§ 2.38 p.m.
§ LORD SALTOUN rose to move to resolve, That this House regards with sympathy and concern the difficulties of old people, and calls upon the Government to secure the greatest measure of co-ordination between the Health Services and other social services, with a view to ensuring that adequate personal service and attention are available to such old people. The noble Lord said: My Lords, it is rather over a year ago since I drew your Lordships' attention to this important matter. When I did so, the Government questioned my facts, scouted my fears and painted a rosy picture of old age and poverty under the present régime. 328 I wish that I could see things through their rosy spectacles. Last year I asked for Papers, and explained that I wanted figures showing the number of cases where, as disclosed by coroners' inquests and inquiries of that kind, there had been neglect of the dying. I was told that the figures could not be procured and that my facts were incorrect. It is not easy for a private person to collect such figures, but over a period of rather more than eight months I have collected cuttings on this and similar subjects from local papers, which is where these things are to be sought. I would remind your Lordships that such a collection must be imperfect. I have made an analysis of the first six months, and as the later months were precisely similar I discontinued a rather depressing task. This analysis fully supports what I am going to say later.
§ The number of people found dead, in varying conditions and degrees of horror, over the space of six months, I found to be seventeen; and I have also come to learn privately of other cases which did not appear in the Press. In one case —and I do not think it is so uncommon as one would like to think—the dead man had been gnawed by rats. And there are other cases with similarly unpleasant concomitants. Therefore, I do not think I misled your Lordships very much last year. I do not propose to say again what I said then. I will say merely that I stand by what I said. Do these people die of disease, or do they die of starvation? Is there anybody who can answer that question? So far as I can see, it is part of the new system that these people are nobody's care, and these cases are accepted as normal. I refuse to accept such things as normal. I hope your Lordships will pardon me if, in order that you may follow what I am going to say, I briefly sketch the system of relief—I do not know what else to call it—which is in existence at the present time, and which we have set up.
§ The Ministry of Labour and National Insurance deal with old age pensions, sickness and employment benefit. The National Assistance Board deal with rent, clothing and the financial needs of poor people, old or otherwise. The county councils provide hostels for the homeless, and meet the difference between the hostel charge and the scale allowance of the National Assistance Board. They deal with mental cases, through a special duly 329 authorised officer; they deal with children, deserted and homeless, through the children's officer; and the education authority comes in through the school health officers. In passing, may I express the hope that some noble Lord who has time for it will look into the question of children? They also deserve some consideration and attention from your Lordships. The Ministry of Health deal with sickness, in particular through the regional hospital board. The local authority, the borough, deals with housing, and a private body, the citizens' advice bureau, deal with general advice on questions about divorce and other matters of that kind. I imagine that the county welfare officer would also act in that capacity, as his predecessor certainly did.
§ That is a picture of the machine that is working to-day. Your Lordships will see that nearly all these bodies deal with old age from one angle or another. I want to draw attention to one point in this machine. The National Assistance Board have a very large area to administer and a clearly defined function. Again, the regional hospital board, with a very large and different area, have one definite function. Then there is the county council, covering another large and different area, with a function which I suppose is intended to fill the gaps between the other two services. The point in which these areas, administrations and functions meet is the body of one man or one woman. Knowing as I do how careful public departments are and must be, to clear the ground with all others interested in the same matters, I am bound to say that I should be surprised if of itself this system worked really well. As a matter of fact —and I am going to submit this point to your Lordships to-day—the system does not work well, in spite of the strenuous efforts of all concerned. I want to emphasise that all concerned are making strenuous efforts to make the machine work. In some ways I rather wish that they were not, because then the faults of the machine would be more readily evident and some reform and amendment would be seen to be imperative.
§ To start with, I would take, for example, the relations between the regional hospital board and the county council. The hospitals have always been in a difficulty about old people, because 330 hospitals, in the first place, are intended to heal the sick and not to serve as homes for chronic and incurable cases. But when the duty of maintaining parents was removed from children, and when also the housing situation became increasingly acute and difficult, families began to refuse to receive back relations who had been cured in hospital, and the hospital was obliged to retain them, to the stultification of its proper function. Last year I made a suggestion, which I will repeat later, for dealing with the evil, though I do not want to argue the case again. I maintain what I said then. I have even heard of a case where the local county welfare officer actually advised a family that they were under no duty to receive back their old parent and they could "plant" him on the hospital, which was done. Such cases do not often get into the Press but, even so, I have one or two in my book, and I have received serious complaints from responsible people on that subject.
§ Some hospitals have managed to open a chronic ward, and the Ministry of Health have encouraged them greatly to do so, which is a good thing. They have a chronic ward with a long waiting list, and before they take an old person into the general hospital they obtain from the relatives a promise that they will receive the old person back. But, even so, they sometimes get "landed": last year that happened in numerous cases, and even to-day it still occurs. But the chronic ward has the advantage that it enables the hospital, in the course of time, to transfer there suitable patients, so relieving the hospital for its main task. In other cases, where the hospitals are unable to set up chronic wards, the local authority have been obliged to form their own, in spite of the fact that this is against the policy of the Ministry. I believe it will be found that that is done by the London County Council.
§ An important result of the situation which I have described is that hospitals frequently refuse to take an old patient. There have been cases (one of which I know personally) where a hospital has refused to admit an old patient, and where the doctor has threatened to refuse to issue a death certificate if the old patient died and said that he would call the hospital officials as witnesses at the inquest. I have in my book cases where that has 331 been done. Surely a system which leads conscientious public servants, in the interest of the public itself, to resort to devices of that kind stands self-condemned. It must require amendment in some particular if that is the result of the system. In six months I have collected details of eleven hospitals that have refused patients, and although such cases get into the Press only when there is something startling or newsworthy about them, I have found in the Press eleven more cases of conspicuously bad liaison between the hospital and the welfare authority. When we read of a case such as that in which an old man was refused admission to hospital because he was not ill enough and to a hostel because he was not well enough, and who died half-way between the two, public indignation is a little apt to seek individual scapegoats. But these things occur through a faulty system and not through individual malice or individual carelessness. That reinforces my argument that there is something wrong which needs to be put right.
§ I could also show that there is defective liaison between welfare and housing, but perhaps your Lordships will take this for granted, as our time is limited. The shortage of housing, for which the housing authority cannot properly be blamed, does lead to serious difficulties in the department of welfare, because it accentuates the demand for accommodation in county hostels, and the county are unable to provide that accommodation. I have even read of cases—and I have examples with me—where old people, although quite sane, were sent to mental homes because no room could be found for them in any hostel. Many people think that it is only necessary to provide new hostels and the whole problem is solved. With great respect, I do not hold that opinion at all. My own view is that as few people as possible should be sent to hostels. Seeing that one-eighth of our population to-day is over the age of 65, and that that proportion is steadily increasing, it must be obvious that if all the over-65's go to hostels, the remainder of the population will not be able to support the burden. Moreover, we have to consider that when a man goes into a hostel he tends to become infirm. If he is kept out of the hostel he remains active. I believe it is true that in the L.C.C. hostels between three-fifths and three-quarters of the 332 inmates are classified as infirm, which seems to substantiate what I was saying.
§ My noble friend Lord Amulree is going to deal further with hostels, and there is nobody better qualified to do so. I wish that more hostels were run on the lines of his own, and I am sure that, as time goes on, more and more will be. Before I leave the subject of hostels, however, I wish to point out to your Lordships, and to the Government, one evil which affects equally private homes and private nursing homes. It is that neither the National Assistance Board nor the welfare authority nor the hospital board pay the cost of maintaining patients in private nursing homes or hostels. In certain cases, they pay part of the cost—I believe up to 45s. a week. I think the condition is that those patients shall have been entered for a hostel or hospital, but in general they do not pay. The ground alleged for this refusal is, I understand, that these places are run for profit—that is, I suppose, that the people who own them expect to live by them. I am told by experts that most of these places are as good as those provided by the public, and that their charges are as low and often lower. I know of cases where these private nursing homes tend their inmates in a way the county homes are too delicate to do. They are all registered and inspected, yet because the owners are so wicked as to expect to live by their work, they are deprived of their due. If private places received fair treatment, their profits would probably still be lower than the salary of an assistant matron in a county home. In addition, they do not have time off or fixed hours. I do not know whether it is true, but I have been told that one motive for this rather unprincipled treatment—I think I am not being unfair in saying that—is to drive them out of business altogether, or to bring them into disrepute by forcing them to put away their old and helpless patients. It has not had this effect, however, and I know of one case where the Government have "sponged upon" one of these homes for hundreds of pounds. I am sorry to use so severe a term, but if any noble Lord or the Government can give me another term I will willingly substitute it. The authorities themselves own that the treatment is all that could be desired, and that sometimes it is given for only one guinea a week—that guinea being made 333 up of the 26s. old-age pension, less the 5s. which has to be given to the patient. I call this an enormous, if compulsory, charity; and when there is a dearth of such places, and if a Government cannot provide homes, it seems to me foolish that they should try to extinguish them. It has been insinuated that these places are perhaps not so good, that they are perhaps not so high-class as county homes. Yet, as I have said, some of them may be even better. If I may reply to this insinuation in the manner of our old friend Count Schuksen, I should like to insinuate, in the most delicate manner in the world, that it does not become a man who has not paid his landlady to com-plain of the fare which she provides.
§ I was glad to hear the Chancellor of the Exchequer announce the other day that we must adopt a new attitude towards old age. I think that is necessary in all Parties. I suggest that perhaps the Government might like to amend the Companies Act as an earnest of their good intentions. I should have liked to say more about his measure with regard to the old-age pension, but I will say no more than that I think he has missed a great opportunity. If he has enough money to raise the old-age pension to 30s., he has enough to keep it where it is and to relieve the old age pensioner of any deduction because of earnings. In the case of the direct taxpayer, like myself, for example, after giving me my personal allowance and half-rate allowance, he could deduct from my total income and from me the amount of any old-age pension. By making a grant of the pension so received from the revenue to the Insurance Fund, he could put the matter straight. In that way we should be giving the old-age pension to those whom we wish to receive it. But the great point is to keep the people going in their work, and not to make them wonder whether it will affect their pension or not. After all, it does not make a great social difference whether we have an old-age pension of 26s. or 30s. a week. Nobody can live on either sum, and a person dependent only upon the old-age pension for his living must go to the Assistance Board. In the case of old people, that is probably an advantage, because they are then registered and visited. Of course, all the old people are absolutely delighted with the rise. In one 334 nursing home I know, all the old ladies are very pleased at the rise to 30s., although as a matter of fact, the effect will be that the nursing home will receive a little more, 25s., and the old ladies will get the 5s. just the same. I know that the political Party to which I am attached have always recommended the course which the Chancellor has adopted, and I suppose they will be pleased. But I know some noble Lords consider this question in much the same light as I do, and I should like the Government to consider whether the other course would not be a better one to adopt.
§ In all that I have said about liaison between these different branches of what should be the same service, I want to emphasise again that everybody in them is doing his utmost, and particularly is that true of the National Assistance Board. They have fully realised the necessity for smaller areas and more officers. In fact, where I live the area and the number of officers are what we want to see. But it must be remembered that the National Assistance Board deal only with cases where there have been applications for relief. They do not have to seek out the cases. If I may put it in this way they do not derive cases from the areas but from the office. The general supervision of the area is entrusted to the county welfare officer who covers a far larger area. I submit that here again there is unnecessary division and duplication. The duty of prevention, which requires a minute knowledge of an area and the closest and most delicate social contact, is entrusted to a man with a very large area, while financial assistance is entrusted to a man with a small area. Of course the National Assistance Board officer, who does much more than just deal with purely financial needs, keeps in the friendliest touch with the county welfare officer. But the fact is that, owing to his limited scope, people do fall through holes in the net in a great variety of ways—as this book which I compiled with so much trouble shows. All the same, I am grateful to the Assistance Board, both for the very good part in which they have taken some past criticisms of my own and, far more, for the excellent work they are doing to-day and for the way in which they have, if I may say so, allowed themselves to be taught by the job they do. I think they 335 will agree that we all owe a considerable debt to the noble Lord, Lord Soulbury.
§ The Assistance Board officers do not deal with prevention of poverty but only with applications for relief: that is, with applications for a supplement. My Lords, it is the depth of grinding poverty to try to live on a supplement. I have a good deal of information about that in this "black book." As your Lordships know from a Question of mine the other day, the Board keep no index of retail prices, so although in theory they have the power to grant what they think right, in practice they cannot stand up to the Treasury auditor and are confined to the scales. To give an example, the last increase was, I believe, one of 2s., given in June last. Since that time, as your Lordships know, coal has gone up in price; it went up last autumn and rose again only a few days ago. I know of old people who walk two or three miles every day to pick up a few pieces of coal or coke at the local gas works. The scale is provided in Orders which are laid before your Lordships. It is no use to say that these Orders should be more frequently varied; a rise in prices may always be followed by a fall, and the Department cannot keep framing new Orders every day; it is natural for a Department to wait a little and see what will happen. But the people who have to buy things and who are trying to live cannot refuse to pay the higher prices pending an adjustment. There ought to be with the Board a real discretion, governed by a proper index figure. I was rather horrified, if the noble Lord in question will forgive my having a "dig" at him, by the apparent satisfaction with which my Question was answered the other day, because this matter means such a lot to these people.
Ask any welfare officer how he finds out the people who require his services. He will tell you that he could not possibly do it himself, and that the cases are reported to him by the local voluntary committees. That is one reason why, from time to time, there occur these horrible cases to which I have referred. But I beg your Lordships not to think that I blame these committees. On the contrary, I have the greatest admiration and gratitude for what they have done. Indeed, since the breakdown in the Acts
about eighteen months ago became obvious, their work has been beyond all possible praise—and it is the more praiseworthy because up to that time they had been rather elbowed out by the authorities. It is probably, I think, the greatest output of charity that British people have ever furnished. In particular, I must praise the W.V.S.:
Not slothful in business, fervent in spirit, serving the Lord
might well be their motto. When one local council were asked to create an old people's welfare committee, they replied, quite truly, that the work was already being excellently done by the W.V.S. and that they saw no reason to duplicate it. But the old people's welfare committees which have been formed everywhere since the breakdown of the system became clear eighteen months ago have done wonderful work as well. They have been keeping in touch with the Assistance Board and with the old people, and their relations with both are of the happiest. They are the eyes and ears of the welfare officers.
§ But when this essential work is carried out by volunteers there sometimes arises an undesirable position. In the first instance they have to be continually encouraged. Moreover, there is a tendency to cover up an occasional lapse. Sometimes it is not so much an occasional lapse as a complete lacuna; and concealment, in matters of this kind, is very bad. Then again, supposing that the other day His Majesty's Government had found themselves at war, what would have happened to the members of all these committees? They would all have been away doing work which they thought more essential. We cannot make volunteers do what they do not want to do. Already, in every urban district, there would have been in course of formation a dam of unrelieved misery. In any case, these volunteers will grow old and will disappear, and there will not be very many new ones. But these volunteers, at any rate, give us by their presence an opportunity of preparing to do without them. I maintain that in every properly organised system there is always room for volunteers. My point is that we do not want to be entirely dependent upon volunteers.
§ I think it is essential to have a responsible officer with proper powers at a low 337 level. I do not say that the officer must be low in rank, but I want him at borough or district level—a level which he can manage and understand. He should be personally responsible for knowing the cases in his area and also, in the first instance, for the action taken. The various services can adjust their mutual obligations afterwards. He should be empowered to arrange for treatment in homes and nursing homes at rates not exceeding the cost of county homes. He should act as a focal point between county, borough, hospital and Assistance Board. After all, the sensitive part of an elephant's trunk is at the tip.
§ It should not be a question of, "This is a suitable subject for treatment No. 7a devised by the Ministry." I know this goes contrary to the natural predilection of our governors to keep the authority at the top, and I think that this question is probably at the bottom of the quarrel between the Ministry and the doctors and has something to do with the difficulties that have arisen between the Ministry and the dentists. I sometimes wonder whether the Ministry do not look upon the dentist as a kind of superior carpenter. A similar situation arises in the Ministry of Education where you will find a gentle-man of perhaps forty years of age urging men who have grown grey in education to "interest the children in their work." It is this fetish of interesting the children that has ruined our old British education and turned our character from oak to willow.
§ Anyway, I suggest that the man on the spot should be the man who should decide what action to take. I am not going to start an argument by suggesting whose servant he should be but he should be in charge, for example, of home helps. At present, home helps have earned amongst the people they help the title of "Help yourselves." They have a disadvantage, moreover, of not being available at the week-end. This might be a most valuable service, but I am afraid it is beginning to fall into disrepute—and the more so in that no woman whose work is worth her pay is going to be a home help when she can get private employment. This situation could be remedied, and the men I have in mind could do much to correct it. They should be acquainted with the local resources of all the services and, knowing their limits, should use their own influence 338 and wisdom to forestall or prevent coming cases.
§ There is one other reason. Most of these duties to-day are done by volunteers, and in the main by women. It often happens in this kind of work that, in dealing with the old or not so old, a good deal of personal courage is required. For that reason, I think it is better that in the main the person responsible for this work should be a man, and a man who carries some authority. On the other hand, in dealing with young widows (who, I can assure your Lordships, are a most unscrupulous class) I think it is a good thing that the: officer concerned should be accompanied by a woman.
§ That is nearly all that I have to say this afternoon on this subject. I am glad that we have reformed the spirit in which old age and poverty are to be approached. I think we have a very good set-up, if it is reformed in certain ways. The amendments which I recommend are these: first, the appointment of the local officer I have just described; secondly, the enlistment of the co-operation of all who can help us in the task ahead, even if they make profit by doing so. We ought to have power to pay families something for looking after old relatives who would otherwise be a burden on the public. We want to keep old people working and out of hostels as long as possible. In particular, earnings should be disregarded in computing old-age pensions, and old people of any age who are genuinely working should be entitled to sickness benefit. The National Assistance Board should keep an index of retail prices and act upon it. If these measures were adopted, I believe that we should not only do more efficiently what we have to do, but also economise in both staff and money.
§ I know that I have the sympathy of many noble Lords on the opposite side of the House. I do not know how I stand with the Government. I should like to put this point to them. Here is a great social code which has been devised, and for which they must have full credit. I have shown your Lordships that it is too costly and that it fails to deal with urgent needs. I have suggested cures—your Lordships may find better ones—but will the Government not do this? I say to them: Will you not now, before you leave office, perfect the work you have begun and not leave it to your successors? It may require a little legislation, but not 339 much. If I can help, I shall be proud to do so, but I think you can probably get better helpers than I am. If you are not convinced, I suggest that you try what I have suggested in one or two areas and see how it works. Put the plan into operation, and do something yourselves. I hope very much that the Government will consider carefully what I have suggested. Whether my proposals have met with your Lordships' approval, or not, I am certain of one thing: that all of you sympathise with the difficulties of old age, and I feel that I have given your Lordships ample ground for having some concern. I therefore sincerely hope that the Government will accept my Resolution. I beg to move.
§ Moved to resolve, That this House regards with sympathy and concern the difficulties of old people, and calls upon the Government to secure the greatest measure of co-ordination between the Health Services and other social services with a view of ensuring that adequate personal service and attention are available to such old people.—(Lord Saltoun.)