HL Deb 05 April 1950 vol 166 cc820-51

2.46 p.m.

LORD SALTOUN rose to call the attention of His Majesty's Government to the alteration brought about by recent social changes in the situation of old or infirm persons and of persons living alone; to ask what measures they propose to deal with the difficulties which have arisen; and to move for Papers. The noble Lord said: My Lords, the question to which I wish to draw your Lordships' attention this afternoon has, I think, at least in its present form, arisen only during the past ten years. I am about to suggest to your Lordships that the measures for coping with the necessities of solitude and old age under the recent Acts and the reorganisation of the social services are either defective or ineffective. I shall begin by illustrating one side of the subject by a few examples which have come to my notice during the past six years but, with your Lordships' permission, I shall not mention the names of any localities, because it is in fact part of my case that other localities can show examples similar to those which I shall quote.

I have tried to enlist the services of a press cutting agency, in order to give your Lordships a more comprehensive view than my own personal observations can give, but the work was refused—I presume because it entailed such laborious work in searching the files of purely local newspapers. I will give your Lordships some examples of old persons dying, either of sickness or starvation or both, in complete abandonment and neglect. A few years ago, not very far from my house, an old man was found who had been dead four days. He was living alone, and when he fell sick he was unable to rise and obtain food or attend to himself. Even had he received attention, of course, it is possible that he might have died—though that is not certain—but even if that had been so, in his last hours he would have received the ordinary attentions that are accorded to dying humanity.

Again, not very long ago in the North, an old lady was found who had been dead for nearly eight weeks in her house. Your Lordships must remember that these old people are apt not to call for assistance until they become too ill to do so, and then it is a question of whether disease or starvation terminates the affair first. In another town in the North I came across a case of an old man, blind, who was found dead. At the inquest the doctor said that had he been called in there might have been a possibility of hospital treatment. The coroner asked him: "Who would be responsible for a man such as this under the new scheme?" The answer was: "Nobody, so far as I can see. It is a terrible situation." I have heard of two other cases, one in the South, the other in the North. I have also come across another case, which through a piece of good fortune, did not occur, which I shall quote to your Lordships later on as illustrating a point which I wish to emphasise. It seems to me that, if one man without any serious effort can come across so many cases in six years, Parliament has a right, and I think a duty, to ask whether this is merely a "fluke" or what is the seriousness of the situation it has a right to be fully informed of the matter and also to consider what improvements in the present system are called for to cope with the evil.

I have several letters on the subject and, with your Lordships' permission, I will read to you part of one of them which is useful as it will serve to illustrate nearly everything that I propose to say. I think there is a serious gap between the social welfare services are the hospital services. …I have made no serious inquiry into this problem. Therefore, I cannot give you any accurate information as to the numbers…I have had several cases brought to me for help of persons infirm and, in some cases, bedfast, for whom there was no room in the hospital"— this is the hospital side of it— …and who could net be removed to the social welfare hostel, and had no one except probably the next-door neighbour to look after them. Formerly, cases of this kind would have been reported to the public assistance officer, who would have made arrangements for their admission in the public assistance institution. Under the present scheme, the medical department of the public institutions has been taken over by the Hospital Beard, which keep the beds for hospital patients, whilst the hostels under the auspices of the Social Welfare Committee can accommodate only those aged persons who are physically fit. Perhaps one concrete instance will put the matter clearly. An old lady of eighty, who was too ill and infirm to move from her bed, lived alone in an almshouse. Her only help was the next-door neighbour, a person over seventy years of age. The old lady of eighty was locked n the house about 8 p.m. each night, and stayed there alone without anyone to give her a drink or make, her clean and comfortable until the next morning, when about 8.30 a.m. the neighbour called again. The doctor made repeated application for admittance to hospital for a period of some weeks, but was not successful in getting the old lady removed. I appealed to the health offices and managed to get a 'home help' to give some assistance to her. I have spoken of this problem to the chairman of the social welfare. committee who admits there are cases of this kind, but says that it is the responsibility of the Hospital Board to allocate the beat for persons who are bedfast, and the pressure for surgical and maternity cases is so great that there is no room for those who are infirm or suffering from long-term sickness.

My Lords, almost every point in that letter will be illustrated in what I am about to say. In a recent circular of over one thousand words, the Ministry admits, not exactly the evil but the public concern about the problem. The remainder of the leaflet is devoted to praises of the present system—it is rather in the nature of a "puff," I am afraid—with the further suggestion, the only concrete suggestion in the leaflet, that more voluntary aid should be enlisted, and that voluntary committees should be formed. I was very glad to see that, because I am told that since 1948 voluntary workers have been steadily edged out of the welfare services, and I hope that this leaflet indicates some change of attitude on the part of the Ministry with regard to voluntary workers.

In what I am about to say now, I am particularly anxious not to give the impression that I do not value the work of voluntary committees and voluntary workers. They have a place—I think a very important place—in the new system. But I have one rather strong objection to handing over all real executive responsibility to any committee, because with committees I always feel that if anything goes wrong no one is personally to blame and everyone, even the most public-spirited, has an interest in not having too much publicity over what has happened. In fact, so far as I can see to-day, all the forces tend to make for concealment, which is a bad thing.

In the case in which I quoted to your Lordships an extract from the inquest, I happened to be staying in the town concerned, and was talking to members of the town council. I did not know of this case at the time, although it had just occurred. But I talked to them about this question of the old people, and I was told very positively that they had taken excellent measures to meet the dangers, that they had a committee which regularly visited every case in the town and that no such thing could possibly occur. Supposing I had known of this case and had said "What about this?" The reaction of my friends on the council would have been that this case was exceptional; that the committee must not be judged by a single hole in the net; that that net could be easily repaired and that only harm could come from wide publicity. The last thing that even the local Press will wish to do will be to make too much of a failure on the part of the most public-spirited people in the town. Nor can one really blame the people who are honestly doing their best.

I remind your Lordships that in the "bad old days," things were different. Had any of the cases which I have mentioned occurred before 1940 the relieving officer might well have had to face a charge of manslaughter; he would certainly have been pilloried in the Press. Our national passion for keeping our neighbours' consciences would have had full play, and there would certainly have been a strong searchlight of publicity turned upon the matter. The noble Lord, Lord Kershaw (I am sure he will not mind my referring to it), has expressed to me privately doubts about the manslaughter aspect, but I have my reference—namely, Rex v. Curtis, a case of manslaughter heard in 1885. I have not read the case, but I am told that it had a tremendous effect on the profession of relieving officers. They always tell me with some pride that they did their work, and if they did not they would be punished for their failure. I do not think there have been many such cases before 1940, and I do not want your Lordships to think that I am asking for a return of the old system. I am very anxious, however, that the good points of that system should not be done away with, or that, if they have been done away with we should regain them.

I have told your Lordships about a case of that kind that did not occur. It concerned the relative of a friend of mine, a person well known to many of your Lordships. The relative was an invalid lady who had deliberately cut herself off from her family, possibly on account of the effects of her illness. She lived in one part of London while my friend lived in another. The relieving officer in my friend's neighbourhood took the opportunity of seeing my friend and asked him for particulars about his relative. The reason was obvious. The relieving officer in the district where the old lady lived, had seen her moving in the street. He inquired about her and who she was, and ascertained that she was living alone, and he noted that one day she might become his responsibility. He set himself to work to find out who was looking after her, and he asked his confrere to obtain particulars. That is a very good illustration of the way these things used to work. As a matter of fact, quite recently, the lady became ill and was confined to her room. Through the kindness of her neighbour, her family were informed and she was looked after in her last moments. But if nobody had known about her, if she had had no family, or if her relatives had not looked after her, she might have become number six on my list, because those whose duty it was to deal with the case had not the necessary information.

Before giving your Lordships a detailed idea of what I would like to see done, I think I should make some remarks about the general situation of the elderly, apart from those who are living in solitude. We must always bear in mind that this is not a question of wealth or poverty. In fact, the people who are in receipt of public assistance are probably better off in many respects than those who are well-to-do. It is estimated that to-day there are in the country about 7,500,000 people over sixty years of age. Though people do not become really old until a few years after sixty have elapsed, that is the nearest figure that I can give your Lordships; I have no figures for the higher ages. Many of these people—in fact, the great proportion—are living with their relatives, and when they fall sick they are sent to hospital. Quite often when they are ready to leave hospital, their relatives refuse to take them back, and that creates a very great difficulty.

Your Lordships will remember that in law it is now no longer the duty of children to maintain their parents. It was probably in deference to opinions held by noble Lords opposite that that duty was removed. While the duty remained in law, I think it was recognised by the people as just, and it was carried out with a fair amount of affection and a sense of duty; but to-day the duty no longer exists, and the looking after of our elder relatives is felt to be irksome. It is a very irksome duty and the acid of irksomeness rather eats away affection, so that one gets many cases of people refusing to take back old people who have been sent to hospital for any reason. As a result these old people cannot leave hospital, and they occupy valuable beds which are really required by others.

In this connection I have been told by people who ought to know (I do not know if it is true) that there are sufficient hospital beds available for all the work that hospitals ought properly to be called upon to do, including caring for the old when they are sick, hut there are not sufficient to furnish beds for old people who go to hospital for quite temporary reasons and then have to remain there permanently. I should like at this point to say to your Lordships that the system which has grown up is bad for the old people, just it is bad for the hospitals. So far as I have been able to find out, and from my experience, old people are much better out of bed. It is the one way of preventing their becoming bedridden. If they once take to their beds for any period of time, they may never get up again. Anyway, they are much healthier whet they are moving about.

Now I have some suggestions to make to your Lordships for coping with the evil, and I think they can all be adopted, according to the circumstances. I suggest, in the first place, that wherever possible old people ought to be maintained in their own homes. For this purpose we want a very much larger "home help" service. I have heard the "home help" service criticised and I have also heard it highly praised, but I think that the trouble with it is that in winter and where there is a big demand unsuitable people are employed in the work and there is insufficient supervision. It is a kind of work where there ought to be a certain degree of regular supervision. But where it is possible to get home help for old people, that is a very useful way.of dealing with the problem.

Another point is connection with those who are living with relatives. I suggest that local authorities should be empowered to pay the relatives two or three guineas a week for the keep of the old people. I suggest that for this reason. Those relatives have no duty to look after those old people and therefore there is no need for them to do so. They have therefore a right to receive a consideration. It costs seven, perhaps eight, guineas a week to keep an old person in hospital. It would be much cheaper to the public and very much better for the old people and for everybody if they could be kept with their relatives. It would save the public purse, and I cannot see that there would be anything wrong in it. My third suggestion, which I think is already being put into practice to some extent and which is very important, is that adequate homes should be provided. By adequate homes I mean homes suitable for different kinds of people, people of different habits and different tastes. They should be places to which people could be induced to retire voluntarily. It is much better to get this work done voluntarily than by compulsion. If that were done we should have to see that arrangements were made for different kinds of homes for able-bodied old people and for those who are frail. In this way these old people would enjoy a brighter and more varied life, and hospital beds would be freed for those who really needed them.

Apart from the "home help" service these suggestions have hardly touched on the needs of the people with whom I began—namely, the old people who are living in solitude. I know that the local authority has power to remove these people to homes, but I wonder whether the Government really contemplate an extensive use of this power. I very much hope not. What happens to their property? Who is responsible for the lovely enamelled snuff-box or some picture—those things which still make the pleasure of old people through their connection with happier times? It is not an answer to say that the county council are insured against any losses of that kind. I am thinking of the old people who will go back to their properties one day. I believe that that is a very important matter. This power of compulsory removal is, I feel, a very considerable abridgment of the liberty which we have always been accustomed to enjoy. I am certain that no Tory Government would ever have ventured to take to themselves so drastic a power. However, in spite of these powers there seems to me to be no organisation to give us what we need in this matter. The first thing we need is early information of cases which are likely to give trouble (that is the most important thing); and the second is the duty of regularly visiting these cases when they are known.

If I had to organise this matter myself I would make the welfare of these people the concern chiefly of the borough. These cases really do not concern the county; they are all town cases. I would make the local welfare officer responsible, and I would give him a district which was small enough to enable him to know it thoroughly and to become accustomed to the people whom he met in it on his daily rounds. Then I would make him just as responsible as was the relieving officer. He would thus have the same inducement to form the necessary connections and liaisons, and to ferret out these cases. For all those reasons the area under his supervision would have to be small. Without something of that kind I do not see how we can avoid these very lamentable cases.

One of the things about which I would like some information—and this is why I am moving for Papers—is: What is the real extent of the evil? How many of these cases have occurred during the past ten years? I think that we ought to know. If we are going to put this burden on the welfare officers I suggest that they ought to be given certain powers. They ought to be given the power of requiring a hospital to furnish a bed if necessary. In the old days they used to have the power to ask a hospital to provide a bed for a patient, and if the hospital could not make a bed available it had to find a hospital in the area which could. To-day that power is not there, and we get cases like the one which I have no doubt your Lordships saw reported in the papers the other day: an old lady was sent to a hospital with a broken femur, and because the hospital had no room for her she was given a couple of tablets and sent back home. She died. As we know, a broken femur is not, as a rule, a fatal injury.

The second need is that of visiting. That is a thing which I think might usefully and suitably be undertaken by voluntary associations. In this connection I would like to ask for the assistance of the churches in providing for more visiting. They nearly always know their old people. I believe that in this respect the Women's Voluntary Services have done wonderful work. But whatever arrangements of that kind are made, there is one thing that we certainly should have and that is insistence on any visitor to an old person sending a written report of the visit—possibly on a regular form—to the local welfare officer for his information. It would be absurd to impose on voluntary societies the responsibility for the discovery of these cases; that must be the duty of the welfare officer. But if we adopted my suggestion I think we should be in a fair way to coping with the evil. I am sure there would be no difficulty in finding plenty of voluntary visitors. Even in these days there are some people left with sufficient leisure, sufficient good-heartedness, and sufficient of what I shall call natural Toryism to welcome an opportunity of personally assisting their neighbours. I beg to move for Papers.

3.11 p.m.


My Lords, I rise, perhaps not altogether inappropriately, after Lord Saltoun's sudden appeal to the Church. I should like to take the opportunity of expressing my own thanks to him for the plain and practical way he introduced his subject. Of course, it is a matter about which one can expend a great deal of sentiment, but practical effectiveness would probably be in inverse ratio to the amount of sentimentality expressed. I should like to follow his excellent example I do not suppose that it is possible to deal with matters of this kind without making sure that there is an evil to be remedied, arid I noticed that the noble Lord spent some time in trying to establish a case. His case could be established only by enumerating a number of actual instances, and I hope noble Lords will forgive me if I add very briefly to those instances which the noble Lord has already given.

I have in my hand a report sent in by one of our church workers, who strongly emphasises precisely the state of things suggested by the noble Lord. Here are some remarks made.

It is almost impossible to get an old person into hospital. Only recently an old man was left entirely in the care of his mentally deficient daughter. For days he was left unwashed, the doctor just remarking, 'No use.' Another case was that of a bedridden man sent home, and his wife, an invalid, had to get out of the one bed in order to let him occupy it. Afterwards she was found lying on an old sofa, and after a fuss we managed to get the pensions people to buy a bedstead, which they did, but no mattress. We managed to get a mattress from the Church Army and now they both have a bed. A daughter who is at work nearly all day long is doing her best for them in between times. The story continues: The secretary of my Women's Fellowship has her father-in-law ill, and the doctor has told her that he is too old to go into hospital. Certainly he is ninety-two but they cannot lift him, and have a very bad time. So I could go on. and I am sure many others could. The fate of aged sick people now is really pathetic. I mention those instances merely to reinforce the case already set out by the noble Lord who has just sat down. I appreciate greatly what he said about the possibility of calling in to a greater extent the aid of the voluntary societies. I think it would ill become anyone speaking on a matter of this kind not to say how grateful we are to the law for all that it has done in recent years. Actually, the position in regard to old people is decidedly better than it was a few years ago. I am not in the least grumbling against the law, or asking for any remedy in law; I am asking merely, as the noble Lord himself did, that the law should be more adequately applied. I think it is true that there are a number of instances in every part of the country where some such improvement in administration is obviously required.

Let me again follow the noble Lord's example in suggesting some practical steps that could be taken. In the first place, we ought to do something about ensuring the possibility of admitting into hospital old people who are sick. I have no doubt that the noble Lord, Lord Webb-Johnson, will talk about this matter from the medical point of view. I imagine that one of the great difficulties is not the lack of beds (probably there are enough beds), but the lack of nurses. That is a serious situation with which we are all concerned. All I can say from the Church's point of view is that we are prepared to do everything we can to support any move made by the Government in order to increase the recruitment of nurses. In my own diocese, and in the neighbouring diocese of Southwark, the Church is undertaking a kind of campaign to try to induce more young women to recognise the possibility of a vocation in nursing. When we can secure an adequate supply of curses I have no doubt that we shall be able to offer old people admission to hospital.

That, of course, only deals with the minor part of a great problem. What we need is to think of the old people as a whole, and particularly of those who would be greatly benefited by being enabled to maintain their own independence of life. What is necessary is some care about their housing. It is an undoubted fact that at the present time many old people are in much graver difficulties than they need be because they are not satisfactorily housed. It ought to be possible to ensure that local authorities, in every housing estate they establish and in every block of flats they build, arrange a certain number of houses and flats which can be used by old people. If small flats of two rooms were provided—sometimes even of one—on the ground floor, where the people would not have to mount a number of stairs, it would be possible for old people to find comfortable residences for themselves. That is a matter about which the voluntary societies cannot give a great deal of help, although we have voluntary societies which do excellent housing work. There is another way in which we can do work of real value to the country and to the old people, and that is in the establishment of what are called residential homes. In such homes old people can be properly looked after and given adequate care and a certain amount of nursing, until they become too ill to be left in that kind of residence and have to be taken to hospital. I am sure it would be a cheap way of dealing with this great problem if voluntary societies could be helped to build and maintain such residential homes.

One other point which it is important to stress is the need for fighting a real war against the solitariness and isolation that are the bane of the declining years of many old people. We ought to do all we can to bring them into the society of their fellows. One of the most moving experiences I have had is when I recently went down to the East End to look at a club. The club was a joint concern, run by the local authority and the church. I went into a vast room where there were quantities of whist tables with parties, sometimes of men and sometimes of women, sitting round them. There was not an empty table or an empty chair in the whole vast building. Some of the people were playing dominoes, some were playing cards, and some were knitting; and all of them seemed to be extremely cheerful. There was a babel of happy conversation which showed that the atmosphere was of the best possible kind. That afternoon I realised how much could be done by joint action. I feel, therefore, that in this problem there is great scope for co-operation between local authorities, the Government and the voluntary societies, and I hope the voluntary societies will be given every possible opportunity of doing all they can in the matter.

3.20 p.m.


My Lords, I am sure one of the first things your Lordships would like me to do is to give our general thanks to the noble Lord, Lord Saltoun, for having brought up this important question this afternoon. The last time on which your Lordships had an opportunity to talk about the plight of old people in this country was in 1947, when I myself put down a Motion which was spoken to by several noble Lords. I entirely agree with what the noble Lord, Lord Saltoun, has said about the trouble we have experienced through the break-up of the Poor Law and the abolition of the valuable office of the relieving officer. I expect some relieving officers were not very good, but many of them were really friendly with the people who came under their care. There was a certain value in the care of the old people being their personal responsibility, rather than that the aged should be taken care of by a committee, no matter how excellent the people composing the committee may be.

One of the subjects about which I should like to speak is my own particular interest in this work, which is purely on the medical side. One of the difficulties, which has been mentioned both by the noble Lord, Lord Saltoun, and by the right reverend Prelate, is the difficulty of getting people into hospital when they are sick. One learns from one's paper and finds from experience the great difficulty of getting admission for people who have turned the age of sixty or sixty-five, no matter what is wrong with them. It is not that these persons will not get better, but the fact that they tend to be in their bed for a very long time, when there are large numbers of younger people who are waiting for hospital treatment and care. Some authorities prefer to take in more people rather than admit those who are going to remain for a long time. But I feel there is a change of mind coming, certainly in the medical profession, because it has been found that one can rehabilitate people, of no matter what age, to an extent where they can be discharged from the expensive beds in hospital, where they are taking up the time of skilled medical and nursing staff, and be put into some kind of home where they can still be taken care of—that is, if they cannot go to their own homes. A certain number can go to their own homes, but in the case of many of these people who live by themselves, or with their families in very cramped conditions, it is practically impossible for their families to take care of them when they are not fit.

One of the strange things about London (it was mentioned in a report by the Nuffield Trustees, who met under the chairmanship of Mr. Rowntree in 1946 or 1947) is the large number of single or widowed people who live by themselves. The report covered two boroughs in London, one of which I know fairly well. There it was found that of single and widowed people over sixty-five years of age 45 per cent. lived by themselves. That seems an absolutely staggering figure, but that is what Mr. Rowntree found from a very careful survey. In other towns and country districts the figure was about 10 per cent. So there is this enormous number of people in London living by themselves, and by some pure chance—I suppose it is an economic one, under which one pays less rent for a room on the top floor than for a room on the ground floor—a large number of them do live on top floors. That means that when they have been sick with some fairly crippling disease they probably cannot go back home again, because they cannot cope with the stairs, the shopping, the cooking and the general housework.

Some of them can be helped by the local authorities, who can send helps and nurses, but there comes a time when something more than that is required. That is where the real difficulty arises now. What we need in this country is a series of homes such as those the right reverend Prelate mentioned, where people who are not particularly in need of nursing can go for care and attention—the kind of accommodation envisaged under Part III of the National Assistance Act, where the local authority can make provision for people who, by reason of age and infirmity, can no longer take care of themselves. That can be done by the local authority, and a great deal can be done by voluntary bodies, too. Mention has been made of the good work done by the W.V.S. They have a series of residential clubs in the country, and also a series of what they call nursing homes. People who are quite well are admitted to the clubs, but when they become frail and feeble they are not cast on the world but are transferred fro in the residential club to the W.V.S. nursing home. Therefore, there are two ways of doing this work: either through the local authorities or through voluntary bodies.

When your Lordships were discussing the Second Reading of the National Health Services Bill, I raised the question of the care of the chronic sick. I received a warm and encouraging reply from the Government that attention would be given under the National Health Service to see that more people were employed to take care of people in the chronic-sick wards. Most of those in chronic sick wards are people who have turned sixty or sixty-five years of age. I am pleased to see from some figures published recently (they appear in the report of the Minister of Health, published about a week ago) that there are now thirty-six people of consultant or specialist grade, and nineteen or twenty people of the registrar or junior grade, employed in looking after people in chronic sick wards. That is not very great progress, it is true, but it represents a larger number than were employed when the Bill was being debated by your Lordships; I think the number was then two, but it may have been three.

One does not wish to rush this service along too quickly, because one wants to get it done really well and on a solid basis, and not to get people employed who do not know much about the subject. Therefore, one should see an improvement in the treatment of patients in these chronic sick wards in the next five or ten years. I trust that the service will be on a big scale by then. That will mean pari passu that it will be essential for places to be established to which people who have been rehabilitated can go. That is where the importance of these homes arises. I feel that these homes should be provided as quickly as possible, because by that means we shall he able to get patients discharged from their expensive hospital beds into some place just as comfortable and more like their own home, where they can be looked after until possibly they may go back to their own places, or, if not, until they die.

A great deal of work of that sort has been done in the county borough of Rochdale, in Lancashire, where they have established a large number of homes under Part III of the National Assistance Act. By doing that, they have managed to transfer from the wards of the Rochdale Infirmary the patients who were there for purely social reasons, so that the wards are now free for the treatment of sick people and not the non-sick and destitute who were formerly filling them. I am sure the example of Rochdale should be widely copied. It is possible that it is already being copied, and I do not want to be unfair to other county boroughs who are doing this work, but that is just one case I came across comparatively recently. Another body who have realised the need are the King's Fund Homes in London, who, as your Lordships know, have a large sum of money with which to contribute to hospitals things they do not normally have. Their work has been changed since the National Health Service Act, but they have set aside the sum of £250,000 in order to provide homes for people of this sort.

As I have said, the need for admission to hospital is very great. There is a fairly large charity with which I have connection which runs a series of houses in Kensington where people can take a single room and move in with their furniture. They are taken care of and are given a certain amount of help and attention. These houses are in two blocks. One block has no particular trouble in getting people admitted into a certain chronic sick hospital, but I was particularly distressed the other day to find that the other block has very great difficulty indeed. We made some inquiries about the difficulty, and were told that only one bed had become vacant in the wards of this chronic sick hospital in the course of the past year. Whether that meant that a patient had died or was discharged, I do not know. That shows the great need I mentioned a short time ago for people who can treat, remedy and rehabilitate these people and for the local authorities to provide the necessary homes. By carrying out that work, I think we shall go a long way to solving the problem of the infirm and sick person.

I will not touch upon the point mentioned by the noble Lord, Lord Saltoun, with regard to the method of tracking down people who are likely to be in trouble. I think the employment of some kind of welfare officer of the type he mentioned would probably be the most satisfactory method of doing that. This is too big a burden to put upon a voluntary body. They have to report somewhere, and there has to be some person responsible to take the decision as to what shall be done. One does not like to see people forcibly removed from their homes, but there is provision for that in the National Assistance Act. If action on the lines I have just put before your Lordships were to be taken, I am sure there would not be need for any drastic action about hospital beds. There would be enough, or very nearly enough, to go round, and we should have done a great deal towards improving the lot of the old people.

3.33 p.m.


My Lords, I rise to support what has been said, and I do not wish to weary your Lordships by saying it over again. It seems to me that the particular difficulties to which reference has been made cannot be fully resolved unless we look at the whole subject in its true perspective. The problem of old age is not merely a problem of infirmity or penury. It confronts each one of us, and a great deal of unhappiness in life is caused by people stumbling unawares into old age without being prepared for it in mind. That happens at all levels of society. Granted the ubiquity of the problem, those of us who have enjoyed leisure, security and health, some culture and wide interests, are better placed to meet the emergency than those who are straitened by poverty or ill-health.

One of the most important social changes in recent times is the fact that the problem of old age is no longer primarily a problem of poverty, though of course poverty is still a contributory factor. It is still most desirable that everybody should save if he can for that day, and not put his whole trust on pensions and State assistance. We have also to face the fact that the proportion between young and old in the population is going to change considerably in the next thirty years. At the present time those who are of pensionable age are about 13.5 per cent. of the population. It is reckoned that in thirty years that figure will have risen to 18.8 per cent According to the Report of the Commission on Population, the cost of maintenance at the present rate is £238,000,000 per annum. In 1978 the cost will be just over £500,000,000. Therefore the economic burden on the working population of thirty years hence will be enormous. It therefore seems that, for economic reasons alone, the State would be well advised to keep as ma-ay men and women of pensionable age in employment or partial employment for as long as possible. It seems to me that that subject requires more careful consideration than it has yet received, either by local authorities or, if I may say so, by trade unions. The time has come when we want to try and work out a labour policy for those over sixty-five years of age.

This afternoon we are looking at this problem not from the State or economic point of view, but from the point of view of human welfare. From that standpoint it is a great blessing if elderly people can continue in useful employment, or if they have the resources to occupy their days well. We all know of people, at all levels of society, who, when they have ceased their normal job, have fallen into days of retirement. Life loses its interest, and often health quickly deteriorates. When we think of the skilled or the semiskilled workers in the country, I suggest that it is extraordinarily important that those people should feel, when they come to pensionable age, that they are still wanted members of the community. Society has not fully discharged its responsibility towards them by providing a more or less adequate pension. I repeat that a lot more thought needs to be given to ways of keeping such people conscious and active members of a community. That, I would suggest, is the only really satisfactory solution of the sometimes quite terrible onset of loneliness. The other day an old man said to a doctor of my acquaintance: "After sixty, work is the best medicine, doctor."

Next to work, housing, as has been suggested, is extremely important. In the city where I live, a fairly thorough survey has recently been made of this problem, and the report is to be published shortly. Of 60,000 pensionable folk only 3.7 per Cent. are in public institutions, and only 3.5 per cent. in homes or hostels provided by trusts or charities or by the local authority. There is obviously urgent need to increase that provision, especially, as has already been suggested, for the very old. As vitality shrinks they not only become more solitary but often they lapse into squalor. We have also to take note of the changing pattern of society —smaller families, and smaller houses and flats. All this must make it more difficult in the future for the younger generation to house those who are getting old. In any event, I doubt whether it is the best of all arrangements for young and old to be on top of one another.

There is great need of accommodation suitable for old people; and along with it, as has been suggested, there should be a far more generous provision of home helps, some nursing care, and also more facilities for communal life. But as soon as one has said that, one wants to add something to counterbalance it: elderly folk naturally and properly want to go on living in the community where they are known. A hygienic house in a new housing estate miles away, where no one really cares about or knows them, may be all very well, but it is a very poor exchange in terms of happiness. There is in our country as a whole a fine tradition of families caring for their old folk, but unfortunately to-clay so many of the houses in our industrial slums are ill-designed and ill-equipped for infirm folk—though the same slums do at least provide community. Let us then by all means provide more clubs for old people; but the best club, probably, is neighbourliness—the neighbourliness of a little back street where they have been living for thirty or forty years.

So I would endorse, out of my limited experience, all that has been said this afternoon. I would urge that more effort should be made to make even rather bad houses less unsuitable, bearing in mind that in the long run community matters more than mere comfort. I feel that the noble Lord who introduced this debate was right in saying that the old-time relieving officer was often an invaluable friend. His weekly visits were of great comfort, but he has not been replaced. While more supplies have been laid on, the human touch has often been lacking. As things are, the routine visits of the welfare officers occur far more rarely than the visits which the relieving officers used to make. I think our practical concern should be: How can the human touch which was exercised by the best relieving officers be preserved? I should like to endorse the suggestion made that here is an obvious outlet for voluntary service and Christian neighbourliness, untainted by dole-giving. Provided that it is supervised and co-ordinated with the work of the trained State or local authority welfare officers, such work can be done by ordinary, reasonable, kindly members of the community gifted with common sense. I agree with my brother Prelate that here is a work that should have the full support of the Churches; and it should be done in co-operation with both the local authorities and the Government departments.

There is one other matter to which I should like to make reference. There are scattered up and down this country numerous parochial charities and gifts which have long since ceased to serve any useful purpose. It would surely be a good thing if these very considerable charities could be pooled in the several localities for the purpose of providing a valuable supplementary fund out of which amenity schemes for old people could be financed—home helps, more clubs, repairs to wireless sets and so forth, and some kind of shopping service for those who are too old to shop for themselves. Be that as it may, I would end these few remarks on a subject with very wide ramifications by thanking the noble Lord, Lord Saltoun, for raising this matter, and by reminding your Lordships that the aged, to whatever social group they belong, cannot be treated en masse; they have to be considered one by one. Just because they have lived a long time in this world they become more individual, possibly, than youth, and therefore their care should be the concern of the whole community and of every good neighbour. And it is a care in which the State, the local authorities, the Church, voluntary organisations and all well-disposed individuals should co-operate.

3.48 p.m.


My Lords, like noble Lords before me, I should like to express my thanks to the noble Lord who has moved this Motion, because he has introduced a subject that is of very great importance. It is naturally a very wide one, and I rise to speak on an aspect which has not been mentioned before—I refer to the old people who are gentlefolk, who are so often forgotten. Many voluntary charitable associations are doing a great deal of work on their behalf. I speak to your Lordships as chairman of one of these societies a society that does its best to assist and to look after one section of these old gentlefolk, but I sincerely hope that any remarks I make will not be taken merely from that angle, because many of the difficulties that have been mentioned this afternoon apply to all sections. The noble Lord, Lord Saltoun, mentioned in the course of his speech that this is a new problem. I would emphasise that point; it is a new problem that has developed very seriously during the last few years. At the risk of repetition, I hope to illustrate how difficult that problem has become. One of the greatest difficulties that voluntary societies have to-day, as has already been said, is to find out about these old people. We are anxious to know of them, but a great many of them do not like to come forward and say that they are badly off. We therefore have to ferret them out.

Another great problem which has already been mentioned is that of hospital accommodation. Though previously such accommodation may not have been as good as it might have been, it was at least nearly always available for the old and the infirm. Nowadays, in the State hospitals, it is almost impossible to find that accommodation. The result is that these old people have to depend more and more on the voluntary charitable societies. Frequently, though the homes that they run may be moderate in cost, the expense is beyond the means of these old people. Therefore, very often they have to be supplemented in one form or another—for example, under the National Assistance Board regulations. But in such a case, of course, these homes are and have to be subject to a certain amount of control by the local authority.

Much has been said about hospital treatment for the sick. I do not want to repeat what has been said, but I should like to emphasise it with one illustration. It is the case of an old lady of seventy-six, suffering from pneumonia, who was admitted to a State hospital at the end of November. She was discharged at the beginning of January, and was transferred to the sick bay of a convalescent home run by a charitable society. Three weeks later her condition became so unsatisfactory that she had to be put back into an independent hospital, where she remained for a further three weeks. After that, it was felt that she must again have another three weeks' convalescence before being allowed to return home. Altogether, it was nine weeks from the time she left the State hospital, going from one home or hospital to another, until she was able to return home, all because of the difficulty of accommodation in the original State hospital.

Then, in connection with the convalescent homes, we find it impossible to get an old person into a State convalescent home except direct from a State hospital. In the past, the only requirement in order to obtain a place in many of the convalescent homes where such accommodation was free, or where perhaps there was only a small charge to pay, was a doctor's certificate. To-day, an old person who has not been able to obtain hospital treatment and who has stayed at home cannot obtain convalescence without payment, which payment he or she may not be able to afford; and so they have to fall back either on relatives who are not well off or on one of the voluntary charitable Societies.

Generally speaking, we have found that the officers of the National Assistance Board have been doing what they can to interpret with sympathy and understanding the regulations which they are bound to observe, but it would seem that until there are more homes suited to the needs of old people, some relaxation of the regulations may be necessary if further hardships are to be avoided. Until local authorities can meet their obligations under the National Assistance Act, I would suggest to His Majesty's Government that every encouragement should be given to all voluntary charitable societies in order to help them meet the present demands and so that they may be assured of financial assistance for those for whom accommodation is supplied. I would add one further final suggestion—that is, that Assistance Board officers should do all they can to help those old people in voluntary homes.

3.55 p.m.


My Lords, perhaps it is only right that in spite of the cloud that hangs over us from yesterday's debate and which is to be renewed later this afternoon, we should give some thought to this serious social problem. The emphasis this afternoon has been laid on the old. I do not know why such a young and vigorous House as this should concentrate all its attention on the old. We should not have any particular bias, and the terms of the Motion of the noble Lord, Lord Saltoun, include "persons living alone."


Hear, hear.


We are not concerned only with the old. Some of my most pathetic and sometimes tragic experiences have been in finding young people quite alone—very often unfortunately, by their own choice—in the trend of feeling which seized young people in a previous decade when they wanted to get away from the ties of home and have a little flatlet. There they were all alone, sometimes desperately sick; some sympathetic neighbour had summoned the doctor; the doctor had called for consultation, and the situation was found to be desperate. This problem arises not only with the old people, low the old are perhaps more isolated. The youngsters can seek assistance from friends, and are more active, while the old people are not always so sick as they imagine. Many of them who go into homes for incurables would be found to be quite capable of rehabilitation if an enterprising medical staff were appointed. That is one of the tragedies of the homes, particularly if they are labeled "Homes for incurables." The noble Lord, Lord Saltoun, made a gross surgical error in referring to a fracture of the femur in an old person as a comparatively trivial injury. In a large proportion of cases it is the final event, so I warn those of your Lordships whose bones are getting a little calcified to be careful of any edge of the carpet you may meet on the way out from this Chamber, in case you sustain a fracture at the neck of the femur. If you are so unfortunate, I hope you will leek expert assistance quickly, because it is not by any means a minor injury.

The general impression is that the problem of old people has become much greater in recent years, hut that is only an impression. The Motion moved by the noble Lord is therefore fully justified, because we want to be fully informed on this matter, whether it is an increasing or a decreasing problem. I do not want to spend time repeating what has been said before, but what has always struck me in my experience is that the most successful experiment in the effort to solve this problem was that which was devised by William Whiteley and which I have seen in action. He established homes in the country for aged people, and put into that colony a nursing service. That is perhaps the kindest thing that can be done for old people who are more or less infirm, or at least who are alone—to arrange accommodation so that although they have their own homes, nursing assistance is available, either within a little colony or in a block of flatlets in the heart of a city. And those flatlets need not be confined only to the aged a proportion of them could be occupied by young people.

The right reverend Prelate the Bishop of London referred to me personally as likely to offer either some additional problems or some possible solutions. Apart from the ideas which I have suggested, I do not know that I have anything material to contribute. I should like to correct the impression that the Government should be blamed because somebody is not taken to hospital at once. To get an old patient or a chronic sick case into hospital has been a problem for the last century—in my own personal experience, for the last half century. It has always been a problem, and in the great general hospitals you could see the fright of the resident staff if they saw a case of fractured femur in a bed, because they did not know how they were going to get rid of the patient and they were not going to be able to do anything for him except wait. There is a different approach to the subject to-day. Naturally, the hospital staffs did not want a bed which might be occupied by a series of patients whose lives might be saved, to be blocked by a chronic case which might sojourn there for months. This is not a new problem, as I think the noble Lord, Lord Saltoun, realises full well. Nor did I gather from his remarks that he was trying to attach blame to the Government because there was no immediate solution.

There is one final word I should like to direct to the right reverend Prelates—namely, that the real solution, apart from cases which are too heavy a burden and cannot be supported in the homes of the younger generation to-day, is to help the younger generation to keep their old folk in their homes. If the last days of these people are to be happy, they are going to he happy not by their being put into a community with a number of other old people they are going to be happy because they are mixing with the younger generation—and happier still if "generation" is in the plural. The happiest old people are the grandparents.

4.4 p.m.


My Lords, it is typical of the breadth of argument in matters that are debated in this House, that for an interval between considering armaments and the engines of destruction we should devote ourselves to a subject which is essentially humanitarian and one of peace. We are all indebted to the noble Lord, Lord Saltoun, for raising this subject, and I think I detect general agreement that neither he nor other noble Lords who have taken part in the debate are criticising the present scheme of things, but rather are anxious that any weaknesses in the scheme, such as it is, should be discovered and any defects removed.

The noble Lord refers in his Motion to "recent social changes." I take it that by that he means the introduction of the new National Health Service and the National Assistance scheme which came into operation on July 5, 1948. I should be disposed to use rather a stronger term in connection with these matters than to speak of them as "social changes." I would claim that there has in fact been a revolution in our method of dealing with our aged and infirm people, and with people who need assistance in one way or another—in fact, anyone who hats fallen by the wayside in his daily life. I feel strengthened in that claim by the remark of the right reverend Prelate the Lord Bishop of London that the position to-day is infinitely better than it was prior to the introduction of these Acts which are the subject of the noble Lord's Motion.

I start from that standpoint—namely, that we are all agreed that the services provided for our aged and infirm people are, in the words of the right reverend Prelate, infinitely better than they were formerly. But one should not say that in the evolution of the new scheme there may not appear defects, some of which have been 'pointed out this afternoon. It has to be remembered that formerly—the noble Lord, Lord Saltoun, and other noble Lords have referred to this point—practically all the assistance needed by the aged or the infirm was given through the relieving officer and the board of guardians. It is suggested that the present division of responsibility has been created by the new Acts; the National Health Service Act in respect of incapacity and sick people, old as well as young, and the National Assistance Act in respect of those people who for one cause or another can have their necessities met by money grants. There are also the local authorities who are now responsible for domiciliary help. Anyone who, by reason of infirmity or handicap of a nature not usually regarded as illness, can be taken care of by the local authority, who by Statute must provide homes or otherwise see that those people are taken care of by relatives and friends.

I cannot understand why the noble Lord, Lord Saltoun (though perhaps I misunderstand him) seems to be in favour of the return of the old Poor Law system of dealing with aged and infirm people. I believe he is quite mistaken in thinking that only the fear of a charge of manslaughter caused the relieving officer to do his duty. I prefer to say that the relieving officers probably did their duty, as most people do, from sense of wanting to do their job well, and in a spirit of humanity which should pervade anyone who has to deal with this type of person. Since the noble Lord quoted a particular case, I think I ought to tell the House that the case to which he refers is the only one that was ever taken under the old Poor Law, and that was in 1885.


Yes, I said that.


The Poor Law officer in that case was acquitted, and it is the only case that was ever taken under that Act. There is no other occasion on which a relieving officer has been prosecuted. I make quite definitely the claim that good or had—and there may have been both kinds of relieving officers in the past—they have never ordered their method of dealing with these cases by fear of consequences of the nature mentioned by the noble Lord, any more than the present officers under the National Assistance Board would be influenced by fear of consequences of that kind. At the present moment, as I have said, the State is responsible for the provision of hospital treatment and medical treatment generally through the National Health Service, while the National Assistance Board are responsible for money relief and the local authorities are responsible for any domiciliary help that may be necessary.

The noble Lord, Lord Saltoun, has spoken of old people dying under conditions of complete helplessness and abandonment. I suggest to the noble Lord that in whatever system we have, short of a system of snooping to which neither he nor I would agree, such cases of elderly people dying lonely must occur. I know that the noble Lord is, under the impression that the relieving officers had a special capacity for detecting these cases in their normal course of walking about the streets, but I think it is only fair to say that several of the cases which he quoted to illustrate his point occurred before July 5, 1948. Therefore even under that system the cases were not detected in time to prevent these unfortunate deaths.


I did not want to interrupt the noble Lord but if I may venture to do so I would like to point out that I dated my remarks from the time when old people were taken away from the responsibility of the relieving officers in 1940. After 1940 relieving officers had nothing to do with the old people. That is why I took that date, because it is relevant.


I am sorry if I misunderstood the noble Lord. It remains equally true, I think, that it would be impossible to avoid cases of this kind, whatever the system. It has to be remembered that in the main the people with whom we are concerred can be divided into two classes—I mean that only in the sense in which we are discussing this matter. One class manage somehow or other to maintain themselves on the old-age pension. It may be that they are helped by their relatives and friends; that is to say, they live with their relatives and friends: they probably do in the main. The proportion of lonely people in that particular class can never be very high. The other class whom we are considering to-day are the old-age pensioners and elderly people who for one reason or another do come within the purview of the National Assistance Board. When that happens it is fairly certain that the national assistance officer, the welfare officer, and other people concerned with the granting of additional help, will be in sufficient touch with these people. I know that the noble Lord has said that with the aid of a form they can get one of these officers to visit them. But I would point out that the form with which they are supplied in order to get the help of an outside person is a form unlike most forms which emanate from Whitehall, because it requires no filling up whatever. It already has on it the number of the person and requires only to be put in the pillar box for one of the officers of the Assistance Board to visit.

I would like to assure the noble Earl, Lord Buckinghamshire, that it is not quite correct to say that voluntary homes cannot be assisted through the public funds. If he will go into the matter he will find that even without the control which he suggested accompanies help of that kind, there are ways and means of helping the people whom he has in mind. Though I am not complacent about the cases which have come to light, I think we may fairly claim that under the present system which entitles everyone to free medical service it is less likely that anyone can suffer in silence or alone. Anyone who happens to know of a person who is ill can now send for the doctor and be assured that he himself will not be called upon to pay the cost. For that reason, if for no other, it seems fairly clear that the possibility of persons dying alone has been reduced. I do not say that it has been eliminated completely.

We have to admit at once that there are a number of old people who ought to be in some kind of institution. We know that there is a shortage of hospital accommodation for everyone, but I think it right to inform your Lordships that the total number of beds for chronic sick cases available in the National Health Service hospitals in England and Wales at the end of last year was about 57,000. Of those, five or six thousand were unoccupied because of lack of nurses. That is a difficulty which is gradually being overcome. It will appear from such statistics as are available that the number of beds unoccupied because of the shortage of staff roughly corresponds to the number of known cases of elderly people who would be all the better for hospital treatment. It will be within the knowledge of many noble Lords who have spoken (it is clear that my noble friends Lord Amulree and Lord Buckinghamshire themselves take a constant part in the administration of our hospital services) that there have been moves made—


May I interrupt the noble Lord for one moment? My particular interest is not a hospital but a voluntary charitable society.


Perhaps the noble Lord will remedy that defect in his public duties as soon as possible. At any rate, it will be known that, having regard to this known shortage of beds, there is a system now in force whereby all the beds in an area can be pooled to find out where, within that area, there happens to be an odd bed or two vacant. That has helped in relieving the pressure we are concerned about at the present moment.

I am sure the right reverend Prelate the Lord Bishop of London will be pleased to know that housing authorities are encouraged in every possible way to make special provision in their housing schemes for old people by the provision of small bungalows and flatlets. But, as has been said by many speakers, the solution of this problem does not lie in any one direction. From my own knowledge, I know of homes for old people—homes not too large and not too small —that have been provided by local authorities. I know of the efforts that are being made to bring together old people in the over-sixty years of age class. I am myself No. 1 and my wife is No. 2 of one of these "over-sixty" clubs which have been most effective in dealing with the loneliness which troubles old people. Speaking personally rather than officially, I think the idea of segregating aged people in homes has to be considered with extreme caution. There could easily be great sadness in such institutions when one after another of these old folk pass on, leaving behind a feeling of real loss among those who formerly had been associated with them. I believe that that phase of the problem will require greater attention than it has had hitherto.

Let me say, on behalf of my right honourable friend, that we appreciate to the full the services rendered by organisations such as the W.V.S., and by the churches. Without their help it would be almost impossible to do anything effective in this direction. But, having said that, I think the complete answer—and I say that advisedly—to the whole debate this afternoon, is to be seen in Circular No. 11/50 of January 23, quoted by the noble Lord, Lord Saltoun. I had not seen this circular before. After many years in public work of one sort or another, I. cannot remember there emanating from a Government Department a document that was so humane and so full of the spirit of brotherhood. If noble Lords will forgive me, I will quote one paragraph, because I believe it will indicate to them better than I can in my own words the spirit which is actuating the Ministry of Health in regard to the problem we have been discussing to-day. It states: The experience gained since the Act came into force by county and county borough councils in dealing with applicants for admission to the residential establishments and in other ways has shown an urgent need for further services of the more personal kind which are not covered by existing statutory provisions and which, indeed, can probably best be provided by voluntary workers actuated by a spirit of good neighbourliness. These services include the regular visiting of the old people in their homes, in helping them with the shopping, in obtaining magazines and books, in letter writing for them, in helping them to mend their clothes and generally in solving minor domestic difficulties. Who would have expected that kind of thing to come from Whitehall twenty years ago?

I submit that it may fairly be stated, without claiming that the present system is perfect and without being complacent about it, that the possibility of old folks suffering in loneliness will be considerably diminished by the Health Services now available to everyone, and by the general interest which is now displayed in the subject of the welfare of the old people. I assure the House that my right honourable friend will give the most sympathetic attention to all the suggestions that have been made, and every effort that is practicable and possible is being taken and will continue to be taken to smooth the path of those who are lonely and in need of help or friendship.

26 p.m.


My Lords, I should like to express my gratitude to the noble Lords who supported me in this Motion, not excepting the noble Lord who has rejected the Motion. As I am not going to press for Papers and move your Lordships to a Division, there are one or two corrections I wish to make before the matter goes to the Minister. I should like to apologise to the noble Lord, Lord Webb-Johnson, for putting him under a false impression. I did not intend to say that a fracture of the femur was trivial, but to say that it is not necessarily mortal. I am sorry, but I thought I had said so. The noble Lord, Lord Kershaw, says the position of old people is better now than it used to be I hope that my naturally pugnacious manner did not lead him to think I was attacking the Government. There is not much use having a better system unless it is really brought to the people.

The noble Lord said I wanted the old system back and that he would be very sorry to see the return of the old relieving officer who did his duty through fear. I do not want the old system back, but I do want an official with responsibility for these matters in a small area which he can get to know. More than one relieving officer has spoken to me with pride about his position, as if to say, "I am a man who has executive duties and if I do not do those duties I am going to suffer for it." Would the noble Lord rather put that burden on an official to do his duty, even though it be through fear, or that these people should suffer the deaths that I have described to your Lordships? I honestly think he is mistaken in saying that these cases occurred frequently before 1940. It was the pride of the old relieving officer that they did not occur. The only case mentioned to me, and it was mentioned in the noble Lord's presence, goes to prove what I say, rather than the other way. In regard to what was said about the form for a visit by the Assistance Board, I would point out that when a man is sick and really needs a visit he cannot go out and post a form. The point I made about the form is rather different. I said that no member of a voluntary society should be able to visit anybody who ought to be under the care of a welfare officer, without having a form on which to report the visit and the facts which had been found out. That was always done in the associations for whom I visited. In regard to the leaflet, perhaps we understood it in different ways. I have never seen a leaflet which said so little in so many words. It does not really tackle the point: that we need an official who is definitely responsible for these old people. The noble Lord should study the figure of 45 per cent. given by my noble friend, Lord Amulree, which I think is much nearer the truth. With those few remarks and corrections, I thank your Lordships for your attention, and beg leave to withdraw my Motion.

Motion for Papers, by leave, withdrawn.