Dr. Cartwright says: Fifty pre cent. more chiropodists are needed immediately. The elderly should be able to live in a civilised fashion in the community. Therefore, these four areas of concern that I have outlined should be acted upon by the Government.

Local social services, health services and the voluntary bodies co-operate in providing help for the elderly. For example, my much maligned Brent council has provided 2,699 telephones for elderly people who are living alone—and the telephone provides a lifeline, especially for those who live in high-rise blocks of flats.

The combined operation of joint planning and joint funding is now an antiquated system of co-ordination between the local social services and district health authorities. I appeal for an early revision of the system. When will we ever learn? The care of the elderly is indivisible. As my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) said, we can never repay this generation for what they have done for us and for generations to follow.

9.30 pm

Mr. Den Dover (Chorley)

I wish to refer to two aspects of health care, one in the community and one involving mental illness. We have not heard enough about the district nursing service. Over the last decade or so people have been spending shorter periods in hospital and the burden of service has been put on the community. People have to be dealt with by the community nursing service for longer in preparation for hospital treatment. When patients come out after shorter hospital stays an ever-increasing burden is placed on the district nursing service. Are the Government giving enough emphasis to the needs of staffing in the community?

It is all very well saying that in our large inner cities the population is reducing and that we do not need spending on major hospitals. That is right. But it is in those very inner cities and large centres of population that there is an ever-increasing number of elderly people. They need more and more care by the district nursing service. Unbearable burdens are being put on that staff. Are the Government allocating enough resources? The district nursing service is always seen as the junior partner in the provision of health services.

How much or how little emphasis has been put by the Government on mental illness, despite policy studies in the early 1970s, when the Conservative party was in opposition, aimed at improving mental illness services? We have enormous estates. We should try to get the elderly and mentally infirm back into their families if possible. We should redevelop the major estates and release funds for more health care services in hospitals and in the community.

The private sector has a part to play. Surely we need not leave it to the public sector solely to deal with menial illness. There is no reason why there should not be privately financed treatment of the mentally ill and infirm. I should like to see that because there is an enormous untapped resource which could be used to improve the Health Service throughout the nation.

9.32 pm

Dr. John Marek (Wrexham)

This debate has been characterised by Conservative Members saying that everything within the National Health Service is good and that the Government have done everything that needs to be done, yet at the same time in their own constituencies there is something which is not quite right. We have had the unedifying spectacle of the hon. Member for Erith and Crayford (Mr. Evennett) making special pleas to the Government for more funding because of the number of old people in his constituency We have had the spectacle of the hon. Member for Leicester, East (Mr. Bruinvels), who said that he rarely votes for spending more money, telling us about going round Leicester Royal infirmary. He said that some old wards are in a decrepit state. He went further; he said that he was appalled at the state of those wards and he wanted extra spending.

So we could go on. I am sure that, if asked, any Conservative Member could find something in the National Health Service that is not quite right. Of course, the public know very well that wards are being closed every day, that there are five-day wards and that there is a continual search for beds simply because the authorities have to consider performance indicators. The accountant rules, and what the accountant wants he has to get.

My hon. Friends the Members for Holborn and St. Pancras (Mr. Dobson), for Brent, South (Mr. Pavia), for Eccles (Mr. Carter-Jones), for Wolverhampton, North-East (Mrs. Short) and for Stalybridge and Hyde (Mr. Pendry) have put the argument for more and better care of the elderly very well. I agree with those arguments. Eventually, I hope that those arguments will convince the Government— they will certainly convince the next Labour Government—that more should be done for the elderly.

I wish to repeat the figures for old-age pensions given by my hon. Friend the Member for Oldham, West ( Mr. Meacher) in the last debate. They are also valid for this debate. Money is important because that gives the elderly the ability to look after themselves, to provide heat in winter, to feed themselves and to pursue an active life to the end of their days. My hon. Friend said that old-age pensions had increased by 20 per cent. over and above prices during the period of office of the previous Labour Government, but that they had increased by only 4.5 per cent. over and above prices under the present Tory Administration. The Minister for Social Security sought to say that those figures were not as accurate as they should be, but he did not give us the accurate figures. The figures mentioned by my hon. Friend were in the research note that was published on 18 November and had been placed in the Library. Therefore, the Minister, had he wished, had plenty of time in which to find the accurate figures. Suffice to say that, if the figures given by my hon. Friend are inaccurate, they are not very inaccurate.

The Minister was rattled and produced his figures and added in all sorts of allowances concerning poverty or disability. The figures that the Minister produced were misleading because one figure suggested that the disposable income of pensioners had increased faster than the disposable income of the rest of the population. That might be right, but the Minister did not say that a considerable part of the population is unemployed and has little disposable income. That has been the tenor of the statistics and arguments put forward by the Government Front Bench during the two debates.

The Government have sought to say that the figures produced by the Opposition are inaccurate. I am not saying that those figures are the last thing in accuracy. They may be inaccurate in detail, but they seek to provide an accurate, true reflection of what is happening to our old people.

When the Parliamentary Under-Secretary of State for Health and Social Security replied to the previous debate he put a figure on the disposable income of pensioners and said that it had risen 18 per cent. more than the disposable income of the rest of the population. Such a figure is misleading. The crunch of the argument is that central to pensioners' well-being—after increases in public health services for which Governments of all persuasions have been responsible—is the amount of disposable income that they possess. That income helps the elderly to heat their houses in winter, to feed themselves and to lead active lives.

My hon. Friend the Member for Oldham, West said that old-age pensions are equivalent to 18 per cent. of average earnings in this country. They are equivalent to 50 per cent. of average earnings in West Germany and 60 to 70 per cent. of average earnings in France. They are shocking figures and I make no apology for repeating them. I cannot see how any Government can try to get out of accepting those figures. I repeat that the Labour Government, as a start, will increase the single pension by £5 and the married pension by £8.

The Minister for Health pursued the same line in his speech. He said that spending on the National Health Service has increased by about a third in real terms. In the past it has been said that spending has increased by 22 per cent., then 24 per cent. and now the Minister says it has increased by a third in real terms. The Minister did not say that we are getting older as a nation and therefore spending must increase to ensure that the standard of service is maintained. The Minister did not say that the medical price index increases at a higher rate than the retail prices index and that, therefore, we would have to spend more money in real terms to maintain standards.

The Minister did not say that there are now many new operations that were hardly dreamt of 10 years ago, such as hip replacement operations, that are desired by the population, especially the elderly, so that they are assured of an active life in later years. He did not say that presently there is much more unemployment and that the unemployed need the National Health Service more than do the employed. But we know that the Government do not believe that, because the Parliamentary Under-Secretary of State for Wales says that he does not believe that there is a link between unemployment and ill health. Finally, the Minister did not say that there are new diseases such as AIDS, which demand new expenditure and need extra expenditure to keep the standard of service the same. The hon. Gentleman simply said that spending on the NHS has gone up by getting on for one third. That is a shallow misrepresentation, for which I do not blame him. Obviously, it is an edict given out by the Prime Minister some years ago, that one uses all the possibilities of misrepresentation and selection of figures to try to convince the people that everything that can he done by the Government is being done.

Of course, people are not fools. They see long waiting lists. They know that they might be refused admission when they go to hospital and that they might have to go again to see whether they can have their non-urgent operation. They see that there are not enough nurses doing nursing duties because there have been cuts in ancillary staff. They will not be fooled by shallow misrepresentations.

Some of the elderly have been moved into community care. There is an unseemly haste by the Government in pressing health authorities to get rid of their elderly patients and put them into the community. It has meant that some patients are becoming hopeless and suicidal, and are also the victims of grasping and uncaring landlords. The NHS and voluntary bodies simply do not have the resources for proper continuing care after patients are discharged into the community. There have been cases where former patients have been put into community care, and have found themselves sharing a room with two or three other former patients, sometimes of the opposite sex. In one documented case, a 60-year-old woman had not eaten for two days, and had gone into a tiny room at the top of a dilapidated staircase, with electricity being supplied illegally through an adaptor connected to a 5p slot meter.

I have a case at present in my constituency where a housing association is seeking to convert a large home so that is is suitable for elderly patients being discharged into the community, but it says that resources are not there for a warden to be provided. It says that it has money to provide only bedsitter accommodation, and that it does not have the finances to provide properly constructed one-bedroom flats. I fear that that pattern is being repeated throughout the country.

Of course, the Government look at community care as a cheap option. I have seen no evidence to the contrary. They look at it as something on which the Treasury can spend less, whereas proper community care would cost as much if not more than insitutionalised hospital care.

I visited the Truro constituency earlier this week. I was told that the Under-Secretary, the hon. Member for Derbyshire, South (Mrs. Currie), was due to visit it on 16 February. She cancelled her visit. I do not know whether there was any reason why she did that, but the people in the Truro constituency do not know. She did not turn up. Radio Cornwall announced that she was going to look at the hospitals, but when the day arrived, she was not there. She did not go. Was she muzzled? Was she told by her masters and by her mistress that there is something going on in Truro, and it would be better if the hon. Lady was not there?

Mrs. Currie

I would not wish to leave the hon. Gentleman in suspense. I could not attend because I was preparing for the Opposition debate the following day. As he will recall, I replied to another debate that day. The visit was rearranged for today. I decided that I preferred the hon. Gentleman's company on this occasion.

Dr. Marek

What can I say after that? [Hon. Members: "Be careful."] My hon. Friends warn me to be careful. This is a serious point. I hope that the hon. Lady will go to the Truro constituency because I should like to see whether she can say that there is something that she or her Government can be proud of—she has not been in her job that long, and it would be unfair to blame her for all that the Government have done.

When I went round the local hospital in St. Austell, I was told that many things were wrong in the constituency. There is a long waiting list for hip replacement operations. Eye operations are having to be done in the private hospital next door to Truro. Apparently, a surgeon will do them free so that the waiting list can be cut down. I wonder what the NHS has come to when that happens. The ambulance service is not of the same quality as it used to be.

I have only another two minutes to speak, but I wonder whether the Under-Secretary will mend her ways? In the House of Commons, she said: Universal screening is neither desirable nor necessary."—[Official Report, 5 February 1986; Vol. 91, c, 372.]

If she said that— [Interruption] I have it here in a copy of Hansard. Does she still believe that it is neither desirable nor necessary or will she now say that it is desirable for all people to have screening, to have regular checks, so that preventive care will mean something to our elderly people?

On a different day the hon. Member for Derbyshire, South said: We do not believe in equality … There should be a gap between the rich and the poor."—[Official Report, 28 June 1984; Vol. 62, c. 1218.] If she did say that, I do not think that our elderly will derive much hope from the present Government and its policies, certainly not while the hon. Lady is occupying her position.

My hon. Friend the Member for Brent, South talked about dentures and hoped that their price would not rise in the next Budget. The hon. Lady is quoted as saying: charges irritate people and they put some people off, but on the dental side there is no evidence that they put people off."—[Official Report, 25 March 1985; Vol. 76, c. 163.] The charges do not put the rich off, but those are not the people that my hon. Friend was worrying about. The hon. Lady does not give us much hope, and I do not think that we will get much hope from the present Government. The elderly need more home helps; they need cuts in standing charges for electricity and gas, and preferably abolition of such charges. We need more district nurses; we need more therapists; we need more for the medical service so that we can have frequent check-ups for elderly people, and, above all, we need more disposable income for the elderly so that they can look after themselves. In spite of all the cant that we get from the Government, I do not think that we will get that from them.

9.47 pm

The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)

I listened with interest to the words of the hon. Member for Wrexham (Dr. Marek). I do not think that he has much confidence in the Opposition case. He spent most of his speech trying, with singular lack of success, to reopen issues that were disposed of by my hon. Friend the Member for Huntingdon (Mr. Major) in the previous debate. As to the question of universal screening, I thought that we dealt with that last week. I do not think that the hon. Member for Wrexham was present on that occasion; perhaps he was in Truro at the time.

We have had an excellent debate, with a number of well-informed speeches. I hope that some hon. Members will not mind if I write to them in detail about the issues that they raised. I agree with one or two of the comments that were made. For example, I agree with the hon. Member for Eccles (Mr. Carter-Jones), who spoke about rehabilitation. What he said about many of the issues that he raised was right. Prevention also is an important matter. The hon. Member talked about incontinence clinics. It may be that we should have well-elderly clinics that encompass a number of such issues. Broadly, I give the hon. Gentleman the assurance that he asked for on Alzheimer's disease. I hope that he never has need for the services that he called for.

The hon. Member for Brent, South (Mr. Pavitt) asked about chiropodists. We have set up additional training schools, and another school is opening this year. He also mentioned hospices. As he probably knows, we had a debate on hospices last week, which was called by my hon. Friend the Member for Beckenham (Sir P. Goodhart), to whose speech I refer him. We held a joint conference on care of the dying between the DHSS and the National Association of Health Authorities which resulted in a guide for health authorities. A circular setting out DHSS policy on terminal care is coming out at the beginning of next week, which we hope will encompass some of the issues that he raised.

Several hon. Members talked about co-ordination of services for people who are discharged from hospital. Under the Helping the Comrr unity to Care programme we are funding a number of voluntary organisations, including Age Concern and Red Cross, to develop new ways of developing such co-ordination. We will look with interest at the results.

I was a little surprised at the comments that the hon. Member for Holborn and St. Pancras (Mr. Dobson) made on crime. If he is so concerned about crime, we hope that he will persuade his party to back the police in the future. There are a number of other detailed issues, but in view of the time I hope that hon. Members will allow me to write to them about them.

We are all interested in services for the elderly, because we all hope to get there some day—perhaps me more than most, since women are far more likely to do it than men. Currently, there are 3 million people aged between 75 years and 84 years and 750,000 aged over 85 years. There are 3,400 people who are more than 100 years old. A centenarian these days has a life expectancy of two years, and we expect the number of them to increase substantially. No one tonight has paid tribute to medical science, or the improved living conditions and good preventative work that has resulted in this considerable growth in numbers, and we look forward to much of the same.

For many people, old age is not a disaster but, in the terms of "A Handbook For Retirement" recently produced by Age Concern, "The Time of Your Life". Lord Murray said in his introduction: Retirement should not mean inaction but a period of liberation—a time to do all those things which a full-time job made impossible … Today's retired men and women are generally more youthful, active and healthy than ever before. They are branching out in new skills and interests … they are taking up new lines of work, both paid and unpaid; they are the mainstay of social clubs, sports clubs and charities"— as they are of political parties. They are refusing to retire from everyday life and are doing things their way, regardless of how people expect them to act at their 'time of life'. The standard of living of retired people has risen quite dramatically. In 1975 only 20 per cent. of retired households had access to a car, and now it is 30 per cent. Some 48 per cent. had a washing machine, but now it is 65 per cent., which helps with some of the other problems that we have mentioned. Sixty-nine per cent. had a fridge; now it is 95 per cent. Some 37 per cent. had a phone; now it is 75 per cent. Ninety-seven per cent. have a television set, so we would not be surprised that they watch on average 40 hours of television every week, which is twice the amount that young people watch. Most important in terms of comfort, 33 per cent. used to have central heating and now 61 per cent. have. As a result, we can say that they are much better housed than ever they were.

The opening speeches today dealt with how we make the system function, particularly in reference to local councils, which do a great deal of work. I have a report referred to earlier of an independent review of residential care for the elderly in the London borough of Camden. I agree with the hon. Member for Holborn and St Pancras, whose constituency is covered, and some of whose constituents are mentioned, that the council deserves recognition for having had the guts to commission the independent report and publish it. However, the scandals described in it should never have happened. I shall read some of it into the record.

This is what the report said about Camden's care for the elderly: effective management of residential care in Camden has broken down … The Council's concern to be a good employer became carried to a point at which elderly residents have suffered. It presents a detailed report of each home and says of one: We observed failure to clean up urine and faeces; residents being scolded … Standards of hygiene generally very poor and in our view contained a risk to health … Custom and practice has led to care assistants being able to take up to one hour's tea break—all at the same time … We heard of difficulty in gaining access to the building during tea breaks. We know of one resident left helpless during a tea break, lying transverse across the bed with only a vest across her shoulders and was blue with cold … the Trade Union had remained adamant that there should be no reduction in the time out taken … care is not a priority for some staff". Another home was described in this way: A downstairs lavatory approached by steps which is inaccessible to people using wheelchairs or walking frames. In consequence dependent residents are regularly toiletted on a commode in a four-bedded downstairs bedroom with no privacy at all. Another home is described as having bedrooms that are "unacceptably overcrowded". Furthermore, the lift is subject to frequent breakdowns and has been left unrepaired for as long as six weeks. In that home the depression rate of residents is 53 per cent. Furthermore, there has been a recent suicide of a very disturbed woman who could not be adequately supervised … Getting up of residents starts at 5.45 a.m. Of another home, the review said: For physically disabled residents the care system appears to have collapsed … a dirty neglected appearance of both surroundings and individuals … 14 out of 18 'incontinent' residents could in fact be kept continent with proper care. Clothing … is often dirty and unkempt, often with no underwear and in particular there is an absence of knickers—similar complaints have been voiced by relatives … We had drawn to our attention a number of incidents concerning residents. One man was reported as having been found by a visiting doctor as so soaked in urine that it had made a 'high tide' mark, which would have taken up to seven hours to form, across his shirt … some staff members expressed themselves as deeply distressed at their inability to offer good care, because some colleagues did not carry out their duties responsibly, refused orders and were aggressive and abusive. We heard allegations of fights amongst staff members and of staff having to be escorted to public transport because of fear of retribution from other staff members. As things are we however feel it necessary to say that the Home is very close to disaster, and could easily become the focus of a major scandal.

Mr. Dobson

The hon. Lady will accept that any sensible person would regard the circumstances described in that report as disgraceful. Does she also accept that it is somewhat hypocritical not to note other things said in that report, that the Department of Health and Social Security has statutory inspectorial duties and that the periods between inspections seemed to be of unacceptable duration? Does she recognise that some of the issues raised in this report would have been identified and possibly dealt with earlier if the Department had exercised its statutory duties? We will not take lessons from people who will not accept their own responsibilities.

Mrs. Currie

The DHSS does not run these homes; Camden council runs them. For the hon. Gentleman's information, may I say that I asked whether inspectors had recently visited the homes and was told that they had. I shall make available to the hon. Gentleman the report that they have just produced. They again used the words "dirty" and "untidy", and referred to "poor standards of care". It is not as if Camden does not have any money. It spends more per head on residential care and on just about everything else than any other borough. It is repeatedly compared unfavourably with other local authorities.

I cannot see how the Opposition's policies would be of any help. In the Health Service they would get rid of prescription and other charges, and that would lose at least £350 million a year. They would stop contracting out, and that would lose another £75 million. They would lose all the other cost improvements which my hon. Friend the Member for Nuneaton (Mr. Stevens) drew to our attention. They would do their best to get rid of the private sector. They say that the private sector and care of that sort is no part of Labour's philosophy. They say that their aim is to put public money into good public services. I hope to God that they are not like those in Camden.

The hon. Member for Wrexham spoke a little self-righteously about waiting lists. The waiting lists were longest when NHS staff were out on strike, and the Opposition backed that strike in every way. We saw recently the walk-out of clerical staff from Selly Oak hospital, of home helps in Liverpool and of meals on wheels staff in Hackney. That is what the Labour party supports.

The Opposition talk about reversing tax cuts. I hope that they remember that pensioners are also taxpayers and that 70 per cent, of them have income from savings which would be eroded by taxation and inflation and by what the Opposition plan to do to pension funds. It was all summed up for us by Richard Crossman in his diary entry for Sunday 14 June 1970, when he described the Conservative years as years of economic expansion and a tremendous rise in living standards". The Labour years were described as years of hell and high taxes.

That is exactly what we would have again under Labour. Years of hell and high taxes are all that is promised by the Opposition for us, for our elderly and for everybody else. I trust that they and their motion will be rejected.

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

The House divided: Ayes 186, Noes 252.

Division No. 102]	[10.00 pm
AYES
Adams, Allen (Paisley N)	Dubs, Alfred
Anderson, Donald	Duffy, A. E. P.
Archer, Rt Hon Peter	Dunwoody, Hon Mrs G.
Ashdown, Paddy	Eadie, Alex
Ashley, Rt Hon Jack	Eastham, Ken
Atkinson, N. (Tottenham)	Evans, John (St. Helens N)
Bagier, Gordon A. T.	Fatchett, Derek
Barron, Kevin	Faulds, Andrew
Beckett, Mrs Margaret	Field, Frank (Birkenhead)
Beith, A. J.	Fields, T. (L'poo/ Broad Gn)
Bell, Stuart	Flannery, Martin
Benn, Rt Hon Tony	Foot, Rt Hon Michael
Bennett, A. (Dent'n & Red'sh)	Forrester, John
Bidwell, Sydney	Foster, Derek
Blair, Anthony	Foulkes, George
Boothroyd, Miss Betty	Fraser, J. (Norwood)
Boyes, Roland	Freeson, Rt Hon Reginald
Brown, Gordon (D'f'mline E)	Freud, Clement
Brown, Hugh D. (Provan)	George, Bruce
Brown, N. (N'c'tle-u-Tyne E)	Gilbert, Rt Hon Dr John
Brown, R. (N'c'tle-u-Tyne N)	Godman, Dr Norman
Brown, Ron (E'burgh, Leith)	Golding, Mrs Llin
Bruce, Malcolm	Gould, Bryan
Buchan, Norman	Gourley, Harry
Caborn, Richard	Hamilton, James (M'well N)
Callaghan, Rt Hon J.	Hamilton, W. W. (Fife Central)
Callaghan, Jim (Heyw'd & M)	Hancock, Michael
Campbell, Ian	Hardy, Peter
Canavan, Dennis	Harrison, Rt Hon Walter
Carlile, Alexander (Montg'y)	Haynes, Frank
Carter-Jones, Lewis	Healey, Rt Hon Denis
Clark, Dr David (S Shields)	Heffer, Eric S.
Clarke, Thomas	Hogg, N. (C'nauld & Kilsyth)
Clay, Robert	Holland, Stuart (Vauxhall)
Clelland, David Gordon	Home Robertson, John
Clwyd, Mrs Ann	Howarth, George (Knowsley, N)
Cocks, Rt Hon M. (Bristol S)	Howells, Geraint
Cohen, Harry	Hoyle, Douglas
Coleman, Donald	Hughes, Robert (Aberdeen N)
Conlan, Bernard	Hughes, Roy (Newport East)
Cook, Frank (Stockton North)	Hughes, Sean (Knowsley S)
Cook, Robin F. (Livingston)	Hughes, Simon (Southwark)
Corbett, Robin	Janner, Hon Greville
Corbyn, Jeremy	Jenkins, Rt Hon Roy (Hillh'd)
Cox, Thomas (Tooting)	John, Brynmor
Craigen, J. M.	Johnston, Sir Russell
Crowther, Stan	Kirkwood, Archy
Cunliffe, Lawrence	Lambie, David
Davis, Terry (B'ham, H'ge H'l)	Lamond, James
Deakins, Eric	Leadbitter, Ted
Dewar, Donald	Lewis, Terence (Worsley)
Dobson, Frank	Litherland, Robert
Dormand, Jack	Lofthouse, Geoffrey

Loyden, Edward	Rogers, Allan
McCartney, Hugh	Rooker, J. W.
McDonald, Dr Oonagh	Ross, Ernest (Dundee W)
McGuire, Michael	Rowlands, Ted
McKay, Allen (Penistone)	Sedgemore, Brian
MacKenzie, Rt Hon Gregor	Sheerman, Barry
McNamara, Kevin	Sheldon, Rt Hon R.
McWilliam, John	Shields, Mrs Elizabeth
Madden, Max	Shore, Rt Hon Peter
Marek, Dr John	Short, Ms Clare (Ladywood)
Marshall, David (Shettleston)	Short, Mrs R.(W'hampin NE)
Martin, Michael	Skinner, Dennis
Mason, Rt Hon Roy	Smith, C.(lsl'ton S & F'bury)
Maxton, John	Smith, Rt Hon J. (M'ds E)
Maynard, Miss Joan	Soley, Clive
Meacher, Michael	Spearing, Nigel
Meadowcroft, Michael	Steel, Rt Hon David
Michie, William	Stott, Roger
Mikardo, Ian	Straw, Jack
Milian, Rt Hon Bruce	Thomas, Dafydd (Merioneth)
Miller, Dr M. S. (E Kilbride)	Thomas, Dr R. (Carmarthen)
Mitchell, Austin (G't Grimsby)	Thompson, J. (Wansbeck)
Morris, Rt Hon A. (W'shawe)	Thorne, Stan (Preston)
Morris, Rt Hon J. (Aberavon)	Tinn, James
Nellist, David	Torney, Tom
Oakes, Rt Hon Gordon	Wainwright, R.
O'Brien, William	Wallace, James
O'Neill, Martin	Wardell, Gareth (Gower)
Patchett, Terry	Wareing, Robert
Pavitt, Laurie	Weetch, Ken
Pendry, Tom	Welsh, Michael
Pike, Peter	White, James
Powell, Raymond (Ogmore)	Wigley, Dafydd
Prescott, John	Williams, Rt Hon A.
Radice, Giles	Wilson, Gordon
Randall, Stuart	Winnick, David
Raynsford, Nick	Woodall, Alec
Redmond, Martin	Young, David (Bolton SE)
Richardson, Ms Jo
Roberts, Ernest (Hackney N)	Tellers for the Ayes:
Robertson, George	Mr. Ron Davies and
Robinson, G. (Coventry NW)	Mr. Tony Lloyd.

NOES
Aitken, Jonathan	Bryan, Sir Paul
Alison, Rt Hon Michael	Eluchanan-Smith, Rt Hon A.
Amess, David	Buck, Sir Antony
Ancram, Michael	Budgen, Nick
Arnold, Tom	Bulmer, Esmond
Ashby, David	Burt, Alistair
Aspinwall, Jack	Butterfill, John
Atkins, Rt Hon Sir H.	Carlisle, John (Luton N)
Atkins, Robert (South Ribble)	Carlisle, Kenneth (Lincoln)
Atkinson, David (B'm'th E)	Carttiss, Michael
Baker, Nicholas (Dorset N)	Chalker, Mrs Lynda
Baldry, Tony	Channon, Rt Hon Paul
Banks, Robert (Harrogate)	Chapman, Sydney
Batiste, Spencer	Chope, Christopher
Beaumont-Dark, Anthony	Churchill, W. S.
Bellingham, Henry	Clark, Hon A. (Plym'th S'n)
Bendall, Vivian	Clark, Sir W. (Croydon S)
Bevan, David Gilroy	Clarke, Rt Hon K. (Rushcliffe)
Bitten, Rt Hon John	Colvin, Michael
Blackburn, John	Conway, Derek
Blaker, Rt Hon Sir Peter	Coombs, Simon
Body, Sir Richard	Cope, John
Bonsor, Sir Nicholas	Corrie, John
Boscawen, Hon Robert	Couchman, James
Bottomley, Peter	Currie, Mrs Edwina
Bottomley, Mrs Virginia	Dicks, Terry
Boyson, Dr Rhodes	Derrell, Stephen
Braine, Rt Hon Sir Bernard	Douglas-Hamilton, Lord J.
Brandon-Bravo, Martin	Dover, Den
Bright, Graham	du Cann, Rt Hon Sir Edward
Brinton, Tim	Durant, Tony
Brittan, Rt Hon Leon	Dykes, Hugh
Brooke, Hon Peter	Eggar, Tim
Brown, M. (Brigg & Cl'thpes)	Emery, Sir Peter
Browne, John	Evennett, David
Bruinvels, Peter	Eyre, Sir Reginald

Fallon, Michael	Hubbard-Miles, Peter
Farr, Sir John	Hunt, David (Wirral W)
Fenner, Dame Peggy	Hunt, John (Ravensbourne)
Finsberg, Sir Geottrey	Hunter, Andrew
Fletcher, Sir Alexander	Hurd, Rt Hon Douglas
Fookes, Miss Janet	Irving, Charles
Forman, Nigel	Jenkin, Rt Hon Patrick
Forsyth, Michael (Stirling)	Johnson Smith, Sir Geoffrey
Forth, Eric	Jones, Gwilym (Cardiff N)
Fowler, Rt Hon Norman	Jones, Robert (Herts W)
Franks, Cecil	Jopling, Rt Hon Michael
Fraser, Peter (Angus East)	Kellett-Bowman, Mrs Elaine
Freeman, Roger	Key, Robert
Fry, Peter	King, Roger (B'ham N'field)
Gale, Roger	King, Rt Hon Tom
Galley, Roy	Knight, Greg (Derby N)
Gardiner, George (Reigate)	Knight, Dame Jill (Edgbaston)
Gardner, Sir Edward (Fylde)	Knowles, Michael
Garel-Jones, Tristan	Knox, David
Glyn, Dr Alan	Lamont, Rt Hon Norman
Goodhart, Sir Philip	Lang, Ian
Goodlad, Alastair	Latham, Michael
Gow, Ian	Lawler, Geoftrey
Gower, Sir Raymond	Lawrence, Ivan
Grant, Sir Anthony	Lee, John (Pendle)
Greenway, Harry	Leigh, Edward (Gainsbor'gh)
Gregory, Conal	Lennox-Boyd, Hon Mark
Griffiths, Sir Eldon	Lester, Jim
Grittiths, Peter (Portsm'th N)	Lewis, Sir Kenneth (Stamf'd)
Ground, Patrick	Lightbown, David
Gummer, Rt Hon John S	Lilley, Peter
Hamilton, Hon A. (Epsom)	Lloyd, Peter (Fareham)
Hampson, Dr Keith	Lord, Michael
Hanley, Jeremy	Lyell, Nicholas
Hannam, John	McCrindle, Robert
Hargreaves, Kenneth	McCurley, Mrs Anna
Harvey, Robert	Macfarlane, Neil
Haselhurst, Alan	MacGregor, Rt Hon John
Hawkins, C. (High Peak)	MacKay, Andrew (Berkshire)
Hawksley, Warren	MacKay, John (Argyll & Bute)
Hayhoe, Rt Hon Sir Barney	Maclean, David John
Hayward, Robert	McLoughlin, Patrick
Heathcoat-Amory, David	McNair-Wilson, P. (New F'st)
Heddle, John	Madel, David
Henderson, Barry	Major, John
Hickmet, Richard	Malins, Humtrey
Higgins, Rt Hon Terence L.	Malone, Gerald
Hind, Kenneth	Maples, John
Hirst, Michael	Marland, Paul
Holland, Sir Philip (Gedling)	Marlow, Antony
Holt, Richard	Marshall, Michael (Arundel)
Hordern, Sir Peter	Mather, Sir Carol
Howard, Michael	Mayhew, Sir Patrick
Howarth, Alan (Stratf'd-on-A)	Merchant, Piers
Howarth, Gerald (Cannock)	Meyer, Sir Anthony
Howell, Ralph (Norfolk, N)	Mills, Iain (Meriden)

Mills, Sir Peter (West Devon)	Silvester, Fred
Miscampbell, Norman	Sims, Roger
Moate, Roger	Smith, Sir Dudley (Warwick)
Monro, Sir Hector	Soames, Hon Nicholas
Morrison, Hon C. (Devizes)	Speed, Keith
Mudd, David	Speller, Tony
Murphy, Christopher	Spicer, Jim (Dorset W)
Neale, Gerrard	Squire, Robin
Needham, Richard	Steen, Anthony
Nellist, David	Stern, Michael
Nelson, Anthony	Stevens, Lewis (Nuneaton)
Neubert, Michael	Stewart, Allan (Eastwood)
Newton, Tony	Stewart, Andrew (Sherwood)
Nicholls, Patrick	Temple-Morris, Peter
Oppenheim, Rt Hon Mrs S.	Thatcher, Rt Hon Mrs M.
Ottaway, Richard	Thomas, Rt Hon Peter
Page, Sir John (Harrow W)	Thompson, Donald (Calder V)
Patten, Christopher (Bath)	Thurnham, Peter
Patten, J. (Oxf W & Abgdn)	Townend, John (Bridlington)
Pattie, Rt Hon Geoffrey	Trotter, Neville
Pollock, Alexander	Twinn, Dr Ian
Powell, William (Corby)	Waddington, Rt Hon David
Powley, John	Wakeham, Rt Hon John
Prentice, Rt Hon Reg	Waldegrave, Hon William
Price, Sir David	Waller, Gary
Proctor, K. Harvey	Wardle, C. (Bexhill)
Raffan, Keith	Wells, Bowen (Hertford)
Raison, Rt Hon Timothy	Wheeler, John
Rathbone, Tim	Whitfield, John
Rees, Rt Hon Peter (Dover)	Winterton, Nicholas
Rhodes James, Robert	Wood, Timothy
Rhys Williams, Sir Brandon	Young, Sir George (Acton)
Roe, Mrs Marion
Rowe, Andrew	Tellers for the Noes:
Ryder, Richard	Mr. Francis Maude and
Sainsbury, Hon Timothy	Mr. Michael Portillo.
St. John-Stevas, Rt Hon N.

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 30 (Questions on amendments), and agreed to.

Mr. Speaker

forthwith declared the main Question, as amended, to be agreed to.

Resolved,

That this House congratulates the Government on the steps it has taken to facilitate and prolong the health and independence of elderly people; welcomes its provision for the increasing proportion of elderly and very elderly people in the population; notes the substantial increase in health care of elderly people in hospitals and in the community; and applauds the Government's success in helping elderly people to improve their quality of life.